You know those little smiley and frowny face pain charts in the doctors office?
Doctors started prescribing narcotic painkillers by the millions.
In 2004, state medical boards were encouraged to make under treatment of pain a punishable offense.
Doctors were essentially forced to treat patients with drugs many believed were addictive.. 
The opioid pain pills, like Oxycontin, Oxycodone, Percocet, and Vicodin were usually reserved for severely ill hospital patients.  
They work great, but too often were being prescribed for people with back pain, arthritis, and other chronic pain conditions.
When it was time to wean them off, many patients were helplessly addicted.   
One of the strongest, Oxycontin, made by Purdue Pharma, was initially meant to treat terminal cancer patients.
Doctors were worried about its abuse risk, but the company lied, saying it had less potential for addiction than other painkiller.  
The company was fined more than $630 million for those false claims in 2007, but by then we were in the midst of an opiate epidemic.
In 2010, doctors and pharmacists gave out enough opiate painkillers to medicate every American adult around the clock for a month.  
Southern Ohio was ground zero for the highest numbers of prescription pain medication prescribed in the state.
By the end of the first decade, a push started to limit the amount of painkillers prescribed.
According to OARRS, the Ohio Automated Rx Reporting system,  the peak of prescriptions occurred in 2012 when 793 million doses were dispensed in Ohio.  
That's 68 pills for every Ohioian.
As addiction awareness grew, the number of prescriptions dropped. 
So without access to meds, addicts hit the street where heroin is cheaper, easier to get, and offers a much faster high.  
Then dealers started adding an even stronger opiate, Fentanyl, to their product.
That's when the overdose deaths hit a record high and rocketed Ohio to the number one state with the highest number of overdose deaths relating to heroin and opioid painkillers.
2016 was a grim record year for overdose deaths in Northeast Ohio and it's not slowing down.  At this rate, it's likely Ohio will remain the OD capitol of the nation.
Why Ohio?
While the problem may have started with prescription pills, Ohio's criss- crossing interstates and turnpike make it an easy home base for drug cartels to set up shop.  
Law enforcement in bigger cities like Chicago and Detroit have been working the drug front for decades, smaller heartland towns don't have the same resources. 
For more of WKYC's continuing coverage on this topic, click here