Michael Barrett and Jenna Mulligan, emergency paramedics in Berkeley County, West Virginia, recently got a call that sent them to the youth softball field in a tiny town called Hedgesville. It was the first practice of the season for the girls’ Little League team, and dusk was descending. Barrett and Mulligan drove past a clubhouse with a blue-and-yellow sign that read “Home of the Lady Eagles,” and stopped near a scrubby set of bleachers, where parents had gathered to watch their daughters bat and field.

Two of the parents were lying on the ground, unconscious, several yards apart. As Barrett later recalled, the couple’s thirteen-year-old daughter was sitting behind a chain-link backstop with her teammates, who were hugging her and comforting her. The couple’s younger children, aged ten and seven, were running back and forth between their parents, screaming, “Wake up! Wake up!” When Barrett and Mulligan knelt down to administer Narcan, a drug that reverses heroin overdoses, some of the other parents got angry. “You know, saying, ‘This is bullcrap,’ ” Barrett told me. “ ‘Why’s my kid gotta see this? Just let ’em lay there.’ ” After a few minutes, the couple began to groan as they revived. Adults ushered the younger kids away. From the other side of the backstop, the older kids asked Barrett if the parents had overdosed. “I was, like, ‘I’m not gonna say.’ The kids aren’t stupid. They know people don’t just pass out for no reason.” During the chaos, someone made a call to Child Protective Services.

At this stage of the American opioid epidemic, many addicts are collapsing in public—in gas stations, in restaurant bathrooms, in the aisles of big-box stores. Brian Costello, a former Army medic who is the director of the Berkeley County Emergency Medical Services, believes that more overdoses are occurring in this way because users figure that somebody will find them before they die. “To people who don’t have that addiction, that sounds crazy,” he said. “But, from a health-care provider’s standpoint, you say to yourself, ‘No, this is survival to them.’ They’re struggling with using but not wanting to die.”

A month after the incident, the couple from the softball field, Angel Dawn Holt, who is thirty-five, and her boyfriend, Christopher Schildt, who is thirty-three, were arraigned on felony charges of child neglect. (Schildt is not the biological father of Holt’s kids.) A local newspaper, the Martinsburg Journal, ran an article about the charges, noting that the couple’s children, who had been “crying when law enforcement arrived,” had been “turned over to their grandfather.”

West Virginia has the highest overdose death rate in the country, and heroin has devastated the state’s Eastern Panhandle, which includes Hedgesville and the larger town of Martinsburg. Like the vast majority of residents there, nearly all the addicts are white, were born in the area, and have modest incomes. Because they can’t be dismissed as outsiders, some locals view them with empathy. Other residents regard addicts as community embarrassments. Many people in the Panhandle have embraced the idea of addiction as a disease, but a vocal cohort dismisses this as a fantasy disseminated by urban liberals.

These tensions were aired in online comments that amassed beneath the Journal article. A waitress named Sandy wrote, “Omgsh, How sad!! Shouldnt be able to have there kids back! Seems the heroin was more important to them, than watchn there kids have fun play ball, and have there parents proud of them!!” A poster named Valerie wrote, “Stop giving them Narcan! At the tax payers expense.” Such views were countered by a reader named Diana: “I’m sure the parents didn’t get up that morning and say hey let’s scar the kids for life. I’m sure they wished they could sit through the kids practice without having to get high. The only way to understand it is to have lived it. The children need to be in a safe home and the adults need help. They are sick, i know from the outside it looks like a choice but its not. Shaming and judging will not help anyone.”

One day, Angel Holt started posting comments. “I don’t neglect,” she wrote. “Had a bad judgment I love my kids and my kids love me there honor roll students my oldest son is about to graduate they play sports and have a ruff over there head that I own and food, and things they just want I messed up give me a chance to prove my self I don’t have to prove shit to none of u just my children n they know who I am and who I’m not.”

A few weeks later, I spoke to Holt on the phone. “Where it happened was really horrible,” she said. “I can’t sit here and say different.” But, she said, it had been almost impossible to find help for her addiction. On the day of the softball practice, she ingested a small portion of a package of heroin that she and Schildt had just bought, figuring that she’d be able to keep it together at the field; she had promised her daughter that she’d be there. But the heroin had a strange purple tint—it must have been cut with something nasty. She started feeling weird, and passed out. She knew that she shouldn’t have touched heroin that was so obviously adulterated. But, she added, “if you’re an addict, and if you have the stuff, you do it.”

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In Berkeley County, which has a population of a hundred and fourteen thousand, when someone under sixty dies, and the cause of death isn’t mentioned in the paper, locals assume that it was an overdose. It’s becoming the default explanation when an ambulance stops outside a neighbor’s house, and the best guess for why someone is sitting in his car on the side of the road in the middle of the afternoon. On January 18th, county officials started using a new app to record overdoses. According to this data, during the next two and a half months emergency medical personnel responded to a hundred and forty-five overdoses, eighteen of which were fatal. This underestimates the scale of the epidemic, because many overdoses do not prompt 911 calls. Last year, the county’s annual budget for emergency medication was twenty-seven thousand dollars. Narcan, which costs fifty dollars a dose, consumed two-thirds of that allotment. The medication was administered two hundred and twenty-three times in 2014, and four hundred and three times in 2016.

One Thursday in March, a few weeks before Michael Barrett responded to Angel Holt’s overdose, I rode with him in his paramedic vehicle, a specially equipped S.U.V. He started his day as he often does, with bacon and eggs at the Olde Country Diner, in Martinsburg. Barrett, who is thirty-three, with a russet-colored beard and mustache, works two twenty-four-hour shifts a week, starting at 7 a.m. The diner shares a strip mall with the E.M.T. station, and, if he has to leave on a call before he can finish eating, the servers will box up his food in a hurry. Barrett’s father and his uncles were volunteer firemen in the area, and, growing up, he often accompanied them in the fire truck. As they’d pull people from crumpled cars or burning buildings, he’d say to himself, “Man, they doing stuff—they’re awesome.” When Barrett became a paramedic, in his twenties, he knew that he could make a lot more money “going down the road,” as people around here say, referring to Baltimore or Washington, D.C. But he liked it when older colleagues told him, “I used to hold you at the fire department when you were a baby.”