In this review of 2000-2004 augmented Addiction Severity Index data, those abusing prescription medications reported increased illicit drug and alcohol abuse, polydrug abuse, psychiatric problems, and arrests for property crime. Forty percent reported abuse of OxyContin, a drug implicated in a number of deaths in this region of Virginia. Compared to nonusers, OxyContin users were younger, more likely to be female, and more likely to abuse benzodiazepines, methadone, cocaine, and heroin. Longevity of abuse of these other drugs belies suggestions that OxyContin was acting as a “gateway” drug leading naïve users into addiction and risk of death. Over the past decade, misuse and abuse of prescription drugs, particular opioid pain medications, has increased dramatically. In rural areas like southwestern Virginia, a United States Government report found that abuse of prescription drugs, including opioids, has been particularly acute and has resulted in numerous deaths. Some have blamed this problem and the associated deaths specifically on abuse of OxyContin. This report presents data that identifies abuse of specific opioid and benzodiazepine medications by prisoners in southwestern Virginia, drawing on augmented Addiction Severity Index interviews from 2000 to 2004. The data allows an examination of the pattern of prescription drug abuse in finer detail than the national epidemiological data. Tables, figure, and references