Crushing Up Pain Pills and Spitting Out Lives in West Virginia Coal Country

An economically devastated swath of Appalachia became ground zero for America’s alarming epidemic of opioid addiction. These are the people trying desperately to lift themselves up and out.

Photos by Luke Whyte

When I met JR and Nikki they’d just run away from their own lives. They were penniless, with a backpack full of clothes and a purse containing two cans of potted meat, a packet of crackers and a syringe. They were walking down a set of train tracks between Danville and Madison at the center of West Virginia’s coal country. It was hot out. The air shimmered, thick with creosote oozing from the railroad ties.

I asked them for directions and they asked me why I was walking to Madison. I told them I was hitchhiking through southern West Virginia to learn about oxycodone, about how it had marbled through the hills of this isolated pocket of Appalachia, pushing methadone clinic check-ins up 500% in five years in some parts of the region, and raising the regional death rate from overdose to eight times the national average. They told me about being “D.O.A” at the ER, about smuggling almost a thousand pills a month from Florida to West Virginia, and about the nightmares the…