‘I want my mom and dad’: Derrick Slaughter, just 5, at a march in Norwalk, Ohio, last year. Both parents are heroin addicts and he is being raised by his grandparents Spencer Platt · Getty

Lorain County morgue in Ohio records deaths as due to ‘natural death, homicide, suicide, accident, and what we call undetermined,’ says Stephen Evans, the county’s coroner. Overdoses are classed as accidental, and numbers have tripled in the last four years (132 in 2016). ‘Ninety-five per cent of our deaths are what we call a mixed-drugs overdose, with opioids like fentanyl and heroin being number one,’ Evans says. He classifies an overdose as suicide if the quantity taken is very large. ‘Some coroners’ offices rule these deaths as homicides. Because right now, our biggest problem is that the dealers are substituting fentanyl, which is a synthetic narcotic. And so the person thinks that they’re injecting heroin, but in fact they’re injecting fentanyl, and they die because it’s 100 times stronger than heroin.’ In 2017 the oldest victim was a man of 75 who shared a needle with his grandson.

Lorain County, population 300,000, lies west of Cleveland on the southern shore of Lake Erie. The suburban county becomes increasingly rural towards its south. The police initially believed the first spike in overdoses, in 2012, was due to adulterated drugs, but toxicological analysis disproved this. The number of intravenous opioid users had simply increased. Drug use was no longer confined to poor neighbourhoods or black ghettos in Cleveland and Cincinnati; it had moved out to small, middle-class towns.

Ohio, with more than 4,000 deaths from overdoses in 2016 (compared with 365 in 2003), has more drug-related deaths than any US state except West Virginia. Whites are 89% of victims; blacks and Hispanics are 16.5% of Ohio’s population but only 10% of victims. Lorain County’s 500 police officers and other first responders now carry Narcan, a nasal spray opiate antidote. ‘We were the first county in Ohio to implement,’ says deputy sheriff Dennis Cavanaugh, who estimates that 350 lives have been saved since its introduction in 2013. Narcan is given out free in (...)