Opana, a powerful opioid, is increasingly being abused in rural America, Reuters reports.

At least nine people have died so far in 2012 from prescription drug overdoses in Scott County, Indiana, and most of the deaths involved Opana.

Low-income people and those living in rural areas are at particular risk of prescription drug overdoses, according to the Centers for Disease Control and Prevention.

Law enforcement officials report that Opana abuse began after OxyContin was reformulated in 2010, to make it more difficult to snort or inject. Opana is more potent, per milligram, than OxyContin, making it potentially more deadly, the article notes. Many people who abuse Opana do not realize how strong it is.

People using Opana to get high crush the drug and either snort or inject it. It is an extended-release pill, so crushing it releases the drug all at once. “This Opana pill has really kicked us in the rear,” Indiana State Police Sergeant Jerry Goodin told Reuters. “We’ve never seen an addiction like this.”

While some people who abuse Opana buy them from “pill mills,” others get them from their doctors, or buy them from elderly people who have a prescription for the pills.

Endo Pharmaceuticals, which makes Opana, has announced it is reformulating the drug. The pill will be more difficult to crush, and will turn gooey if liquid is added to it. There has been an increase in pharmacy robberies by people seeking the current formulation of Opana pills since the reformulation was announced.

Opana is prescribed for chronic back pain, as well as pain related to cancer and osteoarthritis.