Smack in the suburbs

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The US is in the throes of a heroin and opioid epidemic - drug overdose has become the leading cause of accidental death, overtaking traffic accidents.

It is a health crisis with tentacles reaching across the social spectrum. Lorain County, in the state of Ohio, is mostly suburban and middle-class, with a large rural hinterland.

Its population is only 305,000 but for the last three years, the number of fatal opiate overdoses has hovered at around 65. This year it only took six months to reach that figure.

Avon Lake is the county's wealthiest community - an upmarket suburb of the city of Cleveland. Here, on the shores of Lake Erie, the scourge of opiates - prescription pills and street heroin - is tearing at the fabric of a tightly-knit neighbourhood.

The addict

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Mason Butler talks about starting detox for the seventh time

Mason Butler is smoking in the garden. The cicadas are close to deafening, Mason has hardly slept and his mother, Marnie, has arrived to drive him to rehab. This will be his seventh attempt at getting clean.

"Every time, you have to have hope," he says. "But when it doesn't work out you get more discouraged than the last time. It kind of sucks when you just feel like a chronic relapser…"

Like so many American heroin addicts, Butler first got hooked on pain medication. At high school he was a wrestler, and the doctor prescribed an opiate drug for his injuries.

"I took it the first time, and I was like, 'That's it.' It hit the mark. That was the high I was looking for and I chased it from the age of 16. Now I'm 26…"

Although he claims he is determined to quit, Butler has arranged to meet a heroin dealer on his way to rehab, to score a final hit. Marnie is not fully aware of her son's plan until she finds herself waiting for him outside a fast food restaurant off the highway.

Find out more

India Rakusen presents Smack In Suburbia on BBC Three - watch it on BBC iPlayer; she also presents Addicted In Suburbia, as part of BBC Radio 4's Crossing Continents series on Thursday 1 September at 11:00 BST - catch up later on BBC iPlayer Radio

"I didn't realise," she says. "It's very stressful - I just want to get him there. And it's nerve-wracking because I didn't bring the naloxone kit," she says.

Naloxone is a prescription medicine that reverses an opiate overdose, and is credited with saving thousands of lives. Ohio's emergency services carry it, and it is available in pharmacies. In Lorain County, like much of the US, the spike in fatalities has been caused by fentanyl, a synthetic opiate pain reliever dozens of times more powerful than heroin. It is the drug that killed Prince. Drug dealers are cutting it with heroin - with or without the user's knowledge.

Back in the car, Butler shoots up the heroin he has scored. Marnie is deeply upset - it's the first time she has seen this.

An hour later, he is pushing the buzzer at the door of the rehab facility.

"I'm here to get admitted," he slurs into the intercom.

"Oh, wonderful, come on in," says a bright, disembodied voice.

The cop

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Addicts are getting younger, says Jim Larkin from the Lorain County Drug Task Force

Jim Larkin was a Navy pilot for more than a decade, then with the FBI for 25 years, where he headed North Ohio's Swat team. Like all FBI operatives, he was compulsorily retired at 57 - but Jim was not ready for a quiet life, and moved to the Lorain County Drug Task Force.

From an HQ in a secret location the force gathers intelligence, pursues drug dealers, runs informants, and brings cases against crooked doctors who over-prescribe opiate medications.

"When I first started here almost all our focus was on cocaine and meth amphetamine. But in the last five or six years, heroin has really taken over. It's almost all we do."

Now with the arrival of an even deadlier assassin - fentanyl imported illegally from Mexico - the outlook is bleak.

"We're going to have twice as many overdose deaths this year in Lorain County as we did last year. And it's not because we have twice as many addicts. It's because there's more and more fentanyl being mixed with heroin. It's so potent, it's causing the overdose deaths," Jim says.

If you touch fentanyl it goes right through the skin, so officers have been told to stop doing instant tests on suspicious materials they come across in the field. It's too risky.

"My son's a canine officer, and most of those guys are afraid to put their dogs in their cars because if there's just a little bit of fentanyl there… Well, my son doesn't want to kill his dog," says Jim.

Even so, Jim Larkin is sanguine about the dangers of the opiate beat.

"It's no more dangerous than flying over Vietnam," he says, referring to his military career back in the 1970s.

The mayor

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Avon Lake mayor Greg Zilka raises the alarm at a council meeting in 2013

Three years ago, the mayor of Avon Lake, Greg Zilka, dropped a bombshell at a council meeting.

"I became aware of five deaths in the community in just nine months - all of them from heroin or opiate overdoses. It has just devastated families, and I was absolutely distraught about that," he says.

Opiate abuse had become a "plague" he said, a "crisis", even in "pleasant comfortable suburbs like ours".

It was a lot for people to absorb. And not all Avon Lake's residents welcomed Mayor Zilka's decision to address the problem publicly.

"I did get a call from an individual who sarcastically thanked me for lowering his property values," Zilka says.

A century ago, a tramway ran down the street outside the mayor's office.

"There used to be little cottages on the lake, and people living in Cleveland would hop on the trolley car and come out here to spend the summer," Zilka says.

Now those lakeside cottages have been replaced by spacious, detached family homes. Wild deer bound across large, manicured lawns, and Avon Lake has become an enclave of the well-off - some of them business tycoons and professional athletes.

But although some residents were unhappy about it, Zilka's speech was the impetus the community needed. Now there are regular town hall meetings to raise awareness, and a volunteer group - Assist Avon Lake - helps families affected by addiction to get support and access drug treatment.

The campaigner

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Jim Coyne describes losing his friend, Jason, to heroin

Jim Coyne is proud to be a graduate of Avon Lake High School. But he has mixed feelings about a forthcoming school reunion to celebrate 10 years since he and his peers stepped out into the world. One face will be missing. Coyne's close friend, Jason, who - like so many other young people - began taking opiate pain medication to treat an injury ended up on heroin.

