West Virginia is a beautiful place, but economic forces at play within the state cause it to face some unique challenges. One of the most tragic of these challenges in recent years is the rise of opioid addiction in the state. An addiction to prescription painkillers or heroin can cost jobs, destroy marriages and ultimately prove fatal. It can also result in steep criminal penalties for violations of drug laws.

As Business Insider reports, West Virginia has the highest rates of opioid overdose in the United States. Even as the rest of the nation experienced an increase in opioid use and dependence in the early 2000s, West Virginia was especially hard-hit. Researchers suggest that the disproportionate impact of opioids in the state is partially a result of the manual labor economy. Coal mining has long been a driver of the state economy. But the long hours of hard labor can result in painful injuries for miners. As drug manufacturers shipped in more and more prescription painkillers, mining camp doctors prescribed them to help workers cope with the chronic pain of these injuries.

As the Washington Post describes, recent lawsuits in West Virginia have placed the blame for the high rates of opioid use ondrug distributors’ shoulders. One report found that over a five-year period in Cabell County, “more than 400 pills for every adult and child,” were shipped in by drug distributors. Even as lawsuits like these change the battlefront of the opioid epidemic, West Virginians are still forced to contend with the devastating aftermath of over prescription.