CLEVELAND - Drug Court Judge David Matia sits in a meeting with his staff, listening to a description of one defendant's downward spiral.
He drops his glasses; his eyes widen; and he says simply, "she's going to be dead."
Judge Matia has been sounding alarm bells for several years now about the explosion of deaths from overdoses of street heroin or opiate pills.
Together, they are now the state's number one accidental killer - taking over 1,700 lives a year. That's more than car wrecks.
The FOX 8 I-Team first interviewed Matia about the epidemic three years ago for a series of reports entitled "Prescription for Disaster."
On the day we were in Matia's drug court in 2011, 19 of the 38 defendants said they were addicted to heroin or opiates.
When we went back last week, it was 27 out of 32.
Judge Matia says the explosion in heroin use - and deaths - can be directly traced to the increase in the number of opiate painkillers, with names such as Oxycontin and Oxycodone, that doctors have been prescribing.
"Our friends in the medical community really need to step up and look at their prescribing practices," he said, "because last year in the state, there were over 800 million opiate-based pills prescribed in Ohio."
University Hospitals has been at the forefront in developing guidelines for opiate prescribing for its doctors.
UH did so starting about three years ago. The guidelines basically make opiate therapy a last resort for dealing with most non-cancer pain.
And UH's Chief Medical Officer, Dr. Michael Anderson, says doctors are being upfront in talking to their patients about pain.
"I really think physicians need to have conversations with patients about what's realistic," Dr. Anderson said.
Dr. Anderson said trying to get some patients with chronic pain to live pain-free may not be in the cards.
"And for us to get you to a zero pain level may be dangerous," he said.
The danger, of course, is that the patient will become addicted to opiates.
Often, when people who've become addicted to pills have trouble getting access to them (because doctors won't write more prescriptions,) they turn to street heroin.
"Heroin devastation is among the top, if not the top law enforcement threat in our community," said U.S. Attorney Steve Dettelbach.
Dettelbach has organized a high-level working group that includes doctors, law enforcement, treatment specialists, and the Ohio Attorney General's Office - all looking for ways together to reverse the heroin trend.
The Ohio Legislature has also been considering proposals that would pump $180 million dollars into treatment, require that opiates be prescribed only in small doses, and make UH's opiate guidelines state law.
Dr. Anderson said UH prefers that the guidelines stay as suggestions, rather than become law.
"The last thing we want is to have another set of regulations come between doctors and patients," Dr. Anderson said.
Still, as compared to three years ago, Judge Matia sees lots of people looking for lots of answers. "The word is getting out," he said.
And people are reaching some of those who are still battling their addictions.
If an addict has overdosed, but is still alive, the naloxone can reverse the effects of an opioid overdose. In other words, it can save a person's life.
MetroHealth Medical Center helps give out naloxone kits free to the families of drug-addicted people every Friday from noon-5 p.m. at the Free Clinic on Euclid Avenue.
The search for answers in the fight to save lives is taking place on many fronts.
Web extra: Watch Bill's extended interview below, with Dr. Michael Anderson, University Hospitals Chief Medical Officer
**Friday on Fox 8 News at 6 p.m.: Lessons learned. We will trace the problem back to where we first found it three years ago in Southern Ohio. And, we'll track how many more opiate pills have been prescribed recently, compared to 15 years ago.
For more on this week’s series, click here.