He died in detox after an adverse reaction to methadone.

Altogether, Coyne has lost three good friends to the drug epidemic - two to heroin, and one to a fentanyl overdose. And it is his experience of bereavement and loss that compelled him to found Assist Avon Lake in 2013. Although he works full-time in marketing, in his spare time Jim is dedicated to fighting the deadly influence of highly addictive drugs.

He does not pretend there is an easy solution, but he believes in the power of individuals.

"It takes that next-door neighbour, that uncle, that friend, that teacher… It takes a whole community to really address this. Even then, we're not going to save everyone. But we can at least acknowledge that we have a crisis - and I think we've done that in this town."

Coyne sees Jason's absence at the forthcoming reunion as another opportunity to educate his peers.

"Jason was all about bringing people together. So if, when we're all there, we remember him, and someone in that crowd learns a little bit more about what they can do to prevent someone else going down that road, well you know… Like I said, it's one person at a time."

The mother

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Lisa Wolanski reads the obituary she wrote for her son, DJ

"Avon Lake is just beautiful," says Lisa Wolanski, looking out across Lake Erie.

Her son, Daniel - or DJ, as he was known - was in seventh grade when the family moved here. At high school Lisa suspected he was using pills, but never found any evidence - and DJ denied it.

"There was a time he kept begging to have his wisdom teeth out. I said to him, 'You only want your wisdom teeth out so you can get pain meds, Daniel.' He said, 'That's not true.' But for sure, he wanted that medication."

DJ became a heroin user. He was in and out of rehab. He did a stint in a half-way house, but it was targeted by drug dealers.

Recovering addicts often wear elastic bracelets with inspirational slogans like, "Dopeless Hope Fiend". "The boys wear those stretchy bracelets and go to the mall. And that's what the dealers look for," says Lisa. "So they were selling heroin to these kids at rehab."

DJ never managed to free himself from one of the most addictive drugs on the planet. He died in April, 2015 from an overdose. He was 24.

Lisa wrote her son's obituary. After the years of embarrassment and shame because DJ was an addict, Lisa decided to write honestly - unlike many other parents in this situation - and make no secret of the cause of his death.

"When I gave it to the funeral director he said, 'You honestly want me to publish this?' I said, 'Yes, that's exactly what I want you to do.' And since then we've got a lot of phone calls through him - families looking for help, and people thanking us for doing it. If we can educate just one person, then Daniel's dying saves a life."

The funeral director

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Mark Busch on young people and the opiate epidemic

DJ Wolanski's obituary was published on the website of Busch Funeral and Crematory Services.

"The Wolanski family wanted to deliver the most powerful and effective message, and I commend them for doing that," says Mark Busch.

"We need more families to step forward and make the position known. These kids need help. We need the community involved to support them, so they're out doing healthy activities, and not taking heroin."

Every month this family business serving Avon Lake and the suburbs west of Cleveland buries or cremates up to four people who have died as a result of a heroin or opiate overdose.

"It's very sad to see friends and family coming to the funeral home. And some of them are users - I've witnessed people coming here when they're high. Recently we handled two overdose deaths over a weekend," says Busch.

The memory of one family has stayed with him - a mother who lost both a son and a daughter to opiates within a short space of time.

"Sometimes you don't have words," he says. "You just have to be present."

The doctor

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Dr Jeffrey Hopcian on denying patients opiate prescriptions

Across the US, the origins of the opiate and heroin epidemic lie in the over-prescription of medication that started in the 1990s. Claims that opiate pills were not addictive were rarely challenged in those days, and some drug companies encouraged doctors to prescribe more opioids as pain-killers.

Since then laws have been enacted to limit the abuse of medicines. But Dr Jeffrey Hopcian, a pain specialist at University Hospitals in Cleveland, still deals with the fall-out from over-prescription.

"On a daily basis I see patients who've been exposed to really high doses of opiates, and developed some element of dependence on them," he says.

Opiate pharmaceuticals were often developed to treat the pain that some terminal cancer patients endure. Then their use became more generalised.

"There are very few instances where I feel opiate prescribing on a long-term basis is appropriate," Hopcian says.

Some patients react badly when Hopcian says he will not prescribe opiates for them. But he tries to educate them about the risks, and he contacts medics whose prescribing practices he finds suspect. Sometimes he reports doctors to the Ohio State Medical Board.

"As a public we're becoming more aware of the problem. But I think doctors - who are in a very intimate way part of this issue - have been naive about the way opiate and heroin addiction are linked."

The recovering addict

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What happened to the father of Marissa's baby?

There is hope. Heroin and opiate addicts do recover - but they need help.

Marissa Darnell looks the picture of health. Her shiny hair and clear skin belie her history of heroin addiction. Darnell is being treated at Lorain County's largest drug rehab facility, LCADA Way. This is her third attempt at quitting heroin.

"The first two times it was pretty much because the courts made me. This time it's because I want to - now I've something to actually live for," she says, hands folded over her stomach.

Since she found out she was pregnant, Darnell has not taken heroin - her baby is due in October. And she is being prescribed buprenorphine to help prevent withdrawal symptoms, and lower the risk of miscarriage. Once the baby is born, both mother and child will be weaned off the buprenorphine.

Darnell is determined to leave her dark past behind - the prostitution, the stealing, the jail time.

"Heroin takes you places you don't want to go," she says. "And after a while, it's not even for the high - it's just so you can feel normal, so you're not sick."

The death of her baby's father, and the spike in fatal overdoses connected to the presence of fentanyl in Lorain County, has worried her.

"Honestly, it's made me scared that if I use again, I'm going to die. We're not invincible."

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