“Most people, when they think of heroin, think of inner-city communities. They think of the heroin epidemic that hit the country in the 1970’s and affected people who were poor and not white,” said Andrew Kolodny, chief medical officer at Phoenix House, a nonprofit treatment organization. “The heroin crisis we’re dealing with today is affecting suburbs and rural areas. It’s much more severe,” he added. “The worst drug epidemic in United States history.” A massive surge in consumption of prescription painkillers took place between 1999 and 2010, as pharmaceutical sales for a wide range of synthetic opiates quadrupled. Four out of five heroin addicts were previously hooked on another opioid substance. Prescription painkiller addicts are 40 times more likely than the general population to become addicted to heroin. On the one hand, American doctors write over 250 million legal painkiller prescriptions per year, while the illegal heroin industry is said to be worth $27 billion nationally. “A $10 bag of heroin will do exactly what a $30 pill of oxycodone would do,” Kolodny said. “And it’s in white households that you’re more likely to find painkillers in the medicine chest.” Meanwhile, the potential for heroin abuse by ever-younger Americans seems to be rising, with the August approval by the Federal Drug Administration of OxyContin use among 11 to 16 year-olds.

With some users, like Sarah Kordenbrock in Covington, Kentucky, the habit began with use on the weekends, then during the day, and then every day. Kordenbrock’s struggle to finance her addiction began to ruin her family life. “It turned me into a liar, a thief,” she said, describing a situation that led to her parents spending $77,000 on drug rehabilitation and to buy back the possessions that their daughter had sold off. After abortive attempts at residential treatment, brushes with death, and intervention from law enforcement, Kordenbrock’s father, Greg, decided he’d seen enough. “I turned 52 and worked 30 years for a company. I have a pension, retirement, and could have walked out of there,” he said. “But we liquidated to pay for this, to save her life.” Sarah soon spent many weeks at the Kenton County jail suffering from withdrawal. “I called and would cry and beg them to come and get me,” Kordenbrock said. Even after going cold turkey, an estimated 60 percent of recovering addicts eventually relapse, according to the National Institute on Drug Abuse. Covington Fire Department Chief Dan Matthew leads a squad that deals with up to 10 heroin overdoses per week, often several in the same house, in a Cincinnati suburb of some 40,000 people. “You find the patients there, usually not breathing,” Matthew said. “We put an airway in them, prepare an IV, give them Narcan” [a brand name for anti-overdose drug naloxone] to revive them.