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, Aug. 23, 2017.
The opioid crisis leaves no community in the U.S. untouched. It’s nationwide, but it hits small towns and rural states particularly hard.

In tiny Bellevue, Ohio, population 8,000, Koriann Evans had just gotten fentanyl from her dealer. Fentanyl is a drug dozens of times more powerful than heroin, and Evans couldn’t wait to get home to take it so she took it in her car and was driving home with her two young children in the back seat when she started to overdose.

One of her daughters asked if she was OK. “Mommy can’t breathe,” Evans told her. Evans managed to hit the brakes before passing out. She was lucky. She was taken to a hospital where doctors revived her before it was too late.

Evans has since stopped taking opioids.

“I almost killed my kids. I didn’t have it (the car) in park. I could have flipped that car and killed them or I could have killed other people,” she said.

Sheriff John Tharp in Lucas County Ohio near Lake Erie, says the number of accidents caused by people overdosing on heroin and other drugs “has just skyrocketed.” Tharp says people commonly shoot up in their cars after buying the drugs.

Manchester, with 110,000 residents, is the most populous city in New Hampshire. Its opioid addiction problem is so notorious that President Donald Trump traveled there to announce his plan to combat the country’s opioid crisis.

President Donald Trump speaks about his plan to combat opioid drug addiction at Manchester Community College, March 19, 2018, in Manchester, New Hampshire.

Three years ago, after overdose emergency calls exploded in Manchester, firefighters started a program called “Safe Station,” a program that encourages addicts to seek help at every firehouse in the state without judgment. It started when one of the firefighters helped a colleague’s brother, addicted to drugs, and on the verge of suicide. In its first month, 80 people sought help. Now the average is almost twice as many.

The Centers for Disease Control and Prevention reports that more than 40,000 people died from opioid overdoses in 2016, a five-fold increase from 1999. More recent statistics are not yet available.

Rural doctors can feel overwhelmed. Dr. Jennifer Allen practices medicine in Hannibal, Missouri, population 17,000. Allen says she feels alone. The next clinic is a two-hour drive from Hannibal. At her clinic, Allen witnesses first hand how hard families and individuals suffer because of the opioid epidemic.

Hannibal, Manchester and Bellevue, like many small towns across the U.S., don’t have the resources to fight this epidemic alone.

“No one agency can do this, no one city can do this,” Manchester’s Fire Chief Daniel Goonan said. “This is way above my pay grade! It’s above any community’s pay grade, any state’s pay grade. This has got to be an all out, all hands on deck effort to fix this thing, nationwide.”

The University of Missouri School of Medicine is making a difference in its state. It started a program that uses video conferencing to help doctors in rural areas.

Inside a secure room at the University of Missouri, doctors from across the state can talk to trained specialists. Dr. Doug Burgess, with the University of Missouri at the Kansas City campus, assists with the program.

“We have therapists, we have pharmacologists, we have primary care doctors and physicians, and as a group there is a lot of expertise there,” he said.

Dr. Karen Edison, the medical director at the university’s School of Medicine says the doctors become part of a learning collaborative where they can ask their questions, present their patients and come up with a strategy that will help that patient.

One out of every 66 deaths in Missouri is related to opioid or heroin overdoses, higher than the national average.

Doctors, firefighters and police in small towns throughout the U.S. understand it will take a team approach to change the trajectory of this epidemic.

In Hannibal, Allen says the program helps her to understand “that yes, OK, we’re doing things right or, no, here is something we can change or improve on.”

Addicts need help without the fear of being stigmatized or being arrested. The crisis is so widespread that the surgeon general is urging people to carry naloxone, a drug that reverses the effects of drug overdoses and saves lives.

Ending the crisis is indeed an all hands on deck effort, and those hands have to be made up of the entire nation.

By  Carol Pearson | VOA News