A new report from the Centers for Disease Control and Prevention shows death rates from heroin overdose haven’t just increased over the last decade, but are accelerating.

A testament to the quiet potency of prescription drugs, many experts suspect a similar trend of rising painkiller use is contributing to the upswing in heroin deaths. Without sufficient physician oversight, which would otherwise control up front how much of the medication people received, painkiller addicts looking for a cheaper, more convenient fix can turn to the real stuff. As a result, heroin use is free to surge unrestricted.

“Although the term ‘gateway drug’ has gone out of fashion recently in the addiction medicine world, I think that prescription opiates are the gateway drug par excellence,” Dr. Howard Forman, addiction psychiatrist at Montefiore Medical Center, who wasn’t involved with the new report, told Medical Daily. Data show one in every 15 people prescribed opiates will go on to try heroin within 10 years.

The new report shows the death rate jumped from 0.7 deaths per 100,000 people in the year 2000 to 2.7 deaths per 100,000 in 2013. More troubling, between 2010 and 2013 the death rate made even greater leaps: from a six percent increase over the previous decade to 37 percent in the last four years.

Prescription painkillers play an important role in uplifting the heroin boom. Earlier this February, for instance, the CDC released data on prescription opioid analgesic use among adults between 1999 and 2012. During that time, the death rate more than tripled and the percentage of people who used an analgesic stronger than morphine increased from 17 percent to 37 percent.

The New Heroin

Beneath this trend lurks a more fundamental change in how heroin is used, and, importantly, who is using it. The demographics of fatal overdose have changed considerably in the last decade. In 2000, black adults between 45 and 64 years old showed the highest rate, at two deaths per 100,000. In 2013, white adults between 18 and 44 earned that distinction, at seven deaths per 100,000. Some suggest heroin’s vanishing stigma can explain the change.

“There are new markets like suburbs where heroin didn’t used to exist.” Dr. Andrew Kolodny, the chief medical officer of the rehabilitation organization Phoenix House, told Time.

What started as a street drug mainly abused by people in poverty has earned something of a white-collar reputation, used primarily by wealthier Americans who choose to take the drug intranasally or as pills, rather than inject it. Health officials fear this sets heroin and other opioids on a dangerous course, as a wider population begins to normalize their use. Painkillers serve an integral role in medicine, Forman concedes, “but it is just not the starring role they have now.”

On the other hand, looking at prescription rates, that trend may already be afoot. In 2014, doctors wrote 259 million painkiller prescriptions, or one bottle for every American adult. The effect is cyclical: As more pills flood into circulation, their use creeps further into the mainstream, producing more of a demand and, of course, more overdoses. Drugs designed to reverse these overdoses, like naloxone, still don’t see widespread use, despite their studied effectiveness. But, Forman says, they are still only one arm of the solution. Ultimately, education is king.

“Educating the public about the risks of opiates and why your doctor may not be so willing to prescribe them to you for common aches and pains is key,” Forman said. “It’s also important to educate physicians about the risks they are exposing their patients to when they prescribe opiates.”