Boston-area paramedics on front lines of US opioid crisis

Dec 22 (Reuters) - The paramedics find them everywhere - slumped over car steering wheels, barely breathing in doughnut shop bathrooms or dead in derelict apartments and expensive mansions.

For the Cataldo Ambulance Service crews outside Boston on the front lines of the U.S. opioid epidemic, the flood of overdose calls is a grim daily reality, despite expanded access to overdose reversal drugs.

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"When I started, this was a rare thing. You did one or two here and there. Now, we do quite a few," said Dave Franklin, 44, a supervisor at the private service that contracts with cities who has worked in the field for more than 20 years.

In Massachusetts, EMS opioid overdose calls hit 20,978 in 2016, up from 8,389 in 2013, according to a state report.

24 PHOTOS
Boston-area paramedics on the frontline of US opioid crisis
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Boston-area paramedics on the frontline of US opioid crisis
Cataldo Ambulance medics and other first responders revive a 32-year-old man who was found unresponsive and not breathing after an opioid overdose on a sidewalk in the Boston suburb of Everett, Massachusetts, U.S., August 23, 2017. REUTERS/Brian Snyder
A full syringe, empty syringe and spoon sit on the roof of the car in which a man in his 20's overdosed on an opioid in the Boston suburb of Lynn, Massachusetts, U.S. August 14, 2017. REUTERS/Brian Snyder
Cataldo Ambulance medics and other first responders revive a 32-year-old man who was found unresponsive and not breathing after an opioid overdose on a sidewalk in the Boston suburb of Everett, Massachusetts, U.S., August 23, 2017. REUTERS/Brian Snyder
Cataldo Ambulance medics and EMTs, along with firefighters, revive a man in his 40's who was found unresponsive after overdosing on an opioid in the Boston suburb of Salem, Massachusetts, U.S., August 9, 2017. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing. REUTERS/Brian Snyder
Cataldo Ambulance medic Jenn Mercouris delivers naloxone through an IV in the arm of a 54-year-old man who was found unresponsive and not breathing after overdosing on opioids in a bedroom in a house in the Boston suburb of Malden, Massachusetts, U.S., November 9, 2017. The man was revived with 8 mg of naloxone. REUTERS/Brian Snyder 
A bystander holds open the door as Cataldo Ambulance medic Rick Yunker checks on a 34-year-old man who reportedly overdosed on an opioid in the bathroom of a donut shop in the Boston suburb of Everett, Massachusetts, U.S., October 19, 2017. REUTERS/Brian Snyder
A 41-year-old man found unconscious after overdosing on opioids in the driver's seat of a car, with the engine running and the transmission in drive, puts his hands over his head in the back of a Cataldo Ambulance at a gas station in the Boston suburb of Malden, Massachusetts, December 2, 2017. A used syringe was found in the car with the victim, who was revived with 10mg of naloxone. REUTERS/Brian Snyder
Cataldo Ambulance medics take away on a stretcher a man in his 40's who was found unresponsive after overdosing on an opioid in the Boston suburb of Salem, Massachusetts, U.S., August 9, 2017. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing. REUTERS/Brian Snyder
Cataldo Ambulance medic Dave Franklin administers naloxone to a 32-year-old man who was found unresponsive and not breathing in the front seat of a car in the Boston suburb of Chelsea, Massachusetts, U.S., November 16, 2017. REUTERS/Brian Snyder 
Cataldo Ambulance medics Timothy Stahl (L) and Derek Travers (R), with the help of a firefighter, tend to a 38-year-old man who was found unresponsive after an opioid overdose in the parking lot of a Walgreens drug store in the Boston suburb of Malden, Massachusetts, U.S., October 19, 2017. The man was revived with 4mg of naloxone. REUTERS/Brian Snyder 
Cataldo Ambulance medics Rick Yunker (L), Derek Travers (C) and Timothy Stahl revive a 38-year-old man who was found unresponsive after an opioid overdose in the parking lot of a Walgreens drug store in the Boston suburb of Malden, Massachusetts, U.S., October 19, 2017. The man was revived with 4mg of naloxone. REUTERS/Brian Snyder
Cataldo Ambulance medics and firefighters revive a 40-year-old woman who was found unresponsive in a grocery store bathroom after overdosing on opioids in the Boston suburb of Malden, Massachusetts, U.S., November 15, 2017. After medics revived the woman with 10mg of naloxone on the floor of the bathroom, police discovered she had been arrested in the past for charges including assault and battery. REUTERS/Brian Snyder 
