Over 75 people die every day in the United States as a result of a painkiller overdose. Countless more see their lives, families, work and dreams disintegrate as their days become a never-ending quest of hunting for scripts, doctor shopping, scoring, getting high and coming down.

Most people are aware of the dangers of prescription drug abuse, work hard to ensure their medicine is kept safe and used properly. However, taking painkillers—even when they’re prescribed for legitimate pain—isn’t always as straightforward as it may seem.

In fact, the people who are most at risk for abuse and overdose are often as surprised when a problem arises as are those around them. With 3 billion prescriptions written in the United States each year—many of them for painkillers—having better information about painkiller abuse can literally save a life. To that end, here are six things your doctor isn’t telling you about painkiller abuse.

Abuse Isn’t Addiction—But it Can Lead to it

Abuse occurs anytime someone uses a medicine in a way other than the doctor who prescribed it intended for it to be used, including: taking more than the directed dose, taking a drug prescribed to someone else, taking a drug to get high or to alter how one feels and more. When these things occur, it does not mean that the person abusing the medication is addicted to it.

However, painkiller abuse can lead to painkiller addiction, which, if left untreated, can ruin someone’s life and health and even lead to overdose and death. When someone crosses the thin line between painkiller abuse and addiction, it is essential that good, professional treatment for the addiction be sought out.

Those Who Are Most at Risk

To at least some degree, anyone who has access to prescription pain medicine is at risk to abuse painkillers, but some factors increase risk more than others. Middle-aged people—those between the ages of 45 and 54—are the group most likely to overdose on prescription pain drugs.

Additionally, being on Medicaid increases your risk for overdose, and rural areas see markedly higher rates of abuse, addiction and overdose compared to urban ones.

Prescription Drugs Aren’t Safer Than Street Drugs

Because they have the backing of science, the medical industry and the lobbying and marketing efforts of the pharmaceutical industry, many people mistakenly believe that prescription drugs are safer than street drugs.

While for the most part, prescription drugs are safe to use when taken as prescribed by the person to whom they were prescribed, this relative safety should in no way be applied carte blanch to all scenarios and to all people.

The reality is that prescription painkillers work in the brain and body in remarkably similar ways to street drugs. They are highly potent and can alter the brain. They should be used with deference and only under the care of a doctor.

The Dangers of Alcohol and Other Drugs

Even if you are using your pain medication exactly as your doctor intends, if you also drink alcohol or take other drugs, you could be setting yourself up for an overdose. According to the CDC, roughly one-half of all prescription overdoses involve the interaction of another drug or alcohol.

Mental Illness and Substance Abuse

For people with a history of mental illness or substance abuse, using painkillers at all can be a recipe for disaster. Because they are more vulnerable to the effects of the drugs, due to the unique nature of their brain chemistry and personal history, people who have struggled with mental illness or substance abuse issues are more likely to abuse prescription pain medicines, which can lead to dependence and overdose.

Painkiller Abuse Can Lead to Heroin Use

When someone develops a dependency on painkillers due to extended use or abuse, the difficulties in obtaining prescriptions or pills from other people, as well as the cost of buying pills on the street can become difficult.

Because an addiction physically demands that a person maintain it through painful withdrawal symptoms, many people whose bodies are dependent on painkillers will finally turn to heroin, because it is cheaper than pills, easy to find in most cities and towns and offers a similar “high” to the pain medication that started their addiction.

Painkiller abuse is becoming more and more of a problem in the United States. Overdose deaths have increased four times in the past 10 years, and painkiller abuse resulting in hospital admissions has increased five times. Thankfully, when people are armed with good knowledge and committed to proper use, abuse, overdose and addiction are likely never to occur.