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AST 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.

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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.”

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  • Why don’t we concentrate on stopping the heroin from coming in across the boarders, it’s a good place to start. If it were important to Obama, he would allow boarder patrols to do their jobs.

  • This little boy’s situation is heartbreaking. It also makes me angry. Here I am a biological childless woman directing movies in Hollywood who would love to have a healthy baby and these irresponsible people were given one. I say let’s change the laws so that when parents do something like this, they must forfeit their child to a psychologically healthier parent or family. That little boy is trapped in a family of addicts and he could be a woman movie director’s son right now, growing up towards going to school in Beverly Hills right now. And I could be happy, raising the child God never gave me but instead gave his parents. Life isn’t fair. I wish that little guy the best and hope he somehow get through this.

  • Thanks to the CIA’s trafficking in drugs to greedily make money Americans suffer. When are Americans going to call for a review of the intelligence agency’s activities?

  • How is the heroin Getting to Ohio? How is it coming into the country?
    I read about this problem, everyday. The opioid problem is well documented.
    Possibly restricting Doctors And taking Legal meds away from people that actually need them< may have made Heroin so popular.

  • Shame on Kasich. No surprise. Make noise East Liverpool! Do more pics so you get the funding you need to help. Social media is your way of getting attention. Even negative attention will help get the word out.

  • What I don’t understand is the number of people who become abusers because of addiction after a doctor’s prescription versus those who first become exposed by buying off the street from a dealer. I have read that some addictions start from a doctor’s prescription in which case I don’t understand why opiods are still prescribed. Isn’t there an alternative? My Mom was prescribed oxycodone after a major surgery. She received no warnings or education about usage. She had horrible hallucinations and stopped using it. I’m so thankful she stopped before there were addiction problems.

    I don’t understand how doctor’s are able to prescribe opiods without some educational information and warnings about addiction. Isn’t that a major par of the problem?

    • By your logic, all alcohol should be illegal. We’ve been there and done that (prohibition years, remember?). The truth is that the great majority of people who drink alcohol will never become addicted to it and the same is true for narcotic pain medications that are given for legitimate reasons. Most people do not have the propensity toward addiction. It takes a combination of factors to come together in the perfect storm for a person to walk toward abuse of a drug. It does not happen form one day to the next, like every other path you take in your life, it is a series of decisions……. don’t blame doctors for wanting to legitimately help a person in pain, most of their patients will never be addicted. That act of prescribing a medication does not cause a person to abuse drugs.

    • You’re right that there needs to be a much more stringent criteria for education when prescribing these drugs.
      But there really is no viable alternative at the moment.
      I have a congenital deformity which causes me a great deal of pain, every day of my life. I currently manage it with Kratom, a herbal supplement which the government has recently cracked down on. It hits the opioid receptors in my body responsible for regulating pain impulses, without hitting the ones that trigger addiction or euphoria.
      It gets me by. But someday, either before or after the inevitable replacement of both my wrist joints with titanium appliances, I will have to resort to something stronger.
      Chronic pain is incredibly debilitating. It takes enormous psychological resources to deal with the fact that every waking moment is going to hurt, badly. As a mortician, I have seen way too many people who couldn’t cope, and checked out ahead of schedule.
      The fact that we have drugs which can address this is amazing. We are living in the most merciful age in history.
      One of the biggest problems with Oxycontin is that it was initially marketed to physicians, as well as patients, as the miracle drug that could address intense pain without risk of addiction. That was a lie, and its manufacturers knew this from the start. It absolutely treats pain. It is nowhere near a “low-risk” drug for addiction.
      But for some of us, there are little to no options. Some of us have been sat down by our doctors and told, “all we can do is give you this drug to which you will soon become very, very addicted.”
      So long as our access to that drug is uninterrupted, we’re fine. Some of us are given very good counselling to help us manage that addiction, to help us keep functioning as people, as parents, as citizens.
      But then again, some of us live in counties where healthcare resources are so strapped that nobody says anything beyond, “take this three times a day.”
      And then, when some of us go to the doctor and hear, “we can’t prescribe this anymore,” we remember that we can score something even stronger with less hassle and for less money, if we know the right streets to go down.
      I haven’t yet gone down those streets, but I keep up on them, just in case. I know my day may come, and I would rather be a junkie than dead by my own hand. Much like a cancer patient signing up for a dangerous chemo trial, I am willing to take my chances on getting another year of functional life.
      Our country is steeped in a philosophy of “suck it up and get on with it already.” This philosophy is cruel and unrealistic.
      Sometimes, we can’t suck it up. And if there is something, ANYTHING that we can get our hands on, that lets us “get on with it,” we will seek it out, and sometimes, it will kill us.
      Most of us know this. Too many of us are living lives that lead us to say, “eh, no loss.”
      It’s the latter that has to change, before education can make any real difference.

