Appalachia's heroin and opiate problem is insideous, sad, and seemingly unstoppable.

If you asked what state has the worst heroin problem, most would probably say New York, California, perhaps even Florida. But per capita, the state having the biggest heroin problem is West Virginia. Yes, West Virginia has the nation's worst rate of drug-overdose deaths. This monster began with prescription painkillers, and eventually spun out to heroin.

Last April, The New York Times published an article titled "50 Years Into the War on Poverty, Hardship Hits Back". The article focused on a southern Mountain State County, McDowell, where the heroin problem is such an epidemic that fatal overdoses in McDowell are more than eight times the national average. McDowell County's incarceration rate is one of the highest in the USA and almost one out of every three babies born in the county's hospital had been exposed to drugs.

According to statistics from the Health Statistics Center in the Department of Health and Human Resources, West Virginia saw 67 heroin overdose deaths in 2012, compared to only nine deaths in 2001. In Kentucky, the report reveals that heroin overdoses accounted for 129 total drug-overdose deaths in 2012, up from 42 the year before. Kentucky, like West Virginia, has a nasty heroin problem, and like the contiguous state that it is attached to from the north, Kentucky's problem of bottoming out on hard drugs began with prescription medications like Oxycodone, Hydrocodone, Vicodin, and other opiate-based pain relievers.

The spread of heroin in the most remote and provincial regions of the United States - Appalachia's rural hollers and little towns - was insidious. It crept up on the people here like a stealthy slithering serpent. Coal has been king in Kentucky and West Virginia for a long time. Despite advances in technology, coal mining remains a highly dangerous way to make a living. Many coal miners suffer injuries on the job and to cope with the pain, they are given a prescription for a painkiller. And for many, even after the pain subsides and the body heals, 'the jones' to use opiates remains as strong as ever. This is not to say that coal miners are the only people suffering from heroin or opiate addiction in Appalachia. No, these days the wide net has ensnared just about every cross-section of society. And it leaves its typical victim unemployable, but with a high-stakes compulsion in which there is never enough money to pay for the drug. Consequently, crime runs rampant with sick drug abusers committing robberies and burglaries so as to pay the dope man for a fix.

According to a March 30 online article of the Charleston Gazette: In Kanawha County, W.Va. alone, emergency responders say they are seeing an average of two overdoses a day, according to Chaplain Mike Jarrett of the Kanawha County Emergency Ambulance Authority.

Police say heroin and prescription drugs are the main reasons."It isn't a car wreck," Jarrett said. "It isn't a heart attack. This is self-inflicted, and these people are suffering. Every time we run something like this, especially with young people, people that are in such emotional crisis, it just carves a little bit of that medic's heart out," according to Charleston Gazette writer Eric Beck.

In 1999, the Joint Commission, a group that gives accreditation to health care organizations, added pain to the list of vital signs that doctors should check, along with blood pressure, temperature, pulse and respirator rate, Beck writes.

Making doctors check for pain, along with other vital signs, even in routine check-ups? What a harbinger of what was yet to come for West Virginia - and the pain of addiction turned out to be a much more dangerous and unhealthy menace than any injury a disabled coal miner could suffer from - even worse than a bad back, strained arm, or broken leg.

The prescription drug scourge in counties like McDowell did not happen randomly. In the late 1990s, Purdue Pharma, the maker of OxyContin, aggressively marketed the pill to doctors in Appalachia, where injuries from hard-labor jobs often produce chronic pain. The use and abuse of OxyContin became so widespread that it eventually earned the nickname "hillbilly heroin," according to an article on the homepage of Phoenix House, a company that has been providing a holistic approach to its patients' addictions for 50 years.

Although many people think that Big Pharma wants to cure people, the sad truth is that Big Pharma wants to keep folks sick. There's no cash to be had from healthy people who do not need medication, after all. Unleashing this monster on two of America's poorest and most distressed states has been a curse and hardly a cure. According to Deborah Taylor, R.N., regional director of Phoenix House Mid-Atlantic, rural America is so sick it almost needs something resembling a societal hospice apparatus - rural America desperately needs "treatment on wheels," Taylor says.

Because many who live in Appalachia experience utter remoteness, perhaps even isolation, getting treated for an overdose is like getting to an emergency room for a copperhead snake bite. Being 55 miles from the nearest hospital poses a dire threat. And with a heroin overdose, like being bitten by a venomous serpent, time is of the essence.

We cannot expect residents of these isolated areas to seek help unless we bring care directly to their doorsteps. For this reason, Taylor and other clinicians see great promise in mobile units that could provide medication-assisted treatment and management. These units should be part of a comprehensive program that would also include vocational training as well as financial incentives for those who successfully complete treatment, Phoenix House's homepage suggests.

Another dramatic remedy to stop overdoses is for police to carry the overdose breaker, Naloxone (commonly referred to as Narcan). With this remedy, a cop in a small town can be a a virtual lifesaving first responder. And likely, the only responder, with the nearest hospital a good 35 or 40 minutes away by ambulance. Law enforcement officials may be able to do something that even a team of doctors cannot pull off - save the life of someone suffering from a heroin overdose. For a long time, heroin abuse has been looked on with disdain by law enforcement, politicians, and the general public. But many law-enforcement officials are realizing that it's futile to charge a corpse with drug possession. Political leaders are realizing fighting the war on drugs is even more of a juggernaut than fighting the wars in the Middle East. And today, Joe and Jane Average Citizen have a son, grandson, niece, or granddaughter with an addiction that's wreaked havoc throughout the whole family.

An opioid overdose will kill if left untreated. The biggest problem with an overdose is that the victim suffers from inadequate breathing. Opioids hit certain brain receptors, slowing down the victim's breathing. The result: Insufficient oxygen in the blood, then the heart, then the brain. Naloxone overrides this dying process by competing with an opioid for the same brain receptors for 30-90 minutes, pulling some poor sot out of a heroin stupor.

Under 'Good Samaritan laws' already in place in many states, family and friends of known heroin addicts can carry Naloxone, just in case 'You Know Who' falls into another overdose. Costing only about $20 a dose, Naloxone is easy to use. Its apparatus is simple to prepare and the drug is contained in a long compartment of something appearing to be akin to a big syringe. The needle-like tip, shoved up a victim's nose, releases the drug after pressing down on the top of the device. Thus, the formula is released into an overdose sufferer's nose. It's not any more difficult than what caused the overdose in the first place - it's the same as using a hypodermic needle.

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