In the United States, opioid addiction is killing almost 150 people per day in a prescription drug fuelled crisis that is now being described as a "national emergency".
It is a form of carnage that US President Donald Trump has vowed to stop, but there is concern his vow to repeal Obamacare or let it collapse will kill people — not save them.
The West Virginia town of Huntington is at the centre of the crisis.
"It's just unbelievable," says Bobby Borders, a former addict who now runs Advocate House, a centre for users to get clean.
"It's going to take some federal government to come into this town to get it cleaned up and to get this stopped."
It is said that a person dies every 10 hours of an overdose in West Virginia.
In Huntington, one-third of all emergency service call-outs, or at least five per day, are drug related.
One in 10 babies born at the Cabell Huntington hospital is experiencing withdrawal from heroin, methamphetamine, alcohol or other opioids.
That is 15 times the national average.
Heroin, recovering user Sam Veasey says, is cheap and easy to get.
"Honestly, we've got four neighbours within 50 metres of this house and I could go get it right now," he tells me.
"I don't even have to know them. I just tell them I'm sick or knock on their door and they're going to sell it to me easy."
Heroin cheaper than pills and sold 'to kids on the street'
Cabell County, which includes Huntington, is suing several drug companies for flooding West Virginia with painkillers for the sake of profit, encouraging over-prescription and fuelling a death spiral that's now devastating families.
Joanna Hammond's son was one of those caught up in it after being prescribed painkillers when he was 16. He became addicted.
"I went home one day early from work and a couple that were in at least in their 50s were in a truck in front of my house selling my son pills," she says.
"So what does that tell you? That doctors are prescribing medications. They overprescribed that to people who don't even need pain pills or nerve pills, and they're selling them to kids on the street."
When police cracked down on the black market that sprang up due to the oversupply, people like Joanna's son then turned to heroin.
"He was told [by the dealer] that heroin would help the pain that as long as he didn't do very much — that he would be OK … and then it ended up taking over him completely," she says.
"Pills are expensive," Mr Veasey agrees.
"A $10 pill, you can get something 10-times as strong as that for $10 of heroin. It's cheaper. It's more readily available. I mean, it's everywhere."
Joanna's is a middle-class family, and she has keen to point out that although many blue collar families are affected by the crisis, they are not alone.
It is an epidemic that goes far beyond stereotypes and as a result figures show heroin deaths tripled nationally over five years.
However, Simon Haeder from West Virginia University says the amount of manual jobs and the lack of services make the state especially vulnerable.
"People get introduced through heavy labour," he says.
"Mine working, logging industry — and then they get hooked on these pills and then it makes it worse."
'We're dead in the water' without Medicaid, says recovery centre
When he came to office, Mr Trump appointed a commission on drug addiction and opioids.
Its preliminary recommendation is to declare a national emergency to trigger federal crisis funding.
One hundred and fourty-two Americans are dying every day, the report says, a "death toll equal to September 11 every three weeks".
"The addiction problem cuts across party lines, it cuts across economic lines," Professor Haeder says.
"Everybody knows someone who's suffering from this or has suffered from this and so I feel there's bipartisan support to do something about it — the problem being of course in the state of West Virginia, which is a very poor state, you need resources from outside of the state so you're really dependent on the Federal Government helping you out."
Kim Miller from the Pestera centre, which relies on federal Medicaid funding and insurance under the Affordable Care Act for its addiction recovery programs, also raises concerns about Republican plans to repeal Obamacare without replacing it.
"It's life-threatening, our treatment programs are literally on life support, so we're trying to keep them alive and so far we have been able to and we will continue to work towards that but if Medicaid goes away — we're dead in the water," she says.
That would leave recovering addicts like PJ, who speaks to us at the centre, with no support.
"Have you ever overdosed?" I ask him.
"I did, three weeks ago," he tells me.
"And that was the first time in my entire life and it scared me to reality."
PJ is not the only one who is frightened.
"As a parent I keep thinking is he going to relapse today?" Joanna Hammond says about her son, now 21.
"Am I going to go home and find him dead?"