West Virginia Was Ravaged by the Opioid Crisis. Things Are Finally Turning Around

West Virginia has for years led the nation in several unfavorable categories, having recorded both the highest rate of per-capita drug overdose deaths and the highest number of babies born with drugs in their system of any state.

But in July, the Mountain State finally made it to the top of a positive list, recording the largest reduction in fatal overdoses over a 12-month period of any state in the country. At that time, CDC data showed the state had seen two months of declines in the annual rate of fatal overdoses, for a 41 percent decrease compared to deaths reported in both preceding 12-month periods.

It was welcome news for the state that has long been considered ground zero for the American opioid abuse and overdose epidemic.

And the trend has held; new federal data released in late March show West Virginia’s opioid overdose deaths have continued to fall at a faster pace than the overall national decline. The most recent data from the CDC show West Virginia recorded 2,042 opioid overdose deaths from October 2024 to September 2025, a nearly 49 percent drop from the prior 12-month period. The U.S. as a whole saw a 44 percent drop in opioid overdose deaths over the same time period.

Governor Patrick Morrisey previously said the declining rate of overdose deaths is the result of a “holistic approach to tackle drug use and abuse.”

Experts who spoke with National Review attributed the decline to a wide array of factors, some of which were the result of local policymaking while others were driven by decisions made in Washington, D.C., and as far away as Beijing.

“There’s so many things that contribute” to the drop, according to the director of the West Virginia Office of Drug Control Policy, Dr. Stephen Loyd. But the most obvious factor, he says, is the widespread availability of overdose reversal drugs like naloxone, which the state has done an “outstanding job” of making available.

The state has worked to arm first responders, police, crisis intervention teams and everyday residents with the drugs, and to help link individuals who have suffered an overdose to treatment resources, though Loyd says there is “room for improvement” on that front.

He also pointed to President Trump’s crackdown at the U.S. border, saying that has likely made an impact on fentanyl-related deaths in the state.

“I’m not a border expert but anytime that you can decrease the flow of drugs into the country, it’s a good thing,” he said.

Another factor West Virginia officials, and also others outside the state, have identified is the decreased potency of the fentanyl that has come across the border over the last two years, prompted by a decreasing supply of the drug’s precursor chemicals. China moved to tighten regulations on the chemicals in late 2023.

Back in West Virginia, state officials have also made an effort to specifically pump funds into treatment resources for people who are being released from jails and prisons, as those individuals represent the highest overdose risk group.

“It is so exciting to see the incredible work of our providers, mom and pop shops, and large organizations and everything in between, who are focused on healing our communities,” Jonathan Board, the executive director of the West Virginia First Foundation, told NR. “One individual at a time, and we now lead the nation in a good category.”

The foundation was established with funds from settlements related to a number of opioid-related lawsuits brought by the state’s attorney general against drug manufacturers, distributors, and pharmacy chains. To date, it has been awarded more than $1 billion through opioid-related litigation.

Roughly 72.5 percent of the settlement funding is earmarked for the WVFF, while 25 percent goes to local governments, such as local municipalities, towns and cities. The rest goes to the attorney general’s office, to continue fighting opioid-related litigation.

WVFF is “a wholly private nonprofit that is not attached to any agency or state governance, but can be nimble and move, cutting through a lot of the bureaucracy and responding to a true public health crisis at the speed it deserves,” Board said of his organization.

He says the funds from opioid litigation settlements have made a major difference to the way the state is able to respond to the crisis. Though Loyd noted the WVFF has only been open for 20 months, and said while the foundation has been pivotal in helping increase the availability of overdose reversal drugs, that he would expect to see the full impact of the foundation and the settlement funds in about four years’ time.

Since the foundation first opened in 2024, it has helped disburse some $40 million into the state, with a commitment to dole out another $20 million to on-the-ground prevention efforts and across the broader recovery continuum of care. Awardees of funds distributed by the foundation are required to show positive outcomes through quarterly reporting in order to access the remainder of their awards.

“We understand we only exist because our loved ones across the state suffered, and many died,” Board said. “And so we have that at the forefront of every decision we make.”

