After the Medical Examiner carried away the young woman's body, neighbors asked each other: Why here?
When the medics came to the same block for the third time in 11 days, you couldn't help but wonder: Why now?
As the young man crumpled for his 14th overdose, who wouldn't ask: What is driving this epidemic?
The ridge running from Carrick to Allentown, along Brownsville Road, has seen more fatal overdoses than any similar area in the region. From July through October, we asked why.
Never miss a local story.
One block, 11 days, three ODs
Dana Lynn Maxwell hurries down the block, saying that this time, she's done with the drugs that have poisoned her body, jeopardized her family and overwhelmed her neighborhood.
Three times over 11 days, Fire Engine 23 responded to overdoses on this eight-house block of Amanda Avenue, close by the Carrick Shop'n Save. The third time it was Maxwell — 35 and a mother of three — sprawled on a floor, turning blue, with a needle nearby. Firefighters and medics saved her with the anti-overdose drug Narcan.
Now she's scrambling to snag a detox bed before some other struggling soul claims it.
"I don't want my addiction to take me to a place where I'm going to end up in jail, away from my kids," she says. Once detoxed, though, how will she stay clean on a block on which overdoses and drug-related crimes have been a weekly occurrence?
"I need to have a plan about where I'm going," she says. "I can't leave out the house without a plan."
There are few, if any, places in the region in which heroin, opioid pills and the synthetic narcotic fentanyl seem as unavoidable as they do in Carrick, the city's fifth-most-populous neighborhood. Overdoses here, by some measures, run two to three times the citywide rate. With at least 30 fatal overdoses since 2015, there's no neighborhood in the region in which drugs kill more.
That means there's no better place to explore a question asked in overdose-plagued cities nationwide: While nearly every neighborhood has been affected by the opioid crisis, why, and how, have some been devastated?
Addiction most often strikes vulnerable people, in unsettled surroundings, with easy access to drugs. The needles of all of those gauges point to Carrick.
Home to 10,000, Carrick is a place where education often ends at high school and backbreaking labor is a common career path. Once a place to which millworkers moved to raise kids, public housing closures and absentee landlords combined to turn Carrick into a haven for the dislodged and dysfunctional. Situated between suburban money and Hilltop drug markets, its main artery, Brownsville Road, is an easy path to score, by car or the 51 bus.
"We are right at the nexus of where the dealers meet the customers," says city Councilwoman Natalia Rudiak, "and that's certainly contributed to the mess we're in."
Now stop-and-go Brownsville Road traffic snarls when someone overdoses at the wheel. A glance at the sidewalk can reveal discarded stamp bags, or the instructions from a Narcan kit. Amid two-story brick houses with freshly painted porches and front yard flower gardens, you'll find others choked with weeds or junk, or bereft of the downspouts and awnings that were sold as scrap for drug money.
From July through October, the Pittsburgh Post-Gazette's Steve Mellon, Stephanie Strasburg and Rich Lord roamed Brownsville Road, visited the homes of anti-crime activists and narcotics users alike, attended community meetings, and watched as public safety workers responded to overdoses — in time, usually.
"The first time I ever tried heroin, it was IV," meaning intravenous, says Dana Maxwell. "It made me throw up so bad, but I loved it."
She grew up in Baldwin, moving to Carrick to be with the father of her three children. Years of pain pill abuse, starting with prescriptions written in Beltzhoover by a now-retired doctor, gave her a taste for the numbing power of narcotics. When she moved up to heroin, she could always find it in nearby St. Clair Village, a since-demolished public housing complex.
She spent occasional weeks in jail and years in East Liberty, but moved back to Carrick last year after the father of her children fatally overdosed. That way the kids could get her full attention, while staying in their familiar Carrick schools and Brownsville Road church.
Her bid to be a good mother led her to rehab, but there she met Jose Garcia. She invited him in, he relapsed, and she followed.
One late summer night, while the kids were asleep, Garcia overdosed, according to a police affidavit. "Engine 23 administered 2 doses of Narcan prior to our arrival at approx 0045 hours," an officer wrote. "Medic Unit 2 arrived on scene shortly after us and continued to breath(e) for Mr. Garcia while he was unconscious."
After the Narcan kicked in, Garcia refused to allow medics to take him to a hospital. Police, though, found that he was the subject of a Berks County warrant, and took him to jail.
Maxwell, according to the officer, said "she had Garcia inject her with the heroin." Police didn't arrest her, but charged her by summons, for endangering the welfare of her children.
