INDIANAPOLIS -- Just before 4:30 p.m. Monday, a 55-year-old woman in the Near Eastside's Bosart Brown Neighborhood loaded up a syringe with heroin.
Twenty minutes later she was dead.
That morning, IMPD officers responded to a home just a few miles southwest in Fountain Square. They arrived to find another patient, this one a 36-year-old man, dead of a suspected overdose.
Later that evening, officers again were dispatched to a possible overdose at a gas station on Emerson Avenue. This time emergency responders arrived on time to revive the 34-year-old woman with the anti-overdose drug naloxone.
All told, Indianapolis EMS crews were dispatched to 13 reported overdoses Monday. The patients were found in Burger King bathrooms, passed out in their vehicles and in north side apartments. Six patients received naloxone. At least two died.
It was an average day.
"This really is typical these days," said Dr. Charles Miramonti, chief of emergency medical services for the city of Indianapolis and Eskenazi Health. "Public places, public bathrooms. Oftentimes it's really right where the deal was done. Right where they purchase their drugs is where they stop to use."
IEMS is dispatched 13 times a day on average for overdose runs. At least five of those 13 typically involve opiate overdoses. That means emergency responders are setting new records for doses of the anti-overdose drug naloxone every year.
In 2011, IEMS administered 565 doses of naloxone. By 2014 that number was 1,061. Last year, IEMS administered 1,818 doses – a more than 220-percent increase from just five years earlier.
"We've broken records every year for the last four or five years," Miramonti said. "Now with the advent of these new versions of fentanyl like carfentanil and u-47700 that are out there, it takes two, three, four times the amount of naloxone to reverse the effects. These drugs are incredibly fast-acting and very difficult to reverse, and oftentimes they move so quickly that you have no chance to call EMS."
Despite all that, Miramonti says we are "probably still at the tip of the iceberg" with the heroin epidemic.
"Heroin is fascinating in that it knows no socioeconomic boundaries," he said. "It doesn't care who you are. It goes across every income, every class, every gender, every race – it doesn't care. It's the first time I think we've ever seen a drug to this extent being across so many different lines and so many different demographics."
In 2015, Indiana ranked 17th in the nation for drug overdose deaths, with 19.5 deaths for every 200,000 residents. In all, 1,245 people died of overdoses that year. The state at least fared better than neighboring Ohio and Kentucky, which ranked third and fourth in the country, respectively.
In Indianapolis, Miramonti says a group of healthcare providers made up of IEMS, Eskenazi Health, Midtown Mental Health and the MESH Coalition is working to tackle the heroin epidemic head on.
"These organizations are really coming together to combat the heroin epidemic and treat it as a true epidemic here in Marion County," Miramonti said.
The group's initiatives include partnering with IMPD to increase naloxone access and training and the implementation of new software to help route drug patients to available mental health, substance abuse and detox beds.
"So we can actually see the system as a single system and move these patients back and forth and open up resources for the folks who are really doing the frontline work," Miramonti said. "We're really trying to find new ways to tackle this problem to invest in ourselves, invest in our community, because as we've seen, just throwing Narcan at this problem isn't the fix."