Heroin use has increased so much in Ohio that users say it is “falling out of the sky,” according to a new report by state health officials. Children as young as 13 are starting to use the drug, they said.

Heroin’s popularity is increasing because it is seen as less expensive and easier to obtain than prescription opioids, according to the Associated Press. Many heroin users responding to a state survey said increased demand for the drug was due to the reformulation of OxyContin, which makes it more difficult to abuse.

The report, released by the Ohio Department of Alcohol and Drug Addiction Services, said availability of heroin in Cleveland is considered to be at epidemic levels. The survey found an increase in heroin abuse across the state during the previous six months.

The state’s Department of Health reports that heroin-involved deaths increased from 16 percent (233) of all drug overdoses in 2008, to 20 percent (283) in 2009, to a high of 22 percent (338) in 2010.

At the Recovery Center in Lancaster, Ohio, an area considered to be the “hotspot” for heroin use in the state, most of the 360 patients are addicted to painkillers or heroin, according to CEO Trisha Saunders. She told the AP that most patients who are addicted to heroin started with painkillers. “They say, `I never thought I’d switch from taking a pill to putting a needle in my arm,’” Saunders said.

The Department of Justice 2011 National Drug Threat Assessment found increased heroin-related overdoses have been reported in cities in at least 30 states.

The report notes, “New users frequently overdose because they are unfamiliar with their tolerance levels; users resuming heroin use after prolonged absences often restart at their prior dosage level, even though their tolerance may have declined in the interim.”