Maybe that could have, or should have, served as the wake-up call she needed. But it didn't.
"I didn't quit using, because I was already in that cycle," she says. "You don't want to do it, but your body is telling you: 'You have to do it.' You're not getting high. You're trying not to be sick and sweaty and restless.
"You're using against your own will."
The social contagion
It's lunch hour, and The Family Restaurant has just one set of diners.
"My customers do not like to drive to here," says Sam Farah, owner of the Syrian food eatery. "Four years, I haven't put a penny in my pocket. . I lose four years of my life because bad area."
One of his customers, Ralph Tarter, a professor at the University of Pittsburgh School of Pharmacy, has spent a career asking why people become addicted. He's never before been to Carrick, and is only here now because reporters invited him here for a lunch interview. Nothing about the neighborhood, though, surprises him.
Genetics and upbringing make some people more likely to develop addictions, he says. Some of them tumble down the socio-economic ladder, clustering in places with less expensive housing and easy access to drugs. In such places, institutions like churches, schools and athletic leagues often weaken. A "social contagion" takes hold, in which drug abuse becomes accepted. Because impulsive behavior is passed from parents to children, by genetics and household stress, a neighborhood's spiral can become generational.
All of that has been true since mankind discovered that some plants make you happy. Modern life, he says, adds an "enormous buffet of compounds," including cheap opioids that grab and hold people, particularly the young.
The country, state and county are seeing an exponential spike in drug deaths, and it may have roots in economics and attitudes, says Donald S. Burke, dean of the University of Pittsburgh's Graduate School of Public Health, in a separate interview.
"The price of heroin as a drug has fallen about fivefold" in recent decades, he says. "And fentanyl is cheaper to produce than heroin." He adds that studies suggest that "lack of sense of purpose" in a community is also tied to overdoses.
"This can be fixed, and there are places that it is being fixed, because they're being rational about it," says Dr. Tarter. Churches, schools, recreation centers and libraries "need to be repurposed, and can be repurposed" so that they guide people toward better decisions, he says.
But Carrick could also start small: Gather a corps of volunteers to go to homes with newborns, offer help, counseling, diapers -- whatever they need. A child, he notes, can be a catalyst.
Someone, he says, needs to tell the parent, "'My gosh, you have a child that's looking up to you.'" Then, he says, "You have a hook to get an intervention."
Three days after Fire Engine 23 pulled up to save Garcia, it's back, on the other end of the same troubled block of Amanda Avenue.
It's rare that the firefighters serving Carrick go more than a few days between overdoses. They make 10 percent of the "saves" logged by their bureau, though they cover just 3.3 percent of the city's population.
This time, the crew hauls the Narcan kit up the steps of a "recovery house," owned by Samuel Vogt, where numerous young women are trying to leave old habits behind.
Neither Narcan nor a body bag, it turns out, are needed. The woman used benzodiazepines, a class of tranquilizers, rather than opioids, and is coming out of it. After other residents of the house shout down their stumbling housemate, she packs her bags, under a police officer's eye, and another woman drives her away.
Brownsville Road bustles with drug deals, but just as much with traffic in and out of recovery houses and Narcotics Anonymous meetings. Recovering here involves facing temptation.
"You're going to have people offer you drugs," says Dan Pace, 31, of Observatory Hill, whose two-year fight to get sober included a stint in a recovery house on Brownsville. "You're going to be walking past trap houses" where dealers posted on porches watch for users, and you'll quickly spot the "bandos" -- abandoned houses in which users gather to shoot up.
A few relapses later, he's now two months clean and staying in a "Serenity House" in the West End, run by Gus DiRenna, a former heroin user who now houses, employs and counsels others in recovery.
There are some phenomenal recovery houses in the area, says Stacie Brown, who visits them as part of her job at the Onala Club, a South Shore gathering place for people who are trying to stay clean. A few months in such a place gives the addicted person "time to figure out who they are, that they don't have to shoot dope, they don't have to live like that."
Where there's recovery, though, there will be relapses. They can be deadly, because the person has been off drugs, has a lowered tolerance and may use too much.
Most days, Brown holds training sessions in the use of Narcan, many of them at recovery houses. She knows that in Carrick, some people blame the recovery houses for bringing into the neighborhood people who have problems -- including a few who don't deal with them well. "It takes one individual," she says, "and then that house is condemned, basically, by the neighborhood."
Recovery houses should be registered and regulated, but aren't the cause of Carrick's troubles, says Rudiak. "They are here because there's a need for them here."