Cataldo Ambulance medics Ricky Cormio (L) and Luke Magnant take a 40-year-old woman out of a grocery store where she was found unresponsive in the store's bathroom after overdosing on opioids in the Boston suburb of Malden, Massachusetts, U.S., November 15, 2017. After medics revived the woman with 10mg of naloxone on the floor of the bathroom, police found out she had been arrested in the past for charges including assault and battery. REUTERS/Brian Snyder
A Cataldo Ambulance medic holds used doses of naloxone after medics revived a man in his 40's who was found unresponsive from an opioid overdose in the Boston suburb of Salem, Massachusetts, U.S., August 9, 2017. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing. REUTERS/Brian Snyder 
Cataldo Ambulance EMT Matt Tavalone takes notes as a 42-year-old female kicks the roof of the ambulance after she was revived with 8mg of Narcan given to her by a housemate before EMTs arrived on the scene in the Boston suburb of Lynn, Massachusetts, U.S., August 14, 2017. The woman who overdosed on an opioid showed signs of withdrawal caused by the Narcan. REUTERS/Brian Snyder 
Cataldo Ambulance medic Paula Gageiro drives to a reported drug overdose in Revere, Massachusetts, U.S., October 24, 2017. REUTERS/Brian Snyder 
Cataldo Ambulance third rider Wayne Taft arrives at the hospital with a 61-year-old man who was found unresponsive in the doorway of an apartment building after an opioid overdose in the Boston suburb of Somerville, Massachusetts, U.S., August 28, 2017. When the medics returned to the hospital hours later with an unrelated patient, they were told the man who overdosed had still not fully woken up. REUTERS/Brian Snyder 
Cataldo Ambulance medics John Gardner (L) and David Farmer care for a man in his 40's who was found unresponsive after overdosing on an opioid in the Boston suburb of Salem, Massachusetts, U.S., August 9, 2017. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing. REUTERS/Brian Snyder 
Bystanders watch as Cataldo Ambulance medics take a man in his 40's, who was found unresponsive after overdosing on an opioid, to an ambulance in the Boston suburb of Salem, Massachusetts, U.S., August 9, 2017. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing. REUTERS/Brian Snyder
Cataldo Ambulance medics Paula Gageiro (L) and Al Driscoll (R) take a man in his mid-40's, who was found unresponsive and not breathing in his car after overdosing on opioids, to an ambulance in the Boston suburb of Revere, Massachusetts, U.S., November 8, 2017. The man showed signs of withdrawal in the ambulance after being revived with 8 mg of naloxone. In response to repeated questions from the patient about what had happened, Gageiro replied, "You made a bad decision, you were dead." REUTERS/Brian Snyder
A woman identified as the victim's wife watches from the front porch as Cataldo Ambulance medics take a 54-year-old man to the ambulance. He was found unresponsive and not breathing after overdosing on opioids in a house in the Boston suburb of Malden, Massachusetts, U.S., November 9, 2017. The man was revived with 8 mg of naloxone. REUTERS/Brian Snyder
A used syringe sits on the roof of the car where a 41-year-old man was found unconscious after overdosing on opioids in the driver's seat of the car, with the engine running and the transmission in drive, at a gas station in the Boston suburb of Malden, Massachusetts, December 2, 2017. REUTERS/Brian Snyder
A 41-year-old man slumps over unconscious after overdosing on opioids in the driver's seat of a car, with the engine running and the transmission in drive, at a gas station in the Boston suburb of Malden, Massachusetts, December 2, 2017. A used syringe was found in the car with the victim, who was revived by Cataldo Ambulance medics and EMTs with 10mg of naloxone. REUTERS/Brian Snyder
A Cataldo Ambulance medic escorts a 39-year-old woman to an ambulance after she was revived from an opioid overdose in a home in the Boston suburb of Salem, Massachusetts, U.S., August 15, 2017. The woman was revived with 4mg of naloxone. REUTERS/Brian Snyder
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Amid wider use by bystanders and police of naloxone, a drug that reverses overdose symptoms, state figures showed a small drop in opioid deaths in the first nine months of 2017 compared with 2016. But Franklin does not yet see a turning point.

