July 16, 2012 12:29 AM EDT

The girls aren’t here but their presence lingers everywhere —their images hang in larger than life posters that cover the walls — Olympic and world champions, frozen in fierce, mid-competition poses — their chalky white footprints cover the mats that litter the gym floor, tracing the crazy circuits of routine after routine performed here at the U.S. Gymnastics’ National Training Center. The chalky dust that anchors tiny gymnasts to their precarious apparatus cakes their calloused hands, too, and is shed in ghostly prints on the 4-inch balance beam, on the uneven bars that loom 8 feet off the ground, and even on the rest room door. That might be the dusty legacy of where the reigning Olympic all-around champion jumped onto the beam; those could be the footprints of the country’s best gymnast on the uneven bars; that might be where the world vault champion stuck a difficult landing.

(For TIME’s daily coverage of the 2012 Games, visit: Time.com/Olympics)

This is where every girl who wants to be an elite gymnast must come, at some point in her career, to pay tithings, in the form of blood, sweat, and often tears, to Martha Karolyi. This is where every gymnast with Olympic dreams earns the right to represent the U.S. and wear the coveted team leotard. This is where Karolyi puts the girls to the test, once a month, for four strenuous days. It’s called training camp, and while there are bunk beds and the shared cabins and bucolic surroundings deep in the woods of New Waverly, Tex. — complete with lakes and boats and tennis courts and a pool — it’s nothing like the care-free summer excursions that most of us know.

