12 and 17 reported abusing prescribed opioids. Deaths from overdose of heroin affect younger people more than deaths from other opiates. Prescription rates for opioids vary widely across states. In 2012, healthcare providers in the highest-prescribing state wrote almost three times as many opioid prescriptions per person as those in the lowest-prescribing state. Health issues that cause people pain do not vary much from place to place and do not explain this variability in prescribing. Researchers suspect that the variation results from a lack of consensus among elected officials in different states about how much pain medication to prescribe. A higher rate of prescription drug use does not lead to better health outcomes or patient satisfaction, according to studies. In Palm Beach County, Florida, overdose deaths went from 149 in 2012 to 588 in 2016. In Middletown, Ohio, overdose deaths quadrupled in the 15 years since 2000. In British Columbia, 967 people died of an opiate overdose in 2016, and the Canadian Medical Association expected over 1,500 deaths in 2017. In Pennsylvania, the number of opioid deaths increased 44 percent from 2016 to 2017, with 5,200 deaths in 2017. Governor Tom Wolf declared a state of emergency in response to the crisis. Impact The high death rate by overdose, the spread of communicable diseases, and the economic burden are major issues caused by the epidemic, which has emerged as one of the worst drug crises in American history. More than 33,000 people died from overdoses in 2015, nearly equal to the number of deaths from car crashes, with the deaths from heroin alone outnumbering gun homicides. It has also left thousands of children suddenly in need of foster care after their parents have died from an overdose. Addiction does not only affect the people taking the drug but the people around them, like families and relationships. Conflict is usually the number one problem between family members and the people abusing heroin, the fighting becomes an everyday routine. In Jeff Schonberg and Philippe Bourgois's ethnography, Righteous Dopefiend, they did a participant observation from 1994 to 2006, and they focused on the lives of the homeless heroin addicts in San Francisco, California. They found that for example, Sonny is still in contact with his family, but he doesn't live with them, and he vowed to himself that he will never let his family see him at his worst, but he goes to