The first time Lauren, a suburban teenager in Connecticut, took a prescription pain killer, she says she was sick with strep throat during her freshman year in college and grabbed a Percocet from her parents' medicine cabinet. She never dreamed where that one pill would take her.
A few weeks later, she took an OxyContin pill to help her sleep. The next day she took another. "Once I started, I never stopped," she said.
In less that two years, Lauren, who asked that her last name not be used because of privacy concerns, said she was spending $300 to $400 a day on pills. She stole jewelry from her mother and aunt in North Haven, an upper middle class bedroom community near New Haven, Conn., and passed back checks, racking up close to $20,000 in debt, according to her mother.
But when she still couldn't afford pills, which can cost more than $60 each on the street, Lauren turned to something more affordable and more deadly to satisfy her addiction: heroin.
"When you think of a heroin addict, you don't think of me," she said. "But that's what I became."
"When you're sick" from withdrawal "nothing else matters except making it go away," she said. "I took whatever I could find, whatever was there."
Though overall heroin use has remained relatively stable nationwide, numerous police agencies across the country say the drug, once the scourge of poor inner cities, has in the last several years attracted a new generation of users who are largely young, middle-class and living in rural and suburban areas.
At least part of that resurgence, police say, is a side effect of the explosion in prescription drug abuse. Federal statistics show that nearly 7 million Americans abused prescription drugs in 2007, more than marijuana, cocaine, heroin and Ecstasy combined -- an 80 percent increase since 2000.
Police fear the boom in pain killer abuse is leading teens and young adults, like Lauren, from pills to heroin, a cheaper and more powerful – and far more dangerous - opiate.
"It's an economics thing. If someone is hooked on Oxy and can't afford to pay $80 per pill, then they turn to heroin," which can cost as little as $4 a hit, said Drug Enforcement Administration spokesman Garrison Courtney.
National statistics show that heroin use among high school students and young adults is relatively uncommon compared with other illegal drugs and has remained basically unchanged in the last few years.
But local law enforcement agencies say that an increasing number of young people are using the drug.
"People say that heroin went away. It's never gone anywhere," said Special Agent Douglas Collier of the New Jersey division of the DEA. "But the user group has changed. The old time heroin user was the guy on the street corner. Now we have kids from the suburbs."
Heroin, an opiate made from the poppy plant, works on the body in the same way as many prescription drugs such as morphine and Oxycontin. It is among the most addictive drugs and can be injected, smoked or snorted.
The 2008 National Drug Threat Assessment from the National Drug Intelligence Center, a division of the Justice Department, called prescription drug abuse leading to adolescent heroin abuse an "emerging concern" to law enforcement and a trend that was likely to continue as prescription pain killers become more difficult to obtain.
The Center, also based on anecdotal reports from local law enforcement, says heroin use is growing outside the Northeast, where the drug has traditionally been a problem, and into areas such as Appalachia and Ohio. Law enforcement agencies in areas such as Maine, Alaska and Wisconsin told ABCNews.com that the drug is growing in popularity.
"Unfortunately, 18 to 26 is our big target audience," said Dave Spakowicz, a special agent at the Wisconsin Department of Justice who heads the Milwaukee High Density Drug Trafficking Heroin Initiative. "The price of Oxycontin has doubled in the last year and a half in the Milwaukee area. People are moving to heroin."
Nationwide, the number of people who said they used heroin in the last month grew from 119,000 in 2003 to 338,000 in 2006, the latest years for which statistics are available, according to the National Survey on Drug Use and Health. In 2006, 3.7 million Americans said they had used heroin at some point; about 60,000 were under 18.
While use of most illicit drugs by 8th through 12th graders is down, heroin use has remained steady over the last several years, with roughly one percent of high school students saying they had used the drug in the last year, according to the Monitoring the Future Survey. After a boom in heroin use among high schoolers in the last decade, the numbers have dropped since 2000.
But in some areas, particularly in the Northeast, the numbers are higher. Nearly twice as many New Jersey young adults admitted to using heroin at some point than the national average, according to national surveys. Similar results have been reported in Connecticut and Massachusetts.
"Heroin used to be thought of as a drug of the poor, in depressed areas," said Anthony Marotta, assistant special agent in charge of the DEA in Columbus, Ohio. "Here, it's across all lines. We have everything from well-to-do affluent areas to depressed housing."
Aside from the reduced cost, law enforcement experts say the increased purity of the drug is contributing to its prevalence. Kids are more apt to try the more potent drug, several times more pure than the drugs coming into the country in the 1970s, because it can be snorted or smoked, rather than injected.
"When you can snort it and you're already snorting other drugs, it becomes no big deal," said Lt. Chris Martin of the Brewer, Maine, police department.
The path from prescription pills to heroin was a common one among teens at the Daytop residential treatment center in Mendham, N.J., said Brian Gamarello, the clinical director. "Why am I taking 10 pills when I can do a bag [of heroin] and get 7 or 10 times as high?" Gamarello asked.
Dale Freeman said he didn't think much of it when a doctor prescribed Oxycontin for his daughter after she fell and fractured her tail bone.
But, after her treatment had dragged on for more than a year, Danielle was hooked to the powerful painkiller, Freeman said. "Two weeks after her surgery, her back was fixed," he said. "But her Oxy problem wasn't."
With her prescription having run out and pills running as much as $80 each on the street, Freeman said, Danielle, a one-time "A" student from a stable family, turned to heroin.
The next several years, Freeman and his wife said, became a nightmare. Danielle stole money from his diving business in Quincy, Mass., a blue collar city outside Boston. She lived for a time in motels, between stints in rehab. She is now in jail on a probation violation after she left a sober house sponsored by a drug court, her lawyer said.
She faces several years in prison if she is not accepted back into the drug court program. Danielle had used other drugs and had struggled with mental illness before her problems with heroin, her mother said.
"There was no end to what she could have become," Freeman said. "Now she's locked up in a women's prison. She hasn't seen her kids in over a year. It crushed my family and it's ruined her family."
Danielle was arrested in 2006 for allegedly stealing checks and credit cards from her father's company, after her father turned her in to the police. She admitted in drug court that there was enough evidence to convict her of larceny, check forgery and improper use of a credit card, according to the Quincy court clerk's office, and was placed on supervised release.
"And we don't see any end in sight," Freeman said.
Both Lauren and Danielle had used other drugs before using painkillers.
Experts say it is easier to overdose on heroin than on prescription pills, which have regulated dosages. Emergency room visits due to heroin use grew from 47,000 in 2003, eight percent of total drug-related emergency room visits, to 164,000, or about 20 percent of the total, in 2005, according to the Drug Abuse Warning Network, which monitors drug-related hospital emergency department visits and drug-related deaths.
Heroin addicts have much trouble staying clean, with some studies showing relapse rates as high as 75 percent after treatment.
Lauren, now out of rehab and clean for several months, said she relapsed several times. She said once she began using drugs regularly, she found she had easy access to prescription pain killers and heroin in her tony suburb. "I just had to call up one of my friends. I just had to go around the corner," she said.
As her addiction escalated, she said began taking more and more money and jewelry from her family and friends. "You would see jewelry and you would just have to take it," she said. "No matter where you were. You just see it as drugs. Any rational thought process is out the window."
"She was my daughter and I loved her, but at the same time I hated her at that moment so much for what she had done to her family," said her mother, Valerie.
Lauren is now working and hopes to be a lawyer. "I come from a good family. You never imagine yourself stealing from your own family. You never imagine yourself as a heroin addict. But it grabs onto you and it doesn't let go."