The series of nine opioid summits held around the state since July ended last week where the drug epidemic has hit the hardest — St. Louis.

Leaders in government, medicine and public health gathered on the Washington University medical school campus to discuss strategies for combating the problem that killed 273 city residents last year, more than double the previous year.

Mayor Lyda Krewson described the opioid epidemic — abuse of prescription painkillers plus illegal heroin and fentanyl — as a “complex national, state and local problem.”

“It’s going to take all of us,” she said.

St. Louis is a hot spot, said Rachel Winograd, director of a federal grant in Missouri aimed at improving response efforts.

“We have renewed vigor but we need to make sure it reaches everyone among us,” Winograd said.

There were 23 heroin deaths per 100,000 city residents from 2012 to 2016, the highest rate in Missouri and nearly double the rate in Jefferson County, which ranked second. The city also leads the state in all types of opioid deaths and emergency room visits for prescription painkiller and heroin misuse.

Opioid deaths spiked sharply in the city from 2015 to 2016, from 131 to 273. The 2017 numbers — 161 deaths as of Sept. 18 — are down 30 from last year’s pace.

The troublesome change this year has been the rise in fentanyl, a powerful opioid with a potentially lethal dose of just 2 milligrams.

Of the opioid overdose deaths in St. Louis in 2016, 56 percent involved fentanyl. And 84 percent of overdoses in 2017 involve the drug, city data show.

James Shroba, special agent in charge of the Drug Enforcement Agency field office in St. Louis, said 80 percent of heroin addicts started by abusing prescription painkillers. As prescription pills become too expensive and harder to get, addicts switch to street heroin, which can be as cheap as $5 to $10 a dose.

Meanwhile, the purity level of heroin has dramatically increased, he said. And the addition of fentanyl has been a game changer. He said a third of the 64,000 fatal overdoses in the U.S. in 2016 involved fentanyl.

“I challenge all of us to … look at the individuals behind those statistics,” Shroba said.

Janel Marie Wells, 24, of Fenton, overdosed Jan. 28 in a house in the 2900 block of South Kingshighway Boulevard, across from Tower Grove Park. She was pronounced dead at Barnes-Jewish Hospital.

The cause of death was acute fentanyl intoxication.

“To me, this is murder,” said her mother, Sharon Hardcastle. “Somebody put fentanyl in whatever my daughter took, and she died.” But she said nobody ever came to ask questions.

Overdose victims “are just gone, and everybody goes on,” she said.

She said her daughter was arrested for having Xanax pills at Fox High School at age 18 and was placed in drug court.

“It seemed to snowball from there,” her mother said.

She said Wells was new to heroin and fentanyl. Now Hardcastle tries to warn about its dangers.

“That’s all we feel like we can do is educate people,” she said. “You are not going to go do this one night and have fun. You are going to die.”

Seasoned addicts also get hit by it. A few blocks from where Wells overdosed, Robert Patrick Stief, 35, died March 3 from a mixture of heroin and fentanyl.

“My boy lived a life of pain,” his mother, Patricia Gillis, said. “And I lived a life of struggle to work and try to pay to fix him.”

She said Stief’s father and grandmother died from overdoses. She said he had stenosis of the spine and schizophrenia, which was undiagnosed for years. Apart from a six-year stint when he was prescribed Suboxone, a medication-assisted treatment for opioid addiction, his mother said he’d abused drugs since going to Parkway South High School.

“He did well for a very long time, and then that was it,” Gillis said. “He was a very loving boy. He ended up dead. We tried.”

Dr. Will Ross, chairman of the St. Louis Joint Boards of Health and Hospitals, said the opioid crisis should be handled like any communicable disease threat. With a heroin overdose, the neighborhood should be flooded with information, treatment referrals and anti-overdose drugs, he said.

“We need to interrupt the habits, the enablers, the structures that perpetuate the epidemic,” Ross said.

Craig Schmid, government services analyst for the St. Louis City Department of Health, said the department could not respond to individual opioid overdoses.

“Quite frankly we don’t have the resources to investigate each and every incident,” Schmid said. “I don’t say silver bullet anymore. There isn’t one thing that you can do. Like most issues, it’s complex.”

The city health department participates in a prescription drug monitoring program that allows doctors to check a patient’s prescribing history and watch for potential abuses. Pharmacists can watch for signs that a patient may need to carry the overdose-reversing treatment naloxone.

The health department plans to hire an epidemiologist to track the data that come out of the drug monitoring program. But the department’s director, Melba Moore, said she needed additional funding to respond to the epidemic.

“It’s not like we’re turning a deaf ear,” Moore said. “We need more people. We need more action.”