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EAST LIVERPOOL, Ohio — The photo that drove home the depth of America’s opioid crisis — two overdosed adults sprawled in the front of a car, while a little boy in a dinosaur T-shirt looked on from the back — did not shock authorities in this faded Rust Belt city. They see something like it nearly every day.

Unconscious addicts are so frequently dumped in the hospital parking lot that administrators developed a special alert system to treat them. Paramedics have plucked overdose victims from roadside ditches, from the Walmart parking lot, and from living rooms across town. It has become routine for children to see a passed-out parent jolted to life with a dose of Narcan.


“Do you know how many houses we go into that the kids are sitting on the couch watching us?” said paramedic Christine Lerussi.

Liverpool Ohio
East Liverpool Police posted this image of overdosed adults and a child on the city’s Facebook page. The child’s face has been blurred by STAT.

The photo has stirred emotions around the world since police posted it on Facebook last week. It caught the eye of Ohio Governor John Kasich, too: State substance abuse officials have visited East Liverpool to discuss the problem. The governor’s office told STAT it is increasing the supply of Narcan to communities in that part of the state and raising alarms about the danger of fentanyl.

Still, the overdose problem is outrunning them.

The despair here echoes across the country. But the opioid crisis is particularly acute in Ohio. Last year, a record 3,050 people in the state died of drug overdoses. Overdoses from the potent opioid fentanyl more than doubled, to 1,155.


Spend a few days in East Liverpool and it’s easy to see why. Drug dealers from out of state flock to the desolate streets, selling powerful highs for $10 or $15 a pop. For too many residents, there’s little else: No jobs. No recreation. No long-term addiction treatment.

The city responded to eight more overdoses, and one suspected drug-related death, in the week after the photo was published. Some paramedics recently doubled the number of Narcan doses they carry to revive addicts on the brink of death. “We’re not making it back to the garage to restock,” Lerussi said. “You get down to that last dose and you’re panicking trying to find it.”

As familiar as they are with overdoses, city leaders still recognized the power of the photo. They spent hours debating what to do with it.

Their decision to put it on Facebook was, in some ways, a cry for help.

It was also a strategic move. Police saw the photo as indisputable proof that the adults passed out in the front of the car had endangered the child in the back — and should never again get custody. Posting the image online, they told STAT, was a way to protect the little boy in the dinosaur T-shirt.

“We knew we would save this child,” said Brian Allen, director of public safety in East Liverpool.

He added: “We were hoping, anyway.”

East Liverpool
East Liverpool police officer Fred Flati, a 24-year veteran of the department, took the now-viral photograph.

Moments before the photo, a narrow miss

The Ford Explorer was skidding.

It was 3:11 p.m. on a sunny Wednesday in September.

A school bus was making its way down St. Clair Avenue, stopping now and then to let off children. The Ford Explorer was just behind it, weaving erratically. Now, abruptly, the driver hit the brakes. The SUV skidded across the pavement — narrowly missing the bus. It drifted at an angle onto Prospect Street and came to rest near the spot where the children had disembarked, steps from a church.

By chance, Officer Kevin Thompson had been driving behind the SUV as he prepared to start his evening shift. He’d seen the whole thing. When he approached the driver’s window, he saw a middle-aged man in a black T-shirt and jean shorts at the wheel. His head was bobbing back and forth. His pupils were pinpricks. His speech was almost unintelligible. Next to him, in the passenger seat, a blond woman in a tank top appeared unconscious.

The man mumbled something about driving her to the hospital. He reached for the gear shift.

But the officer leaned in, turned off the ignition, and grabbed the keys. That’s when he noticed the boy in the back seat.

At that moment, the driver, later identified as 47-year-old James Lee Acord, “went completely unconscious,” Thompson wrote in the affidavit. The woman, 50-year-old Rhonda Pasek, the boy’s grandmother and legal guardian, was “turning blue.” Authorities found a pink powdery substance in the SUV they suspect was heroin laced with fentanyl. Toxicology results are still pending.

Thompson called for an ambulance and backup. As he waited, he wrote, he tried to keep Pasek’s airway open.

Backup arrived, including paramedics to administer Narcan — and Officer Fred Flati, armed with a Nikon camera. Ohio law calls for murder charges against drug dealers if one of their customers dies from an overdose. So overdose victims routinely get photographed.

