Officials are waiting on autopsy results for Oscar-winning actor Philip Seymour Hoffman. New York police suspect a drug overdose, possibly heroin. Hoffman had struggled on and off with addiction. It's brought attention to a grim reality in America at the moment: the increasing use of heroin. What was once a drug of the urban poor is now exploding in the country's heartland, and drug enforcement officials say it's become an epidemic.

NPR's Laura Sullivan reports.

LAURA SULLIVAN, BYLINE: This isn't the first time heroin use has skyrocketed. Heroin spiked in the cities in the 1970s and '80s. But this time it's national, flooding across the Southwest border from Mexico. Joseph Moses is a special agent with the Drug Enforcement Administration.

JOSEPH MOSES: You didn't usually think of heroin as suburbia or rural America, and that's what we're seeing.

SULLIVAN: The result, however, is the same.

MOSES: If you look at just the raw statistics, over the last four or five years, heroin deaths - overdose deaths - went up 45 percent.

SULLIVAN: Here's what happened. Fifteen years ago, doctors began prescribing what are called opioid drugs more aggressively. Heroin is an opioid drug, an illegal one. But so are some prescription pain medicines - Oxycontin, Percocet, for example. They're all made from the poppy plant, and they're all addictive.

Dr. Andrew Kolodny is chief medical officer for the Phoenix House. and president of Physicians for Responsible Opioid Prescribing.

DR. ANDREW KOLODNY: When you talk to people who are using heroin today, what you'll find is almost all of them will tell you that their opioid addiction began with exposure to painkillers, and that the main reason they've switched to heroin is that heroin is either easier to access or less expensive than buying painkillers on the black market.

SULLIVAN: Kolodny says when you look at areas with the highest rates of opioid or heroin addiction, it's often middle- or upper-class places. It's places where people have access to medical care, access to a doctor who would write them a prescription.

KOLODNY: Often, a doctor who meant well; not a doctor who was a drug dealer, but a doctor who may have been under the impression that the compassionate way to treat a complaint of pain was with an aggressive opioid prescription.

SULLIVAN: As more people became addicted, doctors began cutting back their prescriptions. Drug companies agreed to make the pills less snortable. States created registries of patients who doctor-shopped. It became harder to get opioids, and heroin suppliers were happy to fill the void.

Kolodny says to get the heroin epidemic under control, doctors and dentists have to prescribe opioids more cautiously. And the hundreds of thousands of people already addicted to heroin and prescription painkillers need to find treatment.

Laura Sullivan, NPR News, Washington.

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