One US county, 70 minutes, 8 overdoses

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The first call came at 7.33pm local time: two people had overdosed on heroin in a home just a few hundred metres from the station where firefighters were awaiting their nightly round of drug emergencies.

By 8.42 - 69 minutes after the first report - a county of a little more than 200,000 people had recorded eight overdoses, all believed to be caused by heroin.

There would be a total of 16 overdoses in 24 hours and 25 over two days. Three people died. Many of the others were saved by a recent decision to equip every first responder with the fast-acting antidote naloxone.

The toll was not from a supply of heroin that had been poisoned on its journey from South America to southwestern Pennsylvania. Nor was there an isolated party where careless junkies miscalculated the amount of heroin they could handle. It was simply an extreme example of what communities in parts of the United States are enduring as the heroin epidemic rages on.

"It's absolutely insane. This is nuts," said District Attorney Eugene Vittone, a former paramedic who is trying to hold back the tide of drugs washing across Washington County, a Rust Belt community 48km south of Pittsburgh.

On any day, Vittone said, the county averaged five to eight overdoses, almost all from heroin.

"There's been a progressive increase in overdoses the last two years, and it just went out of control," added Rick Gluth, supervising detective on Vittone's drug task force. "I'd be glad to have the crack epidemic back."

The national drug-death total is disproportionately concentrated in the Rust Belt, the Great Lakes region and the Northeast.

In southwestern Pennsylvania, two labels are flooding the area stamped "Made in Colombia" and "Black Jack". Authorities are still investigating but believe both types of heroin are laced with fentanyl, a powerful synthetic opiate that increases the drug's potency and may have contributed to the rash of overdoses.

Nationally, there is only a small fraction of the inpatient rehab beds needed for addicts, but David Hickton, US Attorney for western Pennsylvania and co-chairman of the National Heroin Task Force, in an increasingly common stance for prosecutors, has agreed users need help more than they deserve incarceration.

With many more middle-class people addicted via prescription opioids this time around, heroin is bought and sold in bars, nightclubs, homes and more unlikely places, according to Neil Capretto, an addiction psychiatrist and medical director of Gateway Rehabilitation Centre.

On the streets, prescription drugs sell for about US$1 a milligram, or US$20 for a single dose. Heroin is much cheaper at about US$8 a bag. It is also much more potent than the heroin of previous eras, according to Capretto. Users often start with a single bag, but as their resistance grows, they need increasing amounts. All of which signals more overdoses and deaths, at least until authorities can stem the demand and the supply.