As he looked through the lens, Flati said, his thoughts focused on the boy in the back seat.

“He never said a word,” said Flati, a 24-year veteran of the force and a father himself. “To this day I have not heard his voice.”

But Flati said the boy didn’t need to say anything. “Just seeing that blank, emotionless expression on his face — it spoke for itself,” he said, adding that he agreed with the decision to publish the photo. “As soon as I saw it I thought, ‘How are these two … going to dispute charges of child endangerment with this picture?’”

He added: “Shame on them.”

East Liverpool
East Liverpool, Ohio, sits on the edge of the Ohio River.

A town overrun with drugs

The way Todd Morando sees it, shame is powerless against opioid addiction.

A nurse administrator, Morando runs the emergency department at East Liverpool City Hospital. The hospital has placed a gurney and wheelchair by the door and instructed staff to hit a triage alarm when another victim of an overdose is dumped in the parking lot. The nurses are supposed to dash outside and rush the patient to one of the acute care rooms to administer lifesaving treatment.

If it works, he said, his staff tells the patient how close they were to death, and offers them treatment.

But most of the time, it’s still not enough, Morando said.

He’s seen people overdose, be revived, then show up again the next day, blue in the face and overdosing again. He said one patient was revived three days in a row.

“When they are looking at their children, and their children are not enough to make them stop, what really can you say to them?” Morando said.

East Liverpool is in that steel country nexus where Ohio, West Virginia, and Pennsylvania meet. The local mill, Crucible Steel, shut down in 1982. The city’s once-famous potteries have also closed, leaving behind only a museum at the edge of town. A population that was as high as 26,000 in 1970 is now under 11,000. Nearly one-third of residents live in poverty.

Beyond the flashing lights of emergency vehicles, there is little to do or see in East Liverpool. Last week, the biggest attraction was a small sign of progress — the demolition of an old commercial building being turned into apartments. Some people watched from lawn chairs; others smoked and talked.

But mostly, the sidewalks and storefronts on West Fifth Street were empty.

East Liverpool
A crew works at a demolition site of a historic building in East Liverpool.

The only inpatient treatment in the city is a three-day program at the hospital. Administrators said participation in the program increased 80 percent in 2016 from the prior year. But three days of treatment isn’t much. Unless they can find a rare recovery bed elsewhere in the county, addicts end up on familiar streets, in easy reach of their dealers, just as they’re battling the fierce pains of withdrawal.

The state has tried to attack the opioid crisis by limiting the amount of painkillers doctors can prescribe. But illegal sales of heroin, fentanyl, and other synthetics are thriving.

Dealers prey on towns like East Liverpool because demand is so high, they can sell at a premium. They can get $160 per gram of a drug they’d sell for just $100 in places like Cleveland or Detroit, police said.

Out-of-town dealers don’t even bother to fight over turf in East Liverpool, police said. There are plenty of customers to go around. “There’s too much money to be made,” said Brian McLaughlin, director of the Columbiana County drug task force. And there’s not much risk that they’ll be caught: East Liverpool’s 17 police officers are so busy dealing with overdoses and petty drug crimes, it’s hard to muster the time and resources to go after dealers, public safety officials said.

Overdoses come in batches. Two or three days might pass with no calls. Then three or four will come on the same day.

“On Friday the same guy overdosed twice,” Police Chief John Lane said. “Before the officers got there the first time, he jumped up and ran off through the woods, so they didn’t get him. Later on that night, he OD’d again. It just goes on and on and on.”

East Liverpool
East Liverpool Public Safety Director Brian Allen says the city determined it could not blur the boy’s face in the photo because Ohio law prohibits officials from altering public records.

Reverberations from a Facebook post

It was against that backdrop that officials considered the photo of the unconscious adults and the solemn little boy in the back of the Ford Explorer.

The image didn’t capture just one crime in one city. It captured the entire opioid crisis. The adults turning blue. The child watching. The family that would soon be torn apart.

“I don’t think people realize how bad it is,” Police Chief John Lane said. But he knew the photo could show them.

Local media had been asking for the photo since soon after it was taken. Allen, the public safety director, said he knew it had to be released, but the city wanted to control when and how. The central question: Whether to put it on Facebook. Allen said the department routinely posts photos of drug raids, but this image was different.

