"They're just showing up and dying."
Those six words made emergency responders' ears perk up in Huntington, W.Va., when they buzzed over the radio. An official was quoting a caller who needed help at a local home.
"I just caught a bit of that," another official replied. "What are people showing up and doing?"
"All they can tell us is that 'people are showing up and dying,'" the first official said. "We're not sure what's going on."
It was Monday afternoon, and an unusual mass crisis was beginning to unfold in Huntington, a city of nearly 50,000 on the western edge of West Virginia — a crisis increasingly familiar to paramedics, firefighters and police officers across the United States.
When police arrived at the house shortly after 3:30 p.m., they found seven people -- four inside, three outside in the yard — who had just overdosed on what appeared to be an especially nasty batch of heroin.
Yet that was only the beginning.
"I've just got another one that just come in," an official radioed a few minutes later, bringing news of another overdose call.
"Annnnnd we just got another one."
"I've got two additional overdoses."
The calls didn't stop. All afternoon, ambulances, police officers and firefighters began crisscrossing the city, responding to reports of more than two dozen men and women overdosing -- in homes, in a gas station bathroom, at a Family Dollar store, in a Burger King parking lot, slumped behind the wheel in traffic on the West 17th Street Bridge. Others appeared at the hospital.
Overdoses are not something new to Huntington, a college town that often sees drugs flow in from Detroit and Columbus, Ohio. Gripped first by pill mills and now by a heroin epidemic, West Virginia has the nation's deadliest overdose rate by far, with 35 of every 100,000 residents dying each year by that cause. Huntington's overdose rate is more than three times higher.
"It's not uncommon to find them slumped over at a red light, car in gear," Huntington Police Chief Joe Ciccarelli said. "We have led the state in last two years in DUI arrests, and 65% of those arrests are people on drugs."
But what happened earlier this week was exceptional.
Cabell County normally sees about 18 to 20 overdose calls a week, according to Gordon Merry, the director of Cabell County Emergency Medical Services, whose offices are in Huntington.
In just five hours on Monday, the county blew way past that weekly average.
From 3:21 p.m. to 8:33 p.m., officials responded to calls for 26 overdose victims, almost all of them in Huntington, according to city spokesman Brian Chambers. Their ages ranged from their 20s to their 50s.
"3:30 to 4 p.m. was unbelievable," Merry said. "I've never seen it that bad. … Truly, it was overwhelming for us."
Investigators think that it's likely a potent batch of drugs had just appeared in Huntington and had been distributed — and taken — widely and quickly, leading to a crush of overdose cases all at once.
As the opioid addiction crisis has grown across the U.S. in recent years, illicit batches of unusually powerful opiates can bring overdose outbreaks with dozens of victims, such as when at least 11 people died in the Sacramento County area last spring.
In some of those cases, the drugs are laced with a powerful and potentially lethal additive such as fentanyl that can cause addicts to stop breathing and their hearts to stop beating.
On Monday night, officials responded to what they didn't initially realize was their 27th call, a Huntington man who died after being taken to the hospital. A relative reported that the man had been suffering a seizure, and did not mention that he was an addict, Ciccarelli said.
The next day, officials found another body outside city limits, that of a man who had been in recovery from addiction and who had probably overdosed Monday, Ciccarelli said.
But given the scale of the crisis that had unfolded, those were the only two deaths. For that, Huntington likely has naloxone to thank.
Last year, Gov. Earl Ray Tomblin signed a bill into law expanding access to naloxone, the highly effective opioid overdose antidote, to first responders and the public. Now, every Cabell County ambulance crew carries naloxone, and since earlier this year, so do the local police and fire crews.
One Huntington officer used naloxone on a man and a woman when he arrived at the house with seven overdose victims. Officials said EMS responders gave naloxone to about 10 other victims.
Expanded naloxone access came after opioid overdoses had surged in recent years to epidemic levels and become the third-leading cause of death in Huntington, killing 58 of the town's residents in 2015, according to Dr. Michael Kilkenny, the physician director of Cabell-Huntington Health Department.
In response, the city expanded its anti-drug efforts to include overdose treatment in addition to needle-exchange programs to prevent transmission of HIV and hepatitis B and C.
As a result, needle-sharing has plummeted among addicts, and so far in 2016, overdose deaths have dropped 25% to 30%, Kilkenny said.
"I think that it reflects that our strategies are working," Kilkenny said. "Naloxone is a great tool to use, and especially useful in the hands of community members closest to the victims. But it takes more than just tools; you have to know how to use them, and the community's done a great job about education concerning drug overdoses."
But the struggle will continue, and officials have to watch out for how addiction can affect the next generation of West Virginians.
Jan Rader, the deputy chief of the Huntington Fire Department and a registered nurse, has worked in the area for 22 years and rarely used to see overdose calls. Now, emergency responders might respond to a home and find parents who shot up and overdosed while their children were in the room.
"Children being present with the overdose victim is the norm, not the exception, now," Rader said. "Kids are being raised in this environment."
As Rader spoke on the phone, she was interrupted by a loud alert noise.
"I have an overdose that just came in over my radio," Rader said. "Sorry about that."
Follow me on Twitter: @mattdpearce