He is a confident, smart, healthy young man with a good job and a future. He is also an addict.

He has been clean for 10 years, but he still occasionally thinks about shooting heroin into his veins. Living on Martha’s Vineyard, hit hard by the same heroin epidemic gripping many communities, he still faces triggers that present a challenge to staying clean. He now recognizes, however, that his mind is capable of playing cruel tricks on him.

“It’s only remembering that one little 30-second feeling of euphoria, nothing else,” he said. “When those thoughts pop into my head, it’s only those 30 second clips, my brain never plays the tape through. My addict brain is programmed to remember those little bits of good. I don’t remember the hooker kicking me in the stomach in the morning. I don’t remember the gun shots. It’s amazing how powerful heroin is.”

According to scientific research studies, four out five heroin users in the current epidemic first became addicted to opioid pain medications. These were often prescribed for legitimate pain management such as a sports injury or recovery from surgery.

He was one of those four out five.

“I got hooked on pain pills for a back injury,” he said. “It was pretty much right off the bat. I really liked the way opiates made me feel. I managed to go to college and get a degree and a good job, but all the while my addiction just got worse and worse. I lost my job, and my wife and my house. Everything that I had, I sold for drug money. I was homeless living on the streets, right behind the building that I once worked at. Hookers, gun battles. It was a nasty place.”

She is a respected and admired member of the Vineyard community. She is also an addict.

For much of her life she battled heroin addiction. She was clean and sober for many years until a doctor prescribed opioid pain medications for a back injury. She was soon hooked, and desperate.

“It brought me to my knees,” she said. “I didn’t have a way out at that point. I was ready to go back and pick up heroin.”

She and others spoke to the Gazette recently about their addictions. The Gazette agreed not to use their names. They credit the medication containing buprenorphine and naloxone, often known by the brand name Suboxone, for successful, extended recovery from opiate addiction.

“It saved my life,” she said. “It’s given me back a life.”

Buprenorphine and naloxone themselves are classified as opiates, which makes them the subject of some controversy. The medications work on the central nervous system to short circuit the euphoria associated with heroin, as well as the symptoms of heroin withdrawal. The symptoms — chills, diarrhea, cramping, nausea and vomiting — can set in within hours of the last heroin use, and they are often severe. Addiction experts say that after a short period of addiction, most addicts do not use heroin to get high, but to avoid those withdrawal symptoms.

Buprenorphine is a long acting opiate, but with very different characteristics than those associated with heroin or prescription pain medications. It does not deliver a “high,” but it suppresses the craving for heroin, and also blocks the euphoric effects of subsequent opioid use. It has an effective “ceiling,” according to addiction experts. Unlike more harmful opioids, taking higher doses does not produce a more intense effect. In addition, if an addict uses heroin while taking buprenorphine, the addict will not experience a high.

Buprenorphine is illegal to possess without a prescription, and there are numerous cases of people abusing the medication. Some addicts use it to avoid withdrawal, until they can get more heroin.

The addicts interviewed for this article all said they had tried many forms of treatment, but could not kick their habit until they began taking buprenorphine, under the supervision of a doctor.

“I was in and out of so many treatment programs, they just never worked,” said one addict, who said he had gone through medical detoxification more than a dozen times. “I would get out and I would immediately go right back to it. The cravings were just so intense, it was impossible to stay sober. It took me two months before I actually got sober. I did have a few slips in the beginning. If it wasn’t for that, I’d be dead, no question. You can only overdose so many times and eventually your luck runs out. I’m one of the lucky ones.”

Several recovering addicts tried to explain the grip of heroin addiction, and the perception that they are weak or lack willpower.

“The last couple of years shooting heroin, I despised it,” said one man. “I didn’t want to get high, all I wanted was to not be sick. I had a $300 a day habit. It wasn’t fun.” He said the addiction was so intense, that when he attended 12-step support programs for heroin addicts, he didn’t believe recovering addicts who said they got clean.

“I couldn’t imagine getting through the meeting without shooting dope in the bathroom, never mind a whole day or years. That hump seemed so insurmountable.”

Addiction experts on Martha’s Vineyard say the biggest barriers to effective treatment are not the lack of services or the cost. They say there are two primary reasons addicts don’t get help. The first is denial.

“I thought I had a little problem,” said one person who used heroin for many years. “If you still think you’re having fun, then you’re going to keep using.”

“When I was ready, it seemed easy, almost,” said another recovering addict.

The other major barrier for addicts seeking treatment is the stigma associated with addiction. That stigma, according to addicts and medical providers, is more pronounced in a small isolated community like Martha’s Vineyard. Addicts said they feared seeking medical treatment would identify them as drug users, and they would be scorned. They also said once they got effective treatment, many realized their fears were unfounded, that their families and friends supported their treatment, and welcomed them getting clean.

“One day I woke up and said I’m done,” said one addict. “Didn’t like the way my family looked at me. Didn’t like the way my daughter looked at me. Nobody trusted me. I didn’t trust me. I kind of felt ashamed of it. A month or two into it [buprenorphine treatment] for me it was a spiritual experience. I’ve not had the desire to use at all. I look at myself now compared to who I was then; it’s really two different people.”

The addicts stressed that buprenorphine should not be thought of as a miracle drug, but a tool to stay clean. They see doctors, counselors and attend support groups or 12-step meetings to stay on track.

Every addict who spoke to the Gazette, however, credits the medications with a remarkable transformation in their lives, from a life of stealing, lying and isolation because of their heroin use, to a normal, productive life with jobs, families and a future.

“I might [have been] one of the statistics,” said one woman. “I’m married, I have kids. Now I have a good life. My husband accepts me. He says I don’t know what it does to you, but keep doing it.”