Of the 2,900 babies born last year in Cabell County, West Virginia, 500 had to be weaned off of opioid dependence.
In Ohio, counties are renting refrigerated trailers to store the mounting number of bodies of drug overdose victims.
In New Hampshire, hospitals have so many overdose patients they have to treat them in operating rooms and neonatal nurseries.
And in Palm Beach County, Florida, where President Donald Trump spends his weekends, 10 people died of overdoses on Friday alone, likely from a batch of heroin tainted by fentanyl, a powerful, synthetic opioid pain medication.
After a decade and hundreds of thousands of deaths, the US opioid addiction crisis is entering a new phase. With the government finally cracking down on the free flow of prescription pain killers fueling the crisis, addicts are turning to heroin pouring in from Mexico.
And towns, cities and states are being overwhelmed.
Overdose deaths surging
More than 33,000 people across the country died in 2015 from opioid overdoses, up 15.5 percent from 2014. That equated to a record 10 overdose deaths for every 100,000 people—10 times the level in 1971, when the US government declared its "War on Drugs" after a surge in overdoses.
But whereas six years ago four out of five overdose deaths came from prescription painkillers like oxycodone and hydrocodone, now heroin and heroin-fentanyl deaths account for about half.
In Cabell County, the overdose death rate was about 30 per 100,000, not even the highest in West Virginia, the state hit hardest by the addiction crisis.
Lawyer Paul Farrell last week filed suit for Cabell and a neighboring county, Kanawha, seeking damages from drug companies for dumping massive amounts of addictive opioids into the state, fueling the addiction epidemic.
"My community is dying on a daily basis," he said. Every sixth baby born locally suffers from neonatal abstinence syndrome, in which a mother's addiction is passed on to her child.
"The hospital has to rock these babies 24 hours a day as they scream their way through addiction," Farrell said.
He said counties like his had little choice but to sue to force drug companies to pay for the present and future costs of the crisis.
"What we're asking for is not only to hold them responsible for blatantly violating federal and state laws, but to fix the damage they caused, so that we stop creating another generation of addicts," Farrell said.
Hundreds of millions of pills
How prescription opioid producers and distributors fed the crisis is made clear by previously unreleased US Drug Enforcement Agency (DEA) data reported in December by the Charleston (West Virginia) Gazette-Mail.
It showed that from 2007 to 2012, those companies sold 780 million opioid painkillers in West Virginia, 421 extremely addictive pills for every man, woman and child in the poor eastern state.
Every state is feeling the impact. On March 1, Maryland Governor Larry Hogan declared the addiction crisis a "state of emergency," allowing him to draw on funds normally appropriated for natural disasters to deal with the problem.
Two weeks ago, New York City Mayor Bill de Blasio announced a sweeping new campaign to cut addiction, after the city's overdose death toll hit 1,075 last year.
"The pharmaceutical industry for years has encouraged the overuse of addictive painkillers," he said.
From prescription drugs to heroin
The surge in deaths follows a shift in the nature of the crisis. After the DEA last year ordered a 25 percent cutback in the distribution of prescription opioids, addicts turned to heroin. But that drug is frequently cut with extremely potent fentanyl, causing even more overdoses.
"Everybody is starting to see a slowdown of prescription opiates. As you see supply drop, what we are seeing is an equal rise of heroin," said Farrell.
"We are going to see an all-time high transition to heroin abuse in the next five years."
To raise funds to deal with it, cities and counties are suing manufacturers like Purdue Pharma, which makes OxyContin, the most prevalent of the opioid painkillers; mega-drug wholesalers McKesson, Cardinal Health and AmerisourceBergen; and pharmacy operators like Rite Aid and Walmart.
New Hampshire, the New England state which rivals West Virginia for the rate of overdose deaths, has sued Purdue.
"Last year we had 450 overdose deaths" in a state of 1.3 million, Senior Assistant Attorney General James Boffetti told AFP. "Their marketing exacerbated this addiction problem."
Paul Hanly, whose law firm Simmons Hanly Conroy LLC is suing 11 opioid distributors and manufacturers on behalf of Erie County, New York, said the companies' behavior resembled that of neighborhood drug pushers.
"Certain of the conduct that is alleged in our cases and the West Virginia cases do smack of racketeering and conspiracy," he said.
The companies are fighting the suits, denying they are to blame.
In a statement to AFP that reflected the stances of the others, Cardinal Health said: "We believe that these copycat lawsuits do not advance any of the hard work needed to solve the opioid abuse crisis - an epidemic driven by addiction, demand and the diversion of medications for illegitimate use."
The US addiction crisis in numbers
The United States is experiencing a drug addiction crisis of rare proportions. An estimated 2.6 million people are hooked on prescription opioid painkillers like oxycodone and hydrocodone, or on heroin and fentanyl, an extremely potent synthetic opioid. Here are some key facts:
How many Americans are addicted to opioids?
In 2015, an estimated two million Americans were addicted to prescription opioid painkillers, and 591,000 to heroin. But the tightening of supplies of prescription opioids has sent many opioid addicts moving to heroin. Heroin producers and dealers in turn are increasingly cutting their drug with fentanyl, which is so potent that a minuscule amount can turn a standard heroin dose deadly.
How are prescription drugs and heroin use linked?
Experts say four out of five US heroin users started with prescription opioids like oxycodone and hydrocodone. A new study ties the likelihood of addiction to the amount and strength of the opioid painkiller first prescribed by a doctor. Patients who are given a prescription lasting more than three days, or who get a second prescription, or who are prescribed longer-lasting painkillers, are significantly more likely to be using the drug a year later.
How many people are dying from opioid overdoses?
The latest US data show that in 2015, 33,091 people died from overdoses tied to prescription opioids, heroin and fentanyl. That was up 15.5 percent from the previous year, and four times the number of deaths in 1999. Experts say the surge continued last year.
Which states have the highest levels of overdose deaths?
The national average for opioid overdose deaths in 2015 was 10 for every 100,000 people. In West Virginia, the figure was 41.5 per 100,000; New Hampshire, 34.3 per 100,000; Kentucky and Ohio, 29.9 per 100,000; and Rhode Island, 28.2 per 100,000. Nineteen of 50 states saw significant increases in overdose deaths that year.
— Data from the Centers for Disease Control, the Substance Abuse and Mental Health Services Administration, and the American Society of Addiction Medicine
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