When it comes to dangerously addictive drugs, the real killers aren't in baggies or dirty needles sold on street corners. They're in prescription bottles, doctors' offices and medicine cabinets throughout Hall County.
A panel of experts met at the Hall County Chamber of Commerce Wednesday to discuss the toll prescription drug abuse has taken on Hall County and Georgia as a whole.
The panel included local physician Jack M. Chapman, Georgia Bureau of Investigations Inspector Fred Stephens, Hall County Drug Free Coalition volunteer Mary Parks and Shelley Davis, the Greater Hall Chamber Drugs Don't Work coordinator.
"It's an epidemic in our community," Dr. Chapman said.
In recent years, deaths from prescription drug abuse have dwarfed deaths from illicit drug use in Georgia.
In fact, Xanax overdoses alone killed more people in Georgia in 2010 than cocaine, methamphetamine and heroin overdoses combined, according to information from the GBI's Medical Examiner's Office. Xanax, or alprazolam, is used to treat anxiety or panic disorders.
The GBI covers the trafficking, or "pill mill" side of prescription drug abuse. In pill mills, doctors and pharmacists can use pain management clinics to provide people with prescription pain killers, or opiate drugs, Stephens said. The most notorious opiate prescribed is oxycodone, commonly known as OxyContin.
Hydrocodone, the key ingredient in Lortab, is another highly abused prescription, as is methadone, which is often prescribed to people who have addiction to other opiate drugs.
The customers then use the painkillers or sell them on the street, Stephens said.
In fact, the "pill mill" stigma associated with pain management clinics is so great that one local clinic is changing its name from Specialty Clinics of Georgia, Pain Management to Specialty Clinics, Spine Intervention.
Dr. L. Todd Stewart is a physician at the clinic and performs random drug screenings to help ensure that his patients are not abusing prescription medicines.
He also only prescribes opiates or narcotic painkillers to patients as an absolute last resort. Only two or three of his patients are prescribed OxyContin and those are chronically ill individuals in severe pain, he said.
"I think my practice is a lot cleaner than it used to be because word on the street is, we don't even want to give opiates," he said.
When Stewart began screenings, 50 to 60 percent of his patients failed the tests. Now, fewer than 20 percent have dirty screenings, he said.
Interstate 75, which runs through Florida, Georgia, Tennessee, Kentucky and Ohio has been dubbed the "OxyContin Highway" because of the addicts who flock to these states to visit pill mills.
But pill mills only account for 30 percent of the state's prescription drug abuse. The other 70 percent comes from family members and friends sharing or stealing prescription medicines from each other, Chapman said.
Prescription drugs are safeguarded and protected while they're produced and stored in pharmacies, Chapman said.
"All through that process, the pill is regulated, locked up, it's treated like gold," he said.
Once those prescription medicines gets into the home, however, they can be stored in flimsy medicine cabinets within reach of children and everyone else. Chapman recommends everyone use a lock box for prescription medication, he said at the presentation.
The Hall County Drug Free Coalition is in the third year of a five-year federal grant, which will help fund prescription drug abuse prevention in the county.
"Looking at the data right now, we've got a major increase in the number of kids using prescription drugs recreationally," Parks said.
While she didn't provide exact numbers, Parks said prescription drug abuse among youth and lack of education about the dangers of prescription drugs are the biggest threats in Hall County.
"The public in general is very uninformed about the misuse and abuse of prescription drugs," she said.
Parks also lamented the easy access to prescription drugs in the county.
"You can go down many streets, main streets in Gainesville and Hall County, and you see new pain management clinics popping up," she said.
In Hall County, Davis advocates drug screenings for employees, including random screening.
Employers who don't screen, Davis said, are in high danger of hiring users.
"That means you are paying for higher health insurance costs, higher worker's comp premiums and having a less effective workforce," she said.
Davis added prescription abuse can start innocently, with people who have been prescribed medicines in an ethical primary doctor's office or pain management clinic.
A person might save a prescription and then decide to pop just one or two pills when "I get a real bad day and I just don't want to feel anything," she said.
"It's just the very beginning of an addiction," she added.
Dr. Gale Hansen Starich, dean of Brenau University's graduate school and the College of Health and Science, attended the meeting and discovered prescription drug abuse may be a new focus in her classroom. Starich is a professor of biochemistry and teaches a course on the neurochemistry of addiction.
"I've always focused on the illicit drugs," Starich said. "It really changes the conversation with the students."
Starich teaches her students that addiction can permanently alter brain chemistry in a way that causes addicts to return again and again to their drugs of choice, illicit or prescription.
Since addiction actually reforms the brain, breaking the cycle of addiction is less about "being good" and more about addressing brain changes over a period of decades.
In other words, good people are addicts, too, Starich said.
"This is not about a lack of moral fiber or not knowing Jesus well enough," she said. "It's a lifelong battle, and I don't think most people know that."