Photo by Mark Pynes

In a special report, PennLive is chronicling the state of the deadly opioid epidemic raging across Pennsylvania by examining the unique circumstances and the differing community responses in six of the state’s the hardest-hit counties, as identified by 2016 overdose death rates.

We begin with Luzerne County in Northeastern Pa.

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Chapter One: An epidemic intensifies

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By John Luciew

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WILKES-BARRE, Pa. -- An otherwise healthy 27-year-old woman lay on the stainless steel exam table in the pristine, ultra-modern autopsy suite located just down a hall from the Luzerne County coroner’s office.

All the young woman’s vital organs are laid bare by the pathologist’s Y-incision, exposing the chest cavity. The cause of death is immediately clear.

The victim’s bloated, purplish lungs provide the tell-tale sign. This is the garishly obvious indication of an opioid overdose.

Too much of the highly potent pain relievers or a hot dose of street heroin cause a person’s chest muscles to relax, slow and eventually stop. But the heart keeps pumping blood into the slowing, weakening and swelling lungs.

Soon, fluid pools there. The compromised lungs grow bloated and maroon-colored.

The overdose victim drowns in his or her own bodily fluids, having quite literally “relaxed” to death under the influence of opioids.

This fatal result is commonly known as “heavy lungs.” By contrast, healthy lungs are pink and bubbly.

Luzerne County Coroner William Lisman has seen this many times before. Abuse of prescription opioids and the rising level of heroin use have brought victims of all ages to his autopsy table.

Only this time, something didn’t add up.

(The complete series is here.)

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Photo by Mark Pynes

The state-of-the-art autopsy room the Luzerne County Coroner's Office, Wilkes-Barre.

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In this story:

A long-time addict sheds a tear for herself and her city

The opioid epidemic ruins a class reunion and devastates entire towns

Overdose funerals are different

A fire department finds a new way to save lives

The complete series is here.

Read the other chapters:

Chapter Two: ‘More drug dealers than cops’

Chapter Three: ‘I feel in love with the drugs’

Chapter Four: 'This time around it's everybody'

Chapter Five: 'Disgusting is a mild word for this'

Chapter Six: 'I couldn't believe I was doing it'

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Photo by Mark Pynes

Luzerne County Coroner William W. Lisman.

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A riddle is solved

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Prior to the autopsy, all of the initial drug screens on the woman turned up negative for opioid pills and heroin. Yet, there were those tell-tale heavy lungs, so ghastly under the glare of the operating room lights.

Lisman knew he was looking down at yet another overdose case, so how could the drug screens be clean?

The riddle would be answered by results of expanded toxicology tests. The deeper-dive report turned up toxic amounts of a synthetic opioid called fentanyl. This had been missed on the more rudimentary initial screens.

By then, however, Lisman had other deaths, mostly 20- and 30-somethings and all with the same maroon-colored heavy lungs but clean initial drug screens.

The opioid epidemic was changing. This synthetic form of heroin is at least 50 times more powerful, making it all the more lethal. Now, it was on the streets of the county’s struggling former coal towns.

And it was killing people.

The only thing Lisman could do was sound the alarm, which he did in the fall of 2015.

But his warnings didn’t stop 140 people from dying the following year, the majority with deadly doses of fentanyl in their systems. And it hasn’t prevented a similar number of residents here from losing their lives in 2017.

The opioid epidemic in northeastern Pennsylvania had jumped to another level of lethality.

The worst was yet to come.

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'You would think that the using population would be going down' - Coroner William Lisman

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Dying to get out

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Drug dealers are always a step ahead.

More iterations of the synthetic opioid are coming out all the time, Lisman said. So he keeps tweaking his initial toxicology screens performed on urine from fatal overdose victims.

Street-sold fentanyl and its various analogs that are even more lethal have carved a path of death across this economically depressed county of 318,000 people.

