GILBERT, W. Va. - When his craving for painkillers got to be too much, Steve Dotson lay down and let his wife drive a car over his leg. It hurt, but he could dismiss the pain with thoughts of the medicated bliss that would follow.
Soon, he lost his house, the state took his children away and he was spending nights under a bridge, where the 43-year-old southern West Virginia resident hoped to die.
Dotson is one of millions of Americans who have experienced the harm that can come from addiction to the prescription narcotic hydrocodone. Less regulated than similar prescription painkillers, drugs containing hydrocodone have quietly become the most widely prescribed - and, perhaps, widely abused - opiate painkillers on the market.
With 124 million prescriptions in 2005, drugs containing hydrocodone are the most popular of their type in the country, according to the U.S. Drug Enforcement Administration's Office of Diversion Control. They are sold under hundreds of brand names and generic titles, and hydrocodone can be found in medication ranging from cough syrup to painkillers.
The most commonly prescribed product combines hydrocodone and acetaminophen, which is marketed under brand names like Vicodin and Lortab.
The DEA reported in 2006 that legal retail distribution of drugs with hydrocodone had grown by roughly 66 percent nationwide since 2001.
Its illicit use had grown as well, and by 2005, hydrocodone was the most frequently encountered pharmaceutical of its kind in drug evidence submitted to the National Forensic Laboratory Information System.
The extent of prescription painkiller abuse in central Appalachia drew national attention about five years ago, when oxycodone was the drug of choice for many people.
As OxyContin came under scrutiny, doctors were more careful about how they prescribed it. Many switched to hydrocodone products, which were already popular but didn't have the same stigma.
All 50 states saw increases in the distribution of hydrocodone between 2001 and 2005. But the trend was particularly significant in the South, where all of the top 10 states in terms of increased distribution are located, the DEA says. Four of the top five - Tennessee, West Virginia, Kentucky and Alabama - include parts of Appalachia.
Authorities say hydrocodone is so popular in this region partly because it's easy to acquire. Street drugs like heroin are harder to come by in sparsely populated rural areas. Prescription painkillers can be found at every pharmacy and pain clinic, and can be ordered over the Internet.