Three days after Fire Engine 23 pulled up to save Mr. Garcia, it’s back, on the other end of the same troubled block of Amanda Avenue.

It’s rare that the firefighters serving Carrick go more than a few days between overdoses. They make 10 percent of the “saves” logged by their bureau, though they cover just 3.3 percent of the city’s population.

This time, the crew hauls the Narcan kit up the steps of a “recovery house,” owned by Samuel Vogt, where numerous young women are trying to leave old habits behind.

Neither Narcan nor a body bag, it turns out, are needed. The woman used benzodiazepines, a class of tranquilizers, rather than opioids, and is coming out of it. After other residents of the house shout down their stumbling housemate, she packs her bags, under a police officer’s eye, and another woman drives her away.

Brownsville Road bustles with drug deals, but just as much with traffic in and out of recovery houses and Narcotics Anonymous meetings. Recovering here involves facing temptation.

“You’re going to have people offer you drugs,” says Dan Pace, 31, of Observatory Hill, whose two-year fight to get sober included a stint in a recovery house on Brownsville. “You’re going to be walking past trap houses” where dealers posted on porches watch for users, and you’ll quickly spot the “bandos” -- abandoned houses in which users gather to shoot up.

A few relapses later, he’s now two months clean and staying in a “Serenity House” in the West End, run by Gus DiRenna, a former heroin user who now houses, employs and counsels others in recovery.

There are some phenomenal recovery houses in the area, says Stacie Brown, who visits them as part of her job at the Onala Club, a South Shore gathering place for people who are trying to stay clean. A few months in such a place gives the addicted person “time to figure out who they are, that they don't have to shoot dope, they don't have to live like that."

Where there’s recovery, though, there will be relapses. They can be deadly, because the person has been off drugs, has a lowered tolerance and may use too much.

Most days, Ms. Brown holds training sessions in the use of Narcan, many of them at recovery houses. She knows that in Carrick, some people blame the recovery houses for bringing into the neighborhood people who have problems -- including a few who don’t deal with them well. "It takes one individual,” she says, “and then that house is condemned, basically, by the neighborhood."

Recovery houses should be registered and regulated, but aren’t the cause of Carrick’s troubles, says Ms. Rudiak. “They are here because there’s a need for them here.”

Gus DiRenna, 58, of Whitehall, instructs Dan Pace, 31, of Observatory Hill, on a renovation job. Both are in recovery. Pace is learning the ins-and-outs of renovation from DiRenna and is staying in one of the older man's "Serenity Houses." (Stephanie Strasburg/Post-Gazette)

Steve Roak strides down the block, his arms swinging wide like wings, then coming together in thunderous claps. He’s feeling good this morning. That won’t last, though, and from this block in Carrick, he doesn’t see a clear path away from heroin and fentanyl.

"Everybody you talk to is on it,” says the 33-year-old landscaper, after he settles down on the front steps of the home his family rents from a police officer. “There's not one person in Carrick that don't do it. Not that I know of."

It’s been almost a month since he was last arrested for heroin possession. Two of his sisters, Margie Johnson and Doris Roak, were also arrested with drug paraphernalia within the prior month. His younger brother, James Roak, lost his job, marriage and house to narcotics, and in 2014, at the age of 29, fatally overdosed on black market methadone, leaving behind two children.

His family's landlord, Pittsburgh police Officer George Cunic, says later that he has tried to help the Roaks, including James.

“I knew he was on heroin, and I told him, ‘There’s so much help out there,’" says Officer Cunic, before declining to talk about it further. "He laughed at me, and told me, 'George, I know what you do for a living, and I don’t tell you that you can’t have a beer.'”

Back on the front steps, Steve Roak rattles off a list of friends who died from drugs.

"Some people are just so greedy, they think that they're not going to get high off of it, and they put too much in there, and they do it, and it's over," he says. "Because I ain't stupid, I only do a half [bag]. Even if I have a whole 10 bags, I only do a half.”

He says his drug problem started when doctors treated his neck pain -- perhaps due to a childhood car accident -- with the narcotic Tramadol. When the doctors stopped the prescriptions, he chose heroin over withdrawal. Now, every morning he’s “dope sick.”

"I try to take ibuprofen or something or drink a lot of coffee or drink a Red Bull -- something just to give me a little bit of energy,” he says. “It don't get me off sick, but it helps me a little bit."

Then he’s off in search of odd landscaping jobs. Success means a few strips of black market Suboxone, or a few stamp bags of heroin, fentanyl or both. "I gotta find something,” he says, as the sun climbs.

The alternative? "You feel dead to the world. You feel irritated. You feel -- you just feel not like a person at all, like a zombie, basically," he says. "You sweat. You shake. You can't sleep. Your legs twitch and jump. You have anxiety. You can't sit still.”

There aren’t many people in his life who have cleaned up and straightened out. Still, he doesn’t believe it’s impossible. "I just got to get my head out of my ass and do it."