"It's not going away anytime soon. People are still dying regularly," he said.

In the United States, deaths from drug overdoses have surpassed deaths by firearms and motor vehicle crashes, according to a 2017 Drug Enforcement Administration report.

President Donald Trump has declared a public health emergency over opioid abuse, promising to increase treatment but initially dedicating no money for it.

Opioids, primarily prescription painkillers, heroin and synthetic drugs like fentanyl, a pain medicine 50 to 100 times more powerful than morphine, are fueling the crisis. Opioid-related overdoses kill 91 people in the United States each day, the Drug Enforcement Administration said.

On Thursday, the Centers for Disease Control reported, based on the latest available figures, that the U.S. rate of drug overdose deaths in 2016 grew 21 percent from the prior year.

"It's hard to watch, and it's devastating," said Domenic Corey, 27, who has seen the evidence up close working as a Cataldo paramedic.

Mornings before starting his shift, another Cataldo paramedic, Andrew Simpson, grabs his stethoscope, intravenous supplies, scissors and pen light.

At the ambulance, he checks to make sure there is enough naloxone. They carry more than double the amount they once did because stronger opioids mean that multiple doses of naloxone are often required for someone who is barely breathing.

See more from the opioid crisis across the nation: 

27 PHOTOS
Opioid and drug crisis in America
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Opioid and drug crisis in America
Discarded needles are seen at a heroin encampment in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 7, 2017. In North Philadelphia, railroad gulch as it is knowen, is ground zero in Philadelphia?s opioid epidemic. Known by locals as El Campanento, the open air drug market and heroin encampment is built with the discarded materials from the gulch and populated by addicts seeking a hit of heroin to keep their dope sick, or withdrawal symptoms, at bay. In one area, near the 2nd Avenue overpass, empty syringe wrappers blanket the refuse like grass the used needles they once contained poking through like thistles. / AFP PHOTO / DOMINICK REUTER (Photo credit should read DOMINICK REUTER/AFP/Getty Images)
NEW YORK, NY - JUNE 07: 'Surfer' shoots heroin in a park in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50. (Photo by Spencer Platt/Getty Images)
NEW YORK, NY - JUNE 07: A man leans against the wall appearing to be under the influence of drugs on a street in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50. (Photo by Spencer Platt/Getty Images)
WASHINGTON, DC - SEPTEMBER 18: Family members of those who died of opioid overdoses attend the 'Fed Up!' rally to end the opioid epidemic on at the National Mall on September 18, 2016 in Washington, DC. Activists and family members gathered on the National Mall to march to the Capitol Building. Some 30,000 people die each year due to heroin and painkiller pill addiciton. Speakers called for Congress to provide $1.1 billion for the Comprehensive Addiction and Recovery Act, which Congress passed in July without funding. (Photo by John Moore/Getty Images)
NEW YORK, NY - JUNE 07: A man rests against a wall appearing to be under the influence of drugs on a street in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50. (Photo by Spencer Platt/Getty Images)
NEW YORK, NY - JUNE 07: Brian smokes a synthetic drug called K2 on the street in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50. (Photo by Spencer Platt/Getty Images)
NEW YORK, NY - JUNE 07: 'Surfer' shoots heroin in a park in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50. (Photo by Spencer Platt/Getty Images)
WASHINGTON, DC - SEPTEMBER 18: Activists and family members of loved ones who died in the opioid/heroin epidemic take part in a 'Fed Up!' rally at Capitol Hill on September 18, 2016 in Washington, DC. Protesters called on legistlators to provide funding for the Comprehensive Addiction and Recovery Act, which Congress passed in July without funding. Some 30,000 Americans die each year due to heroin and painkiller pill addiciton in the United States. (Photo by John Moore/Getty Images)
Quincy Massachusetts Police Detective Lt. Patrick Glynn holds a nasal injection containing the overdose-reversing drug naloxone at the police headquarters in Quincy, Mass., June 13, 2014. Quincy, Massachusetts, in 2010 became the first U.S. city to make the drug standard equipment for its police officers, who have used it to reverse some 275 overdoses, a significant number in a city of 93,000 people. Police forces nationwide are starting to follow suit. The state program has now moved far beyond police, training some 25,747 people in Massachusetts how to recognize the signs of opioid drug overdoses and administer naloxone. June 13, 2014. REUTERS/Gretchen Ertl (UNITED STATES - Tags: DRUGS SOCIETY HEALTH CRIME LAW)
