The overdose crisis began early in central Appalachia, a region encompassing much of West Virginia and eastern Kentucky.
The largely rural area – dominated by physically taxing industries, including coal mining, agriculture and timbering – was susceptible to the pain-relief promise of prescription opioids such as OxyContin and Vicodin. These painkillers were aggressively marketed throughout the 1990s and early 2000s. As prescriptions proliferated, so did misuse and abuse.