Eleven days after Engine 23 arrived to save Jose Garcia, and a week after it showed up at the recovery house, it made yet another trip to this block. This time, as night fell, it was Dana Maxwell who needed Narcan to survive.

"Maxwell stated that she was at the hospital earlier because of an abscess on her arm," according to the resulting police affidavit. "Maxwell said the doctor gave her fentanyl and then she came home to rest. Maxwell said her friend came over around 1900 hours and gave her a loaded needle of heroin."

Police wrote that the teenage girl who called 911 was "visibly upset" and "began to hyperventilate," but eventually calmed down. Police let Ms. Maxwell's kids go to their grandmother's house, and charged the mother, for the second time in two weeks, with endangering the welfare of children.

Twelve days after that overdose, Ms. Maxwell is back on her porch following a week in a detox facility and one night in jail. She’s a little bit sick, and whirling between anger, guilt and thankfulness.

The anger? At the “friend,” a Carrick man who, she says, dashed when she overdosed. “He left me to die," she says. She’s alive because her kids heard the thud of her body against the floor, called 911 and tried CPR. “I gave them life, and they turned around and saved my life.”

The guilt? Because she isn’t the mother she wants to be. “They deserve someone that’s going to be there," she says.

The thankfulness? “I feel like I’m blessed and favored by God and I don’t want to keep throwing this in His face. … I don’t need to be the next fatality here in Carrick.”

Block watch leader Carol Anthony is tired of paying for Narcan.

Her husband just got a bill for thousands of dollars in copays for conventional medical care, Ms. Anthony tells her 40 fellow Carrick Overbrook Block Watch meeting attendees. Narcotics abusers, by contrast, are “getting free Narcan over and over and over.”

Somebody from the back of the Pittsburgh Concord K-5 auditorium shouts out that people who overdose should pay for their Narcan, (which its maker sells for $37.50 per dose in bulk) at least after their first “save.” Others in Carrick argue that drug users should be left to their fates.

A woman gets helped to an ambulance along Brownsville Road after being revived from an overdose by first responders in Mt. Oliver. (Stephanie Strasburg/Post-Gazette)

City policy, though, is to do what it takes to save every possible life. This year through August, firefighters serving Carrick used Narcan 91 times. That’s nearly 10 percent of firefighter “saves” in the city, while Carrick is home to just 3.3 percent of the city’s population. (Police and medics -- who, combined, made a similar number of Narcan saves citywide -- were unable to provide neighborhood breakdowns.)

Overdoses, drug-related petty crime and suspicious-seeming newcomers are the talk of the neighborhood. Some of Carrick’s veteran advocates tie those problems to absentee landlords who live as far afield as Israel, the elimination of nearby public housing and the gradual decline of neighborhood institutions and businesses. Though a new coalition is trying to curb overdoses in this and other South Hills communities, few believe the solutions are simple, none profess that the problem has peaked, and morale is sagging.

“It’s very frustrating for police officers that the person was almost deceased, we give them the Narcan, and they can just walk away,” Pittsburgh Police Officer Christine Luffey tells the block watch crowd.

While they wait for their guest speaker, the officer gives them highlights from the past month’s cases. Among them: the overdose of Jose Garcia, and the resulting charge of endangering the welfare of children against Dana Maxwell, 35. The officer’s takeaway: “Drugs and kids do not mix well.” The crowd tsk-tsks the absent mother.

Officer Jake Alex inspects confiscated stamp bags as he does paperwork at the end of his shift at the Mt. Oliver Police Department. (Stephanie Strasburg/Post-Gazette)

In walks city narcotics Detective Calvin Kennedy, dressed in gray street clothes that match his hair. He tells the watchers that until this year, he thought saving people meant getting them out of the path of a gunman, rather than “squirting something up somebody’s nose to have them OD again 24 hours later.”

And before this year, his idea of a good day at work was to go to a neighborhood, identify the bad actors, establish probable cause, then jump out of an unmarked car and make arrests. Starting Jan. 1, though, his orders changed.

“My job now is to investigate overdose deaths,” he says, holding up a thick sheaf of papers. “How the hell? Do you see this list?”

District Judge Richard King keeps closing files for his least favorite reason: Because the defendant has died of an overdose. For the most part, these aren’t criminals, but defendants in civil cases, like evictions. “I do over 500, 600 landlord-tenant cases" each year, says Judge King, who lives in Carrick and holds court there in a room decorated with photos of Pittsburgh sports triumphs. "A lot of that is addiction. … The money goes to the drug. It doesn’t go to the bills that need to be paid, and they get behind on the rent.”

When he was growing up in Carrick, around 1970, drinking beer and smoking marijuana in clearings in the woods was part of the typical coming-of-age story. Few people, though, moved on to hard drugs. These days, his courtroom swells with people who completely skipped the “gateway drugs.”

“They just started out with the heavyweight champion of the world,” he says. “It kind of took hold with a lot of people, mostly younger, that I don’t think had an idea of how powerful an addictive drug” an opioid can be.

