Sue Cantrell

Sue Cantrell was a former pharmacist and longtime health-department director whose career in southwest Virginia bridged two phases of the opioid crisis: the early spread of OxyContin and the later effort to make treatment and harm reduction reachable in rural communities. She warned state officials that the new drug signaled an epidemic, but her concern was redirected away from public health. In later years, she worked to widen access to testing, overdose-reversal medication, and treatment, while arguing that recovery also depended on housing, education, and viable employment.

Public health in a changing region

In the early 1990s, Cantrell took a mobile clinic to the parking lot of the Buster Brown apparel factory. The women working there were paid by the number of pieces they sewed and had no sick leave; leaving work for a Pap test or breast exam meant giving up income. Bringing the clinic to the factory addressed that immediate barrier. The episode also reflected Cantrell’s attention to how work and health care were connected in communities where many families had little room to absorb a lost day’s wages.

The factory jobs paid poorly, but Cantrell considered them important for more than their paychecks: they helped families keep food on the table and utilities on, and provided a structure of regular work. That structure was eroding. Coal-mining jobs, once central to the regional economy, were cut in half between 1983 and 2012 amid competition from natural gas and cheaper low-sulfur coal, pollution regulations, automation, and factory closures. Cantrell’s account placed the arrival of OxyContin against a backdrop of shrinking employment and few replacement jobs, rather than treating drug use as detached from local conditions.

Warning of an epidemic

The first call Cantrell received about OxyContin came from a doctor in St. Charles, a town of 159 people in one of Virginia’s poorest counties. Cantrell regarded the drug’s arrival as especially badly timed: communities were already absorbing economic decline when the new reports began. In the late 1990s, she called the public-health commissioner in Richmond to warn that this was not simply a continuation of familiar substance-use problems. The drug, she said, was more potent than anything she had seen among the comparatively small group of people with addiction in the preceding decades.

The warning was passed to the behavioral-health and substance-abuse system. Although infections among people using drugs raised risks of tuberculosis, hepatitis C, and HIV, officials did not officially treat the situation as a public-health matter. Cantrell’s assessment was later recalled by another regional health-department director as an early recognition of an epidemic at its source. The medical examiner’s OxyContin death count in southwest Virginia rose from one in 1997 to three in 1998 and sixteen in 1999, but those figures did not become publicly exposed until 2001. Cantrell’s alarm preceded broad institutional recognition, while the rising numbers showed the cost of treating the threat as someone else’s responsibility.

Harm reduction and rural access

By the summer of 2017, Cantrell was holding town-hall meetings in coalfield counties, with the Scott County HIV outbreak still in mind. Virginia had passed legislation enabling syringe-exchange programs, yet every legislator from the coalfields had voted against the measure, citing local law-enforcement concerns. Cantrell hoped to arrange a visit from a police chief in West Virginia, where a 2015 exchange program had been followed by lower overdose deaths and five times greater access to treatment and disease-prevention services. While seeking support for a broader response, Cantrell and her staff were already teaching people who injected drugs to clean their syringes, distributing bleach packets and plastic cups, and sometimes offering free food to encourage people to get tested and return for their results.

At a Remote Area Medical clinic, free hepatitis C testing was offered for the first time. A pharmacy professor estimated that three-quarters of intravenous drug users in the region had contracted the infection without knowing it. The clinic also distributed take-home naloxone kits and training to nearly four hundred people. Cantrell emphasized the practical challenge of getting rural patients to appointments: two people attending the medication-assisted treatment clinic she ran in nearby Lee County either hitchhiked or walked, sometimes from more than five miles away. Treatment availability alone could not solve that distance problem.

Cantrell also sought forms of support that could make recovery more sustainable. She proposed turning some subsidized housing units into clean-living facilities with wraparound services and support groups. She described addiction as a chronic disease deserving the kind of continuing support given to other illnesses, and connected treatment and prevention to education leading to living-wage jobs. People, she argued, needed real options either to remain in the region or to leave it. Her proposals joined clinical care to the conditions that shape whether people can reach care and build a life around it.

A continuing push for services

Cantrell’s harm-reduction work advanced unevenly. Efforts to establish a syringe exchange in Roanoke remained slow and politically contested even as she finally secured permission to open one in Wise County, Virginia, among the state’s most conservative areas. The contrast captures both the limits and the reach of her approach: local resistance could delay a program, but persistent public-health work could still establish a foothold elsewhere.

Across these episodes, Cantrell appears as a public-health advocate who repeatedly identified the gap between need and institutional response. Her early warning was redirected even as deaths accumulated; later, legal authorization did not by itself ensure access, and a clinic could offer treatment while patients still faced a long journey to attend. She responded at each scale available to her, from taking preventive care to factory workers to teaching safer practices, distributing naloxone, and pressing for treatment, housing, and employment. The thread running through that work was her insistence that addiction required a sustained public-health response, not a narrow handoff between agencies or a service that rural residents could not reach.