The Food and Drug Administration (FDA) has approved the first auto-injecting version of Naloxone as part of the government’s efforts to control the epidemic of opiate addiction and overdoses from narcotic drugs, which include prescription medications such as morphine, oxycontin, and hydrocodone, as well as illegal drugs like heroin. Naloxone reverses the effects of opioids, which bind to receptors on the brain and trigger narcotic effects on the body, including slowing breathing and lowering blood pressure. Opiate overdoses can lead to death when these functions become too compromised, so quickly giving Naloxone to someone who has taken an excessive dose of opiates can save that person’s life. MORE: Philip Seymour Hoffman Didn’t Have to Die But Naloxone is currently only available by prescription and as an injection, two factors that have limited its use primarily to emergency rooms and among emergency first responders in certain states that allow them to carry Naloxone. (An nasal spray version is available, but not approved by the FDA and requires users to purchase separate atomizers.) In addition, broader social and ethical concerns about how its availability might promote opiate use and abuse have kept it from being distributed more widely. While the Obama administration called on states to loosen restrictions on Naloxone access, some governors, including Paul LePage of Maine, oppose making the drug more widely available, citing concerns that it would promote more illicit drug use. But with a quadrupling in the number of prescriptions written for painkillers between 1999 and 2010, deaths related to opiates have also skyrocketed. In 2008, 14,800 overdose deaths were tied to prescription painkillers, more than deaths from cocaine and heroin combined. Some experts say that doctors and shifting social norms about treating every illness with a medication bear part of the burden for the current epidemic of addiction, since sales of prescription pain killers have increased 300% since 1999, and made the drugs more available. MORE: Government Considers Overdose Antidote, Naloxone, to Fight Prescription Drug Misuse Introducing a relatively easy to use, auto-injecting version of Naloxone could help more communities and states get comfortable with the idea of increasing access to the life-saving drug. More importantly, the drug, called Evzio, is approved specifically for family members, caregivers, and other non-medical people who might need to help an overdose victim. The kit comes with a training device that lay people can use to practice giving the drug, which is administered in the thigh. It has automated audio instructions to guide users through each step in the process, much like automated defibrillators do. “In our study, even among individuals not trained to use the product, 90% administered the correct dose of Naloxone during a simulated opioid emergency,” Dr. Eric Edwards, chief medical officer of drug-maker Kaleo, said to reporters during a teleconference about the product. The drug could be prescribed for either someone who is taking opiates, whom the prescribing physician feels might be at high risk of an overdose (such as those with a history of previous or other substance abuse), or to a caregiver or family member of someone who is at risk. “We do not intend to take action for the administration of naloxone on individuals for whom it is not prescribed for,” Dr. Douglas Throckmorton, deputy director for regulatory programs at the FDA’s Center for Drug Evaluation and Research told reporters. That could help to ease current restrictions on Naloxone availability in some states; some states have stronger regulations against such third-party prescribing, while others have less restrictive rules on who can have access to and use the drug. MORE: Wider Use of Antidote Could Lower Overdose Deaths by Nearly 50% In King County, Wash., for instance, Naloxone is distributed in the county’s needle exchange programs, and drug abusers are taught how to administer the medication in case they witness a friend overdosing. That’s because a 2010 law allowed prescriptions to be written to not just people at risk of overdosing but those who may witness an overdose. A local pharmacy chain has also agreed to work with the state pharmacy board to make Naloxone available to anyone who might witness an opiate overdose, without the need to see a physician to get the prescription. Those who request Naloxone are given a 20-minute counseling session on the risk of overdose and trained in how to use it, and then given the drug, prescribed by an authorizing physician who collaborates with the pharmacy. Many pharmacies already do this with things like flu vaccines and epi-pens, says Caleb Banta-Green, research scientist at the Alcohol and Drug Abuse Institute at the University of Washington, who has spearheaded research into and developed innovative strategies for addressing the opiate epidemic in the state. Across the country, Massachusetts recently became the first state to make Naloxone available to law enforcement officers so overdose victims don’t have to waste the precious minutes it can take to call for and receive medical help. In 2009, a pilot study involving police officers in 15 Massachusetts communities found that those who were given Naloxone saw a drop in opiate-related overdose deaths than communities in which law enforcement didn’t carry the drug. “We know Naloxone works, and it has dramatically saved lives,” Hamburg says. “All of us who have taken care of patients who have overdosed and used it, know what a remarkable reversal occurs. It’s just a question of getting industry to see this [drug] as an opportunity to develop the right kind of product to be used in the community setting, and address the variability of state laws on how to handle use of these kinds of products.” The move is just the latest in the FDA’s years-long effort to tame the growing tide of opioid addiction. In addition to the latest approval, Hamburg says the agency is working to corral the boom in prescriptions by intensifying its efforts to better control who is writing them, and why – while ensuring that the patients who need pain-killing relief are receiving it. As part of that strategy, in December 2013, the FDA recommended that hydrocodone, an opiate that comes in long-acting doses, be reclassified as a Schedule II drug, which restricts who can prescribe it and how use of the medication is monitored. For drugs in this class, doctors cannot phone in prescriptions and can only call for a three-month supply; doses cannot be refilled without a new prescription in order to avoid potential dependence. That’s also the case for Zohydro, which the agency approved in 2013 as a Schedule II drug, despite concerns by some that it is highly addictive and has a high chance of being abused because its tablets can be easily crushed and injected intravenously. Hamburg says the approval was based on the fact that currently there are no forms of hydrocodone available without acetaminophen, the primary pain-killing ingredient in Tylenol, and is associated with stomach and intestinal irritation. For patients who need longer-term treatment for chronic pain, such drugs aren’t an option because of the risk of bleeding. “It’s been said that Zohydro is super-potent. That surprises me because the highest dosage unit of Zohydro extended release is lower than the highest dosage unit of all the other available extended release products on a milligram basis,” says Hamburg. “No doubt it’s a powerful drug, and it needs to be used appropriately with the proper oversight. But it’s certainly not the most powerful drug on the marketplace.” Still, after Mass. governor Deval Patrick declared a public health emergency over the state’s opioid addiction and heroin overdose rates, the state’s health regulators have decided to ban the prescribing and sale of the drug. But controlling access to and distribution of opiates is only one way to address the epidemic. Earlier in 2013, the FDA also took steps to make opioid pain medications more difficult to abuse by green-lighting the first abuse-deterrent formulas of opioids, which make the pills hard to crush or dissolve for injecting or snorting. While the new versions don’t prevent taking the tablets by mouth in higher than recommended doses, the strategy can be another way to discourage abuse, says Hamburg. Evzio, she says, is a last-resort step in the agency’s multi-pronged approach to controlling the epidemic of opiate addiction. “We’d rather not bring people from the brink of death with Naloxone,” she says. “We’d rather prevent addiction use and abuse from occurring in the first place.”
Carolyn Drake for TIME

“I make it very clear for the girls, they come here for one single reason, that’s to train,” says Karolyi in her sharp, Hungarian-inflected English.
The remoteness of the location is actually an advantage, at least in Karolyi’s eyes. A 30 to 40 minute drive from Houston, reached after a nearly 10 minute ride along a dirt road that winds through forest where deer and wild boars roam, the training center is the focal point of the Karolyis’ 3000 acre ranch. For the girls, making the pilgrimage here has but one purpose — to impress Karolyi. While a selection committee that includes Karolyi, a USA Gymnastics representative and an athlete representative determines the Olympic team, everyone — coaches and gymnasts alike — knows that the person with the strongest voice is Karolyi. “She is the big lady,” says Shawn Johnson, the Olympic all-around silver medalist in Beijing. And the way to Karolyi’s heart? Nothing short of perfection. “We strive for perfection. I state that every moment when I have a chance,” she says. “If that is not your goal, then you are in the wrong place.”

Read more about the USA Gymnastics training center and the Karolyis here.

Alice Park is a staff writer for TIME covering health and medicine.

More Must-Read Stories From TIME

Contact us at letters@time.com.

You May Also Like
EDIT POST