Andrea Suhoski is raising her children in a neighborhood where drugs have ruined many lives. On a recent fall evening, she took two of her sons -- Stefan, 17, and Kalib, 8 -- and the family dog on a walk along Brownsville Road. "My oldest son was a part of it," she said. "He was on heroin." That son, Cody, is now in prison -- and clean, she said. "I don't have the money to leave," Ms. Suhoski said. "If I did, I'd grab my kids and be gone." (Steve Mellon/Post-Gazette)

“When you talk to older people in the neighborhoods, they say that South Pittsburgh had a pill problem,” says city Councilwoman Natalia Rudiak, who grew up in Carrick in the 1990s and lives there now, in a separate interview.

Her hard-working neighborhood may have been more susceptible than most. “Whether you’re laying brick or working as a construction worker or a nurse’s aide, a lot of the work is physical,” she says. “We’re strong, working people. We make the city go around. But the work is literally backbreaking work.”

In recent years, a sore back led to “a doctor pushing painkillers,” she says. Extra pills stowed in medicine cabinets found their way to the streets.

When law enforcement and state regulators told doctors to curb their painkiller prescribing, heroin dealers swooped in -- a narrative heard nationwide, but especially in the hills from Western Pennsylvania to Tennessee. Then cheaper, more powerful synthetic narcotics like fentanyl, largely concocted overseas, grabbed market share and boosted the body count.

“We were just, like, racking our brains,” says Ms. Rudiak. She called meetings with the Allegheny County Department of Health and Department of Human Services, state agencies, academic experts, nonprofit treatment groups and city public safety bureaus.

Those meetings led to the creation, early this summer, of the South Pittsburgh Opioid Action Coalition, which includes representatives of schools, churches and community groups, plus public safety and health officials. It meets monthly in neighboring Brookline, and has closed its doors to the press.

The coalition is working on improving drug education in schools and sponsoring a "recovery volunteer fair" to attract people who want to help. It plans to sponsor teams that will visit people post-overdose "and talk with the person to try to get them into treatment," says Ms. Rudiak.

Her term ends with the year, but she believes the coalition, and neighborhood, will march on.

"I have no doubt in my mind that Carrick will return to its full vibrancy,” she says, “and I think it will happen in the next three to five years."

Dawna Stanek may not have three to five years of patience left.

“I wouldn't want to move to the country,” she says, as she leans on the fence near her neatly trimmed shrubs. “But if this doesn't change, we'll move out in a few years."

Why?

Devon Kroon, pictured with her daughter, died at age 21 from a fentanyl overdose in Carrick. (Source: The Kroon family)

She points down Concordia Street. "See the Drug Free School Zone sign? It's really sad that is there. It's not drug free at all.”

In March of this year, 21-year-old Devon Kroon died from fentanyl, across the street from Ms. Stanek’s house. Ms. Kroon moved from Somerset County to Carrick two weeks before, with her boyfriend and their 5-month-old daughter.

Ms. Kroon died in one of three adjacent rental houses. The revolving door of tenants in those three houses “caused a lot of ruckus in the neighborhood," says Janet Shook, who has lived on Concordia for 40 years.

The property in which Ms. Kroon died is owned by Blue Line Property Management, a company created by a Carrick man, Fred Miller. The other two rental houses in the row were purchased in 2013 by Realty Choice Investments, a company which had a profound effect on Carrick.

From 2008 through 2013, Realty Choice bought at least 42 in Carrick, part of its countywide portfolio of more than 200 rental houses. Run by Dov Ratchkauskas, of Squirrel Hill, Realty Choice’s business model was brilliant: Buy at prices depressed by the real estate collapse, and sell within days or weeks to Israeli investors who paid double or triple the purchase price. Those investors invariably hired another of Mr. Ratchkauskas’ companies to manage the properties and collect the rent.

Would-be tenants “would call to see a home, and [Mr. Ratchkauskas’ employees] would say, ‘If you have the cash, here’s the keys,’” says Trish Hatfield, president of the Carrick Community Council, as she sits on her porch on Belplain Street. “That’s when we saw an influx of drug activity, and they did not maintain the properties.”

Mr. Ratchkauskas, 50, now sits in federal prison in Allenwood, serving a sentence of almost five years for bank fraud and money laundering. He didn’t respond to a letter seeking his thoughts on Carrick. Some of the houses Realty Choice bought are still owned by Israelis, while others were sold to new owners.

Prior to the arrival of Realty Choice, says Ms. Hatfield, “You were moving up when you moved to Carrick.”

Then Mr. Ratchkauskas and other absentee landlords, plus people displaced by the demolition of the St. Clair Village public housing complex, combined to create “a pivotal moment in the change here,” she says. “It took the neighborhood a few years to figure out what to do about it.”

Eventually, the block watch formed, and began working with police to gather intelligence about problem properties. The community council brought in the nonprofit group Economic Development South to rehab a few Brownsville Road properties. But the decade-long acceleration of drug activity hasn’t reversed, Ms. Hatfield says, as she looks across the street at a rental duplex with a boarded up front window, broken in a police drug raid.

