CLEVELAND - As Northeast Ohio struggles to try and curb a horrific and deadly drug epidemic, a new threat has emerged from a narcotic whose potential to kill dwarfs even heroin.
Like heroin, fentanyl is an opiate-based painkiller. Its legal uses include to help control pain for cancer patients, and to help keep patients sedated during open-heart surgery.
While estimates vary on its potency, Cuyahoga County Medical Examiner Dr. Tom Gilson puts it at "twenty to thirty times heroin."
And, as Mexican drug cartels have begun mixing fentanyl in with heroin, the number of overdose deaths from the drug in Cuyahoga County has been soaring.
There were five fentanyl-related deaths in the county in 2013, 37 in 2014, and at least 68 last year (the final death toll from last year may go up as results from autopsies come in over the next month.).
"It is far more devastating than heroin ever could be," says Jason Sebaugh, one of the lucky few to have overdosed on fentanyl and lived to tell about it.
Sebaugh received treatment at Stella Maris in Cleveland, after paramedics were able to revive him by injecting him with three doses of an antidote drug.
He says fentanyl is more potent than heroin, but, ironically, the more intense "high" that addicts are chasing just isn't there.
"That's completely not the case," he says.
As with heroin, Ohio has become an epicenter of the fentanyl epidemic.
The Ohio Department of Health reports there were 84 fentanyl-related deaths in the state in 2013; in 2014, that number skyrocketed to 502.
"I've talked to a couple clients who've told me that actually request fentanyl (from drug dealers)," says Carole Negus, the Nursing Director at Stella Maris.
"We are not right-sized for the problems," says Bill Denihan, the CEO of the local mental health board.
Indeed, the fentanyl problem is worse here than anywhere, according to numbers from the Drug Enforcement Administration.
Neighboring Pennsylvania had the third highest number of fentanyl seizures by law enforcement in 2014 with 419, according to DEA statistics.
The second highest state that year, the latest for which numbers are available, was Massachusetts with 630.
That same year, authorities in Ohio made 1,245 fetanyl seizures - more than Massachusetts and Pennsylvania combined.
Prosecutors say they know that they won't be able to stop the epidemic just by arresting dealers.
But outgoing U.S. Attorney Steve Dettelbach says prosecutors are "willing to bring very serious, death penalty specifications against people caught dealing fentanyl."
For users, their first encounter with fentanyl can be their last.
"Usually, people who use fentanyl don't make it to drug court, - it kills that quickly," says David Matia, Cuyahoga County's Drug Court Judge.
Matia says a much more intense and widespread effort is needed to curb the abuse of the drug, in part because of its potential to kill so fast - often, the first time an addict tries it.
"Are diabetics worth saving? Of course, the are," Matia says, "So, what's different about a heroin addict? Nothing, they have the same type of chronic disease."
And Jason Sebaugh, who was revived from a fentanyl overdose, says he thought he was buying heroin - but it was laced with fentanyl.
He says people battling addiction need to understand that they may not know what they are injecting - and what they don't know may kill them, even while the needle is still in their arm.
Sebaugh says he is telling his story because "even if it helps just one person, it would be worth it."
"Maybe," he adds, "this is one of the reasons God kept me alive."