Three or four years ago, Saline mayor Brian Marl recalls, then police chief Paul Bunten told him that Washtenaw County officials were alarmed that “heroin is becoming more prevalent” in the county. Until then, Marl, a lifelong resident, had never imagined that the deadly drug might come to small-town America.

Between 2012 and 2013, the number of heroin-related deaths in the county doubled, from fourteen to twenty-eight. Most of the casualties lived in the county’s biggest municipalities, Ann Arbor, Ypsilanti, and Ypsilanti Township–but four had Saline addresses. “Two in the latter part of 2013,” Marl says. “And then the fallout–three teens from Saline” charged with robbing and fatally beating an MSU student. While there’s no evidence the students were on heroin at the time, the prosecutor told local media the suspects wanted money for drugs.

“Statistically, for the size of our city, the overdose and deaths we had were much more than anywhere else in the county,” says Larry Hrinik, Bunten’s successor.

What’s going on? Says Hrinik, “I think if I could answer that, we would not be having this conversation.”

Heroin is a highly addictive opiate. According to the National Survey on Drug Use and Health, the number of Americans using it increased by two-thirds between 2007 and 2011. There’s a widespread belief that prescription painkillers were the “gateway drugs” for many of the new addicts.

“Back in the late Nineties there was a big push” to manage pain more aggressively, recalls county medical director Alice Penrose. “As clinicians we were told to get that pain level down to zero.” The anti-pain campaign led many doctors to prescribe painkillers “without thinking of long-term consequences”–namely, addiction.

It wasn’t just patients who were at risk. Others bought or stole the medications to get high. Once those users “start running out of their grandmother’s and best friend’s [prescriptions], they start buying on the streets,” Penrose says. There they find that “heroin is less expensive.” But once they start, they quickly become addicted: “It is very hard to stop using it without treatment,” Penrose says. “It causes all kinds of changes in the brain.”

The Washtenaw Health Initiative Opioid Project formed last year to bring together scattered efforts. Saline has its own task force working on prevention and community response. Hrinik, a co-chair of the task force, says he and other law enforcement people are exploring the possibility of being trained to treat drug overdoses on the spot–but says that “education is probably the biggest thing we’re going to accomplish.” Parents and others need to know signs of addiction, he says, “like sudden mood changes.”

Saline mom Kimberly Ray couldn’t agree more. Her twenty-one-year-old son, John Strawbridge, died of a heroin overdose in December. Ray is channeling her grief into action: she’s working with the task force, and reaching out to parents through her Facebook page, Heroin Epidemic In Washtenaw County, which urges drug users and their families not to let “shame” stop them from getting life-saving help.

Heroin may have surfaced first in Saline because it’s close to Ann Arbor and Ypsilanti. Jesse Kauffman, Chelsea program coordinator for SRSLY, a nonprofit that combats youth substance abuse, says that at the moment, the group is more concerned with marijuana and alcohol. Though drinking is a more familiar peril than heroin, it can be at least as deadly: SRSLY was founded in 2009 after two local teens died in an alcohol-related motorcycle accident.

In Dexter, “we’ve heard about some cases [of heroin use] in the past,” says Stephanie Jacques, SRSLY’s Dexter program coordinator. “It’s on our radar.”

“Knock on wood, we have not had cases in the school involving heroin,” says Dexter High principal William “Kit” Moran. Noting a “strong perception” that Pinckney has a heroin problem, Moran adds, “We know it’s happening in Pinckney. It’s happening in Saline. We’re in between.” It would be “foolish,” he says, “to think we’re invincible.”