For many they are the difference between life and death.
Cleveland emergency rooms are the heroin epidemic's ground zero of sorts. People are dropped off or rushed in at all hours of the day, every day.
University Hospitals Dr. Robert Hughes sees it almost every shift.
"We're seeing people you never would have associated with drugs. It's a much broader problem then we give it credit for," Hughes said.
On Thursday, the Ohio Attorney General's Office announced it would extend its Narcan rebate program, which has saved state and local agencies almost $400,000 since it began 2015. The extension will last for one year, offering $6 rebates on syringes, the attorney general's office said in a news release. Learn more.
Every case a different story
Just as there is no cookie cutter addict, there's no cookie cutter problem to solve.
"People are getting creative. They're outpacing what we are able to do. And we just have to react," Hughes said.
Like, nasty skin infections.
"Those infections can get pretty bad, leading up to amputations."
Or, many times, people need emergency care, but because they've used drugs hospital staff have issues finding a vein.
"We have the best possible people trying to find IVs and when they can't? We get pushed into a corner," Hughes said.
Doctors are now using ultrasound technology, just to find a usable vein for an IV.
No easy antidote
Narcan (naloxone), administered as a nasal spray or injection, is the go-to for emergency treatment of a heroin overdose. But it's not that simple.
Hughes said sometimes a shot of Narcan is enough to bring someone back from overdose, out of the hospital, so they decide not to head to the ER. However, the antidote is only so strong, so it can wear off and a person can re-relapse at home.
"It doesn't matter if we have one person who overdoses," Hughes said. "Ten. Twenty. Thirty. We find a way to make it happen."