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Only 1 in 5 people who misuse opioid painkillers like Vicodin get their drugs exclusively from doctors, and 69% never obtain any of these drugs from medical sources, according to a recent study published in the Archives of Internal Medicine.

Researchers led by Yale’s Dr. William Becker examined 2006-08 data from the National Household Survey on Drug Use and Health (NHSDUH), an annual survey that includes information from interviews with thousands of people about their drug habits.

Information was obtained for more 3,000 people over 18 who reported having taken an opioid painkiller that was not prescribed to them or for nonmedical reasons in the last month. In line with prior research, the new study found overwhelmingly that most opioid misusers were not being treated for pain and had obtained their drugs from friends, family or dealers, not doctors.

Younger drug misusers were less likely to get their drugs from doctors than middle-age and older ones: 77% of 18-to-25-year-olds got their painkillers exclusively from nonmedical sources, compared with 52% of those older than 50.

Prior research examining this question from the other direction — looking at the proportion of pain patients who develop first-time drug problems when given drugs by their doctors — finds that less than 3% become addicted this way. NHSDUH data also show that 80% of Oxycontin misusers have previously taken cocaine, suggesting that their addiction was not likely to have originated from being legitimately prescribed an opioid for pain.

Nonetheless, efforts to fight opioid misuse are focused almost exclusively on trying to get doctors to write fewer prescriptions and using databases to track patients’ medical records and doctors’ prescribing habits. The new data suggest that it a more fruitful approach to the problem of painkiller misuse — and to the problem of legitimate pain patients not begin able to get drugs — may be to focus on what drives people with drug problems to seek out opioids and on supply sources other than doctors, including foreign drug companies, dealers and theft from factories, friends and family.