The images in this story were updated on May 6, 2019.

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.

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. 
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.  - 
A tractor-trailer moves along the "four-lane" overlooking the Powell Valley at sunset in December in southwest Virginia.
A tractor-trailer moves along the "four-lane" overlooking the Powell Valley at sunset in December in southwest Virginia. - 
Yard ornaments sold at a gas station near Wise County include a ceramic Jesus praying and a yeti known locally as the Wood Booger.
Yard ornaments sold at a gas station near Wise County include a ceramic Jesus praying and a yeti known locally as the Wood Booger. - 
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.
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. - 
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.
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. - 
A coal preparation plant crosses Kent Junction near Appalachia, Virginia.
A coal preparation plant crosses Kent Junction near Appalachia, Virginia. - 
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.
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. - 

 

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.
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. - 
Detective Tim McAfee waits for speeding vehicles just outside of Wise County.
Detective Tim McAfee waits for speeding vehicles just outside of Wise County. - 
Joey Ballard in custody at the Wise County Courthouse.
Joey Ballard in custody at the Wise County Courthouse. - 
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.
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. - 
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.
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. - 
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.
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. - 
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.
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. - 
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