Youngstown was once a relatively affluent blue-collar city. The steel mills that stretched for 25 uninterrupted miles (40 kilometers) along the banks of the Mahoning River in north-eastern Ohio employed tens of thousands. The blast furnaces ran 24 hours a day, filling the sky with charcoal-colored smoke and the pervasive smell of sulfur. 

These days the sky around Youngstown is clear blue. The clang of metal and the hiss of steam have disappeared. The steel industry collapsed in the 1970s. Like the work, the people have left. The population of Youngstown plummeted from around 140,000 in 1970 to less than 65,000 today. Bruce Springsteen even wrote a dolorous lament to the town's post-industrial plight.

Traditionally Youngstown's white working classes were rock solid Democrats. Now many are switching over to Donald Trump. The Republican nominee's protectionist message is playing well across the American "Rust Belt," not least in Ohio. This could augur well for Trump: Ohio has backed the winning candidate in 28 of the last 30 contests.

"Trump is the only option that's not the political establishment," says Justin Summer, a 22-year-old barman in O'Donold's Irish bar. "Neither the Democrats or the Republicans have done anything for us. If he gets in he'll shake things up. We just want someone who will do something for us."

Retired insurance salesman Tom Burnbrier agrees. "We need a change. The Democratic Party has run Youngstown for years, and it has done nothing but get worse."

Smoke and mirrors

Traces of Youngstown's glory days can still be seen in the fine, early 20th century buildings that line Federal Street. But instead of branches of Macy's or upmarket restaurants, most of the units are either vacant or house liquor stores and bail bondsmen. Entire city blocks lie empty.

One of the few colorful shop fronts downtown is a bookshop window filled with posters for Jill Stein and the Green Party. Inside, Jim Villani, owner of Pig Iron Press, makes the case for the third-party candidate. 

"Republicans and Democrats is so much smoke and mirrors. Donald Trump is the smoke and Hillary Clinton is the mirrors," says Villani, surrounded by old paperbacks and bundles of lime green leaflets. "Clinton has some progressive ideas but she is in the pocket of wealth and power. We don't need more wealth and power in government."

'Many turned to heroin'

The biggest issue in Youngstown is not politics, or even jobs. It's drugs. The city, and particularly its more salubrious suburbs, are in the midst of a heroin epidemic that is ravaging much of Ohio and the Midwest. In one recent weekend 11 overdoses were reported in a single district of Mahoning County.

Heroin came quietly. It began almost innocuously in the late 1990s and early 2000s when pharmaceutical companies began promoting new, opiate-based medication for pain relief. The drugs were marketed as non-addictive. The reality was very different. 

"We saw a lot of kids who had been hurt playing sport, who got a prescription and said "this feels good," so that they started sharing it with their friends. Then they were hooked," explains Brenda Heidinger, associate director of Mahoning County Mental Health and Recovery Board.

"Pain management clinics" started opening up in the center of Youngstown, doling out medication with minimal oversight. Ohio's state government has started clamping down on the "pill mills," but it's too late. Many users have already started turning to heroin. Where opiates can retail at $100 (90 euros) a pill on the streets, a bag of smack is as little as five bucks. Often it comes laced with fentanyl, a powerful tranquillizer implicated in many recent deaths.

Cable television is peppered with commercials for addiction services.

Everybody seems to know someone who is a user.

"People are still reluctant to admit that this is happening but we need to face up to the scale of this," says Pamela Ramsey from the Neil Kennedy Recovery Clinic in Youngstown. Each week around 650 people attend the center's Alcoholic Anonymous-style clinics.

Ramsey takes me to a residential clinic on the outskirts of Youngstown. At the end of a tree-lined street pockmarked with boarded-up houses, a dozen or so patients are huddled outside smoking. Most wear hoodies pulled tight around their faces, but it is clear that the majority are in their 20s, white and well-dressed. This is not the usual picture of urban drug abuse.

"When I started 19 years ago the average person was 35-years-old and on crack," says Judge Jack Durkin, who administers Youngstown's drug courts. "Now the average age is 23 and they are addicted to opiates or heroin."

Judge Durkin is a registered Democrat but he says he understands some of Trump's appeal in Youngstown. "The middle class have lost hope in 'government as usual,'" he says over lunch at one of city's many Italian restaurants.

"There is a proportion of undecided voters who traditionally would have voted Democrat but who are now considering voting Republican because of Donald Trump," says Durkin.

Republican rise

Youngstown is showing some signs of recovery from the Great Recession: the unemployment rate, which peaked at nearly 17 percent in January 2010, stood at 7.6 percent in June. But around the sprawling suburban strip malls a few miles outside of town, where most people go to shop and eat, the only signs are for Trump. 

Even in Youngstown, decades of stagnant wages does not tell the full story of the rise of Donald Trump. There are racial overtones, too. 

Downtown Youngstown is predominantly black, the suburbs overwhelmingly white. Earlier in the summer, Trump campaign chair in Mahoning County, Kathy Miller, was filmed telling a journalist that she didn't think "there was any racism until Obama got

elected." The video went viral. Miller was forced to resign.

Taxi driver Ronnie says that Trump "is clearly a racist." After four decades working in the steel mills the African-American now drives an Uber cab. He will be voting Clinton: "The union is backing her, and that's good enough for me."

Back in O'Donold's bar, Adam Brite is finishing a lunch of fried fish. The 28-year-old voted for Obama in 2012, but will be staying at home on Tuesday. "I'm so disillusioned with the whole thing. I don't like Trump, but I can't bring myself to vote for Hillary." The number of people who feel the same could yet decide this most unpredictable of American elections.