At the Turning Point clinic in East Baltimore the chief weapon employed against the monster comes in small plastic cups, filled with red liquid. That red liquid is methadone, administered to some 2,200 people here every day, "We are the largest methadone clinic on plant Earth."
The clinic assigns each patient a number, which in most cases is matched with their Medicare or Medicaid status. They have to be sober, so there's a breathalyzer test, then the dose goes through the heavy glass partition. Most of the time patients drink right at the window.
Reverend Milton Williams is the pastor of New Life Evangelical Baptist Church and the operator of the Turning Point.
"It stops what's called the withdrawal symptoms, the cravings that cause an addict to go back into the street back into the alley commit violent crimes in order to get that fix," he said.
There is a line to get in, a waiting room, and eight windows staffed 12 hours a day, six days a week,
"Managing 2200 addicts, 2200 former heroin users is a daunting task," Rev. Williams said.
And the clinic is not just managing their methadone intake, patients are also encouraged to attend daily church services. Patients with children can bring them to an on-site day care center. There's a food pantry, including breakfast and lunch service, even counseling sessions, which are mandatory.
The clinic granted ABC2 News exclusive access to this session, participants agreed to have their conversations recoreded. Here's some of what they shared:
"Even though I used, I never enjoyed it. I never enjoyed drugs man. I used to use and get high and be asking myself, why man?"
"When you're using you don't care about stuff like that. I know I didn't. What about Christmas. Ok oh well, give me 10 dollars. Because I know at Christmas people got money."
"Some of my family members, when I was out there, they didn't want me around."
"Some days do I think about using, yes I do. Because if a baseball player breaks his arm and he's home the first thing he's going to think about is doing what- playing ball. But that's all I do- I don't act on what I think."
Nationally there is a debate over the effectiveness of using Methadone and other drugs like it to treat heroin addiction. Some states adhere to what's called "abstinence treatment", better known as cold turkey. In Maryland, city and state health officials say research has shown that medical assisted treatment works better.
For Rev. Williams, there is no doubt, "Do we want to treat this thing with compassion? Or do we want to just act like it doesn't exist and take those who are addicted to heroin, call them 'dope fiends' and just ignore them?"
Williams says the typical heroin user uses drugs several times a day. He compares daily methadone treatments to the medication taken by people who have high blood pressure, or insulin used by diabetics. For now, he says Medicaid and Medicare pay for the methadone in full, for almost every patient.
But he's heard of proposals, at the federal level, that would cut those cost reimbursements by half, "Which is going to translate into hurting people who are not part of the problem. We don't want to send heroin addicts back on the street to their former life to provide for a craving a withdrawal that must be satisfied it's going to be satisfied."