During a national taskforce meeting about opioids in August 2016, an aide whispered into Huntington Mayor Steve Williams’ ear.
The top federal drug control official wanted to meet privately with Williams.
Just five days earlier, 27 people had overdosed in the span of four hours in Huntington. Twenty-six were brought back to life. Another died. Fentanyl, a powerful opioid deadlier than heroin, had come to town.
“Felt like I was being called into the principal’s office,” Williams said.
But Michael Botticelli, the director of the White House Office of National Drug Control Policy, wasn’t there to admonish.
He reached up, grabbed Williams by both shoulders and congratulated him.
“Director, I don’t know that I could say that I’ve done an awful lot,” Williams told him. “We just had all these overdoses.”
Botticelli squeezed his shoulders.
“You didn’t have two dozen funerals to attend to,” he replied.
The difference maker was naloxone, an opioid overdose reversal drug. The city had been distributing it to the community and among all first responders.
In that same week, West Virginia Attorney General Patrick Morrisey announced new prescribing guidelines for painkillers, to reduce abuse by more than 25%.
In a campaign ad, Morrisey stood in front of a road and talked about how the best practices would promote alternatives to using opioids for pain management. As he spoke, images of syringes and pills flashed across the screen.
But by 2016, legislation across the country, and in West Virginia, had largely squashed doctor shopping and pill mills. Users had been driven to heroin.
Morrisey said the guidelines were an important step to address the root causes of the crisis, by tamping down on the overprescription of painkillers.
“While some users had indeed shifted to street drugs like heroin, prescription opioids were still a significant gateway to addiction for many,” he said in an email response to questions for this article.
After more than a decade grappling with the opioid epidemic — whether in the courtroom or the city council chambers — both men are vying for the Governor’s Office. Whoever wins will inherit a list of challenges: economic inequality, generational poverty, environmental degradation and poor infrastructure.
But it’s hard to name a problem more vexing and ubiquitous than the state’s drug epidemic.
Nearly 12,000 West Virginians have lost their lives due to overdoses between 2012 and 2023. Opioids have driven the foster care crisis, jail overcrowding and poverty.
During Mountain State Spotlight’s barnstorming of all 55 counties, West Virginians from all walks of life said the drug problem is a top concern. They’ve asked for more treatment options, better transportation to those resources and money to pay for it all.
And for many, it’s personal. Over in the small coal town of Nellis, in Boone County, Susan McCallister said her nephew went missing for months, until searchers found “what was left of him.”
“He’d OD’d up on the mountain,” she said. “He was 25.”
Morrisey and Williams’ times in office have paralleled one another. Both have undergone their own transformations tackling the state’s opioid crisis.
Williams shifted from a standard-issue, law-and-order mayor to embracing holistic solutions rooted in science and data. He wants to take that same plan across the state.
Morrisey went from openly deriding trial lawyers hired by the state to working with them in securing the highest per-capita settlements in the country. But he has aligned himself with national Republican platforms that could make the problem worse.
He fought to overturn the Affordable Care Act, which provides treatment for thousands of low-income West Virginians. And now, he’s repeating Donald Trump’s false claims that illegal immigration is driving drug smuggling.
A crisis well underway
On Jan. 14, 2013, Morrisey sat on the West Virginia State Capitol steps awaiting his turn to take the oath of office as Attorney General. It was a Who’s Who of politicians and state leaders, including Gov. Earl Ray Tomblin, bundled up in black wool coats.
When called up, he sauntered with his family over to the podium. Left hand on the Bible and right hand in the air, he took the oath.
Morrisey’s upset win was a bellwether for the eventual Republican take over of the state government. He’d beaten Democrat Darrell McGraw, who had held the office for two decades.
During his campaign, he railed against how much outside lawyers were paid while working cases for McGraw’s office. Now, Morrisey was inheriting those very cases – including one filed against the opioid distributors who had flooded the state with pills over the last decade.
Reporters and critics immediately raised their eyebrows. He had worked as a lobbyist in Washington, D.C. for a trade association representing the same companies being sued. His wife was actively lobbying for Cardinal Health, one of the major drug distributors named in the suit.
And his campaign and inaugural ball got money from those companies too.
Morrisey recused himself from one of the cases. He also capped how much outside counsel could earn working a case for his office. A business owner in Milton even filed an ethics complaint against him – the lawyer disciplinary board cleared him, but warned the AG that he was riding the line.
In an op-ed later that year, Morrisey accused the naysayers of trying to score political points. He wanted everyone, including the distributors, to work together towards a solution.