A woman suspected of acting under the influence of heroine shows arms to police on April 19, 2017 in Huntington, West Virginia. Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. 'This epidemic doesn't discriminate,' Huntington Mayor Steve Williams said. 'Our youngest overdose was 12 years old. The oldest was 77.' / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)
Paraphernalia for smoking and injecting drugs is seen after being found during a police search on April 19, 2017 in Huntington, West Virginia. Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. 'This epidemic doesn't discriminate,' Huntington Mayor Steve Williams said. 'Our youngest overdose was 12 years old. The oldest was 77.' / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)
Paraphernalia for smoking and injecting drugs is seen after it was found during a police search on April 19, 2017, in Huntington, West Virginia. Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. 'This epidemic doesn't discriminate,' Huntington Mayor Steve Williams said. 'Our youngest overdose was 12 years old. The oldest was 77.' / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)
Paraphernalia for injecting drugs is seen after being found during a police search on April 19, 2017 in Huntington, West Virginia. Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. 'This epidemic doesn't discriminate,' Huntington Mayor Steve Williams said. 'Our youngest overdose was 12 years old. The oldest was 77.' / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)
Jessica, a homeless heroin addict, shows her kit of clean needles, mixing cap and tourniquet in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017. In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia's opioid epidemic. 80 percent of us want to get out,' said Jessica, before outlining the numerous ways she has tried to get treatment for her addiction. In one case, she said, there weren't any available beds. In another, a treatment provider required a positive drug test before delivering aid, meaning if she hadn't used recently she'd be denied. Instead of getting treatment, she spends her nights trying to keep warm on a mattress under a bridge, the very spot where she was raped and infected with HIV. People come from throughout the city, and some as far away as the Midwest, for heroin that is remarkably cheap and pure at the largest heroin market on the East coast. / AFP PHOTO / DOMINICK REUTER (Photo credit should read DOMINICK REUTER/AFP/Getty Images)
Drug paraphernalia and other garbage litter a vacant house on April 19, 2017 in Huntington, West Virginia. Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. 'This epidemic doesn't discriminate,' Huntington Mayor Steve Williams said. 'Our youngest overdose was 12 years old. The oldest was 77.' / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)
A man injects himself in the foot with heroin near a heroin encampmentin the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017. In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia's opioid epidemic. At the camp, and throughout the nearby area, a user can buy a bag of high-grade heroin at a low price and even pay to have another person inject them if for any reason they are unable to inject themselves. For several individuals, the addiction process was a slow one that started with a doctor's prescription for pain pills after an accident or surgery, and by the time the medication was finished, a dependency was born. After seeking black-market pills to feed their addiction, the simple economics of heroin won out: the price of a single pill could fetch anywhere between 2 and 10 bags of heroin, a savings that's hard to ignore when an insurance company is no longer underwriting the cost. / AFP PHOTO / DOMINICK REUTER (Photo credit should read DOMINICK REUTER/AFP/Getty Images)
WASHINGTON, DC - SEPTEMBER 18: Michael Botticelli, U.S. National Drug Control Policy Director, speaks at the 'Fed Up!' rally to end the opioid epidemic on September 18, 2016 in Washington, DC. Activists and family members of people who have died in the opioid and heroin epidemic gathered on the National Mall to march to the Capitol Building. Some 30,000 people die each year due to heroin and painkiller pill addiciton. Speakers called for Congress to provide $1.1 billion for the Comprehensive Addiction and Recovery Act, which Congress passed in July without funding. (Photo by John Moore/Getty Images)
A man uses a syringe to gather the last drops from a scavenged water bottle to mix up a shot of heroin near a heroin encampment in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017. In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia?s opioid epidemic. The tracks and the surrounding property are owned and operated by the Consolidated Rail Corporation, a joint subsidiary of Norfolk Southern and CSX. People come from throughout the city, and some as far away as the Midwest, for heroin that is remarkably cheap and pure at the largest heroin market on the East coast. According to the city Health Commission, Philadelphia is on track to see 33 percent more drug overdose deaths in 2017 over last year. / AFP PHOTO / DOMINICK REUTER (Photo credit should read DOMINICK REUTER/AFP/Getty Images)