“I would like some control over the opioid issue,” she says. “Do I see it disappearing 100 percent? I do not. That is a pipe dream.”

A cat stalks through an overgrown lot behind the 1600 block of Concordia Street in Carrick. Devon Kroon died from a fentanyl overdose in the cream house pictured at left. (Stephanie Strasburg/Post-Gazette)

“Opioid heaven” is what Donna Williams calls her street, two blocks from Carrick’s border with Baldwin.

“This street used to be beautiful,” she says of Kirk Avenue, as she sits on the front porch of the home she inherited from her mother. Then her mother’s generation passed on. “The old people died and the kids didn’t want the houses.” So the kids sold out to landlords.

Ms. Williams was a passive observer of her street’s changes until 2011. That’s when Realty Choice bought the house next door -- from the Department of Housing and Urban Development, for $18,000 -- and sold it a week later to an Israeli couple for $49,000. Mr. Ratchkauskas’ property management arm then rented it to Charla Brice.

The comings and goings at Ms. Brice’s house made Ms. Williams suspicious. Concern turned to fear after a strange man walked into her house, opening doors and shouting, “Char!”

“I was actually afraid for my life,” Ms. Williams says. She didn’t cut and run, though. “I won’t be pushed into a corner and abused because you think you can do that to me.” She started attending block watch meetings and working with police, who set up surveillance.

Eventually, police searched Ms. Brice’s home.

“Boom, boom, bang, bang -- in a matter of two minutes, it was done,” she recounts. “I walked outside, and I was just bawling” with relief and thankfulness that she still feels today.

Ms. Brice soon moved away.

In 2012, the Israeli owner, David Smoshkovitz, was found guilty of having debris throughout the property, and fined $1,076, which hasn’t been paid, according to online court records. In 2015, the county Health Department ruled the house unfit for human habitation. As a result, the house next to Ms. Williams sits empty.

Ms. Williams’ activism has only increased. She’s a member of the Zone 3 Public Safety Committee, and from a computer-filled room in her home runs a “virtual block watch,” where her cameras feed four views of Kirk Avenue into a server and a large wall-mounted monitor. She’s convinced others to do the same, and to share footage with the police.

“Now you have a group of people who want to restore the community to what it was,” she says. “But it could take years.”

Kirk Avenue residents and city police officers gather to chat at Donna Williams' home on National Night Out in August. Mrs. Williams celebrates the annual event by inviting neighbors and law enforcement officers in an effort to strengthen police-resident relationships. (Steve Mellon/Post-Gazette)

In 2011, when Charla Brice moved her family from Bethel Park to Carrick, Kirk Avenue “was a very quiet street,” she confirms, as she sits on the porch of her current home, near the center of Carrick.

Ms. Brice knows the signs of trouble. Her record includes drug possession convictions from the 1990s. After moving to Carrick, as her five sons “started breaking their curfew to hang out with the kids,” she says, she realized that they were at a crossroads, and so was the neighborhood.

When they arrived from the suburbs, the Housing Authority of the City of Pittsburgh had just finished tearing down the 50-year-old St. Clair Village. The razing of St. Clair was part of a decades-long, nationwide trend toward eliminating old “projects,” and typically shifting some of the residents to the Housing Choice Voucher program, known as Section 8.

St. Clair housed more than 400 low-income families at its peak, and its economy was spiked with heroin dealing. When it closed, many of its residents drifted down Brownsville Road. Carrick this year hosted 265 families with vouchers, the second-highest among city neighborhoods.

Some new residents clashed with the old. A feud worsened between young men from St. Clair, organized in a gang called Darccide, and a Beltzhoover-based clique called Zhoove. “After St. Clair Village got torn down, [Carrick] became a war zone,” says Ms. Brice. She preferred that her sons invite their friends over to Kirk Avenue, so she could keep an eye on them. She says the young men seemed to unnerve her neighbor, Ms. Williams.

“Donna made it real uncomfortable,” says Ms. Brice. “When people would pull up, she’d be writing down license plate numbers.” Detectives “camped out right across the street from my house,” she says. Finally, police searched her house. “There was nothing there.”

Ms. Brice was not charged following the search. She decided to move anyway.

She says she’s had no problems with her current neighbors. Overall, though, the neighborhood doesn’t feel like it did in 2011. “There’s a lot of robbing and thieving and shooting and people stealing from each other,” she says, “and it’s all around heroin.”

Some evenings, Shawn Reynolds sits on his front steps, watching people park their cars, hurry into the apartment buildings across the street, come out minutes later and drive away. He’s not sure what they’re doing, but he has his suspicions.

A Brentwood native whose family is scattered throughout the South Hills, he moved to a Carrick apartment in 2015. Last year, when emergency responders pounded on his door, he was baffled, until he heard the cries from the basement unit. "The [victim’s] girlfriend was back there screaming, 'He's dying, he's dying,'" he recounts. Her boyfriend, in his 20s, survived.

