Their pictures hang in the front window of an empty department store, a makeshift memorial to more than two dozen lives. The youngest was still in high school.

Nearly 1 in 10 babies born last year in this Appalachian county tested positive for drugs. In January, police caught several junior high school students, including a seventh grader, with painkillers. Stepping Stone House, a residential rehabilitation clinic for women, takes patients as young as 18.

In Ohio, fatal overdoses more than quadrupled in the last decade, and by 2007 had surpassed car crashes as the leading cause of accidental death, according to the Department of Health.

The problem is so severe that Gov. John R. Kasich announced $36 million in new spending on it this month, an unusual step in this era of budget austerity. And on Tuesday, the Obama administration announced plans to fight prescription drug addictionnationally, noting that it was now killing more people than crack cocaine in the 1980s and heroin in the 1970s combined.

The pattern playing out here bears an eerie resemblance to some blighted cities of the 1980s: a generation of young people who were raised by their grandparents because their parents were addicts, and now they are addicts themselves.

“We’re raising third and fourth generations of prescription drug abusers now,” said Chief Charles Horner of the Portsmouth police, who often notes that more people died from overdoses in Ohio in 2008 and 2009 than in the World Trade Center attack in 2001.

“We should all be outraged,” Chief Horner said. “It should be a No. 1 priority.”

Scioto County (pronounced sy-OH-tuh), of which Portsmouth is the seat, has made it one, bringing what had been a very private problem out into the public.

A coroner and a pharmacist are among its state lawmakers, and a bill in the state legislature would more strictly regulate pain clinics where drugs are dispensed. The most popular drug among addicts here is the painkiller OxyContin.

The county’s efforts got the attention of political leaders in the state, including Governor Kasich, who declared the county a pilot project for combating addiction.

The problem is so bad that a storage company with business in the county recently complained to Chief Horner that it was having trouble finding enough job candidates who could pass drug tests.

“Around here, everyone has a kid who’s addicted,” said Lisa Roberts, a nurse who works for the Portsmouth Health Department. “It doesn’t matter if you’re a police chief, a judge or a Baptist preacher. It’s kind of like a rite of passage.”

About 10 years ago, when OxyContin first hurtled through the pretty hollow just north of town where the Mannering family lives, the two youngest children were still in high school. Their parents tried to protect them, pleading with neighbors who were selling the drug to stop. By mid-decade, they counted 11 houses on their country road that were dealing the drug (including a woman in her 70s called Granny), and their two youngest children, Nina and Chad, were addicted.

A vast majority of young people, officials said, get the drugs indirectly from dealers and other users who have access to prescriptions. Nina and Chad’s father, Ed Mannering, said he caught a 74-year-old friend selling the pills from his front door. The sales were a supplement, the man said sheepishly, to his Social Security check.

“You drive down the road here, and you think, ‘All these nice houses, no one’s doing any of that stuff,’ ” said Judy Mannering, Nina and Chad’s mother. “But they are. Oh, they are.”

Nina Mannering tried to quit, her mother said. She had a small daughter to care for. She was in a counseling program for a few months, but was told to leave when her boyfriend brought her pills. At one point, Ms. Mannering counted the number of schoolmates in four graduating classes who had died from overdoses, her mother recalled. The total was 16.

“It’s like being in the middle of a tornado,” said Ed Hughes, director of the Counseling Center, a network of rehabilitation and drug counseling clinics in the county. “It was moving so fast that families were caught totally off guard. They had no idea what they were dealing with.”

Photographs

Prescription Drug Abuse in Appalachia