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One statistic that shows America's opioid painkiller crisis is truly an epidemic

One in five: That's the startling number of Americans who say they have a family member who's been addicted to prescription painkillers, according to a new Kaiser Family Foundation survey published on Tuesday.

Beyond families, more than four in 10 Americans said they personally know someone who's been addicted to the drugs. The survey was conducted in April, reaching more than 1,200 adults.

More than four in 10 Americans know someone who's addicted to prescription painkillers. Kaiser Family Foundation

These are troubling statistics, showing that the opioid painkiller and heroin epidemic has personally affected nearly half of all Americans.

What's more, Americans reported widespread agreement that it remains very difficult to access drug treatment. According to the Kaiser poll, 75 percent of respondents said "lack of access to care for people with substance abuse issues" is a problem, and 58 percent said it's a major problem.

Although both painkillers and heroin are opioids, respondents in Kaiser's survey said they view heroin addiction as more serious and potentially stigmatizing than a painkiller addiction. About 35 percent of respondents, for instance, said heroin abuse is an "extremely serious" problem in the US, while 28 percent said opioid painkiller abuse is.

Heroin is more potent — and affordable on the black market — than opioid painkillers, but both are based on the same deadly, addictive substance.

The drugs are so linked, in fact, that painkiller and heroin abuse now make up the same modern drug epidemic: As doctors ramped up and eventually clamped down on opioid painkiller prescriptions, many addicts have moved toward heroin. And all along the way, tens of thousands have died of opioid overdoses.

The opioid painkiller and heroin epidemic goes back to the 1990s

Back in the 1990s, doctors believed — and many still do — in the need to treat pain as a serious medical issue. There's a good reason for that: About 100 million US adults suffer from chronic pain, according to a 2011 report from the Institute of Medicine.

Pharmaceutical companies took advantage of this concern. Through a big marketing campaign for doctors and by backing advocacy groups, they got doctors to prescribe products like OxyContin and Percocet in droves. The drugs proliferated, landing in the hands not just of patients, but also teens rummaging through their parents' medicine cabinets, other family members and friends of patients, and the black market.

As a result, opioid painkiller deaths skyrocketed. In 2014, nearly 19,000 Americans died from overdoses linked to opioid painkillers.

Seeing the rise in opioid abuse and deaths, doctors, clinics, and governments began to crack down on prescriptions for painkillers. Law enforcement, for instance, threatened doctors with incarceration and the loss of their medical licenses if they prescribed the drugs unscrupulously.

Ideally, doctors should still be able to get painkillers to the many patients who really need them — after, for example, evaluating whether the patient has a history of drug abuse. But doctors who weren't conducting even such basic checks are being told — not just through the crackdown, but by health care organizations and public education campaigns — to give more thought to their prescriptions.

But many people who lost access to painkillers were still addicted, so they looked for other ways to satisfy their habit. So some who no longer could get painkillers — or perhaps could no longer afford them — turned to a cheaper, more potent opioid, heroin. Not all painkiller users went this way, and not all heroin users started with painkillers, but statistics suggest many did: A 2014 study in  JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 CDC analysis found people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.

So heroin abuse increased, and so did overdoses: In 2014, more than 10,000 deaths in the US were linked to heroin.

That doesn't mean cracking down on painkillers was a mistake. It appeared to slow the rising number of painkiller deaths, and may have prevented doctors from prescribing the drugs to new generations of potential addicts. So the crackdown did lead to more heroin deaths, but it will hopefully prevent future populations of drug abusers, which could have suffered even more overdose deaths.

But ultimately, the likely solution is to get opioid addicts into treatment to ensure they don't resort to even more dangerous drugs if painkillers are restricted. So the Obama administration, for one, is asking for more funding for treatment programs, including medication-assisted treatment like methadone and Suboxone. Some states have also talked up treatment programs, although others, like Louisiana and Indiana, have taken a "tough-on-crime" approach that focuses on incarcerating drug traffickers.

Whatever the approach, based on Kaiser's polling, most Americans don't believe that the government is doing enough — and many of them are being personally affected.