The event made an impression that was only compounded by the occasional drug parties in the Birmingham Cemetery behind their apartment building. When he recently watched a man, screaming profanities, push someone into Brownsville Road traffic, the 31-year-old equipment operator with a fiancee and three children decided it was time to go.

“It strikes me that the area really needs a lot of work before it’ll be a decent place for people to live in,” he says.

“I really don’t care where I live,” he adds. But his fiancee and children? “It’s important to them that they have a safe, stable area to live. Unfortunately, Carrick doesn’t offer that right now.”

They’re looking at ads for apartments in Florida, where his fiancee has family. “As soon as we find a place,” he says, “we’re gone.”

There is nothing anyone can do for the 35-year-old woman found cold on the back porch of a vacant house on the 100 block of Santron Avenue this afternoon -- nothing but carry her to the medical examiner’s van, and try to figure out who supplied the deadly dope.

Police pound on a neighbor’s door. No one answers. Eventually, the detectives move on. Overdoses occasionally bring arrests, but not today.

Every day the city’s public safety technologists produce a new map of overdoses, and too often Narcotics and Vice Cmdr. Reyne Kacsuta sees dots along the Carrick streets she used to roam.

Caiden Kasten, 4, eats a honey bun along Brownsville Road as he waits to get his hair cut in Carrick. "It's just bad here," said Cayden's mother Kayla Yanko, 24, who is in recovery after getting introduced to opioids through pain pills. "I was just tired of living like that. At a certain point you hit rock bottom. My 24th birthday I was homeless living in a van...It happens so fast." (Stephanie Strasburg/Post-Gazette)

“I would ride my bike up and down Brownsville Road all the time” as a kid, she says. Along that road there were shoe stores, family restaurants, a Sears, a five-and-dime. “If you weren’t at the movie theater, across the street was the library. … The burnouts were the kids who drank in the park.”

Today’s burnouts are melting into dots on her map.

She admits to some of the same frustrations voiced at Carrick’s block watch meetings. Under current law, police generally can’t arrest people who survive an overdose. Oftentimes, they have no means of forcing the user into a court proceeding that might lead to mandatory treatment. (Gov. Tom Wolf backs a proposal to allow family members to force drug users into treatment, but eight months after its introduction, it hasn’t yet gotten a committee vote.)

When the overdose is fatal, detectives try to collect enough evidence to charge a drug seller with dealing narcotics that result in death. “Some cases we do not get very much evidence and there’s not much we can do,” she says. In other cases, police collect branded stamp bags, cell phones full of electronic evidence, and witness accounts. That makes for “long and complicated investigations.”

A key piece of evidence, the toxicology report by the county Medical Examiner, doesn’t come in until months later. That report can make or break the probe. If there were multiple drugs in the body, and no one dealer can be blamed, the case ends. “The sad part of it is,” she says, “people are using so many different drugs and combining them.” Besides killing them, that makes it almost impossible to get justice.

As the neighborhood faithful settle in for another Carrick Overbrook Block Watch meeting, leader Carol Anthony frets, for the second month in a row, that there may be too few of them to turn the tide. Last year, 75 or more watchers regularly showed up for meetings. Now it’s 40. Why, she asks the mostly-empty auditorium, have people dropped out?

“I just think people get fed up, like there’s no hope,” shouts one of the attendees, from the back of the school auditorium. That brings Pittsburgh Police Officer Christine Luffey to her feet. “If we just give up, we lose, the good people lose,” she says. “The day you put your hands up and say, ‘Hey, I don’t want to do this anymore,’ we lose another person who is the eyes and ears of the community.”

As the officer describes the standout crimes from the prior three weeks in the neighborhoods along Brownsville Road and Route 51, the root of the hopelessness comes into focus: Drugs, and drug users, just keep on coming.

Pittsburgh Police officers opened their vehicles for children to explore during National Night Out in the city's Knoxville neighborhood. (Stephanie Strasburg/Post-Gazette)

A Brookline man named Dennis Hamilton, then 34, was arrested after he was found slumped in a vehicle on Glenbury Street, with stamp bags and six hypodermic needles, Officer Luffey tells the watchers.

Someone robbed a Brownsville Road pizza shop, while apologizing and explaining that he was addicted. There has been no arrest, she says.

Michael James Kagan, 39, of St. Clair, was stopped while riding a bicycle straight into Brownsville Road traffic, while carrying a hypodermic needle.

Justina Lauren Herrle, 26, of Bethel Park, was arrested after she was spotted under the porch of a vacant Kirk Avenue house, with 26 stamp bags and $2,010, the officer says.

An unknown woman stole a bag of prescribed medicines from a man walking on Brownsville.

Jeffrey Kapolka, 36, of Overbrook, was cited after neighbors saw him shooting up in a car on Carrick’s Parallel Avenue, the officer recounts, and police found eight empty stamp bags and four full ones, branded “Ride or Die.”

