SALT LAKE CITY -- There's a killer taking nearly one Utahn a day, while staying largely hidden behind doors in every community in the state.
Prescription opioids have created tens of thousands of addicts in the Beehive State: some who remain on the medicine prescribed by doctors, and others who transition to heroin because it's cheaper and doesn't require continued deception in a doctor's office.
Opioids, Fentanyl and heroin have been identified by the Drug Enforcement Administration as the most dire drug-related threat to the United States, and Utah is feeling the impact more than most other states.
Robert Burton is surprised he is still alive after ten years of opioid abuse.
"There's times I don't remember how I got home," he said. "I'd wake up in my vehicle all the time."
Burton started taking prescription painkillers after hurting his back on the job as a certified nurses assistant.
"It cost me my marriage, it cost me everything basically in a nutshell. Worldly possessions, trust with my family," said Burton who recently finished inpatient treatment with the Odyssey house in Salt Lake City.
Doctor Paula Cook of the University Neuropsychiatric Institute at the University of Utah says opioid addiction is treatable, but most addicts never get help.
"We only have about one in ten of those who need treatment who are actually accessing treatment," Cook said.
The epidemic is relatively new, with American deaths attributed to opioid overdose spiking from 4,000 in 1999 to more than 16,000 in 2013, according to the Centers for Disease Control.
The rest of the world has not experienced the same spike, and the explanation is relatively clear, according to researchers who published an examination of prescription and marketing data in the American Journal of Public Health.
They report that the pharmaceutical company Purdue Pharma implemented an intensive marketing campaign for their new opioid formulation, OxyContin, in the mid to late 1990s.
Marketing the drug to doctors, they said "The risk of addiction from OxyContin was extremely small."
As the deadly incorrectness of that pitch became obvious, Purdue executives faced criminal charges and faced $634 million in fines.
At the same time OxyContin took fire, Doctors started feeling a new pressure: online physician reviews.
"Providers feel consequences if they don't give patients what they want, and patients expect to be treated aggressively for their pain," Cook said.
So an epidemic was born from a unique American circumstance: advanced medicine fueled by market forces.