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resident Trump will be in Huntington, W.Va., on Thursday evening for the latest in a series of rallies he’s held around the country since he took office.

STAT will be watching to see if he addresses the opioid crisis. It’s not clear whether Trump will say anything about the addiction epidemic, but he will be speaking in a city that’s become a symbol for the danger posed by synthetic opioids like fentanyl, and in a state that has the highest rate of drug overdose deaths in the country.

On Wednesday, Attorney General Jeff Sessions announced that one of the 12 federal prosecutors being added around the country to investigate pill mills and opioid fraud would be in West Virginia.

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Which is all to say, the rally could be an opportunity for the president to lay out his plans to address the opioid crisis.

Here are five things to know about the opioid crisis in Huntington and in West Virginia.

A city with a coordinated response

In Huntington, where officials estimate up to 10 percent of residents use opioids improperly, local officials, in tandem with Marshall University experts, have been trying to grapple with the opioid crisis for years. They realized early that law enforcement alone couldn’t solve the problem, and in 2014, the city established an office of drug control policy.

The town has distributed naloxone to police, supported a clinic to help babies born dependent on opioids, and opened West Virginia’s first syringe exchange program. (As the opioid crisis has devastated rural states, even officials in conservative states have come around to syringe exchange programs, which are shown to reduce transmission of diseases like hepatitis C and HIV.)

That Huntington still faces such challenges in addressing the crisis shows how deeply rooted the problem is, in both the city of 50,000 people and statewide. According to the New Yorker, the state’s indigent burial fund has run out of money each of the past six years because of so many overdose deaths.

A struggle to get people into treatment

Trump and other administration officials have regularly talked about expanding treatment for addiction. But Huntington has served as a case study for how hard it can be to get people into treatment, both because of the limited availability of options in many places and because of logistical hurdles in connecting people with treatment.

A year ago, more than two dozen people overdosed in one afternoon in Huntington. A report released by state epidemiologists in January noted that of the people treated in the hospital, more than half left against medical advice, and none was referred for treatment or counseling. Clinicians in emergency departments often say they cannot convince people who arrive after overdoses to try to enter treatment in that moment.

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And even when people do try to get treatment, they face obstacles. The family of one woman who overdosed that August day, Taylor Wilson, sought for the next 41 days to try to find a treatment bed for her and medication to try to treat her, but kept hitting roadblocks. Wilson overdosed again in September, this time fatally.

Recovery advocates and others worried treatment would become even less accessible if Congress rolled back the expansion of Medicaid, as was envisioned in the Republican effort to repeal and replace the Affordable Care Act. Sen. Shelley Moore Capito of West Virginia ultimately supported the Republican plan, which failed in the Senate, but also pushed to add more funding to address the opioid crisis to the legislation.

State officials have been dealing with the crisis for years

One example: The officials who ran the state employee health plan in the early 2000s tried to limit OxyContin prescriptions after noticing an increase in deaths tied to the active ingredient in the medication, oxycodone. But the drug maker, Purdue Pharma, pushed back and wound up preventing insurers from restricting prescriptions.

And more than a decade before the recent spate of state and county lawsuits against opioid makers, West Virginia settled a lawsuit against Purdue in 2004 (although for a relatively paltry sum of $10 million). The company admitted no wrongdoing as part of the settlement.

It’s not just drug makers

As Pulitzer Prize-winning stories in the Charleston Gazette-Mail have shown, drug wholesalers have flooded the state with prescription pain pills, and tried to hide their sales numbers from the public. Over six years, enough pain pills were brought into West Virginia for every resident to have 433 of them. Now, West Virginia counties have filed suit against some drug distribution companies.

Doctors and pharmacists have also been found to have played a role in seeding addiction in West Virginia.

A ‘listening tour’ that didn’t go according to plan

As part of an opioid “listening tour” in states around the country, Health and Human Services Secretary Tom Price stopped by West Virginia in May. But his trip made news for many of the wrong reasons. He seemed to criticize using weaker opioids like methadone and buprenorphine to treat opioid addiction, despite a definitive body of evidence showing that such medication-assisted treatment is an effective therapy for opioid addiction. A spokeswoman later clarified that Price supports expanding access to all kinds of treatment, including MAT, but advocates have continued to use Price’s statement to question how serious the administration is about tackling the crisis.

Perhaps Trump will have an answer for them Thursday.

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  • Meanwhile alcohol contributes to over 100,000 deaths each year in the US and remains the number one intoxicating substance of abuse while cigarettes contribute to over 480,000 deaths each year in this country. Both substances are legal and have no medicinal purpose. *Crickets*

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