Gotta find something
Steve Roak strides down the block, his arms swinging wide like wings, then coming together in thunderous claps. He's feeling good this morning. That won't last, though, and from this block in Carrick, he doesn't see a clear path away from heroin and fentanyl.
"Everybody you talk to is on it," says the 33-year-old landscaper, after he settles down on the front steps of the home his family rents from a police officer. "There's not one person in Carrick that don't do it. Not that I know of."
It's been almost a month since he was last arrested for heroin possession. Two of his sisters, Margie Johnson and Doris Roak, were also arrested with drug paraphernalia within the prior month. His younger brother, James Roak, lost his job, marriage and house to narcotics, and in 2014, at the age of 29, fatally overdosed on black market methadone, leaving behind two children.
His family's landlord, Pittsburgh police Officer George Cunic, says later that he has tried to help the Roaks, including James.
"I knew he was on heroin, and I told him, 'There's so much help out there,'" says Officer Cunic, before declining to talk about it further. "He laughed at me, and told me, 'George, I know what you do for a living, and I don't tell you that you can't have a beer.'"
Back on the front steps, Steve Roak rattles off a list of friends who died from drugs.
"Some people are just so greedy, they think that they're not going to get high off of it, and they put too much in there, and they do it, and it's over," he says. "Because I ain't stupid, I only do a half (bag). Even if I have a whole 10 bags, I only do a half."
He says his drug problem started when doctors treated his neck pain -- perhaps due to a childhood car accident -- with the narcotic Tramadol. When the doctors stopped the prescriptions, he chose heroin over withdrawal. Now, every morning he's "dope sick."
"I try to take ibuprofen or something or drink a lot of coffee or drink a Red Bull -- something just to give me a little bit of energy," he says. "It don't get me off sick, but it helps me a little bit."
Then he's off in search of odd landscaping jobs. Success means a few strips of black market Suboxone, or a few stamp bags of heroin, fentanyl or both. "I gotta find something," he says, as the sun climbs.
The alternative? "You feel dead to the world. You feel irritated. You feel -- you just feel not like a person at all, like a zombie, basically," he says. "You sweat. You shake. You can't sleep. Your legs twitch and jump. You have anxiety. You can't sit still."
There aren't many people in his life who have cleaned up and straightened out. Still, he doesn't believe it's impossible. "I just got to get my head out of my ass and do it."
Throwing it in His face
Eleven days after Engine 23 arrived to save Jose Garcia, and a week after it showed up at the recovery house, it made yet another trip to this block. This time, as night fell, it was Dana Maxwell who needed Narcan to survive.
"Maxwell stated that she was at the hospital earlier because of an abscess on her arm," according to the resulting police affidavit. "Maxwell said the doctor gave her fentanyl and then she came home to rest. Maxwell said her friend came over around 1900 hours and gave her a loaded needle of heroin."
Police wrote that the teenage girl who called 911 was "visibly upset" and "began to hyperventilate," but eventually calmed down. Police let Maxwell's kids go to their grandmother's house, and charged the mother, for the second time in two weeks, with endangering the welfare of children.
Twelve days after that overdose, Maxwell is back on her porch following a week in a detox facility and one night in jail. She's a little bit sick, and whirling between anger, guilt and thankfulness.
The anger? At the "friend," a Carrick man who, she says, dashed when she overdosed. "He left me to die," she says. She's alive because her kids heard the thud of her body against the floor, called 911 and tried CPR. "I gave them life, and they turned around and saved my life."
The guilt? Because she isn't the mother she wants to be. "They deserve someone that's going to be there," she says.
The thankfulness? "I feel like I'm blessed and favored by God and I don't want to keep throwing this in His face. . I don't need to be the next fatality here in Carrick."
A neighborhood looking for recovery
Block watch leader Carol Anthony is tired of paying for Narcan.
Her husband just got a bill for thousands of dollars in copays for conventional medical care, Anthony tells her 40 fellow Carrick Overbrook Block Watch meeting attendees. Narcotics abusers, by contrast, are "getting free Narcan over and over and over."
Somebody from the back of the Pittsburgh Concord K-5 auditorium shouts out that people who overdose should pay for their Narcan, (which its maker sells for $37.50 per dose in bulk) at least after their first "save." Others in Carrick argue that drug users should be left to their fates.
