According to a new survey, almost 40 percent of Massachusetts adults know someone who has abused prescription painkillers in the past five years, and almost three-quarters say that heroin abuse is an extremely or very serious problem in the state. The rise in abuse of prescription opioids has been called an epidemic, and it is one of the foremost public health problems in America. The new survey compares opinions of adults in Massachusetts with those of adults around the U.S., revealing that Massachusetts residents are generally more concerned about the abuse of opioids than adults in the country as a whole, and existing evidence tells us they\u2019re right to be worried. Prescription Painkiller Abuse in the U.S. Despite no change in the levels of pain reported by Americans, the number of opioid painkillers prescribed quadrupled from 1999 to 2013, according to the Centers for Disease Control and Prevention (CDC), and in 2013 almost 2 million Americans aged 12 or older either abused or were dependent on prescription painkillers. Alongside the rise in prescriptions, deaths from prescription painkiller overdose have also quadrupled over the same period, with over 16,000 deaths as a result of opioid painkiller abuse in 2013. Overall, drug overdose (of prescription and illicit drugs) was the leading cause of injury death in 2013, killing more 25- to 64-year-olds than motor vehicle accidents. Although the rate of prescription painkiller overdose appears to have been leveling off since 2012, the problem is still a significant one. The trend across the country is broadly being mirrored in Massachusetts, with over 1,000 people in the state believed to have died from opioid abuse in 2014. This represents an increase of around a third since 2012, showing that the positive steps across the country as a whole aren\u2019t being replicated in all states. How Big of a Problem Is Opioid Abuse? The questions in the poll\u2014conducted in April 2015 by the Harvard School of Public Health\u2014can be roughly split into those addressing the perceived severity of the problem and those looking at what should be done to combat it. Overall, Massachusetts residents believe that heroin and prescription painkiller abuse are very serious problems, and they are more likely to say this than most adults in the U.S. The survey showed that 71 percent of Massachusetts residents believe heroin abuse to be a very or extremely serious problem, compared to 45 percent of Americans as a whole, and 60 percent said the same about prescription painkiller abuse, compared to 51 percent of the nation as a whole. Additionally, almost half of Massachusetts adults said the problem had gotten worse since 2010, compared to 39 percent across the nation. In Massachusetts and across the country, 39 percent of respondents said they know somebody who has abused prescription drugs in the past five years. Co-director of the survey, professor Robert Blendon, called this figure \u201cstaggering.\u201d The effects of this abuse were widely recognized, particularly in Massachusetts, with one in five saying it led to the user\u2019s death, almost three-quarters saying that the user\u2019s family suffered major harm, almost two-thirds saying that the user\u2019s career was impacted and over half saying it had a deleterious effect on the individual\u2019s health. About half of those who knew somebody who abused pills said they believed prescription drugs led to the use of heroin and other drugs. The most shocking disconnect between Massachusetts and the rest of the country was in the number of those prescribed opioid painkillers whose doctors had discussed the risk of addiction with them. Just 36 percent of Massachusetts respondents saying they had such a discussion, compared to 61 percent nationwide. Blendon added that, \u201cFor some reason in the Commonwealth, people who are taking painkillers do not remember having this conversation.\u201d What Can Be Done About Opioid Abuse? Overall, respondents in Massachusetts were more in favor of approaches to tackle the problem than most adults in the U.S. For example, 54 percent of state residents favored the sale of Narcan\u2014the opioid overdose antidote\u2014in pharmacies, compared to 42 percent nationwide. Additionally, 58 percent of state residents said that insurers should cover more addiction treatment, even if it means raising premiums, compared to 48 percent nationwide. However, only a third actually believed that long-term, effective treatment was available, suggesting that more needs to be done to convey the success rates of treatment to the general public. There were some implicit contradictions between respondents\u2019 views on what should be done, though, with 58 percent of state residents saying that prescription drugs are too easy to obtain, but half of respondents also saying that current regulations on their sale are \u201cabout right.\u201d Blendon finds this perplexing: \u201cWe have this dichotomy where people recognize that overprescribing is one of the problems, but when you ask if there should be more regulation, people say no.\u201d Continued Action Is Needed to Tackle Opioid Abuse In one sense, the results of the survey show that public awareness of the risks of opioid abuse\u2014especially in Massachusetts\u2014is quite good and appears to be improving. With increasing scrutiny placed on prescription medicines, the rise in awareness is a sign that people are paying attention to public health messages about their risks, but some findings are still concerning. The most troubling is Massachusetts physicians\u2019 lack of discussion about the risks of addiction to prescription opioids, meaning that some people receiving the prescriptions may not even realize that they could easily become addicted, and this is likely an issue in other states. Overall, the survey suggests that positive steps have been made in tackling opioid abuse, but it underlines the core point that more needs to be done, particularly to offer treatment to those in need and to help citizens understand its effectiveness.