Their pictures hang in the front window of an empty department store, a makeshift memorial to more than two dozen lives. The youngest was still in high school.
Nearly 1 in 10 babies born last year in this Appalachian county tested positive for drugs. In January, police caught several junior high school students, including a seventh grader, with painkillers. Stepping Stone House, a residential rehabilitation clinic for women, takes patients as young as 18.
In Ohio, fatal overdoses more than quadrupled in the last decade, and by 2007 had surpassed car crashes as the leading cause of accidental death, according to the Department of Health.
The problem is so severe that Gov. John R. Kasich announced $36 million in new spending on it this month, an unusual step in this era of budget austerity. And on Tuesday, the Obama administration announced plans to fight prescription drug addiction nationally, noting that it was now killing more people than crack cocaine in the 1980s and heroin in the 1970s combined.
The pattern playing out here bears an eerie resemblance to some blighted cities of the 1980s: a generation of young people who were raised by their grandparents because their parents were addicts, and now they are addicts themselves.
"We're raising third and fourth generations of prescription drug abusers now," said Chief Charles Horner of the Portsmouth police, who often notes that more people died from overdoses in Ohio in 2008 and 2009 than in the World Trade Center attack in 2001.
"We should all be outraged," Chief Horner said. "It should be a No. 1 priority."
Scioto County (pronounced sy-OH-tuh), of which Portsmouth is the seat, has made it one, bringing what had been a very private problem out into the public.
A coroner and a pharmacist are among its state lawmakers, and a bill in the state legislature would more strictly regulate pain clinics where drugs are dispensed. The most popular drug among addicts here is the painkiller OxyContin.
The county's efforts got the attention of political leaders in the state, including Governor Kasich, who declared the county a pilot project for combating addiction.
The problem is so bad that a storage company with business in the county recently complained to Chief Horner that it was having trouble finding enough job candidates who could pass drug tests.
"Around here, everyone has a kid who's addicted," said Lisa Roberts, a nurse who works for the Portsmouth Health Department. "It doesn't matter if you're a police chief, a judge or a Baptist preacher. It's kind of like a rite of passage."
About 10 years ago, when OxyContin first hurtled through the pretty hollow just north of town where the Mannering family lives, the two youngest children were still in high school. Their parents tried to protect them, pleading with neighbors who were selling the drug to stop. By mid-decade, they counted 11 houses on their country road that were dealing the drug (including a woman in her 70s called Granny), and their two youngest children, Nina and Chad, were addicted.
A vast majority of young people, officials said, get the drugs indirectly from dealers and other users who have access to prescriptions. Nina and Chad's father, Ed Mannering, said he caught a 74-year-old friend selling the pills from his front door. The sales were a supplement, the man said sheepishly, to his Social Security check.
"You drive down the road here, and you think, 'All these nice houses, no one's doing any of that stuff,' " said Judy Mannering, Nina and Chad's mother. "But they are. Oh, they are."
Nina Mannering tried to quit, her mother said. She had a small daughter to care for. She was in a counseling program for a few months, but was told to leave when her boyfriend brought her pills. At one point, Ms. Mannering counted the number of schoolmates in four graduating classes who had died from overdoses, her mother recalled. The total was 16.
"It's like being in the middle of a tornado," said Ed Hughes, director of the Counseling Center, a network of rehabilitation and drug counseling clinics in the county. "It was moving so fast that families were caught totally off guard. They had no idea what they were dealing with."
In January 2010, Ms. Mannering was killed less than a mile from her parents' house. A man broke into the house where she was staying with a 65-year-old veteran who had access to prescriptions, and shot them both, looking for pills, the police said. She was 29. Her daughter, who was 8 at the time, watched.
"It was like your worst fear that could ever come true," said Judy Mannering, who discovered her daughter's body at dusk, bathed in the light of a flickering, soundless television. Her son, Chad, served three years in prison for robbery. He is now sober.
Families are joining forces to combat the problem. Mothers whose children died from addiction have started to picket clinics that they believed were reckless with prescriptions. Last month the City Council passed a moratorium on new clinics.
"If you look at the problem, it's the darkest most malevolent thing you've ever seen," said Terry Johnson, a former Portsmouth coroner who is now a state assemblyman. "But right now, people are feeling like they are making a difference, and that's the most important thing. We need to capture that spirit."
The authorities have had some successes. Last month, agents raided a doctor's office and revoked his license. Another doctor from the area, Paul Volkman, is on trial in federal court in Cincinnati and accused of illegally disbursing prescription painkillers. But the drugs are legal, and it is hard to prosecute the people selling them. There are still five clinics in the county, several of them run by felons, officials said.
Chief Horner believes the problem will continue to fester without a coordinated effort by local, state and federal law enforcement agencies.
The state is stepping up efforts with prevention and rehabilitation, a spokeswoman for Governor Kasich said, but there are no plans to increase local financing for law enforcement, which remains, in the view of Chief Horner, woefully inadequate.
The trial of the man who shot Nina Mannering begins in June. Her mother awaits it with a mixture of dread and anticipation. For a while Judy Mannering felt so suffocated by grief that she could not leave the house, but that has passed.
Her grandchildren keep her going, as does her husband, Ed, a logger, who at 59 is still working full time, having spent their entire retirement savings on legal fees and rehab programs.
Mrs. Mannering has joined a group of other grieving mothers, who made the memorial of photographs in the store window. She has protested with them, holding up a sign with her daughter's photograph outside a clinic that dispenses pills. It was something she had never done before, but the ache of her loss gave her the courage.
"I miss her so much," she said of Nina. "If you had 100 kids, you'll never replace the one you've lost."