City policy, though, is to do what it takes to save every possible life. This year through August, firefighters serving Carrick used Narcan 91 times. That's nearly 10 percent of firefighter "saves" in the city, while Carrick is home to just 3.3 percent of the city's population. (Police and medics -- who, combined, made a similar number of Narcan saves citywide -- were unable to provide neighborhood breakdowns.)
Overdoses, drug-related petty crime and suspicious-seeming newcomers are the talk of the neighborhood. Some of Carrick's veteran advocates tie those problems to absentee landlords who live as far afield as Israel, the elimination of nearby public housing and the gradual decline of neighborhood institutions and businesses. Though a new coalition is trying to curb overdoses in this and other South Hills communities, few believe the solutions are simple, none profess that the problem has peaked, and morale is sagging.
"It's very frustrating for police officers that the person was almost deceased, we give them the Narcan, and they can just walk away," Pittsburgh Police Officer Christine Luffey tells the block watch crowd.
While they wait for their guest speaker, the officer gives them highlights from the past month's cases. Among them: the overdose of Jose Garcia, and the resulting charge of endangering the welfare of children against Dana Maxwell, 35. The officer's takeaway: "Drugs and kids do not mix well." The crowd tsk-tsks the absent mother.
Officer Jake Alex inspects confiscated stamp bags as he does paperwork at the end of his shift at the Mt. Oliver Police Department. (Stephanie Strasburg/Post-Gazette)
In walks city narcotics Detective Calvin Kennedy, dressed in gray street clothes that match his hair. He tells the watchers that until this year, he thought saving people meant getting them out of the path of a gunman, rather than "squirting something up somebody's nose to have them OD again 24 hours later."
And before this year, his idea of a good day at work was to go to a neighborhood, identify the bad actors, establish probable cause, then jump out of an unmarked car and make arrests. Starting Jan. 1, though, his orders changed.
"My job now is to investigate overdose deaths," he says, holding up a thick sheaf of papers. "How the hell? Do you see this list?"
Once there was a pill problem
Brownsville Road, 2200 block
District Judge Richard King keeps closing files for his least favorite reason: Because the defendant has died of an overdose. For the most part, these aren't criminals, but defendants in civil cases, like evictions. "I do over 500, 600 landlord-tenant cases" each year, says Judge King, who lives in Carrick and holds court there in a room decorated with photos of Pittsburgh sports triumphs. "A lot of that is addiction. . The money goes to the drug. It doesn't go to the bills that need to be paid, and they get behind on the rent."
When he was growing up in Carrick, around 1970, drinking beer and smoking marijuana in clearings in the woods was part of the typical coming-of-age story. Few people, though, moved on to hard drugs. These days, his courtroom swells with people who completely skipped the "gateway drugs."
"They just started out with the heavyweight champion of the world," he says. "It kind of took hold with a lot of people, mostly younger, that I don't think had an idea of how powerful an addictive drug" an opioid can be.
"When you talk to older people in the neighborhoods, they say that South Pittsburgh had a pill problem," says city Councilwoman Natalia Rudiak, who grew up in Carrick in the 1990s and lives there now, in a separate interview.
Her hard-working neighborhood may have been more susceptible than most. "Whether you're laying brick or working as a construction worker or a nurse's aide, a lot of the work is physical," she says. "We're strong, working people. We make the city go around. But the work is literally backbreaking work."
In recent years, a sore back led to "a doctor pushing painkillers," she says. Extra pills stowed in medicine cabinets found their way to the streets.
When law enforcement and state regulators told doctors to curb their painkiller prescribing, heroin dealers swooped in -- a narrative heard nationwide, but especially in the hills from Western Pennsylvania to Tennessee. Then cheaper, more powerful synthetic narcotics like fentanyl, largely concocted overseas, grabbed market share and boosted the body count.
"We were just, like, wracking our brains," says Rudiak. She called meetings with the Allegheny County Department of Health and Department of Human Services, state agencies, academic experts, nonprofit treatment groups and city public safety bureaus.
Those meetings led to the creation, early this summer, of the South Pittsburgh Opioid Action Coalition, which includes representatives of schools, churches and community groups, plus public safety and health officials. It meets monthly in neighboring Brookline, and has closed its doors to the press.
The coalition is working on improving drug education in schools and sponsoring a "recovery volunteer fair" to attract people who want to help. It plans to sponsor teams that will visit people post-overdose "and talk with the person to try to get them into treatment," says Rudiak.
Her term ends with the year, but she believes the coalition, and neighborhood, will march on.
"I have no doubt in my mind that Carrick will return to its full vibrancy," she says, "and I think it will happen in the next three to five years."