St. Charles, Virginia, appears as a rural coal-camp community in Lee County, a place where the book connects the opioid crisis to persistent economic distress and the practical limits of providing care. It is both a site of treatment and a place where emergency responders describe risks that can make reaching people in need more difficult.

Setting and Regional Context

During a drive through Lee County, Art Van Zee showed the author coal-camp communities marked by deteriorated buildings, cracked windows, and houses left burned out. The author describes the scale of the region’s hardship as striking, while Van Zee stresses that poverty and poor health are not confined to places such as St. Charles or Lee County. The account situates the community within a broader rural crisis rather than treating its conditions as isolated.

Treatment and the Limits of Access

Art Van Zee’s clinic in St. Charles is a point of contact for people seeking care for opioid addiction. In discussing complaints about buprenorphine, Van Zee acknowledged that lax practices at some rural providers had contributed to diversion and abuse, while arguing that treatment should be expanded through nonprofit health services and community clinics. The book recounts a sixteen-year-old patient who learned at his clinic that she had contracted hepatitis C after injecting black-market Subutex, illustrating how unsafe drug use and gaps in treatment can converge in the lives of young people.

Emergency Response and Safety

St. Charles also figures in accounts of the hazards faced by emergency workers. An emergency responder warned the author that some places in the hamlet were best avoided at night by someone unfamiliar to local residents. The same account describes how ambulance crews in isolated Lee County communities, including St. Charles, faced attempts to take their medical supplies. These concerns had practical consequences: in some situations, responders adopted procedures that delayed entering a home until police arrived.

Narrative Significance

The book presents St. Charles through the tension between need and access. It is a community where a clinic provides treatment, yet where residents and responders confront the consequences of addiction, infectious disease, economic hardship, and danger. The location’s significance lies in this overlap: the crisis is not only a matter of individual drug use, but also of whether care and emergency help can reach people safely and consistently.