Gates, N.Y. - The man with long, brown hair is slumped in the driver's seat, one arm extended out the open window. The first police officer on the scene calls out "sir, sir" before reaching the door and taking a pulse. It's all captured on the body camera she wore.
It's 2 p.m. on an August afternoon on Lyell Avenue at Howard Road, one of the busiest intersections in Gates. The 30-year-old driver has overdosed in the turn lane.
"The light turned green, cars were driving around him, people beeping their horns," recalled Gates Police Chief James VanBrederode.
Ironically, he was on his way to a ribbon-cutting of a new outpatient clinic not far away.
Some shoot up, others take a pill. They end up impaired and behind the wheel. The American Journal of Public Health says that for the first time, drug use causes more fatal crashes than does alcohol use.
"We've seen a big up-tick in the number of crashes where people overdose while driving a car," said Chief VanBrederode.
Said another way: Drugged driving is a bigger threat in fatal crashes than drunk driving.
Traffic fatalities specifically involving heroin or opioid use are seven times what they were 15 years ago. Some drivers are getting high through the illegal use of heroin. Others are doing it legally, with prescription opioids.
"Even if they're taking it per doctor's orders, they still could be impaired," said Dr. Scott Dent of Rochester Behavioral Health.
Nearly 92 million adults were prescribed opioids in 2015. Cell phone video posted by the Lousiana State Police shows the potential danger: A driver later determined to be high on opioids weaves back and forth between two lanes of traffic and crashes into the back of a police car.
"They would make you drowsy, dizzy. They would impair you reflexes," said Dr. Dent.
He said some might take the pills and get behind the wheel because they would not feel the impact at first. "If you take a pill, the on-set is slower - maybe 20 to 30 minutes," he said.
Street heroin behaves much differently. Nearly every dose now being sold in Monroe County contains fentanyl, sometimes in high concentrations. Fentanyl is 50 to 100 times more potent than heroin, and according to the Monroe County Heroin Task Force it is killing 15 people here every month.
Desperate users shoot up while on the road, or get behind the wheel right afterwards.
"That takes effect probably within 30 seconds, because it's going right into the blood and right to the brain," said Jim Wesley. He is a clinical chemist who is retired from the Monroe County Crime Lab. "It's very possible for them to overdose right in the car."
The American Journal of Public Health report concluded nearly half of the drugged drivers who die in crashes have taken opioids or heroin. Another chilling conclusion: Just as often, drugged drivers will cause the accident and survive; it's an innocent person who is killed.
Back at the Gates intersection on August 29, 2017, paramedics carrying Narcan arrived in time. The police body camera footage shows the man who had overdosed alert and in a stretcher as the officer asks "Which hospital are you going to?"
While the reversal is dramatic, every first responder there know there will be a "next time" - if not for this man, then for someone else.
"One of these is going to end up in a tragic accident," said Chief VanBrederode. "It's just a matter of when and where it'a going to happen."
NOTE: This summer 13 WHAM News is taking an in-depth look at the opioid epidemic in our community and across the county. Our project is State of Addiction: the Opioid Epidemic initiative. Click here for more information and a list of resources in our community.