In less than two years, fentanyl has turned the opioid crisis here on its head. Up until Lisman encountered that first young victim in the fall of 2015, nearly 80 percent of the county’s opioid overdose deaths could be traced to prescription pills.

Today, a full 80 percent of fatal overdoses are now heroin laced with fentanyl or fentanyl all by itself, Lisman said.

The number of victims have been increasing at an alarming rate, nearly doubling in 2016. Since then, the pace hasn’t slowed a bit.

How utterly have things changed? In the 1970s and 80s, if the county saw 15 or 20 drug overdose deaths in a year, it was considered shocking.

What astonishes the coroner most is despite all the people dying, there are always more opioid users here to take their places. They know full well their habit could cost them their lives, yet don’t seem to care.

“You would think that the using population would be going down,” Lisman mused.

“Evidently not.”

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WATCH: Faces and voices of Luzerne County's opioid crisis

Hear first-hand how the ongoing opioid crisis is devastating the northeastern Pennsylvania community of Luzerne County in this PennLive video:

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'You feel like you want to die coming off of it' - ex-heroin addict Cathy Ryzner

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Permanent escape

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So why is Luzerne County such a hotbed for heroin and fentanyl?

Lisman cannot cite a definitive connection, but the lifelong resident whose father was once mayor of Wilkes-Barre in better economic times has his suspicions.

“Does it relate to the area?” he asked. “Yeah, I would say that. The opportunity isn’t here.”

The coal industry went after a mine disaster flooded a major coal seam in the early 1960s. Other industries followed suit in the 1970s and 80s, all part of a mass corporate exodus from once-proud American manufacturing towns in the new global economy.

Wilkes-Barre, with its hollowed-out buildings that once hummed with work and its depressed city property values, has been left behind.

Said Lisman, “You just want to escape it.”

Some, like his own children, move away for a better life.

Others find the unexpectedly permanent escape of an opioid overdose.

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Photo by Mark Pynes

One of the many monuments to the county’s proud, hard-working past.

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Good jobs, good money

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Cathy Ryzner, 54, remembers the glory days.

Luzerne County was hard-working and hard-drinking. Everybody, it seemed, had jobs. Decent jobs. There were dress factories, mines, mills, glass makers -- even Topps Bubble Gum, Ryzner recalled.

“Our parents worked at good jobs, with good money. And they retired from those jobs,” she said.

Most of all, people were happy. Or at least to the little girl raised in Duryea, Luzerne County, some five minutes outside Wilkes-Barre, it seemed so.

“There was a bar and a church on every corner,” Ryzner remembered. “Funerals were three days long, and everybody drank. Everybody’s parents drank. We were raised like that.”

At 10 years old, Cathy said her grandfather would give her money to go buy him a six-pack at the corner bar – and the bartender would sell it to her!

Slowly but surely, everything changed.

“Little by little, they went away,” Ryzner said of the industries and the jobs. “A lot of people fell into depression.”

It’s a classic case of economic depression leading to actual depression.

“It is a very depressed area, very depressed,” Ryzner said. “There’s nothing to do. No future.”

Suddenly, hard-drinking blue collar people lost the hard work that kept everything in balance. Eventually, a shot and beer at the corner bar would become a shot of heroin for some.

It certainly did for Ryzner.

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Photo by Mark Pynes

Cathy Ryzner remembers the county’s glory days.

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Dope sick

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At her worst, Ryzner reached a high of 50 bags of heroin a day. She was doing four to six bags in a single shot.

“Once you get to that level, you're not getting high,” she explained. “You're just keeping yourself from getting sick. You feel like you want to die coming off of it.”

This is why full-blown addicts don’t worry much about overdosing. Near-death experiences are a rite of passage. These days, many addicts measure their brushes with death by the number of Narcan doses it takes to revive them.

Ryzner told of one overdosing friend who required 10 doses of the opioid overdose antidote. At the hospital, he had to be placed on a Narcan-drip IV due to the overabundance of opioids still in his system.

“There are hundreds of stories like these,” Ryzner assured.

