A heroin addiction can start in the most innocent of places, not under a bridge, but in the dentist’s chair or pediatrician’s office.

As noted in H&HN’s previous coverage, there is an opioid epidemic raging across the U.S., killing thousands of Americans every day. Often, doctors are prescribing pain pills like oxycodone for sports injuries, kids end up getting hooked, and when the Rx dries up, they turn to street heroin that’s stronger, cheaper and easier to obtain.

The strongest risk factor for heroin initiation is past abuse of opioids, the Centers for Disease Control and Prevention notes, with 1 in 15 patients who abuse pain pills trying the street drug in the next 10 years. With those stats in mind, the Partnership for a Drug-Free New Jersey is looking to reverse the trend.

Thursday, the nonprofit coalition launched a new advertising campaign called “You Decide Before They Prescribe,” aiming to push parents to ask the tough questions before their kids receive pain pills. The provocative ads feature images of injured children and pose the question, “Would you give your child heroin?” for a sports injury or broken arm. High schoolers who received an opioid prescription before graduation are 33 percent more likely to abuse the drugs in the future, the New Jersey group notes.

“Opiate-based prescription drugs and heroin have many of the same compounds, and there is definitely a link between those who are addicted to prescription drugs and the movement on to heroin,” Angelo Valente, executive director of the Partnership for a Drug-Free New Jersey, told me by phone Thursday. “Sometimes the prescriptions dry up and heroin becomes an alternative that’s not only available, but also cheaper. That’s the reason why we see that strong link between the two, and that’s the reason for this message today.”

The partnership’s campaign kicked off with an event and unveiling of one of the billboards in Times Square. Ads are further being rolled out on trains and buses in New Jersey. Valente hopes the ad campaign eventually will take hold nationwide, with similar partnerships in Rhode Island and Detroit already expressing interest in using the images.

Taking a stand on the issue became all the more important for the group after a study, recently commissioned by the New Jersey partnership, found that four of every 10 parents were unaware of the links between painkillers and heroin abuse. Kids are often going to the dentist to get a wisdom tooth pulled, and coming home with a powerful bottle of pain pills. State politicians have also taken note of this trend, Valente said, with legislation in the works requiring docs to educate and offer alternatives to patients when prescribing opioids.

All walks of society must play a role in curbing this epidemic, including providers, he added. New Jersey hospitals have been doing so by holding educational symposia for docs about proper prescribing procedures. Of those physicians polled afterward, about 90 percent said they planned to modify their prescribing habits, Valente said. Even a change as small as dolling out three pills instead of 30 can make a huge difference in curbing opioid misuse.

“We believe that everyone has a responsibility in trying to reverse the trend that we’ve seen, and end the epidemic,” Valente said. “That responsibility goes across the board — parents, the medical community, the legislatures throughout the country, and Congress all have to respond. If everybody works together, this epidemic will end. But, I think, until that happens, we’re going to continue seeing so many of these families being impacted by this epidemic.”