A new report from Penn State University claims one of the biggest culprits for the ongoing opioid crisis in the U.S. comes from a not-so-likely source — pill-sharing amongst friends and family.

That’s opposed to more prominent causes, like mismanagement from Big Pharma and doctors over-prescribing drugs, study researchers say.

According to the National Institute on Drug Abuse, more than 130 U.S. citizens die after overdosing on opioids on a daily basis.

Additionally, “prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement,” the NIDA reports.

A “friends and family” problem

The Penn State study, entitled “Opioid Misuse Onset: Implications for Intervention,” notes the majority of opioid users received their first pill not from a doctor or even a drug dealer — it came from a friend or family member.

That’s a big problem, as four out of five opioid users used prescription-based drugs as a gateway to the hard stuff, most notably heroin and fentanyl.

“When you talk to the average person on the street, they think it’s all about Big Pharma and that doctors are overprescribing,” Penn State researchers say. “Our findings show that the two top common sources for getting opioids are friends or family.”

Of course, friends and family have to get opioid prescriptions first before they can give them away, and that’s where the trouble begins.

“The reason that the people have these opiates to give to their friends and family is directly because of Big Pharma and doctors handing out these prescriptions too liberally,” says Koorosh Rassekh, founder of Evo Health and Wellness, a mental health and addiction treatment center in Venice, Cal.

There’s also a comfort level in getting prescription drugs from a friend or family member, and by extension, a trusted physician, Rassekh says.

“The very reason why people feel comfortable sharing their medications with loved ones is that they view the drug as a quick, reliable fix that comes from a doctor — ergo, it must be safe,” Rassekh notes. “They are sharing these pills not out of malice but out of concern and a desire to help their friend or relative feel better.”

Plenty of blame to go around

Mike Robinson, founder of the Global Cannabinoid Research Center, in Santa Barbara, Cal., and a recovering opioid addict, says the problem is worse than Main Street Americans may think.

“For 24 years, I took strong opioids and was very addicted to them for chronic pain after a brutal auto racing crash in 1995 and subsequent cancers,” Robinson says. “I used to always carry all prescriptions on me when I was traveling, as I was scared that someone would overdose and die on what I was prescribed.”

“There’s good reason for this fear and I wish more people had it,” he adds. “If I were to give away opioids, breaking the law would likely be the lesser of my concerns, as any drug interaction with the person who got the opioids from a friend or family member could easily cause death.”

“It’s not surprising at all to find that the vast majority of abuse occurs when people give someone else their prescription— once a person takes a pill not prescribed to them, they are abusing those drugs,” he adds.

Like Rassekh, Robinson points to doctors, pharmaceutical companies, and the federal government for the easy access regular Americans have to dangerous opioids.

“Prior to 2002, doctors were legally allowed to be put on a retainer by pharmaceutical companies and the resulting misguided prescribing practices are what fueled the opioid epidemic,” he says.  “When I would go to the doctor for pain management the average appointment lasted less than 10 minutes. Once there, I’d normally see a physician’s assistant who would ask zero questions about whether or not I felt that I was addicted to opioids when I knew I was addicted.”

In that regard, patients who give away the prescription drugs they don’t use largely can’t be blamed too hastily for the epidemic.

“Without a doubt, that practice causes overdose deaths and more,” Robinson says. “Still, the root problem, of course, was the FDA, the pharmaceutical industry, and doctors willing to take money to prescribe them.”

Not to blame?

Other addiction experts say it’s not accurate to blame “drug-sharing” among friends and family for any opioid addiction issues.

“To blame what’s happening today on pill sharing is ridiculous,” says Jonathan Bloom, Ph.D. and the director of chemical and pharmaceutical sciences at the American Council on Science and Health in New York City. “I’m sure that it was a contributor but what we’re experiencing now is a result of other trends.”

One major issue that Bloom cites is the FDA’s approval of time-release OxyContin in the mid-1990s.

“Two decades later, there’s too much of it in circulation, mostly because of so-called pill mills and some overprescribing because of false safety claims made (by OxyContin maker Purdue Pharma) to doctors,” he says. “People looking to get high discovering that they could defeat the time-release properties of Oxy by grinding it up. That gave them very high doses of pure oxycodone, which could be smoked, snorted, or injected and that lit the fuse.”

According to Bloom, the “bomb went off” in 2010 when Purdue came out with an abuse-resistant formulation. “When users tried to grind it up it turned into a useless gum. Its use dropped like a rock and the addicted turned to heroin in droves,” he notes. “The heroin death rate skyrocketed starting in 2010.”

With such a healthy heroin market fentanyl began to enter the US (from Chinese labs and smuggling through Mexico) in 2013, Bloom adds. “By 2014, fentanyl was used to spike or replace heroin,” he says. “After that, the death rates spiked even more. It is much easier to synthesize fentanyl than heroin and much less of it is required.”

Mental health a bigger issue?

Bloom is not alone in rejecting the drug sharing claim. Mental health issues unique to the individual is a more important drug addiction issue, others say.

“I’m not sure I necessarily agree with the notion of friends and family being the gateway to addiction,” says Dr. Casey Green, medical director at Greenhouse Treatment Center, in Grand Prairie, Tex. “Addiction is a chronic, relapsing brain disease and the biology of that disease likely existed within that person before they ever used a substance.”

According to Green, the brain of someone with addiction innately forces them to respond to a substance or substances in a much different manner than others. “Using medication prescribed to a family member or a friend may introduce that person to the substance, but it is the underlying genetic disease that causes the addiction,” he says.

Even so, the notion of sharing a prescription narcotic with a friend or family member is a bad idea, and prescription drug users should avoid doing so.

“Many people start taking opioids because they know someone who has a prescription, and that person is willing to share,” says Dr. Sal Raichbach, a psychologist at Ambrosia Treatment Center, in Riveria Beach, Fla. “Even if they have good intentions, a small amount can be dangerous.”

“They might not realize it, but they could be starting their friend or family member down the wrong path.”