Huntington, West Virginia: The Story of America's "Overdose Capital"

Cities38.42 N, 82.45 W

Huntington, West Virginia: The Story of America's "Overdose Capital"

How Huntington, West Virginia became known as America's overdose capital during the opioid epidemic, and the remarkable community efforts that helped turn the tide against addiction.

Simon WhistlerJuly.1.202617 min read

On August 15, 2016, local ambulance crews rushed around town, performing their duty with competence and courage, as usual. In addition to treating heart attacks, trauma, and other common incidents, local emergency technicians had become accustomed to resuscitating patients suffering from an opioid overdose. On that particular day, they had to rescue a total of 28 overdose patients—more than one per hour.

These figures might not appear impressive in the context of a sprawling megalopolis with millions of inhabitants. In this case, however, we are talking about a city which, at the time, counted some 48,000 inhabitants. Of which a staggering 12,000—or one in four—was addicted to prescription pills, heroin, fentanyl, or a combination of opioid and stimulant drugs.

This city became known as the “overdose capital,” or even the “drug death capital” of America, the epicenter of the tragic opioid epidemic which devastated so many lives across the nation. But while this small city may have made headlines due to the high incidence of overdosing patients, its citizens deserve attention, and credit, for the efforts they put in place to address such a widespread crisis. This is Huntington, West Virginia, and this is the story of its fall—and of its rise.

Key Takeaways

Huntington, West Virginia, faced a severe opioid crisis, with 1 in 4 residents addicted to opioids in 2016.
The city’s opioid epidemic was driven by the decline of the coal industry and aggressive marketing of prescription opioids.
Huntington implemented various initiatives, such as Lily’s Place and Healthy Connections, to support families affected by opioid addiction.
The city’s efforts included distributing naloxone to emergency personnel and establishing a Quick Response Team to address overdoses.
Despite legal setbacks, Huntington continues to fight the opioid crisis with community support and new recovery facilities.

We Are Huntington

The city of Huntington is located in the western portion of the State of West Virginia, near the border with Ohio and Kentucky. Today it is home to some 45,000 inhabitants, and it is the seat of Cabell County. Thanks to its proximity to the Ohio River, in the 19th and 20th centuries Huntington played a significant role in the economy of the region, as it was a major transport hub for Appalachian timber and coal.

Huntington is no stranger to tragedy. On November 14, 1970, a Southern Airways flight crashed against a hill just outside Huntington, resulting in the deaths of 75 passengers. Most of them were players, coaches and supporters of the local Marshall University’s beloved football team. The impact on the community was devastating, so much so that citizens took to dividing Huntington’s history into two eras: before, and after the crash. Nonetheless, the city came together to mourn their losses and eventually healed. Huntington’s recovery from tragedy and loss was immortalized by two films, the 2000 documentary Marshall University: Ashes to Glory, and 2006’s We Are Marshall.

Unfortunately, some years later the seat of Cabell County would become known nation-wide for another, much less enviable reason: being the “overdose capital” of America. A 2016 article by CNN described Huntington as “America’s drug death capital” and described how “One in four residents here is hooked on heroin or some other opioid, local health officials say. That’s a staggering 12,000 people dealing with opioid addiction.”

Huntington was not an isolated case. The suffering endured by the community was the most visible symptom of the opioid epidemic gripping large swathes of the US. An epidemic which had become particularly harrowing in West Virginia. In 2016 the State experienced the highest rate of deaths related to opioid overdose, at 40 fatalities per 100,000 inhabitants. This rate was 169% higher than the national average.

An Opioid Tsunami

Why had the opioid crisis become so severe in West Virginia, and Cabell County in particular?

According to Sam Workman, Director of the Institute for Policy Research and Public Affairs at West Virginia University, the origin lies in two concomitant factors.

First, the local coal mining industry—or rather its decline. As the workforce was cut in half during the early 1990s, many former miners and their families were left with very little prospects, while suffering from the painful consequences of years of physically grueling jobs.

And then, the introduction of powerful opioid prescription drugs, such as oxycodone, marketed as OxyContin, and first licensed by the US Food and Drug Administration in December 1995. As stated by Workman: “The physical wear and tear laid the foundation for a broader crisis. As blue-collar jobs dried up, pharmaceutical companies like Purdue Pharma started promoting new pain-relief medications like OxyContin … Four years after it was introduced, the drug was being prescribed in some West Virginia counties nearly five times more than the national average.”

It was the proverbial perfect storm. On one hand, a community in dire need of effective pain relief drugs. On the other hand, pharmaceutical companies, more than willing to aggressively promote such medication.