Everyone, it seems, knows someone who overdosed, is addicted or dead.

Ryzner counts herself among the lucky few.

She beat her heroin habit and has been clean for 11 years now. It took a decades-long survey of nearly every illicit drug out there, but she made it out.

“I been there, done that, got the T-shirt,” she quipped.

Now, Ryzner is trying to help others make it, too, as a certified recovery specialist at Wyoming Valley Alcohol & Drug Services in Wilkes-Barre.

She speaks from experience. Yet with fentanyl taking over the opioid market here, even Ryzner lacks experience with this newer and much more lethal game.

“The heroin is much different now, with the fentanyl,” she said. “People were using heroin in the 90s. But these kids today are going right for the Oxy, right for the pills, right for the heroin. It is white kids in these little towns. Every day in the paper it is, so and so, 21, died at home. You know darn well what they died from.”

The cause of death may be heroin or fentanyl. But Ryzner is convinced the real killer here is hopelessness.

“I don’t know how we get ourselves out of this mess,” Ryzner said in a voice ringing with worry.

In her own family, Ryzner is looking to break the addict’s bloodline that passed from her father, an alcoholic, to her. She does this by constantly talking about substance abuse to her 9-year-old granddaughter.

It's never too early, she said.

“We need to get to these kids,” Ryzner insisted. “I see them in group (therapy), but by the time they are 14, they are off to the races. They are already lost.”

For proof, check out Nanticoke High School, Class of 2011.

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Ruined reunion

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How lofty those high school graduation speeches can be.

All that soaring rhetoric about a world of possibilities and the fulfillment of following one’s own dreams. Six short years later, it doesn’t just seem like lies in Nanticoke. It’s a cruel joke to 2011 graduate Cassandra Carannante.

Already, she estimates that drugs, addiction, death or prison have taken all but a quarter of her 200 member high school class in the six short years since they all donned caps and gowns to venture forth in what had been billed as their limitless future.

For far too many, death was waiting, instead. It has visited in many different ways.

The father of Cassandra’s 6-year-old daughter was a homicide victim. One of her best friends, an addict, died but not the usual way. She was high and wondered out in front of a car. So many others, too. Often, the common thread is a connection to the opioid epidemic, Carannante said.

Indeed, Carannante, 25, doubts whether they’ll be enough fellow graduates still around to hold a 10-year union in 2021.

“Honestly I'm not going to have a class reunion,” she said.

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"I don't know how this is going to change. It's sad. It's terrible" - Cassandra Carannante, 25

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Photo by Mark Pynes

One of the few things looking up in Nanticoke is this statue. The town’s coal industry is just a museum piece, now.

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Desperate times

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It’s gotten so bad here, Cassandra Carannante just sent her 6-year-old daughter to live with the girl’s paternal grandmother in North Carolina. Carannante is staying behind. She has one of the few thriving businesses in town, a gun shop called Hunting Depot.

Sure, she caters to hunters. But more often, customers flock in looking to buy a firearm for security, an attempt to purchase a little peace of mind.

The line for gun carry permits was out the door of the Luzerne County Courthouse recently, Carannante said. Everyone looking for protection from crime caused largely by the drug trade.

A convenience store right around the corner has been robbed at gunpoint multiple times, including twice on the same day.

“If you were to knock on people’s doors here, you will get all old people and addicts,” Carannante said. “That's it. That's what you get. It's bad. It's real bad here.”

The heroin epidemic is out in the open now, plainly visible on small towns streets that once swelled with blue-collar pride.

“You see them all walking, like zombies. It's just insane,” Carannante said, adding that a local pizza shop has a persistent problem with addicts on their highs passing out while sitting in booths.

“I just decided this is nonsense just because of watching the people around me,” added Carannante, who had her own experiments with pot and pills, beginning as early as age 14, but beat it.

She called her decision to send her daughter away the “craziest right” thing she’ll ever do in her life.

