Introduction: Although numerous U.S. surveillance systems currently report on opioid analgesic abuse, there is a need for additional descriptive and interpretive data, not only to confirm and characterize the cases, but to guide targeted intervention efforts. The purpose of this analysis was to summarize 2005 findings from field research conducted by the Purdue Risk Information Synthesis & Minimization Action Program (PRISMAP™). Methods: Field research inquiries were guided by standard ethnographic techniques and conducted in three-digit ZIP codes (3DZ) meeting a predetermined threshold level of opioid analgesic abuse or diversion. Data sources included RADARS® System studies and media reports. Semi-structured telephone interviews were conducted with a wide range of contacts, including law enforcement officers, physicians, pharmacists, and drug abuse treatment staff in the affected community. In total, 258 interviews were conducted in 40 states comprising 99 distinct 3DZs, with an average of 2.8 interviews conducted per field report. Qualitative Results: I. Major themes: 1) Hydrocodone, oxycodone (immediate-release) and OxyContin® reported to be the most frequently abused and diverted opioid analgesics; 2) Opioid analgesic abuse is most commonly reported in rural areas; 3) Opioid analgesic abuse appears to be rising among teenagers; and 4) Abusers perceive prescription drugs to be safer to use than illicit drugs. II. Other key findings: 1) Antidepressants abused to reduce the side effects of methamphetamine; 2) Abuse of prescription drugs rising in Mormon communities and on Native American reservations; and 3) Local government officials are being forced to redirect resources from diversion and abuse of prescription drugs to combat a rising methamphetamine problem. Conclusions: Interpretation of quantitative reports of opioid analgesic abuse and diversion are substantially enriched by the addition of detailed, descriptive field-based inquiries.