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Opioids cause more than 1,000 emergency room visits and kills 78 people every day. ... Now, to tackle this health crisis, Dr.  (Vivek) Murthy is taking the unprecedented step of mailing letters to the 2.3 million prescribers in America, urging them to to do three things. (8/25)

Surgeon General Vivek Murthy is sending a letter to physicians around the U.S. asking for help in addressing the opioid crisis, the first time his office has done so for a public health crisis. The letter will be sent to 2.3 million health care providers this week, and acknowledges that providers have played a role in the increase of available opioids by prescribing more of the addictive drugs with “good intentions.” Providers were encouraged to treat patients’ pain with opioids, but not educated properly on how to do so safely, and were on the receiving end of heavy marketing campaigns for opioids, he says. (McIntire, 8/25)

The widespread abuse of the potent opioid fentanyl appears to be largely the result of illicit manufacturing of the synthetic drug as opposed to the misuse of legally prescribed versions of the painkiller, according to two US government studies released Thursday. That represents a dramatic change in the way opioids have traditionally been abused, and means public health officials will likely have to adjust their response to the two-decade-long crisis. (Armstrong, 8/25)

Federal data suggest illegally manufactured fentanyl, a drug that is 50 to 100 times stronger than morphine, is behind an increase in synthetic opioid deaths. A report from the Centers for Disease Control and Prevention says that there was a 426 percent increase in seized drug products that tested positive for fentanyl from 2013 to 2014. And separate data show the number of deaths involving synthetic opioids, a class that includes fentanyl and tramadol but not hydrocodone, rose 79 percent during that same period. (Hobson, 8/25)

When paramedics arrived at downtown’s skid row last Friday in response to a 911 call, they found dozens of people who looked as if they’d overdosed. Many were on the ground, passed out.  ... “I’m walking down the street — it looks like a war zone,” said Georgia Berkovich, who works at the Midnight Mission, a block from the intersection. Thirty-eight people were transported to the hospital, many suspected of ingesting the synthetic drug “spice.” (Karlamangla, 8/25)

Across Ohio, someone died from a drug overdose every two hours and 52 minutes on average all year long in 2015. That's 8 people a day.  Drug overdoses killed a record 3,050 people in Ohio last year, more than one-third of them from fentanyl, a super-potent opiate often mixed with heroin. The annual report on unintentional drug overdose deaths released today by the Ohio Department of Health showed the increasing toll from all drugs was 20.5 percent higher than 2014, a disappointment to state officials who have worked for years on many fronts to curb the drug-related carnage. (Johnson, 8/25)

A medical examiner in Ohio has issued a public warning about a dangerous drug that hit the streets this summer. Far more powerful than heroin, it has sent dozens to the hospital -- and dozens more to the morgue. ... Carfentanil is so deadly, it is not even prescribed for humans -- it’s typically used to tranquilize large animals like elephants. The drug is 100 times more potent than the similar drug prescribed for humans, fentanyl, and 10,000 times more potent than morphine. But carfentanil abuse is spreading. Authorities say at least 30 people have died from these overdoses in the Akron, Ohio area since the July 4th weekend. (8/25)

EMS officials said the uptick of K2-related cases started Wednesday. Dozens of people who used the synthetic drug commonly known as K2 or Spice required medical attention in downtown Austin on Wednesday and Thursday as part of what emergency crews described as one of the largest upticks in adverse reactions to the drug they’ve seen. On Thursday, several ambulances staged at several points across the downtown area — including at the Austin Resource Center for the Homeless at Seventh and Red River streets — to respond as quickly as possible to the number of calls they were receiving, said officials with Austin-Travis County Emergency Medical Services. (Hall, Martinez-Cabrera and Wilson, 8/25)

You shouldn't put illegal drugs in your body, and you shouldn't let neighborhood bodies of water ingest them, either. A new study suggests that aquatic life in Baltimore is being exposed to drugs, and it's having an impact. And these aren't soft drugs; they include methamphetamine and amphetamine. They're messing with the growth and development of organisms in local streams. (Christensen, 8/25)

Some arrive on their own, worried about what was really in that bag of heroin. Some are carried in, slumped between two friends. Others are lifted off the sidewalk or asphalt of a nearby alley and rolled in a wheelchair to what’s known as SPOT, or the Supportive Place for Observation and Treatment, at the Boston Health Care for the Homeless Program. Nine reclining chairs have been full most days, especially during peak midday hours. It may be the only room in the country where patients can ride out a heroin or other high under medical supervision. (Bebinger, 8/26)

A task force established to combat a heroin epidemic in the Seattle metropolitan area has endorsed a strategy of establishing places where addicts would be allowed to take drugs without fear of being arrested. At these sites, called safe consumption facilities, addicts would receive clean needles and syringes and would be permitted to inject heroin, smoke crack cocaine and take other addictive drugs under the supervision of trained authorities. (Bromwich, 8/25)