“I don’t think people realize how bad it is.”

East Liverpool Police Chief John Lane

Ohio law prohibits officials from altering public records, so they couldn’t blur out the faces of the two adults, who so clearly needed treatment. Nor could they blur the face of the little boy in the dinosaur T-shirt.

“We do shame drug dealers, but we don’t shame drug users,” Allen said. “And that was the discussion we had. Should we do this?”

In the end, he said, officials concluded that publishing the image would help get the boy out of Pasek’s custody and make sure that “he never goes back there again.”

He also said he wanted the photo to show how desperate the city’s problem had become. Allen said state cuts have siphoned away $1 million from the town’s $16 million annual budget. It has no money to add more officers. It can’t create a comprehensive K-12 drug education program in the schools. More long-term treatment beds are out of the question.

“Governor Kasich has built a $2 billion rainy-day fund on the backs of the small cities in this state,” Allen said. “You built a rainy-day fund? It’s storming in East Liverpool.”

The governor’s office sent a delegation to the city last week to listen to local concerns. Under Kasich, Ohio has instituted an array of measures to respond to the crisis, including legislation to shut down “pill mill” pain clinics, additional funding to help first responders purchase naloxone, and a media campaign to raise awareness of fentanyl in counties with high death rates.

But the governor declined requests for an interview on the problem in East Liverpool, and his administration did not provide details on its plans to help the city.

Meanwhile, the photo has gained more attention than police in East Liverpool could have imagined.

News outlets worldwide have published it, including STAT. It’s rocketed around social media. East Liverpool city officials have been bombarded with letters and emails. Some have been supportive. Others blast the department’s decision to publish such a stark image with the faces so clearly visible.

Among those letters have been vague death threats directed at the officers. But there have also been helpful tips from residents who want to back up their police. “We get more phone calls and tips now,” Allen said. “People are responding.”

The boy in the photo is now in the custody of relatives in another state. The two adults, who live across the state line in West Virginia, are both behind bars.

Last Thursday, Pasek pleaded no contest to child endangerment and disorderly conduct. She received six months in jail.

The TV cameras outside City Hall during the hearing drew the attention of Kim Rawson, who lives in nearby Wellsville. She knows the opioid crisis too well. It’s hit her neighbors. Her friends. And her 21-year-old daughter.

Her daughter managed to stay clean for several months, she said. But she recently relapsed.

“It was the first time she had used since Memorial Day,” Rawson said through tears. “They had to give her five doses of Narcan.”

  • You need a Methadone clinic, It will get people clean and off the illegal drugs. Yes there will always be a few who will still want to use illegal drugs but the majority will be helped. Been clean since 1981 own my own home, raised 2 great children and have never been back to illegal drugs. It can be done and it works if you make the program work for you.

  • There’s so many things in this article that’s not the truth…. The police and emergency care alike most definitely shame people with addiction and mental health issues. Addiction is most certainly is a mental health issue. And its also not as cheap as they explain in this article. Many people here suffer and peaple and children starve to death with food and financial circumstances… It is very very sad and is a very difficult situation to battle. Ask any addict if they like to live such a lifestyle and i can assure you that not one person is going to tell you yes. We have no help here. Since this article has been published our family recovery program in eastliverpool has shut down. There is no help here for both ends of this critical crisis. If there is anyone out there that reads this comment that can help us here in our small community please im begging you with all of my heart and sole with tears in my eyes,, please help us. As the article explains there are no jobs nothing for children and our senior citizens are suffering just as much if not more. I pray regularly that there is a chance for us here. But nothing is happening it continues to get worse. Thankyou for anyone that has read this comment that came straight from my heart and how i feel. I love eastliverpool its my home.

  • Drug users themselves help make the problem. While they are victims, they are also culprits. Users will not quit until they are physically prohibited from doing so, and for a long time. Studies show heroin compulsion lasts up to two years after an individual stopped using. Until an addict is restrained for at least that long, the addict will be drawn back into the drug, and will use, abuse, steal, and do whatever illicit thing to get the drug. Because of lax statutes drug addicts are in and out of jails and rehabilitation centers in a few short weeks. It hurts to see them in never ending cycles.

