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BISMARCK - Look east down Interstate 94, to Fargo, to Grand Forks, to Minneapolis, to Chicago and Detroit. You'll see the road drug investigators say heroin, and now fentanyl, are driving into Bismarck. Look west, you'll see the older roads, where methamphetamine traveled to town for more than a dozen years.

Drug traffic has shifted in the past three years. Though meth and marijuana remain prevalent, heroin has made a stop in Bismarck along its national tour, carrying with it the breath-stopping overdoses seen across the country.

By one metric: Metro Area Ambulance used Narcan, a drug that temporarily reverses an opioid overdose, 22 times last year. They're on track to use it 41 times in Bismarck and Mandan this year.

By another: Narcotics-related deaths in North Dakota rose from 20 in 2015 to 43 in 2016, according to vital records.

"It is definitely here," Bismarck Police Sgt. Mike Bolme said. "It's the most deadly trend I've seen in my 14 years in police work."

By prioritizing life and cooperation with addicts at overdose scenes, police are trying to keep people alive, while building cases against people trying to make money off their addictions.

Called to an overdose

It was a Wednesday evening nearly a year ago, and Bolme, a drug investigator, went to CHI St. Alexius Health to check on a 23-year-old man recovering from a heroin overdose.

The man was brought to the hospital by two friends, who were using heroin with him. He was using from a different supply when he overdosed, according to a police report.

The hospital called in a patrol officer for a suspicious person, who turned out to be a friend "on the nod" from shooting heroin. The officer found small bags of heroin and methamphetamine in the friend's car. Then he called Bolme, a drug investigator, to come see if the overdose could produce any leads on whoever was selling the potent version of the drug.

It's a scenario police and emergency personnel are carrying out more than ever in this area.

For Bismarck Police Patrolmen Damien Girodat and Melvin Vargas, calls to a heroin overdose come nearly twice a month on their shift. It rarely happened when they began as police officers three and four and a half years ago, respectively.

Often, it's a night manager at a hotel or a friend with the report, they said. An overdose is a "code" emergency, so they hit their lights and sirens and rush over.

If police officers are first on scene, they've now got Narcan, Girodat explained, pulling a small orange box from a pocket in his bulletproof vest. The antidote also could be used for a police officer, in case they encounter fentanyl, which can cause a reaction with tiny quantities.

Bismarck Police Det. Tyler Welk said he does not know of police officers using Narcan since it was distributed in May, but the Bismarck Fire Department reports using it 11 times since staff members were trained last July.

Vargas said officers are trying to interact in positive ways with people around the overdose. Users often know where the treatment is, they're just not ready and they're afraid of getting "dope sick," the painful and nauseating process of withdrawal.

"When you interact with these individuals, pretty much take off your uniform and talk to them man to man as adults," Vargas said. "We drill into their heads, we're here to help, we value your friends."

The powerful addiction often evolves from a penchant for pills that can began with legitimate painkillers prescribed after an injury. People turn to heroin when the pills become too expensive. In other cases, people using on other illegal drugs start using and get hooked on heroin.

Girodat told a story about meeting a 24-year-old woman at the hospital about to be discharged from an overdose. She said her brother died the week prior from one and laughed, "I'm not gonna stop."

When they respond to an overdose, the officers' job is also to secure the scene, taking names and collecting evidence, which they'll relay to a narcotics detective. If there is even a small chance of a lead, an investigator will come by looking for clues. Drugs that cause overdoses are often tainted with fentanyl, which is deadlier than heroin.

"If the fentanyl is floating around town, it's going to happen again. But if we can find out the source and stop that, then that eliminates a lot of problems," Girodat said.

The night at CHI St. Alexius last year, the drugs and a syringe were taken as evidence. Bolme left his card for the hospitalized man, but the officers let the three go with no charges.

"All subjects were told by me that because they had done the right thing, no one would be charged in this case," Bolme wrote in a Sept. 6 report.

Bolme was using the Good Samaritan law, which protects friends, who may have shared drugs with the overdose victim, if they seek medical help and stay on scene until it arrives.

Too often, Bolme said, friends will call police and leave before the ambulance shows up, drop a friend alone out of a car or stay but flush all of the evidence.

"The best thing to do would be to stay," Bolme said. "There is still the stigma out there that they will get arrested ... At least in our area, they will not."

The drug trade

Heroin comes here from Detroit or Chicago, according to Welk, who works drug cases for the Bismarck Police.

The drugs are originating in street gangs, who send relatively disposable people to sell them here in Bismarck, Welk said. That's because there's big money to be made. The drug sells for $9,000 on 100 grams in Chicago but $30,000 on 100 grams here - a profit of $21,000 - he said.

It's sold in points, which is one-tenth of a gram, that go for about $60. Typically, addicts will buy a gram for $250 to $300 and sell off a few points to fund their habits.

"We don't have the supply that Chicago does, but we have the addiction," Welk said.

Investigators are watching the problem get worse, but policing has led to some victories with a spike in federal opioid-related cases filed here.

President Donald Trump this week declared the opioid crisis a "national emergency," a move that could enable more resources to combat the problem nationwide.

But medical professionals remain concerned.

Gordon Leingang, an emergency room doctor at CHI St. Alexius, who advises the police, told this anecdote last week. He resuscitated a man who overdosed recently for the third time. The next day, the man's brother came in with an overdose. A woman was there and pulled the doctor aside to tell him that her boyfriend, the guy who overdosed the previous day, was in the bathroom shooting up. So, they went to check it out. He wasn't there. Rather, he was in a car across the street, overdosed with a needle in his arm. So, they dragged him in and resuscitated him again.

Overdoses show up in the ER almost every day now, Leingang said.

"I wish I could be more encouraging. I really do. It's bad. I wouldn't say it's worse in Bismarck than anywhere else, but the raw numbers are truly impressive," Leingang said.

As he spoke by phone last week, his team worked on resuscitating another overdose victim.