Sarah Shay died of a prescription drug overdose five years ago at the age of 19 In the green, wooded hills of eastern Kentucky, two mothers pore over photographs of daughters lost to prescription pills.
Sarah Shay and Savannah Kissick were school friends in Morehead, both addicted to an array of perfectly legal drugs.
Sarah died in 2006, at the age of 19. Savannah followed three years later, aged 22. Both victims of an epidemic of prescription pill abuse sweeping parts of America.
When their mothers reel off the names together, they make them sound like weapons.
"Xanax. Klonopin. Oxycodone. Hydrocodone."
Earlier this year, the White House described the epidemic as the country's fastest growing drug problem, accounting for more accidental overdoses than the combined total from heroin and crack cocaine in the 1970s and 80s.
Karen Shay and Lynn Kissick have become reluctant experts in the medicines which killed their daughters and which are eating away at rural communities throughout the area.
Savannah Kissick, Sarah's best friend died in 2009 as a result of her own prescription drug abuse Both have lent their passionate voices to an education campaign being led by Kentucky's Attorney General Jack Conway.
Mr Conway has few illusions about the scale of the drug use ravaging his state.
"Kentucky has a peculiar problem with prescription pill abuse," Mr Conway says of an issue which first emerged more than a decade ago but has grown steadily. He says Kentucky may have the worst problem in the country.
And he says it's hard to meet a family in the state which hasn't been affected in one way or another. Including his own.
Sources: Kentucky Govt, CDC
"We've had someone who's had to deal with it," he says, reluctant to go into details. It caused a great deal of pain and opened some eyes within my family."
Across the state, a number of treatment and rehabilitation centres are trying to deal with the huge numbers of addicts.
At Shepherd's Shelter, located on the tranquil outskirts of Mount Sterling, east of Lexington, residents go through a programme that includes recovery dynamics, criminal thinking and relapse prevention.
There's a wall of fame featuring pictures of men and women who've successfully completed the programme and stayed clean. Director Wayne Ross, himself a former alcohol and drug abuser, admits that there are plenty who don't.
Lorraine, 26, isn't quite out of the woods. For years, she couldn't do anything without pills and resorted to criminality to feed her addiction.
But the photos of four children which adorn the small room she shares with a fellow resident represent the four reasons why she's desperate to complete the programme.
"I'm just ready to get 'em back," she insists.
Adam, who's completed the programme but is now volunteering at Shepherd's Shelter in an attempt to stay on the straight and narrow, described how medicines designed as slow release pain-killers, like oxycodone, are ground up, mixed with water and injected for a powerful, instant high.
And he gives one simple reason why prescription drugs are so popular.
"We could all have found a better high," he says, "it's just the prescription drug is so easy accessed."
Inevitably, the tidal wave of addiction has triggered a parallel crime wave that threatens to swamp the police, courts and jails of Appalachia.
'Pharmageddon'
In Pikeville, among the coal mining hills and valleys close to the Virginia border, police officers recently rounded up dozens of dealers at the end of a six month undercover operation.
Most of those arrested were suspected of dealing in oxycodone from so-called "pill mills", barely regulated, cash only dispensaries, mostly located in southern Florida.
Kentucky's jails are overflowing.
"I believe I can safely say that over 80% of the inmates in the Pike County regional detention centre are in there for something dealing with their addiction to prescription drugs," said Dan Smoot, director of law enforcement with Unite, an innovative Kentucky counter narcotics programme which brings together police investigations, treatment and education.
Lynn Kissick (right), who lost her daughter to prescription drugs, says some doctors give out prescriptions too easily Responses to questions asked on Unite's treatment line, he says, have revealed that the average age at which users first abuse prescription pills is 11.
It's a statistic that makes him angry.
"We have basically robbed our children of a childhood."
The pill crisis, which some are calling pharmageddon, is only now receiving national attention.
As part of an initiative announced in April, the White House demanded that the makers of one class of drugs, known as "extended release and long-acting opioids", make more concerted efforts to educate doctors and patients.
But back in Morehead, Lynn Kissick wonders if any of this will work.
"I don't know how to get a grip on something so large." she says.
Some doctors, she says, are too busy making money.
"There's a lot of them that just write it out and say 'here you go'. And it doesn't matter if my daughter dies from it. Or your child. They don't care. They don't know them. It doesn't matter."
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Source: http://www.bbc.co.uk/go/rss/int/news/-/news/world-us-canada-13735793
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