MIDDLETOWN, Ohio – The coroner here in the outer suburbs of Cincinnati gets the call almost every day.

Man “slumped over the dining room table.” Woman “found in the garage.” Man “found face down on the kitchen floor of his sister’s residence.” Man “on his bedroom floor – there was a syringe beneath the body.” Coroner Lisa K. Mannix chronicles them all in autopsy reports.

With 96 fatal overdoses in just the first four months of this year, Mannix said the opioid epidemic ravaging western Ohio and scores of other communities along the Appalachian Mountains and the rivers that flow from it continues to worsen. Hospitals are overwhelmed with overdoses, small-town morgues are running out space for the bodies, and local officials from Kentucky to Maine are struggling to pay for attempting to revive, rehabilitate or bury the victims.

As their budgets strain, communities have begun questioning how much money and effort they should be spending to deal with overdoses, especially in cases involving people who have taken near-fatal overdoses multiple times. State and local officials say it might be time for “tough love”: pushing soaring medical costs onto drug abusers or even limiting how many times first responders can save an individual’s life.

“It’s not that I don’t want to treat overdose victims, it’s that the city cannot afford to treat overdose victims,” said Middletown Council Member Daniel Picard, noting this industrial town in northern Butler County might have to raise taxes in response to the crisis.

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To reverse a still-spiraling American crisis fueled by prescription narcotic drugs, a panel of experts advising the federal government has recommended sweeping changes in the ways that physicians treat pain, their patients cope with pain, and government and private insurers support the care of people living with chronic pain.

In a comprehensive report on what must be done to staunch the toll of opiates in the United States, a panel of the National Academies of Science, Engineering and Medicine makes clear that steps needed to prevent the creation of future opiate addicts will drive some people who are now dependent on these medications toward street drugs such as fentanyl and heroin.

“It is therefore ethically imperative to couple a strategy for reducing lawful access to opioids with an investment in treatment for the millions of individuals” already hooked on the painkillers, the panel wrote.

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While most of us do not spend our days preoccupied with the details of a wide-spread disease outbreak or medical transportation services during a large winter storm, there is a small group of seven

The Baltimore City Health Department has declared a Code Red heat advisory Thursday with a heat index around 105 degrees expected.

The National Weather Service has issued a heat advisory for noon to 8 p.m. Thursday for areas east of the Interstate 95 corridor and Maryland's Eastern Shore. A heat advisory means that a period of high temperatures is expected. Temperatures will be in the mid to upper 90s. The combination of high temperatures and high humidity could create a situation in which heat illnesses are possible.

"Heat is a silent killer and a public health threat, particularly for the young, the elderly and those in our city who are the most vulnerable," Baltimore City Health Commissioner Dr. Leana Wen said. "With (Thursday's) extreme heat expected, it is important for all residents to protect against hyperthermia and dehydration. Please be cautious and remember to stay cool and hydrated."

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