Like many fire stations across Columbus, Station 18 in the Linden neighborhood has seen an uptick in the number of overdose runs.
"About four, five years ago we started seeing a real bad increase in this," says Lt. Jeff Shaw.
Shaw opens a narrow closet filled with medical supplies and grabs a bag valve mask - used to pump a patients lungs with oxygen. Then he pulls out a syringe with a blunt tip, called a MAD (Mucosal Atomization Device). Shaw says it's used instead if a needle because many overdose patients lack healthy veins.
"We put the Narcan in and we can spray it up their nose," he says.
Narcan is a brand of naloxone, the overdose reversal drug.
All together, these items cost about $50. That may not seem like a lot, but it adds up: Columbus paramedics answer about a dozen overdose calls a day. Just last year, the city purchased over 7,000 doses of naloxone, for a record $243,560—significantly more than what they spend on any other drug.
If you talk to Battalion Chief Steve Martin, he’ll says it's putting pressure on an already tight budget.
"There's a lot of people that are requesting things that we say no to because there's no money," Martin says.
But, he says, this is by no means a financial crisis. The department runs hundreds of other emergency calls a day and many of the associated costs, like use of the ambulance and staff hours, are already accounted for.
"We're on duty, we're getting paid to be on duty whether we're on a run or not," Martin says.
Another cost to consider is where the paramedics take overdose patients: emergency departments.
Dr. Eric Adkins at The Ohio State University Hospital says overdose patients typically spend about four hours in the ER.
"Once you’ve given them Narcan, then there’s going to be a period of observation," Adkins says.
Doctors want to insure patients respond to the naloxone, that no other drugs were taken and that the patient isn’t suicidal. In more serious cases, patients may have suffer brain injuries and need to stay in the intensive care unit. The price of a single ER visit varies widely in each case, but Adkins knows it's costly.
"It’s expensive to get care in the emergency department," Adams says. "There’s nurses attending to them, we’ve got the techs, respiratory therapists, pharmacists."
The OSU Hospital says last year they saw 232 overdose patients which cost them over half a million dollars. More than half of those patients paid for their care using Medicaid.
This hospital is just one of seven ERs in the city, and each receives hundreds of overdose patients a year.
Adkins says the price of care is something he and his staff rarely consider, but sometimes it's worth taking a step back.
"It does have a big financial burden and it's not necessarily something that's just OSU," Adkins says. "It's emergency departments all over the country."
In the unfortunate event that one of these overdose patients does not survive, the next cost to factor in is the Franklin County Coroner officer.
2016 saw 353 fatal overdoses in Columbus. Each underwent an autopsy, or external exam, to the tune of around $1,200 each. In response to an upswing in overdose cases, the office has had to increase staff and budget.
Elsewhere in Ohio, coroners haven't been so lucky: the Montgomery County Coroner's Office, which covers Dayton, has run out of room. They've had to ask a funeral parlor to store bodies temporarily.
Then, if an individual has no living relatives or anyone else willing to claim their remains, they are cremated at the expense of the city: one final expense of around $700.