The officer called an ambulance, and when the EMTs arrived, they administered the lifesaving drug Narcan, used to reverse opioid overdoses. After 47-year-old James Lee Acord and 50-year-old Rhonda L. Pasek were revived, police arrested them and contacted Columbiana County Children’s Services.

AD

Acord pleaded no contest and was sentenced to 180 days in jail on charges of driving under the influence and endangering children, according to a local news report. Pasek pleaded not guilty to charges of disorderly conduct, endangering children and a seat-belt violation.

AD

It seemed like just another day of near-tragedy on the front lines of America’s opioid epidemic. But the East Liverpool incident was unique in one key respect: Someone at the scene snapped photos of the adults passed out in the car with the grim-faced child sitting in back. The city of East Liverpool then took the surprising step of posting those photos to its public Facebook page.

“It is time that the non drug using public sees what we are now dealing with on a daily basis,” the city wrote in the accompanying post. “We feel we need to be a voice for the children caught up in this horrible mess. This child can’t speak for himself but we are hopeful his story can convince another user to think twice about injecting this poison while having a child in their custody.”

AD

The post spread like wildfire on Facebook after it went up, shared more than 22,000 times and eliciting more than 3,000 comments by Friday evening.

AD

Commenters were split on the merits of the photo, with some saying the child’s face should have been blurred out, while others expressed gratitude to the city for showing what the effects of opioid use look like.

Brian Allen, the city’s director of public service and safety, said the city received a public records request for the photos from a local TV station. After discussion involving Allen’s office, the mayor’s office and the city’s legal counsel, they decided to release the photos without blurring the child’s face.

AD

Allen said authorities in East Liverpool, a city of 11,000 people, are dealing with heroin-related cases on a daily basis.

“We had two overdoses yesterday,” he said. “Today we raided a dealer’s house and arrested a user.”

Ohio is in the throes of a heroin and opioid epidemic that shows no sign of abating. Last year, a record 3,050 people in Ohio died of drug overdoses.

AD

The crisis affects all parts of the state, but it has been particularly severe in small cities such as East Liverpool and in other rural areas in the eastern and southern parts of the state near the Ohio River. Once a mighty industrial artery for Middle America, the Ohio River is now dotted with communities that have lost much of their economic strength as factories have closed and jobs have vanished.

AD

East Liverpool is in Columbiana County, which ranks 57th among Ohio’s 88 counties on health outcomes, as measured by the County Health Rankings compiled by the University of Wisconsin and the Robert Wood Johnson Foundation. The rankings take many factors into account, including premature deaths, obesity and smoking.

Kathleen McCoy, a chemical dependency specialist at the Counseling Center of Columbiana County, said that heroin is a big problem in the county. She said that there are resources to help people struggling with substance abuse but that a big barrier is getting people to seek help.

AD

She said that when she looks at the photographs of Acord and Pasek, she sees a depiction of a terrible illness.

AD

“I have an understanding of how addiction is a disease in the brain; it’s a chronic illness that can be treated,” McCoy said. “So you’re looking at two individuals, in the car with a child. And you’re looking at — once people get addicted, it’s more of a sickness that needs to be treated, versus these are terrible people.”

It’s not clear exactly what drug Pasek and Acord had taken.

Ohio recently has been overwhelmed by a new wave of fentanyl, an extremely powerful synthetic opioid that killed the pop singer Prince. Fentanyl was responsible for more than a third of the state’s overdose deaths in 2015, according to state data.

More recently, the state has seen a rise the use of carfentanil, an elephant tranquilizer so dangerous that a tiny flake can trigger an overdose. Carfentanil was implicated in an explosion of overdose cases late last month in Cincinnati. At least eight people have died of carfentanil overdoses, the Hamilton County coroner determined, according to CNN.

AD

AD

Acord has been arrested for multiple offenses across several states, according to public records, including driving under the influence, public intoxication and unarmed robbery. Many of the alleged offenses occurred in the 1990s.

Court records indicate Pasek was arrested for a number of offenses in the early- and mid-2000s, including menacing, intoxication, resisting arrest and leaving the scene of an accident.

Allen, the public safety director, said the county has been overwhelmed by the opioid problem and doesn’t have enough places to send people who have become addicted to the powerful drugs. “We have no place to send them,” he said. “We arrest them, they go back out and they do it again.”

AD

Other small cities are facing similar pressures. The city of Huntington, W.Va., (pop. 49,000) recently saw 26 heroin overdose cases in a span of four hours.

AD

In the southern Ohio town of Portsmouth, “pill mills” where doctors dispense opioids promiscuously have become common, leading to a government crackdown. Between 2011 and 2014, the state revoked the licenses of 61 doctors and 15 pharmacists.

But the addictions — the craving for the high that comes from opioids — remained. Many addicts switched to cheaper heroin, much of it coming from Mexico.

Nationally, heroin overdose deaths have risen sharply, from 1,960 in 1999 to 10,574 in 2014, according to the Centers for Disease Control and Prevention.

AD

Ohio’s drug overdose death rate has been one of the highest in the nation. In particular, Ohio heroin deaths jumped more than tenfold between 2003 and 2014, from 87 to 1,196, according to the state Department of Health.

In Columbiana County, the death rate for all drug overdoses stood at 22.3 deaths per 100,000 in 2014, adjusted for age, according to the CDC. That’s slightly lower than Ohio’s overdose death rate of 24.6 per 100,000, but significantly higher than the national rate of 14.7.

AD

Allen says more people need to understand what the front lines of that epidemic look like to the people responding to it.

“Sometimes the truth is hard to see,” he said, “and that’s what this photo is. The truth.”

Joel Achenbach and Alice Crites contributed to this report.