Hollywood stars usually set the trends that the rest of us follow — in the cities, to suburbia and beyond.
But not in the case of painkiller addictions.
What started as a problem among the rural poor in America has now spread across the nation and into the Hollywood spotlight. The effective chemicals in prescription painkillers — called opioids — are derived from the same poppy plant used to make opium and heroin. Painkillers give a feeling of euphoria and, just like heroin or opium, carry a high risk for abuse and recreational use.
"Addiction to opioids in America crosses all cultural and economic barriers," said Dr. Andrew Kowal, director of the Pain Center at the Lahey Clinic in Burlington, Mass. "You could be living in the hills of West Virginia, or an actor making $10 million on a movie."
The popularity of opiates skyrocketed during the late 1990s, after pain management specialists went on a mission to treat chronic pain.
Kowal says that between 1997 and 2005, methadone prescriptions shot up by 1,000 percent, oxycodone prescriptions (slow acting OxyContin) went up 600 percent and prescriptions for generic Vicodin increased 200 percent.
Anyone can become dependent on prescription painkillers, but addiction often begins with an emotional dependence. "People start self-treating their anxiety, depression or loneliness," Kowal said.
"That's why you see a lot of the Hollywood stars with it," he said. "Even though they're popular and famous and surrounded by lots of people they're ultimately lonely."
The following stars have dealt with an addiction to painkillers — or "hillbilly heroin," as one celebrity called it. Many of their stories reflect the pain and emotional turmoil that has resulted from the painkiller addiction boom.
Though the pint-size "Simple Life" star seems happy and healthy in her new role as a mother, she has a notorious track record for dangerous behavior and dramatic weight loss.
Richie, who has previously been addicted to heroin and alcohol, added a new substance to her record in December 2006 when she drove her sport utility vehicle the wrong way down a California freeway. Police arrested her and found Richie to be under the influence of Vicodin, the heavy-duty pain medication on which many stars have become dependent.
Richie claimed that she took the pain medication for menstrual cramps, a statement that raised a few eyebrows in celebrity gossip magazines and on Internet forums. After the arrest, Richie admitted to having a history of dodging responsibility.
"I really wasn't learning anything from that," the celebrity told ABC News. "So I kept making bad decisions or mistake after mistake after mistake. And I wasn't growing. I wasn't going anywhere."
Richie now appears to have kicked her substance abuse habits and seems to be focused on her relationship with rocker boyfriend Joel Madden and their baby, Harlow Winter Kate Madden.
"I owe the baby my life," Richie said. "I owe this baby everything and I have a responsibility now. Besides being responsible for myself, I'm now responsible for someone else. And I have to set the right examples. I have to really be someone that I would want my child to look up to."
For years, Ryder was generally a well-respected actress in Hollywood with two Oscar nominations.