Behind the photo: How heroin took over an Ohio town

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.

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.”

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.”

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.

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.”

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.

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.”