“Wouldn’t the world be a better place without drugs?” she asks. “It really would.”

The eyes and ears of this community know well that this is not a world without drugs, and it won’t be one any time soon.

The man crumples to the sidewalk just as Pittsburgh police Cmdr. Karen Dixon drives up Arlington Avenue, on the way back from lunch to the Zone 3 station in Allentown.

“I see him go down. I immediately requested an officer with a Narcan kit to respond,” she recounts, an hour later. “He was turning blue so I had to start giving compressions.”

Five police vehicles respond, followed by an ambulance and a fire truck. Officers Terry Downs and Zachary Vozza help to administer four hits of the anti-overdose drug Narcan, while Sgt. Ronald Tardivo and officers Brian Shelton and Nicholas Bonaccorsi secure the scene.

“Right there at the end, when the medics pulled up, you saw him sit up. That’s when he came around,” says the commander. Sometimes people revived from an overdose lash out, but not this time. “He wasn’t aggressive in any way.”

Paramedics offer the man a list of rehab services and take him to a hospital for an hour of observation. He is neither arrested nor charged.

It’s the first time Cmdr. Dixon has participated in a “save.” But it’s nothing unusual for Zone 3, a hilly triangle dominated by Mount Washington, the South Side and Carrick, with the so-called Hilltop neighborhoods at its center.

Some blame the Hilltop and a now-closed public housing development, where heroin dealers operated for decades, for Carrick’s drug problem, which has led to at least 30 fatal overdoses since 2015. The Hilltop neighborhoods, though, have also seen more than their share of victims. From 2015 through May of this year, Knoxville was the scene of at least 17 drug deaths, Allentown 10, and the Borough of Mt. Oliver, 15.

Cut into 10 little neighborhoods, the Hilltop lacks political clout and resources, and hosts a dwindling number of schools and businesses. But some of its champions are trying to slow the flood of narcotics, and a few of its users are picking themselves up off the sidewalk and heading, tentatively, for higher ground.

The day after Cmdr. Dixon saved his life, Gary Fisher sits shirtless in a backyard carved out of the jungle slopes of Allentown, smoking cigarettes and drinking Mountain Dew -- but not, he says, using narcotics.

“I was dead,” the 29-year-old man says of the prior day’s events. “I’m used to it, sadly.” He estimates that he’s been saved from overdoses 14 times, a record he calls “terrible.”

Over the years he’s purchased heroin and, in recent years, fentanyl up and down Brownsville Road and in Allentown, where he counts six dealers within two blocks of this shady spot.

Mr. Fisher says that on the prior day, he bought a bag on Warrington Avenue, then stopped between two buildings on the busy street and shot it into his veins. He headed for home. “Apparently, I didn’t make it,” he says. “It’s the old Metallica song, Fade to Black.”

The next thing he remembers? “Can’t breathe. Tubes. IVs. People asking you a million questions.”

Gary Fisher, 29, of Allentown, recovers minutes after a fentanyl overdose on Arlington Avenue. He was saved by a police commander who did chest compressions and officers who gave him four doses of Narcan.

He says the police seemed ready for a fight, but he’s not one to rage at being saved. “Me, I’m grateful. That’s how I was raised,” he says. “I'm just thankful that they did what they did, that they kept trying and didn't give up."

He’s also embarrassed that he needed to be saved, yet again. "I feel bad when they do that, because it's possibly taking them away from the old lady who's having a heart attack."

Though his largest tattoo says “Regret Nothing,” he admits that he might make different choices if he could replay some key moments. He’d try to hang on to the ironworking job he had, or maybe parlay his skill with engines into ownership of a repair garage.

But would he have declined the “bump” of white powder a dealer offered him years back, which he’d assumed was cocaine, but turned out to be heroin?

“I loved it,” he recounts. “Now I hate it, because it ain’t heroin. It’s hard to find heroin now. It’s all fentanyl.”

Fentanyl knocks him flat. But he’s used it anyway. Knowingly. Repeatedly. Why? “Depression. I hate my life. I hate where I’m at. It kind of takes the pain away, temporarily,” he says.

“There’s something wrong in my head,” he continues. “I know this. I just don’t know how to deal with it. I don’t know how to deal with it in a healthy way.”

The drug cost him contact with his 11-year-old son, and partial custody of his 5-year-old daughter. It brought criminal charges and a suspended driver’s license, which in turn nixed his bid to go to Harley Davidson maintenance school. He’s lost girlfriends, cars, trucks, motorcycles, a boat and untold money, he says.

"Now I'm sitting here with one cigarette and no gas in my truck,” he says, “like a bum.”

Dusk falls along the side of Arlington Avenue, where Gary Fisher overdosed on fentanyl and was saved by police, in the Pittsburgh neighborhood of Allentown. (Stephanie Strasburg/Post-Gazette)

Up here on the Hilltop, says Roy Blankenship, there’s a word the kids use to describe those who avoid the street life and devote themselves to study, or take a job at McDonald’s: “Lames.”