“It's going to get worse,” she said. “I don't know how this is going to change. It's sad. It's terrible.”

No wonder some people in other parts of Luzerne County call Nanticoke “Heroin City.”

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Nick Malawskey | PennLive.com

READ MORE: Mapping Pennsylvania's Addicted Towns

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Sausage grinder

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Up Nanticoke’s Main Street, Anastasia Vishnefski tends to Tarnowski’s Kielbasa shop with 100 percent Polish pride.

The family business, along with a couple of grocery stores, were founded by Vishnefski’s grandfather.

She and her husband, John, maintain the family tradition, hand-making and smoke-curing the kielbasa according to the same old-world family recipe as when the business began in 1946.

To walk in the shop is to be greeted by fragrant smoke as the meat cures.

The aroma is pleasant, but it can sting the eye. If you want to really bring forth tears, get Vishnefski talking about how the family business has had to pick up and move as one old Luzerne County coal town after another sinks down into heroin’s depths.

Her grandfather began his businesses in nearby Glen Lyon, but that town’s fortunes began to slide even before those of Nanticoke.

“It was a real beautiful town. It's a pit now,” Vishnefski said of Glen Lyon. “We had to sell out of three different grocery stores there.”

So they brought the flagship kielbasa business to Nanticoke.

Now it's sliding, too.

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Photos by Mark Pynes

Anastasia Vishnefski, co-owner of Tarnowski's Kielbasa in Nanticoke.

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Bitter homecomings

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Lately when Anastasia Vishnefski sweeps the parking lot of her relatively new Nanticoke location, she finds the sure signs of community decay: Methadone packets, hypodermic needles and used heroin stamp bags.

And when former Luzerne County residents flock back from all over the country for a taste of Tarnowski’s kielbasa, it's always with mixed emotions. The timeless and unchanged flavor of the smoked meat brings back wonderful memories of idyllic childhoods in northeastern Pennsylvania coal country.

But the harsh, heroin-fueled realities of how far their hometowns have fallen tear at the heart.

Without fail, the faces of these long absent residents who are returning for joyful events like family reunions and weddings show the sadness of seeing the ruins all around them, Vishnefski said.

Her only solace is that her grandfather's no longer around to see what his American dream has become.

“I'm thankful that grandpa died before he saw what his town became,” she said. “It's the same in every little town around here.”

Towns that all too often must mourn their overdose dead.

The funerals of opioid addicts can be very unusual affairs, indeed.

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'It was a real beautiful town. It's a pit now' - Anastasia Vishnefski, co-owner of Tarnowski's Kielbasa

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Photo by Mark Pynes

It’s the funeral everyone sees coming.

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Terrible things

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Overdose funerals are different.

Sometimes, the friends of the victim show up high, stumbling around right in the funeral home.

It never ceases to amaze Blake Collins, the fourth generation owner of the family funeral home business.

He said one might think the body of a friend laid out in a casket might be an object lesson on the dangers of opioid addiction for all those left behind. Instead, the occasion is yet another cause for more opioids.

The grief is different, too.

Overdose funerals can have the inevitable feel of the aftermath of a slow-motion train wreck, Collins said.

Everyone sees it coming.

“They are sad,” he said. “All funerals are sad in general. But it is not profound grief,” Collins explained.

“Deep down, people know this day was going to happen,” he said. “The sad part of younger deaths is you look at the potential these people may have had, and it is never released. Half of their life just didn’t happen.”

Most of the overdose victims Collins has buried have been in their 30s and 40s, though recently the demographic is skewing younger, into the 20s.

“It is an increase in younger people dying due to drugs,” Collins confirmed. “Everyone says, this is a terrible thing, we should do something about it But nothing ever happens.”

Collins’ family funeral home has been in business for 100 years and dates to when young men here were killed by the score in coal mines. Like his forefathers, he will keep burying the problem.

“This is what we are here to do,” Collins said.

“We can’t pass judgment on how they pass away.”

