ST. LOUIS (AP) - As Missouri struggles with the epidemic of opioid abuse, no place in the state has been hit harder than St. Louis.
There were 23 heroin deaths per 100,000 city residents from 2012-16 - the highest rate in Missouri and nearly double the rate in Jefferson County, which had the second-highest rate, the St. Louis Post-Dispatch reported .
The city of St. Louis also leads the state in all types of opioid deaths and emergency room visits caused by prescription painkillers and heroin use.
James Shroba of the Drug Enforcement Agency office in St. Louis said 80 percent of heroin addicts start by abusing prescription painkillers. They eventually switch to heroin because it is easier to get and cheaper, selling for as little as $5-$10 a dose.
Mayor Lyda Krewson said addressing the problem is "going to take all of us."
After opioid deaths spiked in the city from 2015-16, rising from 131 to 273, the 2017 numbers are down 30 from last year's pace. But a troublesome change this year has been the rise of fentanyl, a powerful and often deadly opioid.
Statistics show 56 percent of the opioid overdose deaths in St. Louis involved fentanyl last year, but 84 percent of 2017 overdoses involve the drug.
Janel Marie Wells, 24, of Fenton, overdosed inside a St. Louis home in January. The cause of death was acute fentanyl intoxication.
"To me, this is murder," said her mother, Sharon Hardcastle. "Somebody put fentanyl in whatever my daughter took, and she died."
Hardcastle now tries to warn others about the dangers of fentanyl.
"That's all we feel like we can do is educate people," she said. "You are not going to go do this one night and have fun. You are going to die."
In March, 35-year-old Robert Patrick Stief died after mixing heroin and fentanyl.
"My boy lived a life of pain," his mother, Patricia Gillis, said. "And I lived a life of struggle to work and try to pay to fix him."
Dr. Will Ross, chairman of the St. Louis Joint Boards of Health and Hospitals, said the opioid crisis should be handled like any communicable disease threat: The neighborhood should be flooded with information, treatment referrals and anti-overdose drugs.
"We need to interrupt the habits, the enablers, the structures that perpetuate the epidemic," Ross said.
The St. Louis City Department of Health participates in a prescription drug monitoring program that allows doctors to check a patient's prescribing history and watch for potential abuses. Pharmacists can watch for signs that a patient may need to carry the overdose-reversing treatment naloxone.
Director Melba Moore said the department plans to hire an epidemiologist to track the data that come out of the drug monitoring program. Still, Moore said her department needs more funding to respond to the epidemic.
"It's not like we're turning a deaf ear," Moore said. "We need more people. We need more action."