Mr. Blankenship is now the property stabilization program coordinator for the Hilltop Alliance, an umbrella group of organizations that work the twisted streets from the South Side Slopes to Carrick. He's also involved in the Knoxville Community Council and Mad Dads, which puts green-shirt-clad fathers on the street to deter drug dealing and guide users to rehab.

Today he’s at the McDonald’s on Brownsville Road in Knoxville, talking about the days when heroin seemed like a promising business opportunity. Two decades ago, before he was arrested in a sweep that netted hundreds of stamp bags of heroin, he and his friends viewed the sale of the drug as "the new way to feed your family.

"I didn't know what type of monster it was,” he adds.

The monster settled in on the Hilltop.

Today, veteran players with connections in ports or border cities scrape up a few hundred thousand dollars to make a buy. Somebody makes the drive and brings back the package. Neighborhood experts in chemistry, packaging and distribution do their work to prepare the package for the streets.

The drug then goes out in “bricks” of 50 stamp bags each. Early in the morning, “runners” carry multiple bricks to mid-level dealers. By the time most “lames” have settled in at work or school, the mid-level players have distributed single bricks to low-level dealers, some of whom are teens, while others are adult users who sell to their friends. The low-level dealers then sell half bricks, 10-bag “bundles,” and individual stamp bags to people scraping to feed their addictions.

Dealers in the Hilltop and Carrick have profited from Brownsville Road’s connection to the southern suburbs, with their wealth and growing craving for narcotics. Suburbanites new to heroin are often more comfortable meeting a connection along Brownsville, rather than in the East End or Northside. Veteran users, meanwhile, eventually find the Hilltop’s “trap houses,” where some spend days alternating between crack and heroin, until their money or their body gives out.

Many drug users work, while others prostitute, deal or steal. Mr. Blankenship tells of a woman on Jucunda Street who was away for a few days for medical treatment. She returned to find that eight windows had been stolen right out of her walls -- no doubt traded for drugs.

Alfred "Preach" Hines has driven away dealers who tried to peddle heroin in front of his house. It wasn't always this way in Knoxville, he says.

The heroin trade "was actually centered in Arlington [Heights] and St. Clair Village and Beltzhoover," in decades past, he says. Arlington Heights still has 143 apartments, but St. Clair has been razed. "When they shut down St. Clair, it seemed that everybody from up there just made Mount Oliver the new St. Clair."

He sits in a cavernous room that he is converting into a studio for the neighborhood’s budding multimedia artists. There has to be something here, besides McDonald’s, upon which a young person can build an identity -- neither as a “lame,” nor as a drug dealer.

"If you're selling heroin and crack to your own mothers, fathers, sisters, brothers,” he says, “I don't see being proud of that.”

Alfred "Preach" Hines, of Knoxville, sits with son "Mighty" Michael Hines, 8, in the room he is converting into a multimedia studio. (Stephanie Strasburg/Post-Gazette)

“I think we have a bigger drug dealer problem than a drug user problem,” says Mount Oliver police Chief Matt Juzwick, as he sits in the borough’s modest city council meeting room. His 14-person department patrols a borough of 0.3 square miles and around 3,300 people, surrounded by Pittsburgh and flanked on the west by Brownsville Road. With such a tiny force, everyone -- even the chief -- has to work informants and make undercover buys.

In the first five months of this year, his borough saw six fatal overdoses, including five of its residents and one visitor. While the dead are mostly locals, the chief believes the drug economy is fueled by outsiders.

“Users are coming in from the suburbs,” he says. They can get heroin and fentanyl for $5 to $7 per stamp bag on the Hilltop, then sell a few to their friends in distant townships for $20-$25. So while violent crime is down, he says, “As far as the narcotics, the heroin, it has gotten worse.”

Now and then, the police win a round.

Early one October morning, Pittsburgh SWAT and narcotics detectives hit a house on Helen Way in Allentown. They report finding a Glock with an extended magazine, marijuana, Xanax, crack, suboxone, a flea-bitten pit bull, plus some 373 stamp bags of heroin bearing brand names that wink at the tenuousness of the user’s life:

• “(1) brick of Heroin labeled ‘Killing Season’ in red ink”
• “(1) brick of Heroin labeled ‘‘Wi-Fight?’ in black ink”
• “(1) brick of Heroin labeled ‘Kill Bill’ in green ink”
• “(1) brick of Heroin labeled ‘Soul Survivor’ in blue ink”

They arrest and jail Richard Cotton, 25, and Angelo Henderson, 22, on charges of possession of drugs with intent to deliver.

Drug abuse, criminality and law enforcement are co-dependent parts of an economic system, argues Denon Allen, 30, of Mount Oliver, as he sips Black Velvet whisky with friends in a shady spot between buildings near the Carrick Shop’n Save. "That's never going to die, the heroin epidemic, as long as there's money to be made.”

