West Virginia anchors the opening’s movement between an imprisoned heroin distributor and the wider toll of the opioid crisis. The state is not merely a backdrop to the visit with Ronnie Jones: the prison stands in a county reshaped by the disappearance of coal mining, while a lethal drug batch in Huntington makes the crisis’s scale immediate. The narrator’s journey into the state begins as an inquiry into one young man’s death and opens onto a catastrophe extending far beyond it.

Setting and Institutional Landscape

In August 2016, the narrator visited Jones at Hazelton Federal Correctional Institution, outside Bruceton Mills, West Virginia. Jones was two years into a twenty-three-year sentence for armed heroin distribution, and the visit was his first with anyone. Reaching him required weeks of arrangements with prison authorities and monitored email exchanges in which Jones wanted to know who had been interviewed about his case and what personal information would be used. The interview thus begins inside a controlled institution, with the imprisoned dealer scrutinizing the account being assembled about him.

The prison occupies a county whose economic landscape had changed sharply. Preston County, in West Virginia’s northeastern corner between Pennsylvania and Maryland, had once been dominated by strip-mining. By the mid-2000s, most mines had closed, and the prison had become the county’s largest employer, with eight hundred guards and staff. The setting places incarceration within a community already altered by the decline of an older industry: the prison had not simply arrived in an unchanged landscape but had become a major local institution as mining receded.

Overdose Crisis in the State

The visit takes place against the consequences of Jones’s heroin operation. After his 2013 arrest, users in Woodstock, Virginia, whose supply had been cut off, began carpooling to cities including Baltimore, Washington, and Martinsburg, West Virginia, to find drugs. The book presents those journeys as one local aftershock of the disruption of a major regional supply network, not as the end of the crisis.

At the time of the 2016 prison visit, a separate surge was unfolding in Huntington, four hours west of Jones’s cell. A single batch of heroin, mixed with carfentanil, stopped the breathing of twenty-six people in one day. The synthetic opioid had been imported from China; the account describes carfentanil as an elephant sedative one hundred times stronger than fentanyl, itself twenty-five to fifty times stronger than heroin. The speed and scale of the deaths sharpen the contrast between a prison interview arranged over weeks and a lethal supply that could reach a community with devastating suddenness.

The state’s indigent burial-assistance program was about to exhaust its funds for the fifth year in a row as it paid to inter overdose victims. That recurring shortfall makes the death toll visible not only in individual tragedies but in the strain placed on public resources. West Virginia’s crisis is also set within a national wave, with surges reported from Florida to Sacramento and Barre, Vermont, and people working in treatment, families, and courts increasingly burdened by the scale of the problem.

Narrative Significance

West Virginia frames the book’s opening as both a place of consequence and a point of entry into a larger investigation. Jones had run one of the largest heroin rings in the mid-Atlantic, but the narrator did not travel to the prison chiefly to seek epidemiological explanation or a story of the dealer’s redemption. The journey had been prompted by a grieving mother who wanted to understand how her only son, Jesse Bolstridge, a nineteen-year-old former high school football player, had died.

That distinction gives the setting its narrative force. The prison draws the account toward the person who distributed heroin; the mother’s question directs it back toward the young man who died. Meanwhile, the Huntington overdoses and the exhausted burial fund show that Jesse’s death belongs to a much wider emergency. West Virginia therefore links an individual family’s search for an explanation to the regional drug trade, the institutions responding to its aftermath, and a national crisis whose consequences had become impossible to contain within any one case.