Photographing America’s deadliest drug epidemic

Salwan Georges/The Washington Post

It was after midnight when police and paramedics arrived outside a bar in Taunton, Mass. A young man sprawled in the parking lot. He was suffering from an apparent fentanyl overdose. He was given four shots of the overdose-reversal drug Narcan, and he survived.

Salwan Georges/The Washington Post

The incident was documented by Washington Post staff photographer Salwan Georges, who over the past year has covered the continuing havoc from America’s deadly opioid epidemic. He captured scenes of drug use and apparent overdoses, former addicts and their journeys toward recovery, systems and institutions straining with the deadly influx of drugs, and the pain of those left behind to mourn and pick up the pieces.

Salwan Georges/The Washington Post

Apparent overdose in Taunton, Mass in June.

In 2017, a record 28,869 people died of synthetic-opioid-related overdoses, a 46.4 percent increase from the previous year. The vast majority were from fentanyl, a painkiller 50 times more powerful than heroin. Fentanyl became the third wave of an opioid epidemic that began with prescription pills and migrated to heroin. Estimates for the first eight months of 2018, the most recent available, show that an additional 20,537 Americans have died — a pace set to exceed the previous year’s.

While the fentanyl epidemic has mostly affected white Americans, the drug is increasingly claiming more African American lives in cities such as Baltimore, which saw fentanyl deaths rise by nearly 5,000 percent between 2013 and 2017.

Baltimore’s Penn-North Metro station seen in April as members of a nonprofit, Bmore Power, were handing out free doses of Narcan, an opioid-reversal medication. The station sits in a section of the city known for heavy trafficking of heroin and fentanyl.

A man at the entrance of Baltimore’s Penn-North Metro station snorts fentanyl, according to the man who gave it to him, from a credit card. The man was asked for his name but did not provide it.

In Manchester, N.H., one of the states that was hardest hit by the fentanyl crisis, firefighters and paramedics are called nearly every day to overdose scenes and have opened their station houses to addicts seeking treatment. “In the city of Manchester, we saw 20 overdoses to 80 overdoses a month. We were like, ‘What the heck is happening with these overdoses?’ ” Manchester Fire Chief Dan Goonan said.

Firefighters in Manchester, N.H., respond to a 28-year-old man who overdosed in October 2018.

Firefighter Tim Aramini helps Christopher Abbott, 32, as he checks into the Safe Station program at the city’s Central Fire Station in February. Since its creation in May 2016, Safe Station has helped an estimated 5,200 people seeking treatment for addiction.

As people continue to die in record numbers in communities across the country, health officials struggle to provide treatment for the growing numbers of the addicted.

Whitney Millay, second from right, heads into a residential recovery facility in April in Washington Court House, Ohio. It is the only one for women in Fayette County. Millay says she overdosed 10 times on fentanyl. “It was a fine line between oblivion and death,” she says.

James Proffit reads a book about drug recovery in his room at a Sojourner Recovery Services treatment facility in Hamilton, Ohio, in April. Proffit has lived on the streets for years. His path to fentanyl was typical, starting with large doses of OxyContin and then heroin, not knowing it had been laced with fentanyl. He overdosed four times before seeking treatment.

Inmates in the women’s cellblock at the Fayette County Jail in April in Washington Court House. The inmates often go through withdrawal. The county has the seventh-highest number of fentanyl-related overdose deaths per capita in the nation, according to CDC data.

Ian Rego, 25, sits in his shared room at a treatment center in June in Fall River, Mass. Rego enrolled in a detox program in June the day after he said he overdosed on fentanyl in a gas station bathroom.

On the streets and at ports of entry, officials voiced concerns about being inadequately equipped and understaffed in their efforts to slow the nation’s illicit drug supply as deaths surged from the epidemic, according to government reports and interviews.

Taunton Police Street Crimes Unit detectives search the car of man they stopped after he picked up a prostitute in May, according to police. The city saw more than five overdoses each week last year.

A package mailed from China containing fentanyl is removed for an additional search at last year John F. Kennedy International Airport’s International Mail Facility in New York. The illicit use of the U.S. mail system has been widely recognized but was unaddressed for years.

Paramedics in the Taunton Police parking lot administered three shots of Narcan to a man who had been arrested less than an hour earlier and was believed to be overdosing on fentanyl. He survived.

As the crackdown on opioids gained traction, a sweeping change in chronic pain management took root — the tapering of millions of patients who have been relying, in many case for years, on high doses of opioids. Many chronic pain patients described their anxiety, saying that they were not drug addicts or criminals, just people in pain who were following the doctor’s orders.

“Why am I being singled out? I took it as prescribed. I didn’t abuse it,” Hank Skinner said. Skinner has had seven shoulder surgeries, lung cancer, open-heart surgery, a blown-out knee and lifelong complications from a clubfoot. He uses a fentanyl patch on his belly to treat his chronic shoulder pain.

The epidemic continues to take thousands of lives every year and destroys many more. Those left behind mourn and pick up the pieces. As a single mother in Taunton, Judi Gilmore raised four sons. Todd, 33, died of a heroin overdose in 2006. Jay, 49, at times homeless, would spend nights sleeping on Todd’s grave. He, too, struggled with addiction. A fatal dose of fentanyl killed Jay in May 2018. His mother found him unconscious in a downstairs bathroom after hearing his cellphone ring incessantly.

Judi Gilmore sits at the grave of her two sons in May in Taunton, Mass. She wants lawmakers to know she is incensed they have not done more to stem the epidemic. “I would tell them I’m very, very angry,” she said. “You’re not doing your job. Do your job. If it was their son or their daughter, they would do it.”

In West Virginia, nearly 6,900 children are in state care, double the number from a decade ago. Officials estimate that more than 80 percent have been affected by the drug epidemic. The Kinder family of Charleston is filling in gaps left by the overtaxed system. The family has fostered 21 children over six years.

Haven Kinder, 10, and her sister Cayleigh, 12, play with a their 1-year-old foster brother, whom the family has raised since birth. Several years ago they adopted four sisters whose family was destroyed by drugs. To give them a fresh start, the girls were allowed to choose new first and middle names. “Why am I doing this?” Monica Kinder, their mother, recalled once asking her husband. She answered her own question: “This is where my heart is.”

A baby boy sleeps in a bassinet at a neonatal intensive care unit in Charleston. The 2-week-old was among thousands of children separated from their parents and forced into state care by an opioid epidemic that fractured families in every corner of West Virginia, claiming 5,200 lives over two decades.

Photos by Salwan Georges. Words and reporting from Sari Horwitz, Scott Higham, Steven Rich, Shelby Hanssen, Katie Zezima, Colby Itkowitz, Joel Achenbach, Lenny Bernstein, Debbie Cenziper, Emily Corio, Kelly Hooper and Douglas Soule. Photo editing and production by Nick Kirkpatrick and MaryAnne Golon. Story editing by Jeff Leen.