Ohio police released a graphic photo of a couple overdosing on heroin with a four-year-old boy in the car last month.
Passed out on the supermarket floor, her daughter pulls at her limp body, crying out for help.
It's a confronting scene; toys are spilt across the floor and the mother is well and truly out cold - despite her daughter's desperate attempts to rouse her.
This is just one of the faces of the parental opioid epidemic - one that is sweeping the United States with aggressive speed.
Police say the woman, who was charged with child endangerment, overdosed on an oral version of the drug heroin, or an opiate-based narcotic that's becoming increasingly ingested by addicts and their children.
It took two doses of Narcan, an opiate antidote, to revive the Salem, New Hampshire mother, whose bag contained drug paraphernalia, including straws and baggies with drug residue.
"It's very, very disturbing to see someone obviously in the matter of addiction, where it overtakes someone to the point where they're not able to take care of their child, leaves their child vulnerable," Lawrence Police Chief James Fitzpatrick told media after the incident.
Authorities and health officials across the US are beginning to name and shame their victims as the rates of opiate use across the country reaches staggering new heights.
Opioids killed more than 28,000 people in 2014, according to the Centers for Disease Control and Prevention.
"More than any on record," it stated, adding those figures had nearly quadrupled since 1999.
And the web of exposure continues, with 130,000 children born hooked on drugs in the past decade alone.
Some were suffocated. Some swallowed toxic doses of methadone, or oxycodone. One mother threw her 10-day-old girl in the washing machine with a load of laundry while high on a mixture of methamphetamine, amphetamines, benzodiazepine and opiates.
"Heroin is probably the most commonly known opioid, but more commonly they come in the form of painkillers, including antidepressants, anti-anxiety, antipsychotics," neonatologist Sean Loudin, from West Virginia's Cabell Huntington hospital, told news.com.au.
"Then there are some other newer medications [like prescription nerve pain medication] that also act on brain chemistry that changes them.
"These have been used in increasing numbers in pregnant women and all of them will act on the brain."
There has been a wave of incidents across the US.
"Recently we had a 21-year-old mum who was prostituted by her own mother - at eight - for her own drug use," Dr Loudin said.
"At 13, her mother shot her up with heroin for the first time, she became an addict. She's 21 and we've delivered three babies. Different father every time. She has four sisters and three of them are addicts."
Cabell Huntington Hospital sees the worst of humanity on a daily basis. Delivering up to eight drug-addicted babies to mothers who inject even during birth, the withdrawal, as highlighted last year, is devastating. In many cases, these children are born without hope.
Tragically, at least 110 babies have died from preventable deaths since 2010 after their mothers used opioids. It wasn't the withdrawal that killed them. They recovered successfully after months of rehabilitation. What killed them was being sent home.
Nothing clarified this point more than the disturbing images of an unconscious man and woman passed out in their vehicle, with a four-year-old child strapped in the back.
An affidavit posted by the East Liverpool Police Department reveals the arresting officer noticed the driver's head was "bobbing back and forth" and his speech was "almost unintelligible".
The woman, the child's grandmother, was "completely turning blue" when police arrived
on scene.
The driver, identified as James Acord, was so out-of-it at the time, the officer on scene was forced to put the car in park and shut it off.
According to KTLA, Ohio is in the "throes of a heroin epidemic", citing 24 heroin overdoses in just one day.
"According to the Ohio Health Department, 1424 people died of heroin overdoses last year, up from 87 people in 2003 - a more than 1700% increase in just 12 years," it reported.
CSI has arrived in McKeesport (Pa) where 2 dead bodies where found in this home pic.twitter.com/pfDcCcIZAs
— Beau Berman (@BeauReports) October 3, 2016
In the US, a baby dependent on opioids is born every 19 minutes - and its grip is tightening. As the generations grow older, the problem becomes bigger.
A four-hour drive from the spot where one of America's worst epidemics is playing out, a family of six lived a relatively nondescript life until last week, when the smoke screen came crashing down.
"They were acting normal. No indications. Nothing," a neighbour told WPXI.
Inside though, it was a different story.
It all began when a seven-year-old girl alerted her bus driver that she couldn't wake her parents.
According to The Washington Post, despite this, the girl got dressed, took herself off to school and kept her worries to herself.
On the way home, she alerted the bus driver about her situation.
When police entered the home at 5pm Monday, they found the bodies of the girl's parents, Christopher Dilly, 26, and Jessica Lally, 25, along with the girl's three siblings - aged five, three and nine months.
"That's like the hardest thing because that's a seven-year-old," Jessica's sister, Courtney Lally, told WPXI.
"That's a seven-year-old that did that."
Courtney had been trying to get help for her sister for months. In February, she sent police photos inside the home where her sister and her children lived.
According to Courtney, who posted a plea for help on Facebook last year. This is the horrid state inside the family home:
The children, who were all unharmed, were taken to hospital for checks and placed with the Allegheny county's department of children, youth and families.
Yet, authorities responded to another overdose on the same street earlier that day.
"There is an opioid overdose epidemic in the US, and Allegheny County is not immune," county health officials said in a recent report.
The report cited the epidemic as a "public health crisis" and highlighted "the need for increased use of effective strategies to curb overdose".
Further south, in Memphis, Tennessee, a 12-hour drive from Pittsburgh, disturbing footage captured by a passer-by shows a couple lying unconscious on a pavement after police confirmed the pair "snorted some heroin" at a local chemist.
Memphis and its suburbs are reportedly seeing an increase in heroin overdoses.
When Michelle Burton arrived at a house in Birmingham, Alambama, they stumbled across the body of a 30-year-man, dead from a drug overdose.
Unresponsive on the couch was a 35-year-old woman, with a faint pulse.
Inside were the couple's children; a seven-year-old girl, a three-year-old boy, two-year-old boy and one-month old girl.
Burton noticed the seven-year-old, in particular, looked "quieter".
She asked if the girl needed anything - and the girl asked if she could sign her homework.
"That broke my heart," Burton told the Washington Post.
"She said, 'I did my work.' She pulled it out and showed it to us. It was math homework, (like) 'Which number is greater? Which number is odd or even?' ... I told her, 'Sweetie, you probably won't have to go to school tomorrow. ... But where you're going is going to have everything you need.'
The Post quotes 5200 children in the state of Alabama currently in foster care.
President Barack Obama took the lead on the issue in October last year, describing it as a "crisis" that was "taking lives".
"It's destroying families and shattering communities all across the country," he said at a panel discussion on opioid drug abuse in Charleston, West Virginia, less than an hour's drive from the hospital.
But with an increase in overdoses since, the situation is looking dire.
"Drug addicts are very selfish. Everything revolves around them and their drug, especially heroin addicts, they put the drug before everything, including the baby and themselves," Cabell Hungtington Hospital neonatal nurse Sara Murray told news.com.au.
"They lie about everything, it's a survival mechanism. It's the only thing they've known in their lives, it's the unfortunate symptom of addiction."
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