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Photo by Mark Pynes

E. Blake Collins III, a fourth-generation undertaker in Wilkes-Barre.

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Death's peace

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Overdose funerals tend to be simpler, low-cost affairs.

“Unfortunately, there aren’t many resources,” Collins added. “There is not a lot of money.”

These days, families of victims often turn to Internet donation sites like GoFundMe.com. However, most funeral homes don’t like to wait for their money.

And it’s not just Luzerne County or even northeastern Pennsylvania.

Brian Leffler and his wife own funeral homes in Wilkes-Barre, Pottsville, Coudersport, Wellsboro, Troy, Williamsport, Jersey Shore and Avoca. Overdose deaths are hitting all these locations.

“There is a tremendous amount of death due to the overdoses,” Leffler said. “We receive phone calls every week between our locations. Several phone calls in a week.”

The victims’ age range is more concentrated in the 30 to 45 and 50 range. But Leffler has seen overdose victims ranging in age from 20 to 65.

“It knows no race, no income bracket,” he said. “There’s people you would not suspect.”

The common theme is the heavy toll addiction takes on families and loved ones left behind.

“It is heartbreaking to have families call you and say their child died,” Leffler said. “Sometimes, they tell you that they are relieved. Now they can have their son or daughter cremated, and they can take them home and they will know where they are at. As a parent, you think the worst. And not knowing is sometimes harder than knowing.”

At least now the struggle is over. The worry is ended, if only because a parent’s worst fears have finally been realized.

“A mother will say, ‘Now I know where she is. There were many nights I laid in my bed and I couldn’t sleep because I didn’t know where she was, if she was alive or dead. But now I can take her home, and I know where she is at,'” Leffler recounted one sobbing mother as saying.

In death, at least there’s peace.

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Coroner Lisman

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The high cost of dying

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County Coroner William Lisman has experienced similar and seemingly strange reactions from family members of overdose victims.

“It is very rare that you shock a parent when you tell them their son or daughter died of an overdose,” he said.

But he doesn’t draw any peace from these deaths.

In fact, as parent of four who are thriving, albeit far away from Luzerne County, every overdose death and the seeming acceptance of these personal tragedies bother him deeply.

“Parents have strange reactions,” he said. “There is a sense of resolution. Finally, the suffering is over. I don't have to worry about where they are tonight, whether they are safe. That's one of the things that bothers me the most. They were OK with it. They expected it. It hurts, but they will deal with it.”

There are too many people dying for Lisman accept any of it.

In Luzerne, the overdose dead are mostly Caucasian, as is the county population. Males and females die in almost equal numbers. There have been victims in their 50s and 60s, while the youngest was 19. But the majority are in their 20s, 30s and 40s -- the prime of life.

“Not too long ago it was a major event to have a drug death,” Lisman wistfully said.

There was a full investigation. Everyone from police detectives to the district attorney to the coroner would turn out.

Now, there are so many overdoses in Luzerne County, Lisman has stopped performing full autopsies, at a cost $2,100, on every victim. The pricey procedure is now reserved for only those overdose cases in which a dealer or other drug source might be charged for delivery resulting in death.

The rest of the victims get full toxicology screens, so the exact drugs and their amounts can be documented -- and Lisman can remain on top of the ever-shifting fentanyl analogs. Still, the county autopsy budget has more than doubled to $260,000, swallowing up over half of Lisman’s $500,000 annual budget.

Above all, Lisman cannot fathom the thought process of opioid addicts.

The coroner has held the brains of overdose dead in his hands during autopsies. But he will never know what they were thinking.

“I can't wrap my head around the mentality of the person who would do this,” Lisman said. “I can't grasp that -- what are you thinking?”

Many questions can be answered by forensic exams. Not this one.

And at the end of another long day, Lisman must force himself to stop thinking about such things. This is the only way he knows to stay sane in a community where people are dying all around him.

“You leave it in the office when you go home,” he said.

“If you don't, you can't do this job.”

