Generations of Americans have endured the drugs crisis.
In 2022, 110,000 people in the United States were dying from overdoses, mostly from opioids. The number has been dropping since, down to around 70,000 last year. But that doesn't mean the opioid crisis is over.
Former heroin user Karen knows how difficult it is to quit. She was still using heroin when she got pregnant with her daughter, Abby. She is now 17 years free from hard drugs.
Karen, now a recovery worker, says the drugs being used now are more dangerous.
Synthetic opioids are more powerful and in plentiful supply - and they have transformed the drugs landscape.
Read more on this story: A wave of homemade, synthetic drugs sweeps US and deepens crisis
If you are suffering distress or despair and need support, you could speak to a health professional, or an organisation that offers support. Details of help available in many countries can be found at Befrienders Worldwide, external.
A list of UK organisations that can help is available via the BBC Action Line.