Nearly everyone in Zaine’s life had been anxiously monitoring that line for the past year and a half, ever since both of his parents died of heroin overdoses in April 2015. His parents had become two of the record 33,091 people to die of opioid overdoses that year in a national crisis that has been worst of all in rural West Virginia, where health officials estimate that overdose rates are now eight to 10 times higher than the national average. Middle-aged white men in this part of the country have lost a full year of life expectancy during the past two decades. Middle-aged white women have lost more than two years. The opiate epidemic has essentially wiped out an entire generation of health advances, and now West Virginia has begun to focus more of its resources on prevention and preservation among the next generation entering into the void.

These children are sometimes referred to by health officials here as opiate orphans, and three of the most recent ones live in a small house in South Charleston: Zoie, 10, who believed that her parents had died in their sleep; Arianna, 13, who was just starting to wear her mother’s old makeup; and Zaine, 17, who had been the one to discover his parents that morning on their bedroom floor, and whose grades had begun to drop ever since.