Opiate painkillers cause so many overdose deaths because of the way the body develops tolerance to them, O'Neil said.
"Over time - and usually fairly quickly - we actually develop tolerance to the sedative effects of these drugs," O'Neil said, "and we develop tolerance to the euphoric or buzz effects."
The body, though, doesn't develop tolerance to opiates' respiratory-depression effects -- the way they make the lungs breathe shallower and slower. As an addict takes more opiates to get the same feeling, the drugs can make them stop breathing.
Mixing drugs with each other or with alcohol also can be deadly, he said.
Injecting, snorting or smoking a drug increases the likelihood of addiction, O'Neil said. The drugs reach the brain faster and at higher concentrations because they bypass the digestive system.
"It also overloads other organ systems," he said, "like the heart or respiratory systems."
Some states have made fighting prescription drug overdoses a top priority. In Utah, for instance, legislators in 2007 passed a law creating a program aimed at reducing deaths by prescription drugs by 15 percent.
The state researched overdose deaths to determine which factors made some Utahans more likely to die from prescription drugs. A statewide media campaign educated people on the dangers of prescription drug abuse. Utah also created clinical guidelines for practitioners prescribing opiate pain medications.
In 2008, Utah saw a nearly 13 percent decrease in prescription-drug overdose deaths from the previous year.
In Ohio, then-Gov. Ted Strickland signed an executive order last year creating a state Prescription Drug Abuse Task Force. In October, the task force released a final report of 20 recommendations related to areas like treatment, law enforcement, and public health.
West Virginia House of Delegates Health and Human Resources Chairman Don Perdue said he wants to see the Mountain State take similar steps.
"Unless we develop a sense of urgency about this problem, we will not do anything that's effective," the Wayne County Democrat said. "It's not penetrating the consciousness of the public in the way that it should."
'He wanted to get better'
Nick Bills' family doesn't know where he got the fentanyl patch that killed him. At the time, he had a prescription only for Vicodin, Bloomer said.
But prescription drugs are easy to find, said Bloomer, who is recovering from painkiller abuse.
When she and Nick abused drugs together, they had a friend with cancer who sold his OxyContin pills and fentanyl, a drug 80 times stronger than morphine. They knew people who worked for a company that collected unused drugs from nursing homes and rehabilitation centers. Instead of disposing of them like they were supposed to, they sold them.
When Nick's arm healed enough for him to work again, he found a new job as a heavy-equipment operator, running cranes and bulldozers.
Bloomer snuck him pills while he was working. At eight months pregnant, she stopped in a gas station daily to buy a piece of pizza. She dug her fingers through the crust, stuffed pills inside and dropped off the pizza at his job site.
One day, the two went driving around. By that time, Bloomer said, they couldn't get high any more. They wanted to not feel sick from withdrawal.
They looked for "old people's cars" like Cadillacs in the driveways, Bloomer said. They stopped at the houses and pretended to be lost. She asked to use the bathroom and scoured the medicine cabinets.
"I can remember going home, and we didn't get anything," she said. "We had to crawl back home, and we were so ashamed. And that's when we would look at each other like, 'This is sad, this is serious.'"
Bills can't imagine her son doing that.
"He would do anything for anyone," Bills said. "Any favor was not asking too much. He just was loveable - that other side, I didn't see."
Nick did his best to hide his addiction, Bloomer said, especially from his family.
"He wanted to get better," she said, "but he was too afraid for people to find out that he was sick."
He had always been a private person.
"Drinking brought him out of that shell," Bloomer said, "and so did pills. I think it was his way of being the person that he wanted to be."
Last month, Bills spent her second Christmas without Nick.
"It's almost harder as time passes on," she said.
The numbness is wearing off.
She thinks of him when she sees birds or stars. He always noticed those things.
Some days, when she drives over the mountain above her home, she sees brilliant pink and red clouds. Nick loved it there. When she hits a certain point along the road, she feels like she's in the sky.
Coming Monday in The Charleston Gazette: Doctors grapple with treating real pain vs. supplying pill seekers.
This series was conceived and produced as a project for The California Endowment Health Journalism Fellowships, a program of the USC Annenberg School for Communication & Journalism.
Reach Alison Knezevich at alis...@wvgazette.com or 304-348-1240.
What are the most abused prescription drugs in W.Va.?
1. OxyContin, Percocet
Source: W.Va. Prescription Drug Abuse Quitline
Need help finding treatment for substance abuse?
| W.Va. Prescription Drug Abuse Quitline:
Call 1-866-WV-QUITT or visit www.wvrxabuse.org
| Federal Substance Abuse and Mental Health Services Administration:
Call 1-800-662-HELP or visit www.samhsa.gov/treatment