A Philadelphia Police officer patrols under a bridge near a heroin encampment in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017. In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia��s opioid epidemic. The tracks and the surrounding property are owned and operated by the Consolidated Rail Corporation, a joint subsidiary of Norfolk Southern and CSX. Last month, Philadelphia Mayor Jim Kenney announced citations against the Consolidated Rail Corporation for what the mayor, in a release, said was Conrail's failure to clean and secure their own property.' Visitors and homeless residents of the gulch say the trash isn't their fault, and that they are only there because they have nowhere else to go. According to the city Health Commission, Philadelphia is on track to see 33 percent more drug overdose deaths in 2017 over last year. / AFP PHOTO / DOMINICK REUTER (Photo credit should read DOMINICK REUTER/AFP/Getty Images)
SANFORD, ME - FEBRUARY 16: Milo Chernin, who lost her son Sam to a heroin overdose on Jan. 16, 2017, looks at photos at her home in Sanford. She says that Sam, who died at age 25, struggled with his addiction and could not stay away from heroin despite getting treatment. (Photo by Derek Davis/Portland Press Herald via Getty Images)
WASHINGTON, DC - SEPTEMBER 18: Activists and family members of loved ones who died in the opioid/heroin epidemic take part in a 'Fed Up!' rally at Capitol Hill on September 18, 2016 in Washington, DC. Protesters called on legistlators to provide funding for the Comprehensive Addiction and Recovery Act, which Congress passed in July without funding. Some 30,000 Americans die each year due to heroin and painkiller pill addiciton in the United States. (Photo by John Moore/Getty Images)
GROTON, CT - MARCH 23: A box of the opioid antidote Naloxone, also known as Narcan, sits on display during a family addiction support group on March 23, 2016 in Groton, CT. The drug is used to revive people suffering from heroin overdose. The group Communities Speak Out organizes monthly meetings at a public library for family members to talk about how their loved ones' addiction affects them and to give each other emotional support. Communities nationwide are struggling with the unprecidented heroin and opioid pain pill epidemic. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide, in an effort to curb the epidemic. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper. (Photo by John Moore/Getty Images)
NEW LONDON, CT - MARCH 23: A heroin user injects himself on March 23, 2016 in New London, CT. Communities throughout New England and nationwide are struggling with the unprecidented heroin and opioid pain pill epidemic. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide, in an effort to curb the epidemic. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper. (Photo by John Moore/Getty Images)
GROTON, CT - MARCH 23: Family members of people addicted heroin and opioid pain pills share stories during a support group on March 23, 2016 in Groton, CT. The group Communities Speak Out organizes monthly meetings at a public library for family members to talk about how their loved ones' addiction affects them and to give each other emotional support. Communities nationwide are struggling with the unprecidented heroin and opioid pain pill epidemic. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide, in an effort to curb the epidemic. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper. (Photo by John Moore/Getty Images)
NEW LONDON, CT - MARCH 14: Jackson, 27, who said he is addicted to prescription medication, lies passed out in a public library on March 14, 2016 in New London, CT. Police say an increasing number of suburban addicts are coming into the city to buy heroin, which is much cheaper than opioid painkillers. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper. (Photo by John Moore/Getty Images)
ST. JOHNSBURY, VT - FEBRUARY 06: 'Buck' who is 23 and addicted to heroin, shoots up Suboxone, a maintenance drug for opioid dependence that is also highly addictive on February 6, 2014 in St. Johnsbury, Vermont. Vermont Governor Peter Shumlin recently devoted his entire State of the State speech to the scourge of heroin. Heroin and other opiates have begun to devastate many communities in the Northeast and Midwest leading to a surge in fatal overdoses in a number of states. As prescription painkillers, such as the synthetic opiate OxyContin, become increasingly expensive and regulated, more and more Americans are turning to heroin to fight pain or to get high. Heroin, which has experienced a surge in production in places such as Afghanistan and parts of Central America, has a relatively inexpensive street price and provides a more powerful affect on the user. (Photo by Spencer Platt/Getty Images)
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Simpson, 34, works at least two 24-hour shifts a week in a high-turnover job that can be stressful and where pay starts at $14 an hour. Just touching Fentanyl can send an EMS worker into overdose.

