Her son, then 24, tried treatment at four different facilities. He relapsed repeatedly. Two years ago, Torsch found him dead in his room from a drug overdose — the heroin bag still in his wallet.

Torsch said she was pleased with efforts to curb abuse of painkillers but disheartened at the new drug of choice. "In one way, they're making strides in a better control of one substance. And then it sounds like the balloon has to burst somewhere else," she said.

Some regional law enforcement agencies and drug counselors said they are working to find solutions.

"We've seen a huge transition back to heroin," said Lt. Lee Dunbar, who helps lead the Harford County Task Force, a law enforcement initiative geared largely toward cracking down on the use of illegal drugs and legal drugs for criminal uses.

The task force used federal funds to crack down on the black market for painkillers but now is dealing with heroin cases.

"We've also seen it with our seizures," Dunbar said. "We're starting to get a lot more heroin seizures rather than these pill seizures."

Anne Arundel, Baltimore and Carroll counties have not seen a spike in heroin arrests, spokespeople for the police departments there said. Baltimore City has seen a decline in heroin arrests. Howard County did not provide data on heroin trends.

Some say the trends may not be showing up in statistics yet.

Joseph Ryan, manager of the Harford County Office of Drug Control Policy, said his agency has not recorded an increase in heroin overdose deaths, but he knows from drug counselors that its use is a growing problem. He expects it to get worse.

"That is what the kids are telling us," Ryan said. "They can't find Oxycontin, so they're going to run down to the city and buy heroin because they are going through withdrawal."

Heroin use is increasing in other states as well, Sharfstein said.

A spokesman for the Maryland State Police said heroin seizures have risen along the Interstate 95 corridor. Last year, 1,282 grams of heroin were seized in seven cases. This year, state police have seized 3,101 grams in 19 cases. Those arrested were from Maryland as well as other states.

Gimbel, the drug counselor, who is a former heroin addict, said the pool of prescription drug abusers is very large and includes a wide spectrum of people.

Some, like Dan Torsch, started taking pills for pain and soon were hooked. Some began taking the pills for fun and became addicted.

"Then you had those heroin addicts who switched to Oxycontin because it was pure and it was cheap and you didn't have to go through the violence of the drug dealing," he said.

Toni Torsch joined the support group Grief Recovery After Substance Passing, or GRASP, after her son died. She said the drug abuse problem is only getting worse.

She said she would like to see more of a focus on treatment.

"I know heroin's illegal. I know [addicts] have a choice," she said. "I know all of that stuff. But it's so highly addictive. They may have a choice in the very beginning, but once there's that addiction, even with the pain killers, there's very little control that they have left."