Ian Brown for NPR
In September 2016, the city of East Liverpool, Ohio, brought national attention when a photo of an overdose of a local couple became viral. It showed a woman and her boyfriend, who had stretched out in the front seat of a car, while the 4-year-old grandson of the woman sat behind. The picture was originally posted by the local police department. Overnight, East Liverpool, a city of just over 11,000, became the face of the opioid crisis that surrounded parts of the country.
Like many small communities in the Appalachian region, East Liverpool struggles with a founding economy. The city is located in the Mahoning Valley, where once a thriving steel industry lived. The region now has high unemployment and a low average income and has experienced a steadily increasing overdose rate for opioids over the last decade.
The virus photo triggered a painful moment of self-reflection in East Liverpool. The Community has taken steps to tackle the addiction problem, but progress has been sporadic. New remedies were available for treatment, and a local clinic offered drug-based treatments in the city, which have since been closed. The police department received a scholarship to set up a fast-reacting team to link overdose patients to recovery services, but funding was tight.
Photographer Ian Brown traveled several times to the East Liverpool area to document this community and talk to people about how they feel about their city and their future. Here are the faces and words of the people of East Liverpool.
After seeing CeCe Douglas (on the right), on the brink of addiction, about to become addicted, she brought together a group of women in the community to launch a base called Charitable Enough Enough. The group helps people to connect with community treatment options, as well as food and fur drums. She believes that the local government and the community should do more to combat the addiction.
Clentona Gist (left) is Douglas' half sister. Gist is recovering from a family tragedy a few years ago. Gist says Douglas has been her main support since then, as she struggles with grief and works on her recovery from a hard cocaine addiction.
Ryan Stovall (left), the mayor of East Liverpool and a part-time police officer, Brian Allen (center), the city's security manager, and John Lane (right), the police chief, have jointly decided to publish the photo and to publish that became viral in 2016, triggering a national conversation about the opioid epidemic.
A more aggressive approach to policing drug dealers, including a community-based program that encourages citizens to report suspected drug-related activities they observe. The government also created a Facebook page that publishes photos of people being charged with drug-related offenses to "out" the merchants and to warn them that East Liverpool has an anti-drug stance.
Some in the community say that this is tougher approach could only shift the problem from East Liverpool to neighboring communities. But Stovall sticks to it and says he "would like to share our effective repayment approach with other communities."
Stovall says his government is now shifting its focus from prosecution to economic growth. "Economic diversity and jobs are the key to our continued success," said Stovall by email.
Tawnia Jenkins grew up in East Liverpool and still lives in the house where she grew up. She started taking drugs in the late 1990s, she says, when she lost her job and had to supplement her income. Jenkins was finally arrested and spent his time in jail. When she was released, she said it was difficult to get a job as a criminal, but eventually she took herself to college.
She now works as a drug-intake counselor and peer-support specialist at a local outpatient clinic, the Family Recovery Center.
Jenkins says she wanted to come back and help, "I returned home to become a thriving backer of East Liverpool citizens."
She says the city still has a long way to go to addiction to fight.
"The cops say they got a tear, but there is still an epidemic here," she says. "There are more bars and empty buildings than resource centers or even apartments for people who want to get clean but are unable to due to housing arrangements."
She says the city also lacks activities that young people could attend: "If you look at the city center, you see empty buildings and have lost hope."
Melody Monteiro grew up in East Liverpool and works as a drug-intake counselor for people who are detained. She says the city had an addiction problem before the infamous overdose photo, including crack and alcohol.
"The picture  has highlighted a problem that has existed for years," she says.
It was not until middle-class residents died of opioid overdoses that the city began to wake up to the seriousness of its problem, she says.
Monteiro says she would like to have more resources for the treatment of housing and supportive living environments for people in recovery, such as half the homes. Without long-term support, people with addictions can lead to relapses. In the region there are few inpatient treatment options, especially for women.
Shannon Marie Johnson is a mother of four and lives in East Liverpool. She says she lost many good friends and acquaintances about heroin. She says talking about these deaths with her children was one of the hardest things she ever had to do. She says, however, she is still optimistic about the future of the city.
In 2015, Glen McMillin Jr. was hit by a drunken driver on his motorcycle. After the accident, painkillers were prescribed by his doctors. He became addicted and started buying pills from traders in the city until he finally consumed heroin.
McMillin says he overdosed three times. Here he is pictured in the ditch where he had his third overdose. He was revived with Narcan and was in intensive care for five days. He then took Vivitrol, an opioid treatment drug, and engaged in a faith-based, nonprofit treatment program that changed his life. He has been recovering for over a year.
Josh Lytle used and traded drugs and spent time in prison. His father started a Faith-based treatment program called Family Care Ministries in 2008 to treat Lytle's addiction and incarceration. In 2016, Lytle and his family moved to East Liverpool to open a new chapter of the ministry. He has teamed up with the police to provide help, treatment and counseling to people who are struggling with addiction and their families.
Policewoman Kelsey Hedrick is a 21-year veteran of the East Liverpool Police. He runs the East Liverpool Police Museum and guides visitors through the city's historic crime scenes. He believes that the police have done a good job in combating the drug epidemic with the resources at their disposal.
Mitzi Stoddard says she has been using heroin for seven years before she went into court-ordered convalescence two years ago. She went to a rehabilitation center, where she learned that she had to change more than her drug use. "You need to change your entire life and mindset," she says.
Addiction is a family affair for her. She says she watched an overdose of a loved one in 2017 and watched as the paramedics revived her with several doses of naloxone, the overdose remedy.
Stoddard says the community needs an economic boom and more addiction treatment resources, including long-term rehabilitation. Trauma counseling and mental health advice.
"We need long-term care … 90 days to 6 months .These types of inpatient facilities exist in neighboring countries," she says.
Ian Brown is a freelance documentary photographer based in Toronto. His series " American Dreams" is a collection of portraits of people in the US. His Instagram is @ianbrownphotography .
This story was edited by Meredith Rizzo and Carmel Wroth of NPR. Design and development of Alyson Hurt by NPR.