Denon Allen, 30, stands for a portrait as he celebrates a friend's birthday in his Mt. Oliver apartment. Allen traded a life of drug dealing for rapping. (Stephanie Strasburg/Post-Gazette)

Mr. Allen used to be a drug dealer, but is now a rapper, singing about "personal respect, intelligence and dignity," as he puts it in his song P.R.I.D.E. (The E stands for encouragement.)

He asks rhetorically, "Who's got a passport?" No hands go up. That suggests, he says, that the people here aren’t the ones making big money importing heroin or fentanyl -- just like they’re not the owners of the billion-dollar pharmaceutical companies that spurred the nation’s narcotics binge, or of the palatial rehab facilities that now put paying customers in every bed.

"It's easy to go to the little guy, who can't get a job” and instead sells drugs, he says, “telling him he's doing wrong.”

At the Way of New Life Ministries on the 700 block of Brownsville Road, Ron Shane runs a "life and addiction recovery" program. Shane, a former heroin addict, counsels those struggling with addiction. (Steve Mellon/Post-Gazette)

Two of the five candles on the lectern are lit -- flickering under the influence of the ceiling fan -- and Dave Martinez is fired up to testify, here in a building which lights up weekly to draw the addicted to God.

On a Wednesday evening, at the Way of New Life Ministries, a storefront church on Brownsville in Mount Oliver, the 25-year-old stands to the left of Rev. Ron Shane, and in front of an audience of around a dozen -- half of them friends and family, half of them people struggling with addiction. Behind him is a modest pulpit topped with a powerful sound system.

Mr. Martinez, a construction worker, was one of those suburban users who cop heroin on Brownsville or in the Hilltop. He hopes that telling his story might inspire someone else in the room to get clean, or to stay clean for another day.

Growing up in Baldwin Borough, Mr. Martinez says, he was turned on early to “weed and alcohol and recreational stuff.” By the time he was 17, “the doctors started pushing OxyContin, and everyone had some of it in their medicine cabinet.” He went from weekend Vicodins to a 40-80 milligram per day oxy habit.

He dropped out of high school and did his first rehab stint at 18. “I didn’t make it back to Pittsburgh before I was high again.”

Then oxycodone started getting expensive on the streets. “I ended up shooting heroin. From there, like, there’s really nowhere else to go. It’s just desperate living from that time on.”

At age 20, he was waking up sick every morning. In his early 20s, the relapses continued despite rehabs, Narcotics Anonymous, praying and even his love for his young wife. He relapsed during her pregnancy with their child. “Nobody was happy about that, including myself,” he says.

That was the last time. On this night, he is eight months clean.

“I’m not going to let that clean date go for anything.” His son “has never seen me like that and he’ll never have to.”

A week after he overdosed a block from the police station, Gary Fisher is again sitting in a vine-shaded Allentown yard, working the phone, trying to get the right health insurance, so he can get a prescription for the drug Vivitrol, so he won’t crave heroin, so he can more reliably stay clean, so he can get his driver’s license restored, so he can get a regular job. It wasn’t so long ago that he felt like he could rise above the drugs, this neighborhood, this block.

A man descends the city steps that lead from Excelsior St. to Arlington Ave., in an Allentown neighborhood that has one of the region's highest overdose rates. (Stephanie Strasburg/Post-Gazette)

A few summers back, while sober following a rehab stint, he helped emergency workers to rescue two elderly residents who drove off a steep Hilltop slope. That save made the newspaper. “It did feel good that I helped somebody and made me laugh at the people who wanted to tell me what a piece of shit junkie I am,” he recounts.

Then his bid to attend Harley repair school fell apart, because his driver’s license was suspended. “That hit me hard,” he says. “I worked for almost a year trying to set everything up, doing the financial aid.”

Almost simultaneously, he broke up with a girlfriend. “And then the heroin came back. It seemed a good enough reason at the time.”

He went on and off drugs. He made it through a family beach vacation, lubricated with Coronas, but without narcotics. A day after his return to Allentown, though, he overdosed. A few days later, he overdosed again, resulting in the save at the hands of the commander.

"Every addict has another run in them," he says. "Whether you'll come back or not is the question. And that's not something I think I want to gamble with.

"The way my body reacted, it was kind of telling me that I was pretty much done.”

Now he is starting to feel different. "Waking up at 4 in the morning, my first thought wasn't, 'How am I going to not be sick?'" he says. "It's nice to wake up like that."

Still, he is starting to think he has to get away from the Hilltop, where he’s lived all of his life, and far from Brownsville Road. He knows there are drugs in the North Hills, where his grandmother has a spare couch, and in Washington state, where a friend offers him sanctuary. But at least it won’t be like Allentown or Carrick, where drugs seem to be everywhere, where he’s stumbled so many times.

The craving for heroin, he says, “will never go away. The thoughts will never go away. I just have to figure out what to do about it.”  

Update: Gary Fisher died of a drug overdose on Nov. 30, 2017. Family members said he was proud that telling his story had helped someone else. Read his news obituary here.