“I was a little nervous, scared, but I got a pep talk” from Amber, Beth said as she recounted that first night. “She made it like it was fun. She convinced me there was a freedom in it. She said, ‘You’re making your own money.’”

By that point, Beth said she had already traded sex for drugs with several dealers.

(Beth, as well as Amber's family, asked that they not be identified by their full names to protect their privacy.)

“I had been used to faking it, wearing a mask to survive,” Beth said. “I would pretend to absolutely adore somebody to get people to take care of me.”

But now she was so desperate for drugs she didn’t care how she got the money. And within minutes, a potential john pulled over.

“It was this guy who was well-known down there for picking up girls,” Beth said. “He slows down, gives me the head nod, makes a turn into the back alley.”

And she went to him.

‘We stand to lose a generation’

No place in America has been hit harder by the opioid epidemic than West Virginia. And no place in America was less prepared for the onslaught.

Already grappling with the loss of thousands of coal mining jobs, stagnant growth and an exodus of young people in search of opportunities elsewhere, the Mountain State was a sitting duck when Big Pharma began pumping prescription painkillers into the state.

The House Energy and Commerce Committee is now investigating the pharmaceutical companies and distributors who they say turned West Virginia into the epicenter of the crisis.

Last year, 909 people died in the state’s 55 counties, according to the West Virginia Health Statistics Center. Nationwide, opioids figured in two-thirds of the 63,632 fatal overdoses reported in 2016, according to the federal Centers for Disease Control and Prevention.

Some struggling small cities like Williamson (population 3,200) were swamped with an astounding 6,500 pills per person over a decade, creating a new generation of addicts and further fraying the already torn social fabric.

The epidemic also drove many desperate women, as well as some men, into the street for cash, lawmakers and police said.

“A lot of the addicts are from towns that went bankrupt when the coal industry collapsed,” said Matthew Perry, the Department of Homeland Security’s resident agent in charge, who investigates sex trafficking. “In some places, there just aren’t many other ways to make enough money to support a habit.”

They go from prescription painkillers to heroin to prostitution. Matt Meadows, probation officer in Huntington

While some women in West Virginia choose sex work, others are victims of sex trafficking, forced into prostitution against their will. Sex trafficking “is a crime of opportunity, and the pivot point for that opportunity is opioid addiction,” said Assistant U.S. Attorney Andrew Cogar.

“Pimps often hold out [the] promise of drugs in return for women engaging in prostitution,” he said. “We think that’s fueling a lot of the demand and supply.”

It’s hard to quantify just how pervasive a problem prostitution driven by opioid addiction is in West Virginia, a conservative state that gave President Donald Trump a landslide victory in 2016 (68 percent, to 26 percent for Hillary Clinton).

The FBI compiles annual crime statistics from law enforcement in all 50 states for its annual Uniform Crime Report. But for reasons that are unclear, West Virginia is one of the few states that do not report crimes that fit in the category of “prostitution/commercialized vice.”

“The State Police does aggregate prostitution arrest data, and I do not understand why it hasn’t been forwarded to the FBI,” Cogar said. “But I do know that data exists. And it’s troubling.”

NBC News has requested those figures from the West Virginia State Police.

Matt Meadows, a probation officer in Huntington, said he sees the steady stream of prostitution arrest reports and there is a sad refrain running through them.

“They go from prescription painkillers to heroin to prostitution,” he said. “It’s very common.”

The West Virginia Human Trafficking Task Force, which includes social workers and concerned lawmakers, is trying to figure out how big the problem has become. The group aims to raise awareness about sex trafficking and fight it by developing a network of service providers, victim advocates, agencies and religious organizations to support trafficking victims — and their children, who are straining the state’s foster care system.

“I don’t want to lose any women to human trafficking at all, but we stand to lose a generation if we don’t act more forcefully,” warned Barbara Fleischauer, a member of the West Virginia House of Delegates who sits on the task force.

Amber's dad told NBC News he fears it may be too late for his daughter.

"I wish she would go to prison because then I'd know she was alive," he said. "I know she's having to be hooking and you hate that for your kid. But what can you do but cry and pray every night, and that doesn't seem to be working."

‘I had a sweet innocent face’

Now 28, Beth said she didn’t drink or smoke marijuana in high school. She was already living on her own and working as a waitress when she first crossed that line.

(Beth, like other sex workers quoted in this article, is being identified by an alias. Her story has been corroborated by the local police, newspaper accounts and interviews with her social workers.)

“I had stopped being friends with people because they were using that stuff, I was that good,” Beth said. “Then a friend I hadn’t seen since high school called me and needed a place to stay. She was really sick.”

That friend was Amber. And she was sick because she was trying to get off drugs.

“So I gave her a place to stay,” Beth said. “When she got better, she said she wanted to do it one last time before she quit forever and asked if I would be interested. I said sure.”

Years later, Beth said she doesn’t know why she agreed, why she let her defenses down.

“I tried it with her and it just took off from there,” she said. “My mom’s an alcoholic in recovery and my dad may have smoked weed back when he was a teenager. But nobody in my family had been involved in drugs.”

One Oxy 80 became another, then another and another.

“In my mind it helped me work better,” she said. “I had more energy. I felt more social. There was no hangover.”

But already her world was starting to tilt.

Beth had to kick Amber out because she stole. “But I had gotten involved with her people,” Beth said. “I had an apartment, I had a car, and they jumped on that.”

Before long, Beth was driving dealers around and getting a cut of the money and drugs.

“They used me as the face of their operation,” she said. “I had a sweet innocent face and had never been in trouble before.”

Things were going so well that she didn’t worry when the restaurant fired her for failing to show up for shifts.

“Then I met this older guy who used to take people down to Florida to the pill mills,” she said. “They asked if I wanted to drive and they would pay for the gas and the food and I would get drugs. It was 14 hours down and 14 hours back.”

After a couple of trips, Beth decided “to get clean” — the first of some two dozen attempts to get off drugs.

“I wound up getting on suboxone for 10 months,” she said, referring to an anti-opioid dependency drug. “I found a good job. Then I used one time and I lost my job.”

That was in 2011.

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“The pills were so expensive and heroin is so huge in Huntington, so I started doing that,” she said. “I got to the point that I would sleep with the dealers for drugs.”

I had given up on myself. I’d given up on the idea of having a normal life. Beth

For the next three years, Beth said she was in and out of rehab. She lived with her mother for a time and then moved to Virginia to live with her grandmother.

“I started using again and wound up stealing from my grandmother,” she said. “I ran for a couple weeks before they caught me and I went to jail.”

When she got out, Beth said she tried to go home.

“I wound up back in Huntington with the first girl I used with,” she said. That was Amber.

Women with stories like Beth’s often end up in Cabell County drug court, which is presided over by Circuit Court Judge Gregory L. Howard in an annex across the street from the imposing county building in Huntington.

Howard takes what the probation officers call a “carrot-and-stick” approach with this especially vulnerable population.