Simpson's radio crackles with calls. Difficulty breathing. Person down. Unresponsive. Overdose. They turn on the lights and roll. From experience, they know it might be a man who overdosed into unconsciousness while driving, a teen or elderly user passed out in a park or an already stiffened corpse in a hotel room strewn with needles and powder.

On arrival, they spray naloxone up the nose or inject it into the user, pump oxygen into lungs and wait. Some respond gulping for air or vomiting and confused.

“Why are you in my house? What's going on?” Simpson recalled as a common question from recipients of his aid. Some people are grateful and repentant, crying, shaking hands and promising to get treatment. Others deny they took drugs at all.

The calls often come in waves when fentanyl too potent for users hits the streets. Time of day matters, too.

"If it's in the afternoon, there's a much better chance they are still alive," he said. "If we get the call at 7 a.m., they probably shot up the night before."

The paramedics say they often see families torn apart in front of their eyes or bereaved parents.

"You see the parents, they're crushed; just the look of defeat, you know? They lost the most important person in the world to them. I can’t even imagine. But you see it over and over again," Corey said.

The cost of naloxone has risen with demand, eating into the service's budgets, Franklin said. But they are also using their steady overdose runs to help some cities map drug hotspots and for police to visit users to urge them into treatment.

"In the back of the ambulance, you talk to them and hope they get treatment," Simpson said, explaining that most agree they need to get help. "But then at times I'll see the same person three months down the line and they have overdosed."

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Learn more about fentanyl

Fentanyl Citrate, a CLASS II Controlled Substance as classified by the Drug Enforcement Agency in the secure area of a local hospital Friday, July10, 2009.

(Photo By Joe Amon/The Denver Post via Getty Images)

A seized counterfeit hydrocodone tablets in the investigation of a rash of fentanyl overdoses in northern California is shown in this Drug Enforcement Administration (DEA) photo released on April 4, 2016. At least 42 drug overdoses in the past two weeks have been reported in northern California, 10 of them fatal, in what authorities on Monday called the biggest cluster of poisonings linked to the powerful synthetic narcotic fentanyl ever to hit the U.S. West Coast.

(Drug Enforcement Administration/Handout via Reuters)

Fentanyl Citrate, a CLASS II Controlled Substance as classified by the Drug Enforcement Agency in the secure area of a local hospital Friday, July10, 2009.

(Photo By Joe Amon/The Denver Post via Getty Images)

Dory Bauler's unused Fentanyl patch packets. She is one of millions of patients who used the fentanyl patch, which delivers a powerful narcotic through the skin. The patch, brand name Duragesic, was the subject of a recent FDA alert. Patients are overdosing, sometimes they die. Mrs. Bauler came off the patch when she realized the drug was causing her breathing problems, a sign of serious trouble. This photo was taken at her home in Laguna Woods.

(Photo by Glenn Koenig/Los Angeles Times via Getty Images)

A small bag of straight Fentanyl on display at the State Crime Lab at the Ohio Attorney General's headquarters of the Bureau of Criminal Investigation on Wednesday, September 16, 2015 in London, Ohio.

(Photo by Ty Wright for/ For The Washington Post via Getty Images)

'If I don't put these on, it hurts to breathe,' says Smitty Anderson wearing Fentanyl patches to help him deal with the pain caused by multiple myeloma cancer, a blood cancer that affects the bones. Anderson worked at Savannah River Site from 1981 to 1998. The Andersons filed claims to get federal compensation for his disease, which he said came from working at the nuclear site. He had no luck. 'We've been going through so much red tape for years,' he said. 'My wife has to do all the work now. I just don't have the strength anymore.' He died on Nov. 5, 2015.

(Gerry Melendez/The State/TNS via Getty Images)

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