In fact, only 22 to 35 percent of “misusers” of pain medication report receiving drugs from their doctor, according to the Substance Abuse and Mental Health Services Administration. (Misuse is a term that includes anything from taking an extra pill beyond the quantity prescribed by a doctor to full-blown addiction.) About half obtain pain relievers from a friend or relative, while others either steal or buy pills from someone they know, buy from a dealer, or go out looking for a doctor willing to write prescriptions.

Read: Physicians get addicted, too

People who abuse pills are rarely new to drugs. The federal government’s 2014 National Survey on Drug Use and Health, for example, revealed that more than three-fourths of misusers had used non-prescribed benzodiazepines, such as Valium or Xanax, or inhalants. A study of Oxycontin users in treatment found that they “were not naive individuals with accidental addictions who were introduced to painkillers by their physicians as reported by the media … [Instead they had] extensive drug use histories.”

Among people who are prescribed opioids, addiction is relatively uncommon. The percentage of patients who become addicted after taking opioids for chronic pain is measured in the single digits; studies show an incidence from less than 1 percent to 8 percent. Most of the estimates are skewed toward the low end of this range, when those at risk (due to a history of substance abuse or, to a lesser but meaningful extent, a concurrent mental illness) are removed from the sample. In Feldman’s case, the nature of the risk was constant anguish. When she was 4 years old, her heroin-addicted mother left the family and died of an overdose before she was 12. “For so much of my childhood, I felt abandoned, worthless, unlovable, and confused,” she told me. Her first Percocet came from a girlfriend. “Being numb helped,” she said. Before Percocet, though, she had achieved “escape” with marijuana, alcohol, PCP, benzodiazepines, and cocaine.

As for “Johnny,” the hypothetical shiny all-American kid who seemed to have it all—well, I met a real-life version of him this year. I am a psychiatrist who, for the past 11 months, has taken a break from urban life to do some clinical work at a behavioral-health clinic in a small community in southeastern Ohio. I have gotten into the habit, as I go around town, of chatting with anyone who seems friendly. While stopping at a fast-food place one day, I met a 23-year-old man who was on a vape break from his job there, and he was game to talk. He told me that he had been a star football player at his public high school. At 18, he had been thrilled to receive a full football scholarship to Ohio State University. He planned to major in engineering but truly aspired to the National Football League.

Unlike many of his friends, who felt stymied in the small Appalachian town where pills and heroin were short-term cures for boredom, this young man could imagine a future for himself. But a month before graduation, he was in a car accident. The injury to his right shoulder ruined his ability to throw overhead—and the damage went far beyond his anatomy. He developed post-traumatic stress disorder from the crash. Even worse, he told me, his universe was shattered. Football had given him both social status and a sense of purpose. What made this devastation bearable was the hydrocodone that his orthopedic surgeon gave him. Within six months, he was drinking and still using the pills that the sympathetic surgeon continued to prescribe. Eventually, he moved to heroin. By the time we met, he was enrolled in a buprenorphine clinic and was otherwise drug-free, but was still trying to regain his footing. Every day, he went to work at a fast-food restaurant and felt bitter about the direction of his life.