But the pharmaceutical market does not rely entirely on supply and demand. You need an intermediary, i.e. a healthcare professional issuing a prescription. And it appeared that, since the early 2000s, healthcare professionals in West Virginia were signing millions of such scripts.

The disproportionate volume of prescriptions for oxycodone, hydrocodone and other pain killers attracted the attention of the West Virginia Bureau of Criminal Investigation. In 2001, State Police Sergeant Mike Smith first uncovered one of many “pill mills”: clinics, pharmacies or wellness centres, usually located in small rural towns, which cranked out hundreds of prescriptions every day, with very little supervision or due process.

Sometimes, these “mills” were managed by career criminals, who had spotted a winning business model: instead of dealing illegal drugs, they would make millions of dollars by peddling prescriptions for legal medicines. As reported by The Guardian: “A group of doctors were set up by a former pimp, just out of federal prison for running a gay prostitution ring in Washington DC.”

Pill mills mushroomed in Cabell County, thanks to its strategic geographic location linking three States. As a result, from 2006 to 2014, more than 81 million opioid pills made their way to Huntington and the surrounding county. At the time, Cabell’s population was just short of 97,000. Which means that the area had been flooded with 837 pills for every single inhabitant.

As we shall learn later, these shipments were not managed by the manufacturers of such drugs, but by wholesale distributors, of which McKesson, AmerisourceBergen and Cardinal Health handled the majority of orders.

The effects of such an opioid tsunami on Huntington and Cabell soon became apparent. In 2015, opioid overdose became the third most frequent cause of death in the area, topped only by heart disease and cancer.

For Huntington’s emergency medical services, pulling overdosing patients from the brink of death was a daily occurrence. On a particularly grueling day, August 15, 2016, ambulance crews recorded 28 cases of overdose. On later occasions, emergency personnel would report treating as many as eight overdose victims in the span of just 20 minutes!

The crisis was not limited to Huntington, of course, but had spread nationwide. Thus, in 2016, the Centers for Disease Control and Prevention, or CDC, issued tight guidelines to restrict the prescription of opioids. But this measure turned out to be counterproductive: as locals could not access oxycodone or hydrocodone, they first turned to taking other prescription drugs such as the anticonvulsant gabapentin. And later, to buying heroin from street dealers.

Heroin addicts soon took to injecting far more potent drugs, such as fentanyl, which can be as much as 100 times stronger than morphine. Or carfentanil, initially synthesized as a tranquilizer for elephants, 10,000 times stronger than morphine. Often, they would mix all of these drugs, adding stimulants like cocaine and methamphetamine.

By 2017, Cabell County’s opioid overdose death rate was soaring at 72.7 per 100,000 inhabitants, almost five times the national average.

In the ensuing years, as reported by the CDC, West Virginia would continue to top the grim leaderboard of deaths by overdose in the US. In 2022, the State experienced 1,335 deaths, a rate of 80.9 deaths per 100,000 inhabitants. The vast majority of these fatal cases were concentrated in the counties of Kanawha and Cabell.

One of the most harrowing consequences of the widespread drug consumption was its effects on newborn babies. In 2016, one in ten babies born at the Cabell Huntington Hospital suffered from Neonatal Abstinence Syndrome, or NAS. In other words, they experienced the symptoms of withdrawal from heroin, cocaine, alcohol, or a combination of several substances. Most babies suffering from NAS would be expected to suffer from long-lasting neurological problems, while 10% will suffer from Hepatitis C.

This phenomenon was not limited to Huntington: in 2016, West Virginia was reported as having the highest incidence of NAS in the nation, with a rate of 33.4 per 1,000 babies.

Turning the Tide

What made Huntington stand apart, however, was its willingness to fight back, to reverse the tide by providing coordinated responses to support both the babies and their families.

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Huntington, West Virginia: The Story of America's "Overdose Capital"

A first effort came from Sarah Murray and Rhonda Edmunds, two pediatric nurses at Cabell Huntington Hospital. In 2016, the duo opened a separate facility called Lily’s Place, dedicated to helping babies suffering from NAS and their young mothers. After giving birth, each mother and her newborn could spend some protected time in their own room, where specialized nurses would teach them the first, basic yet vital skills on how to look after their babies.

In 2017, the hospital launched a more wide-ranging initiative, called Healthy Connections, described as “A community coalition designed to serve women struggling with substance use disorder.”

A new mother suffering from substance abuse would be first put in contact with a Family Navigator, in charge of assessing her needs. The Navigator would then get the mum in touch with a peer support group of mothers facing similar challenges. Finally, the Navigator would offer the patient some options for recovery services.

