Police responded to nine heroin overdoses, four of which were fatal, within a 24-hour period in New York City Wednesday into Thursday.

It is unclear if the heroin involved in the multiple overdoses stemmed from a bad batch or mixture with other substances like the often fatal opiate-based painkiller fentanyl. In one of the incidents, police were called to the bathroom at Macy’s in Herald Square at roughly 2:15 p.m., where they found an unconscious man whose brother said he was snorting heroin shortly before passing out, reports New York Daily News.

Paramedics administered a dose of reversal drug Narcan, before transporting him to a local hospital. First responders managed to successfully revive five of the nine overdose victims with timely injections of Narcan.

Officials said the overdoses are a sign of how prevalent heroin abuse is across New York. The state experienced a 135.7 percent increase in synthetic opioid and heroin deaths between 2014 and 2015, one of the largest increases for a state.

Dealers are allegedly competing with each other in areas of the country where heroin abuse is rampant to sell the most potent product possible. Addicts are largely seeking a powerful high, and hearing about a deadly batch will actually attract addicts to that dealer.

“What we hear from users is that quality is important, and that the reputation of a dealer is rated on a scale of one to 10,” Marc Birnbaum, assistant attorney general for Virginia, recently told The Washington Post. “We’ve talked to users whose dealers will say, ‘I got the stuff that will keep you from getting sick, and I got the stuff that will kill you.’ It’s a tragic situation because, for the most part, they want the most potent dose.”

States across the country are experiencing similar problems with random batches of heroin that lead to mass overdoses in a single day or over a week. Authorities believe many of these incidents are due to dealers street-testing a new cut of heroin.

Opioids claimed a record number of lives in 2015, eclipsing deaths in auto accidents and contributing to the first drop in U.S. life expectancy since 1993.

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