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"It is very rare that you shock a parent when you tell them their son or daughter died of an overdose" - Coroner William Lisman

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Photo by Mark Pynes

What’s in this kit is sometimes all that stands between life and death in Wilkes-Barre.

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Front lines

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For now, there is Narcan.

The brand-name for naloxone stands as a super-effective lifeline for overdosing addicts. These days, Narcan is nearly everywhere in Luzerne County. Police carry it. EMS responders have it. And for more than a year, so does the entire staff of the Wilkes-Barre Fire Department.

If you overdose in this city, it’s not uncommon to see a fire engine with flashing light ablaze rolling up to save you.

Is it overkill?

Not according to Wilkes-Barre Fire Chief Jay Delaney. Every one of his 70 full-time firefighters and EMS workers are now equipped with Narcan.

“It's my staff on the front lines every day,” Delaney said. “We are asking the firefighters to go out and administer this. It is still saving a life, whether it is a burning building or an overdose victim. That's how they see it.”

Still, the extraordinary move hasn’t been without criticism here.

Some see Narcan as enabling addicts to continue to get high, over and over. And the public has seized upon reports of the same person being repeatedly revived at an untold cost to taxpayers.

Delaney comes back with a convincing retort to all of it.

“If it was your son or your daughter or your mother or your father, you would want me to save their life with this,” the Chief responded, raising a Narcan container in his hand.

“This is totally out of the realm from when I signed up in 1981,” he said of the job. “But we are in the life saving business. It’s called a disease. This is the most addictive thing on this earth.”

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Photo by Mark Pynes

Wilkes-Barre Fire Chief Jay Delaney.

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Roll call of the living

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If one requires more proof in favor of Narcan, Chief Delaney reaches across his desk for a stat sheet detailing his department’s recent overdose saves.

The calls come in daily. Sometimes, a dozen a week. Sometime a dozen or more over a single weekend. The fire department rolls on all of them, looking to save a life.

Delaney reads down the list, as if sounding roll call.

Female, age 26. Male, age 45. Female, age 52. Male, age 27. Female, age 17. Male, age 34. Male, age 30. Male, age 46. Female, age 24.

It goes on and on, real data direct from Wilkes-Barre’s addicted streets.

Only, these overdose victims are alive.

In a community where too many people are already dying, this smoke-bitten firefighter will take it – at least until a better answer comes along.

“Drug addicts are people, too,” the Chief insisted. “We can save lives. That's why we do it. But we need more money to help us fight the fight.”

In Wilkes-Barre, the battle against the opioid epidemic has been joined.

But it’s far, far from over.

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The six-part series, Addicted Towns of Pa., continues here

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CHAPTER TWO: A community is outraged by a 4 year old’s horrific opioid-related death, prompting an all-out effort to protect innocents from the secondary dangers of the epidemic. Far more than addicts are suffering, as the ripples of death and despair touch more and more people here. (Click to begin reading now)



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Talking Addicted Towns

Check out PennLive's in-depth discussion about the Addicted Towns of Pa. series in this Facebook Live session.

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About this series:

In a special report, PennLive is chronicling the state of the deadly opioid epidemic raging across Pennsylvania by examining the unique circumstances and the differing community responses in six of the state’s hardest-hit counties.

The six-part series continues all week on PennLive.

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About the author:

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John Luciew has been a journalist for nearly 30 years, including nearly 25 years at The Patriot-News and PennLive.com. He's also the author of more than 10 mystery-thriller novels, including Fatal Dead Lines, published by Simon & Schuster.

He's a two-time recipient of Pennsylvania NewsMedia Association’s Distinguished Writer award.

His three-part chronicle of a combat-wounded double amputee’s four-year battle to walk again was a finalist for the Scripps Howard Ernie Pyle Award and won a Society of Professional Journalists/Sigma Delta Chi Award and a Pennsylvania Associated Press Managing Editors Award for enterprise reporting.

He graduated from Penn State University in 1989.