Bonnie Mooney's son struggled for several years with a heroin addiction, but after stints in rehab and prison had recovered to the point that he could work again as an electrician.
"His first paycheck did him in," said Mooney, 57, of Carney.
Able to buy heroin again, Adam Isaacs, 28, died of an overdose Sept. 20, making him one of 578 people to succumb to the drug last year in Maryland, according to a report released Tuesday by the state Department of Health and Mental Hygiene.
The department's annual tally of drug- and alcohol-related deaths shows heroin's toll continuing a steep rise that began several years ago. The number of heroin-related deaths in 2014 was 25 percent higher than the previous year, and more than double the total in 2010.
"I don't doubt it," said Mooney, who knows several friends of her son's who have used the drug.
"My son used to say, 'Mom, it gets ahold of you,'" she said. "It was a long, hard road. People don't know where to send their kids. You don't know what to do. You're blind. And it costs money."
State and local officials have been grappling with the issue in recent years. Gov. Larry Hogan and Mayor Stephanie Rawlings-Blake have appointed heroin task forces to study the problem and develop plans to combat it.
On Monday, the state task force led by Lt. Gov. Boyd K. Rutherford met in Hagerstown, the fourth of six planned summit meetings in which members take testimony from law enforcement officials, doctors, addiction specialists and community members. The group will report on its findings at the end of the year.
The Baltimore task force is scheduled to issue its recommendations to Rawlings-Blake in July. Dr. Leana S. Wen, the city health commissioner, said the new state statistics confirm what she calls a "public health crisis" — but a preventable one.
The number of heroin-related deaths in Baltimore rose from 150 in 2013 to 192 last year, according to the report.
Wen said of the latest statistics, "They're disappointing, but they're also a call to action for us."
She said the continuing rise in heroin fatalities has prompted the city Health Department to start implementing some task force recommendations even before forwarding them to Rawlings-Blake this summer.
Among the initiatives are expanding the availability of the overdose-reversing drug naloxone; refining data collection so health practitioners can target addicts where they are, whether it is in jail or in a neighborhood shooting alley; and improving access to substance abuse and mental health programs, Wen said.
"We are not even close to having enough treatment capacity in Baltimore City or anywhere," she said.
Citing an estimate by the National Institute of Drug Abuse that just 11 percent of addicts who need treatment receive it, Wen said such a low rate would be unacceptable for cancer, diabetes or any other ailment.
"We don't recognize mental health and substance abuse as the chronic, life-threatening medical conditions that they are," she said. "There is such a stigma."
That stigma can prevent users from receiving medication, such as Suboxone or methadone, that can treat their addiction, or keep treatment facilities from locating in neighborhoods because of residents' opposition, she said.
"We have to recognize it's not random people who have addiction — they're our friends, our family members, our neighbors," Wen said. "We would never say, 'Get your dialysis across town.'"
The report issued Tuesday shows that of the 1,039 drug- and alcohol-related intoxication deaths in the state last year, almost 56 percent were attributed to heroin.
Maryland health secretary Van Mitchell said those figures reflect "the toll that addiction has exacted on our state.
"We are resolute in our efforts to curb the epidemic that is claiming the lives of Marylanders," he said in a statement.
Christopher Garrett, a spokesman for the state agency, said the report shows a continuing problem with fentanyl, a powerful prescription painkiller that increasingly is being mixed into heroin and makes an overdose even more likely. Deaths related to the painkiller, increasingly manufactured illicitly for street use, more than tripled, from 58 in 2013 to 185 last year.
Garrett said the state is continuing efforts to expand the use of naloxone to reverse overdoses. Police increasingly are trained and equipped with the drug — previously limited to medical personnel — as are family and friends of heroin addicts, and even the users themselves.
But naloxone alone is just one tool, doctors say. Wen, a former emergency room physician, said she has used naloxone hundreds if not thousands of times, sometimes on the same person on multiple occasions.
"That's not good," she said. "But in the short term, I have to save their lives."
Wen said the key is to provide links to substance abuse treatment. "We have to use that moment, right there and then, to connect them to treatment," she said.
That is something Mike Shetterly wishes had happened with his son, Matthew, 23, who died of a heroin overdose April 18, 2014.
In a common pathway, Matthew Shetterly had first become addicted to prescription pills, then switched to cheaper heroin, his father said.
"It was just so available," said Shetterly, 53, of Essex.
Matthew had recently returned home from serving time on a drug charge. "We were so proud of him," Shetterly said. "He came out drug-free."
But addiction specialists say that is when users are most vulnerable — their tolerance has gone down, and using the same amount as before can lead to an overdose. And indeed, Matthew overdosed, but paramedics were able to revive him with naloxone, his father said.
"He came home from the hospital and shot [up] right back," Shetterly said. That time, his son was not found, collapsed in his bedroom, until it was too late, he said.
Now, Shetterly thinks addicts who are released from jail or the hospital should be sent to a halfway house to ease their transition.
"He's left me with a platform," said Shetterly, who tries to persuade Matthew's friends who are still using to quit.
He saw one such friend in the months after Matthew's death, and called out to him.
"Come over here, I want to talk to you," Shetterly remembered saying. "You look terrible. You have to stop."
But that young man, Shetterly said sadly, has since died of an overdose.