The next priority would be to reach out to the baby’s father and other relatives, bringing them together into a healthy support network. They will provide care and stability to the newborn, while the mother goes through her recovery process.

The mother and the baby will also be referred to the Knowledge In Developmental Steps Clinic—simply known as KIDS Clinic.

The KIDS Clinic provides convenient access to a team of specialists, including a pediatrician, a neurologist, a physical therapist, a speech pathologist, and a social worker—who will all cooperate to help babies suffering from NAS to develop healthy brains and bodies.

As babies progress through their first weeks of age, they will also be enrolled in the CARES program, which stands for Center for Addiction Research, Education, and Support. This program, specially designed for children experiencing NAS, will support their development through the first five years of age, aiming at a smooth transition into the school system.

The initiatives put in place at its hospital show that Huntington is not just the “drug death capital of America.” If anything, over the past two decades, the city has proved to be worthy of another, more positive title: the capital of efforts to combat drug death.

Back in November 2014, Mayor Steve Williams had first instituted the local Office of Drug Control Policy, in charge of collecting and analyzing data about drug usage, with the help of 50 specialized agencies and organizations.

In early 2015, Huntington’s authorities opened West Virginia’s first syringe exchange program, which in its first year in operation distributed 150,000 clean syringes to more than 1,700 people. This program did not just dispense safe paraphernalia. It also offered medical assessments and specialized referrals to addicts seeking to recover. In the same year, Huntington opened its first, dedicated, detox ward, consisting of eight beds.

In 2016, medical and emergency personnel—including police officers—were equipped with a key weapon against death by overdose: injectable or inhalable naloxone, a potent opioid antagonist which can reverse the effects of overdose. Even Mayor Williams took to carrying a naloxone injector wherever he went!

You will remember that we mentioned that on August 15, 2016, ambulance crews had to tend to a total of 28 patients overdosing. Well, on that day nobody died, thanks to the prompt intervention of Emergency Medical Technicians, and their prompt use of naloxone.

But bringing overdosing patients back from the brink of death is just one aspect of the ongoing struggle. In 2017, Huntington authorities addressed what happens after an overdose, by establishing the Quick Response Team. Within 3 days from overdosing, a patient or their family will be visited by a peer recovery coach, a paramedic, a police officer, and a faith leader. Crucially, the Quick Response Team also plays a preventative role, as family members who fear their loved ones may be at risk of overdose can contact the team, to conduct a welfare check.

This innovation clearly had an impact. In early 2017, EMT crews were called to deal with up to six overdose cases per 12-hour shift, an average of 360 per month. Following the introduction of the Quick Response Teams, the number of ambulance calls fell by 40%.

In 2020 Mayor Williams teamed up with local healthcare providers and Marshall University to design a “resiliency plan,” set to tackle both short- and long-term goals. Short-term objectives included expanding hospital care for overdosing patients, and providing educational resources. More importantly, in the long term the city will seek to address the underlying predictors of poor health and substance abuse, such as unemployment and lack of adequate housing.

Distributors on Trial

In addition to addressing the problems of its community, the city of Huntington and Cabell County sought to obtain compensation from the companies held responsible for the opioid epidemic.

In April 2021, Cabell County attorney Paul Farrell filed a lawsuit against medicine wholesalers McKesson, AmerisourceBergen and Cardinal Health, accused of turning Huntington into the “Ground zero of the opioid epidemic sweeping the nation.”

Mr. Farrell argued that the distributors should be held responsible for recklessly flooding the community with millions of prescription painkillers. As such, they were requested to pay $2.5 billion in damages, which would be used to address the substance addiction crisis.

More precisely, the County attorney accused the defendants of causing a “public nuisance,” i.e. of interfering with the rights of the public through their conduct. Quoting from Article 549 of the West Virginia legal code: “Such public nuisance endangers the health, safety and welfare of the community and is dangerous and detrimental to the public health, may violate the laws of the City and/or State as well as obstructs the community from reasonable and comfortable use of property.”

In July 2022, US District Judge David Farber issued the verdict—which was not the one Huntington expected. The judge, in fact, exonerated the three wholesalers, stating that “Plaintiffs failed to show that the volume of prescription opioids distributed in Cabell/Huntington was because of unreasonable conduct on the part of defendants.” He further added that “There is nothing unreasonable about distributing controlled substances to fulfill legally written prescriptions.”

As mentioned earlier, investigations by the West Virginia Bureau of Criminal Investigation had shown how millions of such prescriptions had been written by “pill mills.” Therefore, it can be argued that those scripts were not 100% “legally written.”

