Mullens, West Virginia in Wyoming County. Photo by Duncan Slade.

On Route 1 in Wyoming County, 28-year-old Brandon Jarrell walked along a narrow strip of asphalt between the painted white line and adjoining front yards. One of his car’s tires had popped, and he moved quickly to retrieve a patch, doing everything he could to make sure he and his girlfriend wouldn’t be late for their doctor appointments. 

For the past year, the couple has been driving about 20 miles from Jarrell’s home in Glenn Rogers to a small Oceana clinic to receive medication and counseling services for their opioid use disorders. 

Jarrell, who said many of his closest friends and family members have overdosed, has hope after the first year of his recovery. For others living in Wyoming County, he’s less optimistic.

“I don’t think it’s gonna change,” Jarrell said. “It’s been like this my whole life, and I’ve lived here my whole life.”

The small county and its towns, targeted by companies that profited as millions of prescription opioids were sent in for years on end, will soon receive at least $11 million from West Virginia’s opioid settlements—money that could be put toward a variety of approved uses.

All together, West Virginia will receive over $1 billion from the companies that fueled the opioid epidemic. Just under 25 percent of the money will go directly to local governments, while the majority of the funds will be managed by a private nonprofit foundation set to be created soon. Local governments will start receiving their shares once attorney fees are sorted out, according to the state Attorney General’s Office.

But some Wyoming County leaders and residents, who work day-in and day-out to help others deal with the devastating effects of the opioid epidemic in one of the counties hit hardest, are wrestling with how to use their share and considering everything from water infrastructure to a new rehab center.

A local police chief notes a lack of treatment options

Oceana chief of police Tyler Dunigon
Oceana chief of police Tyler Dunigon sits at his office. Photo by Allen Siegler

In a beige office set along Cook Parkway, Oceana Police Chief Tyler Dunigon reclined in his chair in contemplation. The town, one of the two largest in the county, has been deeply impacted by addiction — including Dunigon’s older cousin, a man who he said was injured at a coal mining job shortly after being discharged from the military. 

“Then he got hooked, and that was that,” Dunigon said. “When you lose someone tragically like that…it’s just harder to accept.”

His grandfather was a Wyoming County deputy for over three decades and worked in southern West Virginia when the pharmaceutical industry first implemented their aggressive prescription drug marketing campaigns. Dunigon said his grandpa was one of the first people he knew who treated substance use as a medical problem rather than a crime or a moral shortcoming. 

Dunigon sees that philosophy as essential for preventing more unnecessary deaths. He praised programs like Wyoming County’s versions of Law Enforcement Assisted Diversion and Quick Response Team programs—each designed to substitute police responses with medical interventions. 

Oceana, WV
Oceana is one of the two biggest towns in Wyoming County. Photo by Allen Siegler

But despite these initiatives and Wyoming being one of the few remaining West Virginia counties with an authorized syringe service exchange, Dunigon noted a gap in comprehensive drug services; no facility in the county offers in-patient substance use treatment.

“It doesn’t have to be specifically in Oceana,” Dunigon said. “But a rehab treatment facility in Wyoming County, I definitely feel is needed.”

While Dunigon would like to see a new center open, he believes that Wyoming and Oceana’s shares of the opioid settlements aren’t large enough to operate a project like that for any sustained amount of time. He also views the settlement funds as repayments to local municipalities for the costs of the opioid epidemic, including those incurred by his six-person police department. 

He said Oceana government officials were planning to use a portion of their money, set at just under $750,000 right now, for a new police cruiser.

“You gotta have a vehicle you can rely on,” he said. “To me, that’s not that big a chunk of it.”

A Pineville doctor hopes for transportation and good jobs

Dr. Joanna Bailey
Dr. Joanna Bailey is a Pineville family physician. Photo courtesy of Joanna Bailey.

As a family physician in Pineville, Dr. Joanna Bailey sees the impacts of the opioid epidemic every day as she treats her patients — whether it’s individuals managing substance use disorders or Hepatitis C, children who have had close family members suffering from addiction or elderly individuals raising grandchildren while trying to meet their own health needs.

