ArticleThe Opioid Epidemic in West VirginiaMerino, Rachel MHA; Bowden, Nicholas MHA; Katamneni, Sruthi MHA; Coustasse, Alberto DrPH, MD, MBA, MPHAuthor Information Author Affiliations: Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia. The authors have no funding or conflicts of interest to disclose. Correspondence: Alberto Coustasse, DrPH, MD, MBA, MPH, Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 (firstname.lastname@example.org). The Health Care Manager: 4/6 2019 - Volume 38 - Issue 2 - p 187-195 doi: 10.1097/HCM.0000000000000256 Buy Metrics Abstract The rate of overdose related to the use of licit and illicit opioids has drastically increased over the last decade in the United States. The epicenter has been West Virginia with the highest rates of overdoses accounting for 41.5 deaths per 100 000 people among the 33 091 deaths in 2015. The purpose of this research was to examine and analyze the cause of the opioid epidemic and subsequent responses to it in the state of West Virginia. This study conducted a literature review using 37 references that were published between the years 2009 and 2018, complemented with a semistructured interview. The number of people injecting drugs has increased from 36% in 2005 to 54% in 2015. The total US cost of prescription opioid abuse in 2011 has been estimated at $25 billion, and criminal justice system costs to $5.1 billion. The reasons for this opioid epidemic incidence in West Virginia have been a combination of sociocultural factors, a depressed economy, lack of education, and a high rate of prescribing and dispensing of prescription opioids. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.