    Disturbing is talk which decriminalizes drug use; that drug use is merely an illness. Drug use should not be turned into a cottage industry for drug treatment facilities, lawyers, and Naloxone vendors.

    Mandatory sentencing needs to be adopted to put drug users into controlled environments, whether it be treatment facilities, or jails, for good sufficient time. Until responsibility is put onto the drug users, the drug problem will not stop.

  • Yes there is a huge problem, and no democrat wants to do anything about it. There is one good solution: Build The Wall!

    Its almost impossible to grow poppy in secret like you can with marijuana. All of the illegal opioids in this country come through our borders, and mostly over land through our border with mexico. Stop the traffic, stop the drug use.

    If you want to end this poisoning of a generation, then I suggest you call your federal democratic representatives and tell them to stop being obstructionists and start doing something that will help their constituents.

  • Funny how they said “we don’t shame the users” except thats exactly what happened! I was shocked how many weeks I saw these people on tv and on the news. We don’t have any idea how these two people got hooked on drugs in the first place. Many people got addicted because their own doctors prescribed them medications for pain after an accident. Others ended up on heroin during the oxycontin epidemic when drug manufacturers were giving doctors sweet financial kickbacks (as they still do) for prescribing it. (You see those nice dressed people with brief cases coming in at the doctors before your appointment don’t you? They are the REAL DRUG DEALERS MY FRIEND!) For example, a person with severe back pain due to herniated dics disease comes into the office and a doctor has prescribed oxycontin explaining, “oh no – you won’t get addicted…you’ll only get a physical tolerance like anyone would who takes opiates..” (because that is what the drug maker tells the doctor to tell the patient while handing them this hell..); and then later – after doctor realizes he HAS turned his patient into an addict – he kicks him out the door!. Withdrawals from 80mgs of oxycontin 3x a day is exactly the same as heroin withdrawals. Plus the person is still in PHYSICAL pain. Now I ask you what is that patient to do? They are kinda in a situation where they are in a place of being tricked/forced/stuck in an addiction they didn’t want or ask for arn’t they? Don’t judge unless you lived it! Also, be grateful if it hasn’t happened to you or your family member…yet. It was the oxycontin epidemic that started this entire mess. I think it hysterical that “Rob” down there thinks anyone would VOLUNTARILY WANT TO BECOME AN ADDICT especially so his/her face could be plastered all over the news and facebook! Sure buddy…that’s what every kid dreams about becoming when they are a child…”I want to grow up and become an ADDICT!” YIPEE! Stupid.

  • I’m in agreement with Rob, only more aggressively. When, oh when, do we hold people accountable for their own actions? No “dare” programs are needed! All of us are inherently, fully aware that drug use is wrong! Narcan 2-3x a day for these abusers? State paid for, I’m positive, along with everything else they own. Why do we even try to help? It’s obvious they have a death wish, after all, read “jpop’s” email! Perhaps it’s a way to thin the herd.
    Sick of taking care of a bunch of babies and their emotional pain or sheer boredom….really? Who hasn’t been hurt in life???? Or bored??? Go out and clean up your community if you want something to do! I feel sorry for the medical professionals and law enforcement people, along with the folks having to live in these neighborhoods! How wonderful for them. And discouraging! What happens when they get sick of it and relocate??!
    We need to find the drug dealers and send them to a gas chamber. No more games!!!

  • How do these people keep getting the money to pay for these drugs? 1/3 of the area is in poverty, the drug goes for $160.00 but these people manage to keep buying it. Maybe us taxpayers should hold the government accountable since it’s probably coming from welfare/entitlement programs.
    I feel bad for the residents who don’t use drugs. It must be horrible living there and watching this, while also hoping they don’t get victimized by users.

    I know this sounds uncaring, but the people using drugs most likely were not forced to. They may be addicts, but they started the habit voluntarily. If this an “epidemic”, then the CDC needs to step in and quarantine them, like they would any other epidemic. When local authorities can’t contain the situation, the State and Federal Government has to step in.

  • I have been using for 5 yrs and have overdosed more times than I can count,but because I love the feeling I just keep using. I have lost 14 friends that died from it but it has not stopped me yet. Went to 16 different treatment center but still out here because I love doing it and it takes the pain away. Treatment centers work but you gotta want to quit and I don’t.

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