Portrait of a heroin victim: Alysa Ivy's fatal overdose at 21 has made her one of the faces of a grim epidemic.

• Author: Sontag, Deborah

Karen Hale averts her eyes when she drives past the Super 8 motel in Hudson, Wisconsin, where her 21-year-old daughter, Alysa Ivy, died of a heroin overdose last May. She's thought about asking if she could lie on the bed in Room 223, where Alysa's body was found.

But Hale isn't ready--just as she's not ready to dismantle her daughter's bedroom, where an uncapped red lipstick sits on the dresser and a teddy bear on the bed.

"My son asked me not to make a shrine for her," she says. "But I don't know what to do with her room. I guess on some level I'm still waiting for her to come home."

When the actor Philip Seymour Hoffman died with a needle in his arm in New York in February, Hale thought first about his mother, then his children. Few understand the way addiction mangles families, she says. Perhaps it took Hoffman's death from a mixture of heroin and other drugs to "wake up America to all the no-names who passed away before him."

There have been many in recent years. The use of heroin in the U.S. has doubled since 2007. Almost all of it comes across the border from Mexico into the Southwest (see box, p. 10), and it has now wormed its way into many unsuspecting communities far from the border. Alysa's death was believed to be the seventh fatal heroin overdose in eight months in Hudson, a town of 13,000 near Minneapolis.

According to Alysa's death certificate, a mix of drugs was to blame for her death. "Alysa was a heroin abuser, and her addiction to drugs killed her," says Patty Schachtner, the county medical examiner.

"It's a tight-knit community, and these kids all knew each other," Schachtner says of those who overdosed. "They were not what you might expect. They were not the faces of heroin addiction we see on television."

Heroin Deaths Triple

Nationally, those faces are getting younger. The most recent federal data show more than 19,000 opioid drug deaths in 2010, with 3,100 involving heroin and the rest painkillers. Eighty-eight percent of those who died from heroin were white, half were younger than 34, and almost a fifth were ages 15 to 24. Heroin deaths of teenagers and young adults tripled from 2000 to 2010.

And those statistics lag behind heroin's resurgence over the last few years, as crackdowns on pill mills have made painkillers harder to get and new formulations have made them harder to abuse. Painkillers remain a far larger problem, but the amount of heroin seized on the Mexican border more than tripled from 2008 to 2012, as Mexican traffickers moved much more heroin into the United States.

The problem is particularly severe in Vermont, where $2 million worth of heroin is trafficked every week and there's been a sharp rise in overdoses and deaths. Governor Peter Shumlin says the state is in a "full-blown heroin crisis."

In Wisconsin, heroin seizures, arrests, and deaths have risen sharply. The first heroin fatality in Hudson occurred about three years ago, says Detective Sgt. Geoff Willems of the Hudson police, and "it was pretty surprising." Phil Drewiske, 23, says he bears some responsibility for introducing heroin to the town. He started abusing painkillers stolen from his friend's grandfather's medicine cabinet at 13 and discovered heroin at 16, he says, "at a time when...