Many know how dangerous and even deadly illegal drugs can be, but a different kind of drug has turned "overdoses" into Hawaii's new number three killer.
The word on Chinatown's streets is more illegal users are over-dosing on drugs.
"Half of our participants have experienced or witnessed a drug overdose in the past two years," said Heather Lusk, the Executive Director with the CHOW Project, which stands for Community Health Outreach Work.
Outreach workers have also seen first-hand what can happen from using too much of a drug, or mixing different kinds of drugs -- both can have potentially deadly results.
"A participant had just shot up some dope, and he ended up sprawled out on the ground in front of me. I kept asking him if he was OK and he would not respond to me," said CHOW outreach worker Hana Barrineau.
A heroin user named "theresa" described her terrifying overdose experiences, "It paralyses your breathing. You can't catch your breath and you can't keep your eyes open. You know you are going to go out, and if you fall asleep you are most likely not going to wake up".
But along with illegal drug overdoses, there has also been a spike in people dying from their own prescriptions.
"People with legitimate pain prescriptions are overdosing because they don't know the dosing or the drug-to-drug interactions," said Lusk.
"the annual number of fatalities has more than doubled in the last ten years," said Dan Galanis, an epidemiologist with the State Department of Health.
Last year alone, there were 109 overdose fatalities compared to just 39 in 2001.