LOUISVILLE, Ky. (AP) — During a recent shift spent treating numerous overdoses, Dr. Robert Couch heard a similar refrain from patients: they couldn't believe that the small amounts of heroin they took nearly killed them.
On Tuesday, at Norton Hospital in Louisville, Couch treated eight overdose patients in five hours — an unprecedented number for the emergency physician.
He sees it as a clear sign of a public health emergency.
"Usually, you don't see true fear in many of the addicted population," Couch said Wednesday. "But several of my patients were really scared about what happened.
"These people were scared because they were using tiny amounts of heroin and almost died."
Couch is on the front lines of what appears to be a spike in heroin overdoses in Kentucky's largest city. It's part of a trend plaguing other communities in Kentucky and the neighboring states of Indiana, Ohio and West Virginia.
Louisville Metro EMS said it responded to 28 drug-overdose calls Tuesday, and 20 patients were transported to hospitals. A week earlier, EMS made 20 such runs.
Drug prevention officials suspect the overdose surge in Louisville was caused by a heroin shipment laced with another powerful drug, perhaps fentanyl, a synthetic opioid.
"These synthetic opioids create challenges like we have never seen before," Van Ingram, executive director of Kentucky's Office of Drug Control Policy, said Wednesday.
Kentucky Gov. Matt Bevin called the state's drug scourge "unacceptable," and said his administration would fight it "with every resource at our disposal."
"In the meantime, I call upon every Kentuckian to stand in the gap as best you can to intervene in the lives of those addicted to drugs," the Republican governor said. "They need our love and support and they need our help in finding their way to rehabilitation and recovery."
The one-day surge signaled a deadly problem brewing for months. In March, Louisville officials said a more dangerous mix of drugs was circulating on Louisville streets.
"Substances are becoming more lethal," said Dr. Sarah Moyer, medical director for the city's Department of Public Health and Wellness. "Despite our prevention efforts, we're seeing more deaths."
Louisville had 140 drug overdose deaths this year as of Sunday, compared to 90 a year ago, she said.
Last year, statewide drug overdose deaths in Kentucky totaled 1,248, up from 1,071 in 2014. Heroin was detected in 28 percent of cases, consistent with the prior year.
But fentanyl was a factor in 420 fatal overdoses in 2015, up from 121 the previous year.
Couch's overdose patients all survived Tuesday, but some of them might have died without naloxone, a now widely available overdose antidote, he said.
Last year, Kentucky lawmakers passed legislation that increased spending for substance-abuse treatment programs and toughened penalties for heroin dealers.
Louisville's response has included bringing together public and private sources to deal with addiction prevention, education and treatment efforts.
But the lack of available drug treatment beds remains an acute problem.
The Healing Place, which treats drug addicts, turns away 300 men, on average, every month from its detox facility in Louisville, said spokeswoman Laci Comer.
"It's heartbreaking for us because these are men who are coming in wanting to get help and we just can't," she said. "We don't have the space."
One man slept in a nearby ditch until detox space opened, she said. The man went on to complete the center's long-term recovery program.
The facility, which also treats women, is raising money for a planned expansion of its Louisville facility for men.
Once opened, the expanded space is expected to fill quickly, she said.
Others are predicting a long, difficult fight to combat addiction woes.
"The way it's been going, I think it is going to get worse before it gets better," Moyer said.