Wisconsin’s battle against heroin yielded more grim results in 2015.

The death toll rose for the ninth straight year, and the total of 281 deaths was triple the number killed by heroin in 2010. Meanwhile, the number of total opioid deaths — which includes heroin and prescription opiates — topped the number of Wisconsin traffic deaths for the third straight year.

>> INTERACTIVE MAP - See heroin and opioid overdoses broken down by county

Officials did, however, see some reason for optimism since the increase in heroin deaths was the smallest since 2010 and the opioid deaths actually dropped for the first time since 2008.

“We are starting to see things, but it’s really too soon to tell,” said Lisa Bullard-Cawthorne, the who runs the opioid harm prevention program for the state Department of Health and Human Services. “This epidemic has been growing over the last decade. We’re not necessarily going to change things quickly.”

The state is several years into a multi-pronged effort to combat heroin and opioid abuse. Departmental and legislative initiatives have included advertising campaigns, prescription drug drop-offs, tighter prescribing guidelines, increasing the availability of the overdose-halting drug naloxone (commonly called Narcan) and increased focus on treatment options, youth intervention and underlying mental health issues.

These responses grew in frequency and magnitude as the death tolls rose steadily in recent years.

It’s not unique to Wisconsin. Data released this month by the U.S. Centers for Disease Control and Prevention show the number of heroin deaths rose 23 percent nationally in 2015, and opioid deaths rose 16 percent.

The Washington Post noted the heroin deaths passed a bleak milestone in the process, surpassing the number of gun homicides for the first time. Gun homicides outnumbered heroin deaths 5 to 1 in 2007.

And new county-level data in Wisconsin shows overdoses are far more prevalent than the death tallies alone convey. In the past five years, 1 of every 1,000 state residents has been hospitalized for an overdose of heroin or prescription opioid, according to DHS.

Fentanyl a growing threat

Heroin has claimed the headlines, but experts say fentanyl is the fastest-growing threat.

The narcotic painkiller is similar to morphine but 50 to 100 times stronger, making it a target for drug users in search of an enhanced high. Versions in use on the street include diverted prescriptions as well as synthetic fentanyl that is being illegally manufactured.

Nationwide, deaths from synthetic opioids other than methadone — a category dominated by fentanyl — jumped 73 percent in 2015, according to the CDC.

Wisconsin also can’t track fentanyl deaths specifically, but the number of synthetic opioid deaths rose from 90 in 2014 to 113 last year, according to DHS. That is nearly double the number in 2012.

“On the street, people are hearing that you get a better high from fentanyl because it’s stronger, so people are using fentanyl instead of heroin, or they’re using heroin laced with fentanyl, or in some cases, they don’t even know.” Bullard-Cawthorne said. “The fentanyl is scary because it is so potent.”

Milwaukee County already has doubled the number of deaths involving fentanyl since last year. The Medical Examiner’s Office reported 30 fentanyl-involved deaths in 2015, and 71 so far this year. Twenty-seven of those 71 also involved heroin.

Bullard-Cawthorne said the state is working to better track fentanyl, since lab tests currently can’t tell if the drug leading to an overdose was prescribed or synthetically manufactured.

Fentanyl is also just one of many opioids that drug users mix together. In Outagamie County, for example, 13 of the 16 opioid overdose deaths last year involved multiple drugs, the coroner reported.

Overdoses often follow jail, treatment

Recent sobriety is another common thread in overdoses.

Regular drug users build up a tolerance that leads them to increase the dosage to get the same high. Those fresh off a stretch in jail or treatment lose that tolerance but often return to the same level of drug use.

“It’s one of the highest risks of an overdose, is someone who had a period of sobriety and then they started using again,” Bullard-Cawthorne said.

It’s a narrative that proved all too real for one Winnebago County mother.

The woman, who requested anonymity over concerns for her son’s safety, said her then-19-year-old son came home in August 2014 after a three-month stint in treatment for heroin addiction. The treatment seemed to go well, but it stuck for only a few weeks.

“He got sucked right back in with a guy he met at drug court who started to use heroin again. Then (my son) started using heroin again,” the woman said. “The second overdose happened in our driveway, and I was the one who found him, and I had to call the ambulance. At the time he wasn’t breathing.”

The son survived, and the drug charge that resulted has kept him behind bars ever since.

The same story plays out across the state, with deadly results.

In Fond du Lac County, four of the 16 drug deaths last year involved someone who had recently been released from jail, said Medical Examiner Doug Kelley.

In Kenosha County, the connection between jail release and overdoses spurred the creation of a drug death review panel in 2014. The group meets every other month to go through overdose deaths in detail and identify trends more quickly. It includes the health department, law enforcement, medical examiner, medical professionals and community agencies.

“A lot of people, if they were being released from jails or detention centers, it seemed like they were turning up dead soon after that,” said Debbie Rueber, health educator with Kenosha County.

A similar review system is launching in Milwaukee County as well.

More than 1,000 hospitalized for opioid overdoses

New data on drug-related hospitalizations shows how much higher the death toll could be without the increasing availability of naloxone, an anti-overdose drug used by emergency responders and drug addicts alike.

Wisconsin ambulance crews administered between 3,500 and 4,000 doses of naloxone each year from 2012 to 2015, according to the DHS. The drug immediately ends an overdose by forcing opioid receptors in the brain to release whatever drug molecules are attached.

Last year in Wisconsin, 1,485 people were hospitalized due to an opioid overdose. Like the opioid death tally, that number has leveled off since 2011, averaging about 1,400 annually.

Heroin-related hospitalizations are growing — up from 175 in 2011 to 359 last year — but still account for only about a quarter of all opioid overdoses, the DHS data shows.

That data, released publicly for the first time, also shows a regional divide between heroin users and prescription opioid abusers.

Hospitalizations due to opioids were more common in rural areas, with the five highest per-capita rates coming from Menominee, Milwaukee, Marquette, Vilas and Sauk counties when examining all opioids.

Heroin hospitalizations were concentrated in urban counties. Kenosha, Milwaukee, Dane, Rock and Waukesha had the highest per-capita rates.

Milwaukee, surrounding counties hardest hit

Heroin hit especially hard last year in Sheboygan, Manitowoc and Dodge counties, all of which more than doubled their five-year average for heroin deaths.

But in recent years, the Milwaukee area has consistently fared the worst, even when accounting for its large population.

Kenosha County had the most heroin deaths per capita from 2010-15 at 5.1 per 10,000 residents, followed by Milwaukee and Racine counties. Eau Claire, Outagamie and Sheboygan counties had the lowest per-capita rates among the counties with at least 100,000 residents.

And things are getting worse in the state’s largest city.

Milwaukee County posted one-third of the heroin deaths in Wisconsin from 2010-15 despite housing only one-sixth of the population, and that ratio appears set to rise this year.

The Milwaukee County Medical Examiner’s Office has confirmed 116 overdose deaths involving heroin in 2016, already above its 2015 total of 110. The office is still awaiting toxicology reports to detail the drugs involved in 53 other deaths.

The deaths included a spurt of 20 suspected heroin deaths in a two-week span in July and August, a streak the medical examiner’s office called “unprecedented.”

An increase in heroin deaths also appears likely statewide in 2016, based on a survey of coroners and medical examiners conducted by USA TODAY NETWORK-Wisconsin. Fifty-two counties provided data on the first six months of 2016, reporting 142 heroin deaths. Those counties had 254 deaths in all of 2015.

Reach Eric Litke at elitke@gannett.com and @ericlitke on Twitter.