Shaking and delirious, Rina ambles half-dressed beside a dump in Ecuador's port city of Guayaquil.
She is under the psychotropic effects of "H," a cheap and addictive drug that is ravaging the poorest sectors of Ecuadoran society.
The scene was captured on video on New Year's Eve and relayed to the municipal health center, which came to her aid.
"When I consume (the drug) I hear voices," the 24-year-old, who is using a pseudonym, told AFP.
For the second time in less than a year she is following a drug rehabilitation program.
In her desperation, Rina stole and even worked as a prostitute to buy H, a heroin-based white powder that can be snorted or smoked and is sold for $1 a gram.
It is much cheaper and much more toxic than cocaine, which goes for $3 to $5.
H is cut with all sorts of toxic materials that can harm humans.
"We have found lime, cement, ether, rat poison and even ketamine, an analgesic used on horses," in the white powder, said psychiatrist Julieta Sagnay, from the Guayaquil-based Neuroscience Institute, an NGO that supports drug addicts.
Guayaquil, a city of almost three million people, has become a hub of drug trafficking and addiction.
Officials say 162 kilograms of H were seized in 2022.
Sagnay, an expert with more than 30 years of experience treating addicts, says the number of patients she treats for H use is increasing every day.
And their physical condition deteriorates quicker than other patients.
In just six months, H addicts are constantly moving their legs, scratching, and not sleeping or eating.
Withdrawal symptoms are so severe, says Sagnay, that it is unbearable without at least eight days of pharmaceutical treatment.
- 'They beat me' -
There are three public clinics in Guayaquil for addicts and there are more than 30 private ones but they can cost up to $700 a month in a country where the minimum wage is just $450.
Some addicts turn to back-alley detox centers.
"They beat me, they poured a bucket of cold water on me and we ate chicken heads every day," said Hugo Mora, who was treated four years ago in a dirty, dark, illegal center with no windows.
It only cost $150 but it was a failure.
After trying out two such clinics, the 24-year-old street vendor spent a week in a municipal hospital, where he was treated in a large room with more than a dozen beds.
The hospital takes in up to 150 daily patients, 90 percent of whom are suffering from an H addiction.
The InSight Crime think tank says H arrived in Guayaquil in 2011, pushed by Colombian cartels hoping to develop the heroin market.
But the H powder contains less than three percent heroin, according to forensic psychologist and retired police officer Segundo Romero.
"As there is so little pure drug, the addict needs to consume more and buy more," said the forensic psychologist.
He told a story about meeting addicts in prison whose faces were covered in dust.
"As they no longer had any drugs, they had scratched the walls and put white paint in their nostrils," he said.
With just one gram of heroin, a dealer can make 40 grams of H, with the mix of ingredients provoking psychotic symptoms and hallucinations.
In Cerro las Cabras, the drug supermarket in Duran, a town opposite Guayaquil along the Guayas river, H sales bring in $1 million a month, according to official estimates.