Bailey and a team at the Tug River Health Association are studying how unreliable transportation to medical appointments makes it harder for people to stay in recovery in southern West Virginia. These rides are supposed to be covered by most health insurance plans but are often canceled the day of or never show up.

When thinking about how transportation impacts the substance use crisis, she recalled one patient with chronic pain and an opioid use disorder brought on by the painkillers prescribed to him. After a spinal disc flare up, he was at high risk of relapsing without a spinal injection.

Bailey helped him set up a specialty appointment at a Morgantown pain clinic and an insurance-covered ride from his McDowell County home — a four hour drive. But Bailey said the initial ride never showed up. When the patient rescheduled for a few weeks later, the driver arrived in Morgantown so late that his appointment was canceled.

“[The doctor’s receptionist] said, ‘Nope, sorry we can’t see you,’” Bailey said. “Then it was another two months of trying to get him in with somebody.”

While Bailey would be happy to see some settlement shares directed toward transportation, she thinks preventing more people from developing substance use disorders should be the priority. 

From investing in the public school system to addressing pollution in local drinking water sources, she believes fixing the systemic factors that can lead to substance use disorders will be crucial.

“It’s gotta be good jobs,” Bailey said. “And part of that is having a good workforce, having a place where people can live and having a good school system.

Decisions to be made by the County Commission

Jason Mullins
Wyoming County Commission President Jason Mullins talks while standing around a barstool inside his restaurant, Rebel Smokehouse. Photo by Allen Siegler

As the county prepares to receive millions in opioid settlement funds, Wyoming County Commission President Jason Mullins also thinks of loved ones lost in the opioid epidemic — among them a “brilliant” high school classmate who died of an overdose soon after graduating college.

Like Bailey, Mullins sees addressing root causes that lead to more health problems, including substance use disorders, as one of the best uses of his county’s settlement funds. And unlike the police chief and the doctor, Mullins is an elected official who will share power with his fellow commissioners deciding where Wyoming County’s money ultimately goes. 

He wants to address problems like the basic needs of his hometown of Mullens, where sewage flows through some nearby creeks that once stored fresh water. 

“These types of things have to be fixed,” he said. “The environment these people live in has to be better before we can improve.”

He also said the County Commission plans to use part of its share to pay off regional jail fees, the daily $48.25 each West Virginia county pays for each of its incarcerated residents. Some health experts worry that using settlement dollars for jail fees will divert money from treatment to imprisonment, and studies have repeatedly linked prison sentences as a detrimental risk factor for overdosing. 

According to Mullins, Wyoming’s annual regional jail fees total to around $500,000 — a number he said has decreased because of programs that divert people who use drugs away from prisons and to treatment programs. For the people who remain in prison, he believes using $500,000 from the settlement instead of taxpayer dollars is a more fair way of paying for the expense.

“That’s a lot of money to use for just locking prisoners,” Mullins said.

What the money can’t do

Mullens, WV
Mullens is among many southern West Virginia towns that pharmaceutical supply chain companies sent disproportionate levels of prescription pain medications to. Photo by Allen Siegler.

Whatever Wyoming County’s funds are ultimately spent on, there are limits to what the money can and can’t do.

Dunigon highly doubts that the state’s opioid settlements can accomplish their stated goal of holding “Pharmaceutical Supply Chain Participants accountable,” companies that are collectively worth nearly $1.3 trillion.

“I know it sounds crazy,” he said. “But for them, $300 million or $500 million is a write off.”

Mullins believes there will never be any full vindication for the county residents who’ve died of overdoses, caused by the opioid epidemic fueled by the business practices of those same companies. 

While he views creating an environment in which future Wyoming County residents can thrive as the best thing his commission can do with settlement dollars, there is no amount that will bring his friends back to life.

“There’s no way there will ever be justice,” Mullins said. “Either way, it should have never happened.”

Correction: A previous version of this story incorrectly identified Tyler Dunigon’s family member who had served as a Wyoming County deputy. It was his grandfather, not his father.

Allen Siegler is the public health reporter for Mountain State Spotlight. He can be reached at (681) 317-7571.