At The New Yorker, Margaret Talbot reports on the opioid epidemic in West Virginia. There, the overdose rate is the highest in the United States and many are fighting to help loved ones, friends, neighbors, and sometimes complete strangers get healthy: An emergency paramedic who routinely sees multiple overdoses a day, sometimes the same people on repeat. A team of moms called “The Hope Dealers” who drive addicts hours away to get the treatment they need. A 71-year-old doctor offering free public classes on how to administer Narcan, a drug that reverses the effects of these now-commonplace overdose. All this in an opioid epidemic fueled by cheap highs and small-town despair over limited prospects.

We were driving away from Hedgesville when the third overdose call of the day came, for a twenty-nine-year-old male. Inside a nicely kept house in a modern subdivision, the man was lying unconscious on the bathroom floor, taking intermittent gasps. He was pale, though not yet the blue-tinged gray that people turn when they’ve been breathing poorly for a while. Opioid overdoses usually kill people by inhibiting respiration: breathing slows and starts to sound labored, then stops altogether.

As we drove away, Barrett predicted that the man would check himself out of the hospital as soon as he could; most O.D. patients refused further treatment. Even a brush with death was rarely a turning point for an addict. “It’s kind of hard to feel good about it,” Barrett said of the intervention. “Though he did say, ‘Thanks for waking me up.’ Well, that’s our job. But do you feel like you’re really making a difference? Ninety-nine per cent of the time, no.” The next week, Barrett’s crew was called back to the same house repeatedly. The man overdosed three times; his girlfriend, once.

But a larger factor, it seems, was the despair of white people in struggling small towns. Judith Feinberg, a professor at West Virginia University who studies drug addiction, described opioids as “the ultimate escape drugs.” She told me, “Boredom and a sense of uselessness and inadequacy—these are human failings that lead you to just want to withdraw. On heroin, you curl up in a corner and blank out the world. It’s an extremely seductive drug for dead-end towns, because it makes the world’s problems go away. Much more so than coke or meth, where you want to run around and do things—you get aggressive, razzed and jazzed.”

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