The funding has helped, in part, to create quick response teams on a “very massive and fast scale,” Board said. The foundation has also gone all-in on “Save a Life Day,” an effort that began with two West Virginia counties in 2020 to distribute free naloxone and provide training to prevent fatal opioid overdoses, but has since grown to a 50-state movement.

But despite the promising overdose data and the strides the state has made, Loyd, the director of the state’s Office of Drug Control Policy, is only cautiously optimistic for the future.

“I believe that we will come out on the other side of this,” he said. “I just think there will be too many body bags in the process. I get worried about the urgency of it a lot of times, getting these funds out there, getting them working in our communities.”

What keeps him up at night, he says, is the concern that the state will fail to use the litigation settlement funds to build a system of care that is sustainable going forward.

“If you look at these funds, they are available to build systems of care for the next two-to-three decades,” he said. “We won’t have another shot at this money. And so my fear is if we missed the boat on that.”

He’s advocating that the state use this one-time chance to invest in the technology side of addiction treatment. He envisions a future where addiction treatment is more personalized to each individual patient, similar to cancer treatment.

Dr. James Berry, the chair of the Department of Behavioral Medicine and Psychiatry at West Virginia University’s Rockefeller Neuroscience Institute, told West Virginia Watch that he too worries about the state’s future, and whether the trend will hold.

“This decline means so many more lives will continue to exist because of efforts that have been going on in the state,” Berry told the outlet in July. “At the same time, in West Virginia, we still lead the nation by far in the rates of overdose deaths. We’ve had a wonderful decline, but still I don’t think people appreciate how far above we are other states [in the rate of fatal overdoses], above the national average. So we still have a very, very long way to go.”

In 2024, West Virginians died from drug overdoses at a rate higher than any other state, and nearly twice the national average.

The state’s small rural communities have been particularly hard hit by the epidemic. The lone pharmacy in Kermit, W.V., a town of 350 people, infamously distributed some 12 million hydrocodone pills during a seven-year period at the height of the opioid crisis. “And that’s not a singular story,” Board said, arguing bad actors in Big Pharma and complicit prescribers helped effectively destroy entire towns in the state.

On the federal level, Loyd gave the Trump administration credit for elevating addiction recovery to the point of an executive order, while West Virginia Senator Shelley Moore Capito (R) noted Congress has also taken substantial steps to approve funds to fight addiction nationwide, funds that she says have helped make a difference back home.

“I, along with others in the federal government, have dedicated funding and resources to preventing overdose deaths over the past decade,” she told NR. “This has ranged from prevention efforts to stop teens from using drugs in the first place to ensuring those who are addicted have access to rehabilitation services and support in recovery. Many of these ideas have come from West Virginia and other hard-hit places across the nation where they have seen them work in their communities.”

Still, all the experts NR spoke with stressed the importance of local government in combatting the state’s opioid epidemic. It is recovery support specialists, crisis intervention teams and police officers trained in how to respond to mental health or addiction crises that can make the biggest impact in recovery.

But with great power comes great responsibility, and some communities in the state have shown more fiscal responsibility than others when it comes to the use of the litigation settlement funds.

Jackson County came under fire in 2024 after it chose to earmark $300,000 in settlement funds for a new shooting range at a law enforcement training center.

Looking again at the state’s recent success in addressing the high rate of opioid overdose deaths, some substance abuse specialists have suggested the drop in overdose deaths can be attributed, at least in part, to a return to baseline from before the Covid pandemic, when substance abuse issues skyrocketed.

“The opposite of addiction is not recovery, it’s actually community and relationship,” Loyd said, noting that an “effective recovery ecosystem” is what helps battle substance abuse.

But the approach to the pandemic was the opposite: isolating, keeping distance, staying home alone.

“I’m not commenting on the effectiveness of that,” he said. “My point is, I knew it would kill the folks we were trying to help.”

West Virginia saw a record number of fatal overdoses in both 2020 and 2021, before dropping each year beginning in 2022.

But Loyd and Board both believe the post-pandemic return to baseline doesn’t account for the entire drop the state has recorded in recent months.

“Everyone talks speed to impact, but this is a generational thing,” Board said. “We understand that we have to change the trajectory of this state. No question.”

“We don’t have an option to fail here,” he said. “We understand generations from now, people are going to look back and ask us what we did with the time that was gifted to us now.”