When his craving for painkillers got to be too much, Steve Dotson lay down and let his wife drive a car over his leg. It hurt, but he could dismiss the pain with thoughts of the medicated bliss that would follow.
Soon, he lost his house, the state took his children away and he was spending nights under a bridge, where he hoped to die.
"You get to where you don't even want them (pills) anymore, you just do them so you can get through the day," said the 43-year-old southern West Virginia resident.
Dotson is one of millions of Americans who have experienced the harm that can come from addiction to the prescription narcotic hydrocodone. Less regulated than similar prescription painkillers, drugs containing hydrocodone have quietly become the most widely prescribed — and, perhaps, widely abused — opiate painkillers on the market.
With 124 million prescriptions in 2005, drugs containing hydrocodone are the most popular of their type in the country, according to the U.S. Drug Enforcement Administration's Office of Diversion Control. They are sold under hundreds of brand names and generic titles, and hydrocodone can be found in medication ranging from cough syrup to painkillers.
The most commonly prescribed product combines hydrocodone and acetaminophen, which is marketed under brand names like Vicodin and Lortab.
The DEA reported in 2006 that legal retail distribution of drugs with hydrocodone had grown by roughly 66 percent nationwide since 2001.
Its illicit use had grown as well, and by 2005, hydrocodone was the most frequently encountered pharmaceutical of its kind in drug evidence submitted to the National Forensic Laboratory Information System. The Drug Abuse Warning Network has said hydrocodone products are linked to more emergency room visits than any other prescription painkiller.
As abuse has grown, treatment for addiction and dependence has become more common — and more controversial.
While abstinence-based programs that encourage addicts to quit painkillers like hydrocodone are common, there is also a widespread drug-based way of treating the addiction with methadone, another opioid.
In many parts of the country, methadone clinics have drawn fire from residents and politicians who contend they attract crime. West Virginia's legislature earlier this year passed a moratorium on any new clinics that use methadone until a study can be completed.
"A lot of these people are soccer moms buying Vicodin off the Internet," said Timothy Lepak, a Connecticut-based advocate for alternative addiction treatments. "They wouldn't even think of going to a methadone clinic."
Some physicians now prescribe Buprenorphine, another drug, to help patients cope with addictions. But only about 11,000 physicians nationally are certified to prescribe it, experts said.
The extent of prescription painkiller abuse in central Appalachia drew national attention about five years ago, when oxycodone was the drug of choice for many people. The drug, most commonly known under the brand name OxyContin, was so widely abused it earned the nickname "hillbilly heroin."
As OxyContin came under scrutiny, doctors were more careful about how they prescribed it. Many switched to hydrocodone products, which were already popular but didn't have the same stigma.
All 50 states saw increases in the distribution of hydrocodone between 2001 and 2005. But the trend was particularly significant in the South, where all of the top 10 states in terms of increased distribution are located, the DEA says. Four of the top five — Tennessee, West Virginia, Kentucky and Alabama — include parts of Appalachia.
Authorities say hydrocodone is so popular in this region partly because it's easy to acquire. Street drugs like heroin are harder to come by in sparsely populated rural areas. Prescription painkillers can be found at every pharmacy and pain clinic, as well as ordered over the Internet.
"When I started in this field, the primary client was involved with alcohol," says David Bailey, a community resource specialist with the West Virginia Prevention Resource Center.
"I wish it were still alcohol. Not that that's not a very dangerous drug, but the addiction (to painkillers) seems to be much more intense, much more severe within a shorter period of time."
It is a mistake to focus on a single drug, said Dr. Peter Cohen, medical director of the Maryland Alcohol and Drug Abuse Administration. He pointed out that while hydrocodone abuse has grown slightly in Maryland since 2002, it is still far less commonly abused than street drugs like heroin.
From 2005 to 2006, the number of people admitted to Maryland drug rehabilitation programs with hydrocodone addictions grew from 284 to 596, according to figures from the drug abuse administration. But the number of heroin addicts admitted to treatment in the same period stayed at nearly 16,000.
The problem is not hydrocodone or even opiates per se, Cohen said, but addiction itself.
"If you're an opiate addict, you're going to find something, based on what's available and what you prefer," he said.
The DEA is considering moving drugs containing hydrocodone from being classified as so-called Schedule III drugs to being Schedule II drugs. The reclassification would mean it would be harder to obtain refills. Doctors and pharmacies would also have to keep more stringent records about how many prescriptions are written and filled.
Dotson has been off drugs since a religious experience in 2001. He got a job and is a board member of Strong Through Our Plan, a local anti-drug group.
He is determined to stay off drugs, and recently chose to pull out his own tooth with pliers to avoid the temptation of receiving a prescription for a hydrocodone-based painkiller after the extraction.
On a recent day, Dotson pointed out the spot under the bridge where he lived and pointed to the spot in the Guyandotte River where he was baptized after getting clean. Not all of his friends were so lucky, he said.
"You've got three choices," he said. "You either die, go to prison or get saved. Mostly, people around here are dying."