Purdue Pharma recently reached a $7.4 billion settlement with all 50 states and the District of Columbia over its alleged role in fueling the opioid crisis through aggressive marketing of OxyContin. Regardless of the case’s merits, this landmark deal highlights what can happen when an expedient narrative replaces data-driven public policy.
Nowhere is the gap between narrative and data more clear than in West Virginia, the hardest-hit state in the country. While a wave of books and Netflix docudramas has promoted an oversimplified and often misleading storyline, new data from the West Virginia Department of Health cast a glaring spotlight on the human cost of “prescription opioid prohibition”—a policy that has failed in every tangible way.
Overdose deaths in the state have doubled as illicit fentanyl and other street drugs have replaced the much safer prescription pills. Meanwhile, policymakers and regulators have demonized pain medications, causing real harm to patients. Many patients can no longer access legal prescriptions and instead turn to the streets, where they have an increased risk of death from taking adulterated or counterfeit pills. Policymakers addressed the wrong problem with the wrong tools—and made the crisis worse.
West Virginia Department of Health data illustrate this deadly shift. From 2015 to 2023, as prescription opioid access declined, overdose deaths in West Virginia soared—even though overdoses from prescription medications declined slightly—because users and abusers turned to riskier street drugs.
Hellbound and Down 