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June 22--First, he started smoking pot because his friends did.
Then he turned to prescription pills -- mainly powerful painkillers, initially prescribed by his doctor or dentist after he broke a bone or had dental work done.
Jeff Nash liked the buzz so much that he soon began raiding family medicine cabinets or exaggerating his health problems to dupe physicians into prescribing more.
By the time Nash graduated from high school, he was a full-blown addict, taking pills and shooting heroin. Even when he spent time in a Honolulu hospital for an addiction-related problem, Nash several times a day secretly injected heroin, using an intravenous line that was supposed to be for his prescribed medication.
Today, 18 years later, Nash runs Habilitat, a residential drug and alcohol rehabilitation program in Kaneohe. The 46-year-old former Texas resident says he hasn't gotten high since 1996, when he nearly died from an overdose and spent six weeks behind bars at Oahu Community Correctional Center, going through severe withdrawals as he served time for a drug offense.
"That was the worst thing I've ever encountered in my life," Nash said of his time in OCCC. "That's the point I decided I really needed help."
After being released from jail, Nash spent four years in Habilitat's residential program.
"I haven't even thought about taking any kind of drugs since then," he said.
Physicians and other treatment providers in Hawaii say they are seeing more cases in which people get hooked on prescription pills, then turn to heroin. That path to addiction has contributed to a dramatic increase in Hawaii's fatal drug overdoses, which have become the No. 1 cause of fatalities in the islands, overtaking motor vehicle accidents.
But the drug deaths represent only a fraction of the problem.
Many more adults and teens have nonfatal overdoses, especially from narcotic painkillers such as hydrocodone, easily the most prescribed generic medication in Hawaii, according to state data.
Some users start taking the drugs, commonly called opiates, for legitimate reasons, such as for chronic pain.
When the patients eventually crave greater amounts but can't get enough from doctors, they frequently pilfer pills from the medicine cabinets of family and friends or turn to street dealers.
When that supply runs dry or proves insufficient, heroin -- another form of opiate that is cheaper and more powerful -- sometimes becomes the next step on the addiction path, physicians and others say.
"We're looking at a huge epidemic coming," Alan Johnson, president of Hina Mauka, a substance abuse treatment provider, said of the narcotic abuse problem.
Reflecting that trend, the number of nonfatal drug overdose cases in Hawaii hospitals jumped more than 60 percent from 2003 through 2012, according to the most recent data from the Department of Health's injury prevention program and Hawaii Health Information Corp.
Of special concern is the problem among Hawaii's adolescents.
At Hina Mauka, for instance, about 6 to 8 percent of the roughly 800 youths it treats each year are dealing with prescription drug abuse, according to Johnson.
"A few years ago, that was practically zero," he said.
Nash, as Habilitat director for the past 13 years, has seen a similar trend with the facility's roughly 100 adult residents.
When he asked at a recent residents' meeting how many came to Habilitat because of prescription pill abuse, about a third raised their hand. Ten years ago, Nash said, hardly any hands would have gone up.
Anthony Marinello, 29, was among those who raised his hand.
Marinello developed an addiction despite being raised in what he called a good suburban family environment in Detroit. No other family members did drugs or even smoked.
Like Nash, though, Marinello started experimenting with marijuana as a teenager, eventually turned to pills, then added heroin to the mix because of the quicker, cheaper highs. Also like Nash, he exaggerated his pain symptoms to fool doctors, raided medicine cabinets and purchased whatever he could afford from street dealers.
At one point, he was taking 20 to 30 pills daily, mostly painkillers such as Vicodin and oxycodone, spending $120 per day. He ate a slice or two of bread and little else the entire day so as to maximize the high, not even considering the additional abuse that was doing to his body.
Marinello said his drug habit put huge strains on his relationships with family and friends, and his performance as an aircraft mechanic suffered as well.
Just like with Nash, it took a near-death experience to set Marinello straight.
At a New Year's Eve party in 2012, Marinello overdosed on a mix of drugs and alcohol, was hospitalized, then spent a week in a psychiatric ward. By then, his fiancee had left him and his family was threatening to disown him if he didn't address his addiction problem.
"I was absolutely at my lowest point," Marinello said. "My whole life was crumbling. It was hell on earth."
Determined to turn his life around, Marinello said he came to Hawaii from Michigan in early 2013, entered Habilitat's residential program and has been clean since.
What makes Hawaii's prescription pill problem so difficult to tackle is access, according to Marinello, Nash and others.
Nash and Marinello say pills are easy to get, legally or illegally, and word spreads on where to get them.
"There are quite a few doctors in Honolulu who prescribe quite liberally," said Nash, a sentiment that some law enforcement and insurance officials acknowledge is the case.
The high price that dealers can get for certain illicit medications also means the incentive is strong to keep the supply going.
The narcotic OxyContin, for instance, can be sold for as much as $80 a pill in 80 mg doses, and one prescription can have as many as 30 tablets, according to Nash and Marinello.
The ease of availability is a factor in what Keith Kamita, chief special agent for the Department of Public Safety'sNarcotics Enforcement Division, describes as Hawaii's most abused narcotic, hydrocodone.
A hydrocodone mix is the most commonly prescribed generic drug in the islands, and, unlike prescriptions for other painkillers that have a higher classification for abuse, it can be refilled without having to see a doctor again, according to Kamita and state data.
In 2013, more than 400,000 prescriptions for a hydrocodone-acetaminophen mix were issued in Hawaii, up 6 percent from the prior year.
The next most common generic prescribed last year was zolpidem tartrate, commonly known by the brand-name Ambien, a sleep aid, at 143,520 prescriptions, according to the state data.
The next was a narcotic: oxycodone. About 123,000 prescriptions were issued.
Hydrocodone abuse has become such a problem nationally that the federal government is considering reclassifying it as a Schedule 2 drug, which allows no refills, from its current status as Schedule 3.
Kamita said people trying to game the system by doctor shopping, forging prescriptions or through other means represent the vast majority of those arrested in Hawaii for prescription drug violations.
Most experts who work in the field contend that education is the best way to combat Hawaii's growing abuse problem.
Various agencies have programs in place and in the works to spread the prevention message and bolster enforcement of existing regulations.
But cuts in state and federal funding in recent years to social service agencies, including nonprofits, have hampered prevention efforts, according to many in that field.
"The problem is certainly there, but the resources are not," said Alan Shinn, executive director for the Coalition for a Drug-Free Hawaii. "We haven't really kept up with the need."
Despite the steep odds, people like Nash and Marinello are willing to tell their stories in hopes that others will think twice about abusing prescription pills and other drugs.
"In the beginning, I thought it was cool and fun," Nash said. "In the end, it was tragic."
He and Marinello consider themselves fortunate, particularly after having seen many of their friends die too young from overdoses.
"I'm lucky to be alive," said Nash, who overdosed at least six times. "There is no doubt about that. Every day I see as a blessing."
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