CINCINNATI (AP) — Forehead furrowed, a woman drags on a Camel cigarette, admitting she has only vague memories of nearly dying five days earlier.
Some flashes of images of being inside an ambulance. Waking up in a hospital bed. No recognition, though, of the solidly built, 6-foot-4 blue-uniformed police officer now leaning against a wall in her kitchen, having returned not to arrest her, but to help with her battle against heroin.
The officer, David Hubbard, a veteran narcotics detective, is part of the "Quick Response Team" formed last July in Colerain Township, a sprawling suburb of some 60,000 people 15 miles northwest of Cincinnati. Police, paramedics and addiction counselors combine to quickly steer users into treatment while their overdoses are still raw and frightening.
It's among new approaches, some that are redefining police roles, being tried in hard-hit communities across the country. While some critics ask whether police are putting social work over law enforcement, authorities say that while they are stepping up efforts against dealers, they can't arrest their way out of such a pervasive epidemic.
"There were some naysayers who say these are nothing but junkies — lock them up," said John Tharp, sheriff in Lucas County, home to Toledo, Ohio's fourth-largest city. "We may think this is soft (for police), but when you have a crisis in your community, you need to be proactive. We're being aggressive."
The U.S. Centers for Disease Control and Prevention reports heroin overdose death rates more than tripled since 2010 as powerful, cheap forms swept America. Ohio ranked among the top five states in drug overdose deaths in 2014, including 1,177 linked to heroin, and had one of the biggest increases.
In Massachusetts, Gloucester's police chief famously pioneered a program last year to help get addicts into treatment if they turn in their drugs and drug equipment, no questions asked. Departments in other states have adopted aspects of the program.
Tharp's Drug Abuse Response Team (D.A.R.T.) was formed in June 2014 amid rising overdose deaths in the Toledo area. Police, accompanied by counselors, meet with users and families as soon as possible after overdoses, even providing rides to treatment. Hundreds have entered treatment through the effort.
In Colerain Township, Public Safety Director Dan Meloy said the program launched last July appears to be having an impact already. On pace to top 200 overdoses when it started, the township ended 2015 with 167.
The programs help reduce other crimes, police say.
"They're not breaking into their neighbors' sheds, they're not robbing the local stores, they're not stealing from their families trying to feed their habit," Meloy said.
Ohio officials are battling heroin on other fronts, too.
Gov. John Kasich's office last month announced the latest in a series of guidelines aimed at reducing prescription painkiller abuse often linked to leading to heroin use, this time promoting alternative pain relief methods. Attorney General Mike DeWine convened a statewide summit and spotlighted "holistic approaches" being tried. U.S. Sen. Rob Portman, R-Ohio, has been building bipartisan support in Washington for a bill that focuses on making sure patients get optimal treatment.
Some black Americans long involved in the criminal justice system point out that gentler responses to the heroin use rising sharply among whites weren't so available when the crack cocaine wave swept into urban neighborhoods.
"I applaud law enforcement agencies for treating the heroin epidemic as a public health, rather than criminal justice, problem," said David Singleton, a veteran attorney who's executive director of the Ohio Justice & Policy Center, in an email. "At the same time, it is deeply troubling that we are shifting our approach from incarceration to treatment for an epidemic that primarily affects white people."
Near Colerain Township, Hamilton city police work with Fort Hamilton Hospital, where chief medical officer Dr. Marcus Romanello said the emergency room has repeatedly seen cases in which overdose patients were saved there, then ended up dying at home in a subsequent overdose. F.O.R.T (Fort's Opiate Recovery Taskforce) began late last year, involving police and other first responders, therapists, a social worker, and a hospital pharmacist to help steer them into treatment and provide families with resources.
Overdose tolls have been aggravated by the spreading use of fentanyl, a strong painkiller that can be combined with heroin or snorted alone. In Lucas County, the number of overdose deaths again rose last year, complicating evaluation of the new program's success.
Police said their helping programs often lead to valuable anti-drug intelligence as they target suppliers.
"We're still arresting people," Hubbard said. "But now we're fighting it from all angles."
He continues to be amazed that drug users, including some he has arrested in the past, will open their doors to him after an overdose. He said they often break down, grateful to be offered help.
"I was skeptical," he said. "It's changed my mind."
The woman Hubbard helped in early January agreed to speak to The Associated Press on the condition of anonymity because she didn't want people she knows to hear about her heroin use.
"I could be dead," the woman, in her 50s, said as Judy Garland's voice warbled in the living room: "Somewhere, over the rainbow, way up high."
A $10 shot of heroin sent her plunging toward death. Emergency crews responding to a 911 call injected the overdose reversal drug naloxone but took her to a hospital when she remained unstable.
She wants to stop using drugs, she said, but "I need help."
Hubbard also recently visited with Damon Carroll, 23, showing off fishing photos from a Florida vacation. Carroll was found overdosed on his bedroom floor last summer, just as the Colerain program was beginning.
"It's a big thing to me," Carroll said. Officers stop by his home just to see if he's doing OK. He's been in treatment and is doing well in a restaurant job.
He said hearing other success stories from the program encourages him: "It lets me know that I'm not alone."
Follow the reporter at http://www.twitter.com/dansewell
To see some of his other recent stories: http://bigstory.ap.org/content/dan-sewell