Scenes from the opioid epidemic: Wise County, Virginia

How do drug epidemics end?
That’s the big, decades-spanning question we’re asking this season on The Uncertain Hour. It’s a more personal, urgent question for the people of Wise County, Virginia. It’s a rural community in the Appalachian Mountains, considered ground zero for the opioid epidemic. The 40,000 people who live here have had some of the highest opioid prescription rates in the country. One town had five prescriptions for every man, woman and child.
The whole county has been hit hard by addiction, and we’ve spent this season talking with people who are affected by it and the cops, lawyers, doctors and advocates trying to fight the worst drug epidemic this country has ever seen. Below, find out first episode about Wise as you explore some the photos and videos we captured this season.
Julia Rendleman for Marketplace
Julia Rendleman for Marketplace
The sun rises over Wise, Virginia, Dec. 6, 2018. The area has been disproportionately affected by the opioid crisis. In the last five years, there have been more than 500 overdoses in the county of about 40,000 people. Narcotics agents and health care professionals in Wise say they have seen a dip in prescription pill abuse in the last year as “pill mills” or doctors writing prescriptions for opioids without a clear medical purpose have been prosecuted. Now, they say, methamphetamine is on the rise.
Julia Rendleman for Marketplace
A tractor-trailer moves along the “four-lane” overlooking the Powell Valley at sunset in December in southwest Virginia.
Julia Rendleman for Marketplace
Yard ornaments sold at a gas station near Wise County include a ceramic Jesus praying and a yeti known locally as the Wood Booger.
Ben Hethcoat/Marketplace
Glemia Walker, 51, and her daughter Angela Cantrell, 29, play with Angela’s 3-month-old daughter, Annsley, at home in Wise, Virginia, in December. Cantrell said that lately it seems opioids are losing their grip on rural, southwest Virginia and are being replaced with meth. “The opioids are going away, but meth is taking over,” Walker adds.
Julia Rendleman for Marketplace
Cantrell smokes a cigarette on her porch. She was addicted to pain pills, which she started using “for fun” and out of boredom in high school, but she was able to get clean. She says she still suffers from depression but having a 3-month-old baby helps keep her off drugs.
Julia Rendleman for Marketplace
A coal preparation plant crosses Kent Junction near Appalachia, Virginia.
Julia Rendleman for Marketplace
Freddie Elkins, 77, a retired coal miner, runs the Meader Coal Museum in Big Stone Gap, Virginia. “I worked underground for 31 years,” Elkins says. The coal industry employed less than 3,000 people in the state of Virginia in 2017, according to the U.S. Energy Information Administration. In 1990, more than 10,000 worked in coal mining in Virginia.
Julia Rendleman for Marketplace
Dr. Gurcharan Kanwal lost his medical license after an investigation by the Southwest Virginia Drug Task Force found that he was distributing drugs without a legitimate medical purpose out of this building in Coeburn, Virginia.
Julia Rendleman for Marketplace
Detective Tim McAfee waits for speeding vehicles just outside of Wise County.
Ben Hethcoat/Marketplace
Joey Ballard in custody at the Wise County Courthouse.
Ben Hethcoat/Marketplace
Nurse Joie Cantrell checks the naloxone supply in December at the Virginia Department of Health in Wise. Every participant of the needle exchange program is offered naloxone, which can reverse an overdose.
Julia Rendleman for Marketplace
Julia Rendleman for Marketplace
Lt. Ryan Phillips of the Wise County sheriff’s office uses a light to search abandoned trailers for possible drug users Friday, Dec. 7, 2018, in Wise County, Virginia.
Julia Rendleman for Marketplace
Phillips talks with a man he pulled over for a burned-out headlight Friday, Dec. 7, 2018 in Wise County, Virginia. The routine traffic stop led to two summons for misdemeanor drug possession. “A lot of the drugs [I find] come from these, running traffic,” he said.
Julia Rendleman for Marketplace
Pastor Robert Fultz enters the Dickenson Center for Education and Research to lead a Celebrate Recovery meeting Thursday, Dec. 6, 2018, in Clintwood, Virginia. Fultz is the pastor of Freedom of Worship, which started in his great-grandfather’s four-room farmhouse. After seeing the opioid epidemic take hold of Wise County, he wanted to use his church to help people recover. “We were vulnerable to the opioid epidemic. We are cut off from the rest of the world. We didn’t have hope. We didn’t have jobs. This region has taken a gut punch here, a gut punch there, and you’re out of hope,” he said.
Julia Rendleman for Marketplace
Ben Hethcoat/Marketplace