A 38-year-old man sits quietly at the Chemical Health office in Red Lake. He's noticeably agitated. This is his first day of treatment.
MPR News agreed not to name this man because he admits that to support his prescription drug habit, he committed crimes.
He's suffering painful withdrawals.
"Feel sick to your stomach, got a headache all the time, constantly," the man said. "Your body hurts. It's pretty bad. It's probably the worse thing I ever felt."
His addiction is an increasingly common one on Minnesota's two largest Indian reservations, where tribal leaders say abuse of prescription drugs has become an epidemic that plagues their communities. The Red Lake and White Earth Ojibwe bands have both declared public health emergencies to draw attention to the problem.
The man at the Red Lake chemical health center started taking pain killers 10 years ago for back pain. His back got better, but he kept taking the pills. He shopped around for doctors and pharmacies that would prescribe him the drugs. He'd take Vicodin, Percocet, Oxycontin -- whatever he could get his hands on. He got most of his drugs in the Twin Cities, where there are lots of doctors and pharmacies to choose from.
To pay for his habit, he stole things and sold drugs on the reservation, where it used to take several days to sell a batch of pills. Now, it only takes hours, because lots more people are looking for drugs.
"Every time I see someone that I knew that hated it or would just talk bad about it, it's completely different now," the man said. "In just a little while they're asking, asking where they can get it. People I never though in my life would do it I see do it now."
Prescription pain killers are fast becoming the drug of choice on the reservation. From 2007 to 2008, the number of people treated for drug addiction tripled, from two to six percent of all Chemical Health clients.
More recent numbers aren't available, but staff members at the Chemical Health program say they believe treatment admissions may have doubled again in each of the past two years. Those numbers don't include tribal members who underwent treatment off the reservation.
Tom Barrett, director of Chemical Health at Red Lake, believes prescription drugs have filled a void after several major busts of crack cocaine dealers three years ago. The pain killer problem got the community's attention last summer, when a Red Lake father and his adult daughter died of drug overdoses on the same day.
Barrett said it's tough to see the growing number of addicts on the tight-knit reservation.
"A lot of them are our friends and relatives, you know," Barrett said. "We hate to see that happening. It's hard. It's just not numbers to us."
The growing misuse of pharmaceuticals is a national problem. But it appears to be more pronounced in Indian Country. A 2009 federal study from the Substance Abuse and Mental Health Services Administration suggests that American Indians were abusing prescription drugs at more than twice the rate of whites.
At Red Lake, many of the prescription drugs come from off the reservation, typically from the Twin Cities, said Kelly Brunelle, a narcotics investigator. But he also suspects Indian Health Service physicians on the reservation are at least partly to blame.
Brunelle said the Indian Health Service hasn't cooperated much with his investigations.
"They'll come back and they'll say, 'I can't give you any information because, you know, we don't share information about our patients,' "he said. "And it gets to the point where, we're the ones who are picking your patients up out of the ditch. ... We've got to help these people, but we don't get it."
Indian Health Service officials at Red Lake say doctors do their best to make sure that patients prescribed drugs for chronic pain don't abuse the system.
Gary Wabaunsee, CEO of the Red Lake HIS agency, said physicians develop careful treatment plans for patients.
"They're not just handing out drugs to everyone that comes in," Wabaunsee said. "They follow the medical practice guidelines."
People from health, law enforcement and drug treatment agencies at Red Lake will form a task force in the coming days. They'll look for ways they can work cooperatively to combat prescription drug abuse.