Appalachia, which has long been dealing with an epidemic of prescription opioid abuse, is now seeing an influx of heroin, The Courier-Journal reports.

In other areas of the country, heroin quickly became a problem when authorities began closing “pill mills” that flooded communities with prescription pain pills. That is because heroin trafficking patterns went through major cities first, the article notes. It has taken longer to get to more remote areas such as eastern Kentucky.

Treatment centers, police and emergency rooms in eastern Kentucky are reporting an increase in heroin use in the area. One reason heroin is taking hold is because it is much cheaper than prescription opioids.