In May 2024, Huntington and Cabell County appealed the initial verdict to West Virginia’s Supreme Court. At the time of researching this episode, the Court is yet to deliver their verdict.

The Road to Recovery

By mid-2024, the brave people of Huntington were still fighting their ongoing war against the scourge of death by overdose. Healthcare authorities opened yet more facilities to help contain the damage of substance abuse.

Karen’s Place, for example, a centre dedicated to supporting mums-to-be through pregnancy, and to manage the symptoms of withdrawal in their babies. Or a detox centre, simply called Recovery Point, managed by fully recovered former addicts.

One of them, Richie Armstrong, spoke to Sky News reporter Mark Stone in the summer of 2024, stating that “Huntington’s recovery community is huge … On the 22nd next week, I’ll have eight years of continuous sobriety. And this is all I’ve done since I’ve been sober, is work in the field of recovery. I had made the decision early on into sobriety that the recovery world was going to be my life. And it absolutely is 100% my life.”

Thanks to the indefatigable efforts of former victims of drug abuse like Richie, of medical professionals, emergency personnel, and local authorities as a whole, Huntington is slowly clawing back terrain, reclaiming the lives of its inhabitants from the darkness of addiction and abuse.

The dark days in which ambulance crews had to attend to 28 overdose victims in a single day are hopefully gone. In August 2024, city statistics showed that the figures had declined to 10 overdoses a week, which seldom become fatal thanks to the prompt intervention and dedication of emergency personnel.

This statistic still implies a total of 520 overdose cases a year, a rate of one per 86 inhabitants. Still too many, in this city of 45,000 souls.

But it is a massive improvement, nonetheless, a testament to the dedication of local authorities, and especially of those who were snatched from the jaws of death, and are now willing to support others through their recovery pathway.

The road to total victory against the stubborn foe of widespread addiction is still long and arduous. But what the people of Huntington have proved again and again, is that they certainly do not intend to surrender.

Presented by

Simon Whistler

Simon Whistler is one of YouTube's most prolific educational creators, with tens of millions of subscribers across his channels. Places is his expedition into the world's most remarkable locations — from cities carved from salt to islands nobody dares inhabit. He brings a researcher's rigour and a traveller's awe to every field note.

Frequently Asked Questions

What is Huntington, West Virginia known for?

Huntington, West Virginia is known as the ‘overdose capital’ or ‘drug death capital’ of America due to its high incidence of opioid overdoses.

How many people in Huntington were addicted to opioids in 2016?

In 2016, approximately 12,000 people in Huntington, which was about one in four residents, were addicted to prescription pills, heroin, fentanyl, or a combination of opioid and stimulant drugs.

What was the opioid overdose death rate in Cabell County in 2017?

In 2017, Cabell County’s opioid overdose death rate was 72.7 per 100,000 inhabitants, almost five times the national average.

What initiatives were started by Sarah Murray and Rhonda Edmunds to help babies suffering from NAS?

Sarah Murray and Rhonda Edmunds opened Lily’s Place, a facility dedicated to helping babies suffering from Neonatal Abstinence Syndrome (NAS) and their young mothers.

What is the Quick Response Team in Huntington?

The Quick Response Team in Huntington visits patients or their families within three days of an overdose, providing support and preventative measures to reduce future overdoses.

What was the outcome of the lawsuit filed by Cabell County against opioid distributors in 2021?

In July 2022, US District Judge David Farber exonerated the three wholesalers (McKesson, AmerisourceBergen, and Cardinal Health), stating that the plaintiffs failed to show that the volume of prescription opioids distributed was due to unreasonable conduct on the part of the defendants.

What is the current status of the opioid crisis in Huntington as of mid-2024?

As of mid-2024, Huntington reported 10 overdoses per week, which seldom become fatal thanks to the prompt intervention of emergency personnel. This is a significant improvement from previous years.

What is the Healthy Connections initiative in Huntington?

Healthy Connections is a community coalition designed to serve women struggling with substance use disorder, providing support and recovery services for both mothers and their babies.

What is the role of the Office of Drug Control Policy in Huntington?

The Office of Drug Control Policy in Huntington is responsible for collecting and analyzing data about drug usage, working with 50 specialized agencies and organizations to address the opioid crisis.

What is the CARES program in Huntington?

The CARES program (Center for Addiction Research, Education, and Support) supports the development of children experiencing Neonatal Abstinence Syndrome (NAS) through their first five years of age, aiming for a smooth transition into the school system.

Sources

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