The Culture That Is West Virginia

From Tyler Cowen - moving from exporting coal to exporting used herion needles:

Arguably, the true malaise is largely cultural, resulting from a mix of mediocre outcomes relative to expectations, drug and alcohol abuse and dysfunctional white identity politics. To cite one striking fact, one West Virginia source reported, “In six years, drug wholesalers showered the state with 780 million hydrocodone and oxycodone pills, while 1,728 West Virginians fatally overdosed on those two painkillers.” That works out to about 433 pain pills for every man, woman and child in West Virginia. There are plenty of poorer regions in history, including the earlier West Virginia, without comparable levels of drug abuse.