Since the 1990s, West Virginia has been hit hard by the national opioid crisis. Experts say the epidemic has transpired in three waves.

1. The first wave started in the early 1990s, when doctors began overprescribing pain pills like OxyContin. Many people became addicted, especially in the southern coalfields, where miners had been repeatedly injured on the job. Some doctors and pharmacists ran their operations like underground businesses.

2. The second wave began in the 2000s, when people addicted to pain pills started turning to heroin, a cheaper and stronger drug. Overdose deaths rose quickly.

3. The third wave started with fentanyl, a powerful synthetic opioid. It's 50 times stronger than heroin, and just a tiny amount can kill. Fentanyl is now the leading cause of death for adults ages 18 to 45 in the U.S.

West Virginia has led the nation in overdose deaths for many of these years. In 2016, the state recorded 892 deaths, rising to over 1,500 by 2021. Since then, death rates in the state from opioids have begun to decline, giving some hope that the worst may be over.