On a beautiful Sunday last October, Detective Dan Douglas stood in a suburban Minnesota home and looked down at a lifeless 20-year-old - a needle mark in his arm, a syringe in his pocket. It didn't take long for Douglas to realize that the man, fresh out of treatment, was his second heroin overdose that day.
"You just drive away and go, 'Well, here we go again,'?" says the veteran cop.
In Butler County, Ohio, heroin overdose calls are so common that the longtime EMS coordinator likens the situation to "coming in and eating breakfast - you just kind of expect it to occur." A local rehab facility has a six-month wait. One school recently referred an 11-year-old boy who was shooting up intravenously.
Sheriff Richard Jones has seen crack, methamphetamine and pills plague his southwestern Ohio community but calls heroin a bigger scourge. Children have been forced into foster care because of addicted parents; shoplifting rings have formed to raise money to buy fixes.
"There are so many residual effects," he says. "And we're all paying for it."
Heroin is spreading its misery across America. And communities everywhere are indeed paying.
The death of actor Philip Seymour Hoffman spotlighted the reality that heroin is no longer limited to the back alleys of America.
Cocaine, painkillers and tranquilizers are all used more than heroin, and the latest federal overdose statistics show that in 2010 the vast majority of drug overdose deaths involved pharmaceuticals, with heroin accounting for less than 10 percent. But heroin's escalation is troubling. Last month, U.S. Attorney General Eric Holder called the 45-percent increase in heroin overdose deaths between 2006 and 2010 an "urgent and growing public health crisis."
In 2007, there were an estimated 373,000 heroin users in the U.S. By 2012, the number was 669,000, with the greatest increases among those 18 to 25. First-time users nearly doubled in a six-year period ending in 2012, from 90,000 to 156,000.
Experts note that many users turned to heroin after a crackdown on prescription drug "pill mills" made painkillers such as Oxycontin harder to find and more costly. It's killing because it can be extremely pure or laced with other powerful narcotics. That, coupled with a low tolerance once people start using again after treatment, is catching addicts off guard.
In hard-hit places, police, doctors, parents and former users are struggling to find solutions.
"I thought my suburban, middle-class family was immune to drugs such as this," says Valerie Pap, who lost her son, Tanner, to heroin in 2012 in Anoka County, Minn., and speaks out to try and help others. "I've come to realize that we are not immune. ... Heroin will welcome anyone into its grasp."
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The night before Valentine's Day, some 250 people filed into a church in Spring Lake Park, Minn. There were moms and dads of addicts, as well as children whose parents brought them in hopes of scaring them away from smack.
From the stage, Dan Douglas gripped a microphone as a photograph appeared overhead on a screen: A woman in the fetal position on a bathroom floor. Then another: A woman "on the nod" - passed out with drug paraphernalia and a shoe near her face.
"You just don't win with heroin," Douglas told the crowd. "You die or you go to jail."
It was the third such forum held over two weeks in Anoka County, home to 335,000 people north of Minneapolis. Since 1999, 55 Anoka County residents have died from heroin-related causes.
Five years ago, county officials were focused on stamping out meth labs. Then investigators noticed a climb in pharmacy robberies, and started finding Percocet and OxyContin during routine marijuana busts.
As prescription drug abuse rose, so did crackdowns aimed at shutting down pill mills and increasing tracking of prescriptions and pharmacy-hopping pill seekers. Users turned to heroin. "It hit us in the face in the form of dead bodies," says Douglas.
Authorities are working to educate doctors about the dangers of overprescribing painkillers and are fighting to get heroin off the streets. The idea for the forums came not from police but rather from Pap, a third-grade teacher whose youngest son died of a heroin overdose.
Tanner graduated from high school with honors. In the fall of 2012, he was pursuing a psychology degree at the University of Minnesota and dreamed of becoming a drug counselor. He had not, to his mother's knowledge, ever used drugs - and certainly not heroin.
Then one day Tanner's roommates found the 21-year-old unconscious in his bedroom.
Amid her grief, Pap realized something needed to be done. She met with county officials, and soon after the community forums were developed. At each, Pap shared her family's story.
"Our lives have been forever changed," she told the crowd in Spring Lake Park. "Heroin took it all away."