“We cannot solely sue, spend or indict our way out of this mess,” he wrote.
Read from the candidate
As the newly elected mayor of Huntington, people would come up to Williams in the grocery store and tell him their neighborhoods weren’t safe. On the sidewalk, a man said his grandchildren couldn’t play in the front yard. At church, in hushed tones, congregants asked him to do something.
Each time, Williams said he’d look into it.
“We’ve got the best police department in the region; we don’t have anything to worry about here,” he recalled thinking at the time.
He started with a hiring spree for additional officers and a promise to out-of-town drug dealers that if they sold dope in Huntington, they’d go to jail.
Early one morning, Williams was outside a home in the Fairfield neighborhood of Huntington with city police officers. The night before authorities heard 500 grams of heroin had been delivered to the address.
The SWAT raided the house. Out of 500 grams, only 35 grams remained. That meant 4,650 hits of heroin had already been pushed into the city. Williams said it was at that moment, he had a moment of clarity.
“It’s really more than just a police problem,” he said.
Williams, modeling what he saw the feds doing, established the Mayor’s Office of Drug Control Policy, the first in the state.
The mission was simple. Get real time data on drugs flowing into the community and attack the issue with all available tools, from the treatment centers to the squad car.
Williams appointed the outgoing police chief, a crime analyst, and Jan Rader, then a fire captain who also worked as an emergency room nurse, to lead the office. They quickly worked with the Cabell-Huntington Health Department to establish the state’s first needle exchange, providing clean syringes to combat disease and giving users a route to recovery.
Through the recovery coaches on staff — themselves former users — Rader estimated 2,000 people got started on the path to get clean.
In those early days, the office conducted educational campaigns, teaching business owners, faith leaders and ordinary people what addiction is and how it can be treated.
“I think that people realized we’re all touched by this,” Rader said.
The struggle for treatment
After Huntington’s rash of fentanyl overdoses in 2016, Williams said he heard a story about one of the women who was resuscitated that day.
She’d sworn that she would do whatever it took to get clean. And six weeks later, a letter came in the mail announcing she’d been accepted into a Subboxone program.
She died the day before.
“All of this resonates with me because I kept saying, ‘when someone is ready for treatment, we have to be prepared to act now,’” Williams said.
The Huntington Quick Response Team, established in December 2017, was directly born out of the mass overdose incident. Williams said there was still more to be done – of the 26 people who survived, none were referred to treatment.
The new team would fill the gap, offering people options and resources within days after an overdose.
“When we find somebody and place them in, help them get in treatment, that’s when we save their life,” Williams said.
Read from the candidate
As Williams was setting up the QRT, Morrisey started having settlements roll into the state. By the time he challenged Joe Manchin for his Senate seat, Cardinal and AmerisourceBergen, two of the nation’s Big 3 drug distributors, had settled the McGraw-era cases for a combined $36 million.
But not everyone was happy about it.
In November 2018, just days before the election, Morrisey sat a roundtable in a Morgantown studio with Manchin and broadcaster Hoppy Kercheval.
During the debate, Manchin stared right at Hoppy and pointed his finger at his opponent. He brought up the last big settlement the state received from a public health crisis.
“We got $1.8 billion dollars, Hoppy, $1.8 for tobacco,” Manchin said. “And he wants to make it look as if this is a great deal?”
Tobacco related deaths still outnumbered fatal overdoses by nearly 4:1 in the state.
Rather than defend his record, Morrisey deflected.
“Part of the reason President Trump is coming back tomorrow to rally for my campaign is because he knows that everything you just heard is part of that whole Hillary Clinton lie, say anything you want,” Morrisey said.
For Morrisey, national conservative talking points – whether it’s guns, the border, abortion or transgender youth – are not just campaign rhetoric, but calls to action. He’s gone to court many times to overturn federal policies, even if it could hurt West Virginians, like when he joined a Texas-led challenge to the Affordable Care Act in 2018.
The ACA required all insurance providers, including Medicaid and Medicare, to cover substance abuse treatment. West Virginia also signed onto a program that specifically addressed treatment through Medicaid, serving ten of thousands a year.
If the ACA was overturned as Morrisey sought, the Medicaid program could in theory still remain. But the two are intertwined, said Rhonda Rogombé, a health policy expert at the West Virginia Center on Budget and Policy. She said the legislation has helped people who don’t qualify for Medicaid get treatment.
