West Virginia Suffers Highest Per-Capita Opioid Rate, 67 Pills Per Person Annually

West Virginia emerged as the epicenter of the opioid crisis, with the highest rate of drug overdose deaths in 2015 at 41.5 deaths per 100,000 people—nearly three times the national average. From 2007 to 2012, drug wholesalers shipped 780 million hydrocodone and oxycodone pills to the state, averaging 67 opioid pills per person annually—the highest per-capita rate in the nation.

Targeted Pharmaceutical Exploitation

West Virginia’s devastation resulted from systematic targeting by pharmaceutical companies and distributors. The state’s characteristics made it an ideal target for aggressive opioid marketing:

• High rates of physical labor and workplace injuries creating legitimate pain patients
• Economically depressed communities with limited healthcare alternatives
• Rural areas with less regulatory oversight and monitoring
• Lower education levels making populations more vulnerable to marketing claims

Purdue Pharma and other pharmaceutical companies specifically targeted Appalachian states like West Virginia, recognizing that economically vulnerable populations with high rates of manual labor would provide profitable markets for prescription painkillers.

Scale of Pills Flooding the State

The numbers reveal systematic oversupply that could only result from deliberate targeting:

• 780 million pills shipped to West Virginia from 2007-2012
• 67 pills per person annually—including infants, elderly, and those who never used opioids
• Some small towns received millions of pills despite populations of only a few thousand
• Pharmacies in tiny communities ordered quantities that defied legitimate medical need

Drug wholesalers McKesson, Cardinal Health, and AmerisourceBergen shipped these massive quantities while ignoring obvious red flags about diversion and abuse. Federal law required distributors to report suspicious orders, but companies prioritized profits over compliance.

Economic Devastation

West Virginia bore the highest economic burden from the opioid crisis at $4,793 per capita—higher than anywhere else in the nation. In 2016, the state lost nearly $8.8 billion in gross domestic product due to the opioid crisis. This translated to:

• Lost workforce productivity from addiction and premature deaths
• Healthcare costs for overdose treatment
• Foster care costs for children of addicted parents
• Criminal justice costs
• Reduced economic activity in devastated communities

Regulatory and Enforcement Failures

Multiple systems failed to protect West Virginia:

• DEA: Failed to halt suspicious pill shipments despite clear evidence
• State medical boards: Inadequate discipline of high-volume prescribers
• Distributors: Ignored their legal obligation to report suspicious orders
• Pharmacies: Filled prescriptions they knew were likely fraudulent
• Pill mills: Operated openly with minimal regulatory interference

Prosecutors later documented cases of doctors writing prescriptions for cash without examining patients, pharmacies filling obviously fraudulent prescriptions, and distributors shipping millions of pills to pharmacies that reported no corresponding patient population.

Human Cost: Highest Death Rate

West Virginia’s overdose death rate of 41.5 per 100,000 in 2015 meant:

• Approximately 725 West Virginians died from drug overdoses that year
• Nearly two deaths per day in a state of 1.8 million people
• Entire communities devastated by addiction and loss
• Generations of children growing up in foster care or with addicted parents

Pattern of Corporate Negligence

The flooding of West Virginia with pills demonstrated corporate negligence on multiple levels:

• Purdue targeted vulnerable populations with aggressive marketing
• Distributors shipped quantities that obviously exceeded legitimate medical need
• Pharmacies filled prescriptions they knew were suspicious
• All prioritized profits over legal obligations and public health

Internal documents later revealed that distributors discussed West Virginia’s “pill problem” while continuing to ship massive quantities. They knew pills were being diverted and abused but continued shipments to maintain profits.

Settlement Failures

Years later, settlements with distributors and pharmaceutical companies would provide compensation to West Virginia, but:

• Settlements came after the damage was done and thousands were dead
• No executives faced prison time despite documented knowledge
• Settlement amounts represented fractions of profits earned
• Money could not restore destroyed communities or lives lost

Example of Targeted Exploitation

West Virginia represents the clearest example of how pharmaceutical companies deliberately targeted vulnerable populations for profit. The state’s characteristics—economic distress, physical labor workforce, rural communities, limited oversight—made it an ideal market for aggressive opioid sales. Companies exploited these vulnerabilities systematically, flooding communities with pills they knew would be diverted and abused.

The 67 pills per person annually demonstrates that legitimate medical need could not possibly explain the quantity shipped. This was systematic exploitation of vulnerable communities for corporate profit, enabled by regulatory capture and lack of enforcement, resulting in the highest overdose death rate in America.