  • Your comment Craig is way off base. Addiction is in any type of family, it has no boundaries. Some time ago,60 Minutes did a special regarding addition in Ohio and they had 5 or 6 families on there from affluent communities in Ohio. I live in Columbus, so I see this daily. The media portrays many poorer towns/cities, because many of the affluent communities still struggle with accepting there is a problem. Some of the communities such as Pickerington, have done a wonderful job in acknowledging the problem but only due to strong advocates, look up Tyler’s Light. The best drugs come from those affluent communities. I am a recovering addict myself with 19 years clean. It was not easy. Believe me. People do not understand that hold that addiction has on a person. It is a DISEASE!!! Nothing to do with willpower. Please educate yourself on this before you say anymore.

  • Play dumb games, get bad results. Starts with smoking then pot then stronger stuff, usually in blue colar towns where kids don’t have a great family structure and hang around with similar minded kids with no goals in life other than to get high. It’s weird how kids in more successful towns who have money don’t do drugs.

    • What a naïve statement. Where I’m from, I can cite plenty of affluent and normal middle-American families who have buried their children from heroin overdoses. If you read the article, you could see how a small town like this could be ravaged by addiction. No jobs, no recreation and a bleak outlook on life. Your lack of empathy is disturbing.

    • Drug addiction is in every educational and socioeconomic group. I live in a pretty affluent area in California and we have this too. The unfortunate part is no one really knows if they will become addicted until they try a particular drug, including alcohol and cigarettes. Then it is too late. By the way, “colar” is spelled collar.

  • I heard Jacksonville, FL has had a 300% increase in opioid addiction in one year. You might bring to light the documentary, “Chasing the Dragon” – the FBI released it earlier this year. It’s riveting and is now being shown on college campuses. Needs to be shown in churches and civic organizations, too. Before it was finished, many of those – all ages – who were addicted died. What is a community to do? Thank you for sharing this photo – it has brought about incredible awareness to this terrible issue.

  • What if there was a policy that the medics would not try to revive a person after 3 ODs within a certain period?? Stupidity is doing the same thing repeatedly & expecting different outcomes. Spend the monies saved on the new generations who are not yet addicted…

    • Kay and Georgia! Have you no heart? You want medics to pull the plug on a human life bc, according to you, they are too stupid. You’d have half of the USA in trouble if we follow your logic, including yourself.

      No one deserves death because they made a few bad choices.

    • After trying several times at taxpayers’ expense to get clean & failing, then it is up to the addicts or their families to pay for further attempts…
      If these people continue to play Russian roulette with their drug addictions, then yes, some are going to die… That is one of the consequences of drug use that they are at risk for…

    • So by your logic people who repeatedly fall ill should be left to die since trying to revive them would be wasteful/stupid. Or are you just sitting on a high horse looking down at people who have become addicted? I hope a family member of yours gets addicted, just to show you some compassion.

    • As a middle class adult, with 2 kids, a good family structure, successful friends, aunts, uncles, and grandparents… and having a cousin that died from opioid use… I can say this…

      There’s nothing that will make people stop using, unless they want to stop. Reviving people multiple times that have willingly re-OD’d is reviving somebody that does not want to stop. Let them have their way…

      Most users know other users. If law enforcement started allowing “repeat OD’ers” to pass away… it will potentially affect 1 or 2 of their user friends to maybe quit. If this happens enough times within the same circle of friends, there will be the users that want to quit, and there will be users that don’t want to quit. However, without allowing the repeaters to die… nobody in the circle of users will want to quit…

      Also… it’s MUCH less painful for the family of the user… after he/she is gone. Losing a child is never easy… but watching your child suffer, get high, lie, cheat, and steal… is worse.

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