A couple years later, he proposed a law to mandate all plans offer substance abuse treatment. In an email for this article, Morrisey said there are “far better ways to expand addiction treatment that don’t involve the bureaucratic mess created by the ACA.”
“As governor, I will work to promote state-led solutions that provide targeted, effective care for those suffering from substance abuse without relying on Washington’s one-size-fits-all approach,” Morrisey wrote.
Ultimately, the Texas suit was struck down by the U.S. Supreme Court.
From the witness stand to the streets
On June 30, 2021, Williams took the stand in a federal court. Huntington and Cabell County were among the first in the nation to sue the companies who started the opioid epidemic.
The city and county asked the court to award them $2.5 billion over 15 years, to effectively combat the opioid epidemic.
“I’m not looking for a money grab,” the mayor said. “All I’m looking for is the capacity to be able to make sure that my community can heal.”
A year and five days later, the judge ruled against Huntington and Cabell County. Within 24 hours, the distributors were ready to settle with the other 54 counties and over 200 local governments, said attorney Anthony Majestro.
Majestro was one of a group of lawyers across the state who formed an ad-hoc law firm to sue the manufacturers, distributors and pharmacy chains responsible for pumping the state with pain killers.
Less than a month later, the lawyers had their settlements drafted, inked and filed. The counties and cities would get $400 million from the Big 3. While other factors were at play, Majestro said what got aired out in court gave the companies the extra push to settle.
Majestro, a long-time Democrat, said throughout all the lawsuits, Morrisey and his people were in the room, asking questions and helping coordinate legal strategies.
During the 2018 Senate run, Majestro represented Senate Democrats’ campaign arm in suing Morrisey for being slow to disclose records about the distributors he sued and formerly worked for.
Looking back, Majestro said while drug companies had thrown thousands into Morrisey’s 2012 campaign, the investment didn’t pay off.
“They are the kind of people that might have thought that when they elected a Republican attorney general who used to represent the pharmaceutical industry that they might have had somebody that would leave them alone,” he said. “That obviously didn’t happen.”
Around this time, Morrisey’s office began announcing settlements like weekly Powerball numbers – $161 million from Teva and Allergan, $82.5 million from CVS, $65 million from Walmart, $83 million from Walgreens and $68 million from Kroger.
Morrisey said those settlements are key to reversing the damage of the epidemic.
“As governor, I would advocate that these funds are used efficiently and strategically to not only treat the epidemic but also prevent future crises,” he wrote in an email.
Part of the big payday was setting up the West Virginia First Foundation. The foundation is still getting on its feet. Counties and cities are now getting their cut; the settlement gives them a wide berth in how they spend it. One county used their money to build a shooting range for police.
The attorney general said he wants to see investment in recovery programs, treatment facilities, mental health resources and prevention efforts.
Huntington and Cabell will be left out of the Big 3 settlements, because they sued them alone. However, they can still get money for settlements from manufacturers and pharmacies.
Sitting in the mayor’s office in Huntington, Williams said he’s still hopeful the city will win its case on appeal.
For a brief moment, things were looking up in Huntington – the upward curve in overdoses had started to dip. But then COVID-19 shutdown the nation. Health officials in Huntington had to shift their focus from the epidemic to the pandemic.
The gains were erased. Flagship programs, like the needle exchange, came under fire from a new county commission. The city became embroiled in legal battles with alleged fly-by-night sober living home operators.
In 2022, 164 people died of overdoses in Cabell County, the second-highest total in the last decade. That number appears to have held steady the following year.
Just blocks away from City Hall, the problem is still evident. Shoeless people push buggies full of all their earthly possessions and smoke cigarettes while sitting on curbs. Williams said the homelessness issue is the latest challenge stemming from the drug crisis.
“A mayor’s work is never done,” Williams said.
Morrisey is heavily favored to win this election. He’s got more cash, more name recognition and an R next to his name.
The Republican hopeful has shifted his focus to fentanyl, calling for it to be named a weapon of mass destruction and linking illegal immigration to drug trafficking, despite the DEA saying otherwise.
Morrisey said both campaign pledges, which are national right-wing talking points, will have positive effects in West Virginia.
“Strengthening border security and cracking down on fentanyl smuggling will significantly reduce the supply of this dangerous drug in our state,” he wrote in an email.
But people are still dying.
Back in Nellis, McCallister still mourns her nephew and many like him.
“Everybody here has a family member who is addicted or has died,” she said.
By the time a new governor takes the oath, current trends suggest nearly another 1,000 West Virginians will have died from an overdose this year.
Allen Siegler contributed reporting.