Hostility, compassion and role reversal in West Virginia’s long opioid overdose emergency

West Virginia leads the nation in overdose death rate and both counties where participants were interviewed for this study were considered to be at risk for an HIV outbreak among people who inject drugs. This study asked the question ‘What on-the-ground environmental factors among PWIH could be contributing to this overdose rate? To this end, we will present qualitative findings from semi-structured interviews, ethnographic observation and filmed injection sequences with a focus on the perspectives of people injecting heroin and drugs sold as heroin, including fentanyl, (‘heroin’ hereafter) in West Virginia.