In Everett, Washington, the jail is overflowing with addicts, the detox facility is set to double in size, and the city spends a fortune clearing its streets and parks of needles and tiny plastic bags.
Those are the hallmarks of a heroin epidemic that began, city officials said, as a crisis dating back to the late 2000s that involved different drugs: opioid prescription painkillers.
"The Oxy was everywhere, like, everybody's a dealer, everybody has it," recovering heroin addict Lindsey Richards told NBC News, referring to prescription painkiller OxyContin.
Nearly a decade after the opioid onslaught, Everett is still struggling with the cost. And now the city wants the company that manufactured OxyContin to pay the bill.
In January, the city filed a first-of-its-kind lawsuit against Purdue Pharma alleging the drug maker "supplied OxyContin to obviously suspicious physicians and pharmacies," ultimately failing "to prevent the illegal diversion of OxyContin into the black market."
While other suits against the company by states and municipalities have accused Purdue Pharma of deceptive marketing — allegedly playing up OxyContin's effectiveness while playing down its addictiveness — Everett's lawsuit is the first to claim the company knew its drugs were being diverted and did nothing to stop it.
In particular, the complaint outlines a drug ring that began with a sham clinic in Los Angeles and ended with a kingpin running OxyContin on the streets of Everett. The unravelling was detailed in a Los Angeles Times investigation that triggered the idea for Everett's lawsuit.
The so-called pill mill was ultimately shut down and the cadre of physicians, pharmacists, and dealers that kept it churning were prosecuted.
While the city's suit seeks unspecific damages, officials are seeking tens of millions of dollars, to help pay for services to help fight addiction.
"Purdue needs to be held accountable for not taking the action they should have taken, that allowed drugs to hit these streets and make addicts of many of my citizens," Everett Mayor Ray Stephanson told NBC News.
Key to the complaint are internal Purdue emails outlined by the Los Angeles Times, including a 2009 excerpt from an exchange between the company's compliance director and a sales manager who had become suspicious of the number of OxyContin prescriptions traced back to the clinic's doctors.
After paying the clinic a visit, the sales manager wrote that "the line was out the door, with people who looked like gang members. I feel very certain that this is an organized drug ring."
The lawsuit claims Purdue never notified the Drug Enforcement Administration of the suspected diversion, which it is required to do by law. In the email exchange, the sales rep suggested the DEA should be contacted.
The pills prescribed by the doctors in Los Angeles that Everett leaders say ended up on their streets were almost exclusively 80 mg doses of OxyContin. In Everett, one local physician was eventually jailed for prescribing more than six times the number of 80 mg OxyContin tablets than the town's medical center dosed out in a single year.
For Lindsey Richards, an "80" cost her about $80 in cash — but the personal toll was much higher.
"It makes me very angry," she told NBC News. "Children don't have their mothers because of this. And there's people that are dying every day over — because of what they've done."
Purdue Pharma disputes the allegations in the lawsuit. In a statement to NBC News, the company said the city "paints a flawed and inaccurate portrayal of events that led to the crisis in Everett."
The company said it has been a leader in developing abuse-deterrent medications, "which the FDA and National Institute on Drug Abuse have said are making a difference in the fight against abuse." The company also said that OxyContin accounts for less than 2 percent of all opioid prescriptions in the United States.
"We are deeply troubled by the abuse and misuse of our medication," it added.
The federal government has not charged Purdue with any crimes connected to reporting of OxyContin sales.
Legal experts said that if the city of Everett prevails in civil court, the floodgates could open for other litigation.
"This point could lead to an avalanche of cases from every city, every state in the country that needs money," says Erik Gordon, a professor with the University of Michigan Ross School of Business who follows legal issues faced by the pharmaceutical industry.
Everett's Mayor Stephanson said he's gotten "a fair amount" of calls from other mayors since the suit was filed.
He and other officials said there isn't a city department that hasn't dealt with the fallout from the OxyContin crisis.
Public works employees hit one particular street three times each week to clean up trash and discarded needles associated with drug use. The cost for that block alone hit $160,000 last year.
The suit aims to not only recoup costs, but help Everett finance its fight with opioid addiction in the future.
The Snohomish County jail is overflowing with addicts, its medical unit nearly always full beyond capacity, city officials said.
After OxyContin was reformulated in 2010 to deter abuse, many users switched to heroin, which was cheaper.
The county also runs a medical detox facility that currently has only 16 beds. The number is scheduled to grow by double to 32 in April, and social workers and police officers who work Everett's streets said they will easily fill them.
The city has deployed a new police unit, pairing an officer with a social worker to make contact with often-homeless addicts and to steer them towards treatment.
"The majority of them want help," Everett police officer Kevin Davis said. "But not having the facilities available, the detox beds open, the stuff they need to get into right away, poses the problem."