Probation officer Krista Ellison can't begin to count how many times she's seen a parent of a drug addict beg for a judge to throw their son or daughter in jail.
And far too often, Ellison and other court officials say, jail is the only option.
"Here, it's a smaller community and many of the judges know a person's family and truly couldn't live with themselves if something happened," said Ellison, who works in the Mercer County Probation Office. "They'll say, 'I'm sorry, but I'm putting you in jail. I can't live with that on my conscience, knowing you walked out of here and died.'"
The opioid epidemic is consuming the state's court system and requiring judges, prosecutors, defense attorneys and probation officers to make what may be life-saving decisions.
West Virginia has the highest rate of overdose deaths in the U.S., more than double the national average. Over the past five years, nearly 2,900 West Virginians have died after overdosing on prescription painkillers or heroin, according to the state Health Statistics Center. President Obama is coming to Charleston on Wednesday to talk about the opioid epidemic facing the state and the nation.
In courtrooms across West Virginia, judges see people selling drugs or stealing to support habits, and neglecting children in order to get high.
"Judges have now become quasi social workers," said Circuit Judge Jay Hoke, who presides over cases in Boone and Lincoln counties. "We have to look at not only the addicted individual themselves, but also what kind of support structure that person has at home and what professional support they have when making sentencing determinations alternative to incarceration.
"The court system itself is a different court system than it was 10 years ago because of those drugs," Hoke said, noting that no one wants to see non-violent addicts locked in jail. "It's depressing."
Many judicial officials said about 90 percent of criminal cases in the state can be attributed directly to drug-related crimes. That's the case in Fayette County, said Prosecuting Attorney Larry Harrah.
"When I talk about the drug problem, I'm talking about prescription pills, I'm talking about heroin," said Harrah. "I'm not talking about marijuana. At this point we need to get real and focus on these drugs that are killing people - killing a whole generation of people.
"Everyone talks about roads and things like that. No. The real problem in West Virginia is the drug problem."
Court personnel are trying to keep non-violent addicts out of jails, despite a lack of inpatient treatment facilities in the state. Alternative sentences are often handed down when it's apparent a defendant is selling drugs or committing other crimes in order to support his or her addiction.
Day-report centers around the state are meant to help clients stay off drugs and function in society. Adult and juvenile drug courts act as diversionary programs for addicts who have been charged with relatively minor crimes. Instead of going to jail, participants take an extensive testing, counseling and community service program run by the court system to help them control their substance-abuse problems. If they complete the program, prosecutors agree to dismiss their criminal charges.
The drug court program is intense, said Richard Holicker, a deputy public defender in Kanawha County. It isn't an option or solution for every defendant.
"It's a wonderful option, but it's not an option for very many people," Holicker said.
The court "can accept only a limited number of people and the prosecutor's office has veto power over who is accepted. So even with the drug court resource being available, it's not available, in my view, to the majority of people who could benefit from it," he said.
"I've had clients - not a lot, but some - who find drug court just too hard and choose to go to prison, because that's easier. But that doesn't cure the problem," Holicker said.
Each of West Virginia's 55 counties should have a drug court by 2016. As of Sept. 1, 39 did. They've graduated about 1,200 people since the first drug court was established in the Northern Panhandle in 2005.
Drug courts have saved West Virginia taxpayers an estimated $25 million in incarceration costs, said state Supreme Court Justice Brent Benjamin, who routinely attends their graduations around the state.
"But I don't know how you estimate the savings that occurs from breaking what is a bad cycle if a person goes without treatment, and the ripple effects addiction causes on the people around the user," Benjamin said.
One of the ripple effects created by the opioid epidemic is a rise in abuse and neglect cases filed by police and prosecutors. Cases involving abuse and neglect charges in the state have doubled over the past 10 years, according to information from the West Virginia Supreme Court.
"Those are starting to overwhelm the court," said Harrah. "We have so many of them now, when we used to file one or two [abuse and neglect charges] a week. Now, who knows how many we're filing a week."
Watching children suffer because of their parents' addictions is one of the hardest parts of working in the court system, said Hoke.
In 2009, 80 out of every 1,000 pregnant women were addicted to drugs at Cabell Huntington Hospital. In 2013, that number was 139 out of every 1,000 pregnant women.
Parents who suffer from addiction often aren't able or willing to care for their children, Hoke said. Those cases not only overwhelm law enforcement resources, but also can be mentally draining for judicial employees.
"That's the scariest part of it," the judge said. "It's one thing to have a 50-year-old get mugged and have his wallet taken for money to buy drugs, but to have someone go off and leave their 3-year-old to wander in the streets or to go down and play in the creek, that's just horrifying."
The epidemic has forced judges and prosecutors to consider alternative sentencing options and learn about addiction.
"That upsets some judges, I can be frank about that," said Hoke, who has been a judge 23 years. "I've heard many judges, especially when drug courts first began, say, 'I'm not a social worker, I wasn't elected to save everybody, I don't have the skills or the education or the background or the temperament to run these [alternative sentencing] programs. But over time, everybody has realized how much of an epidemic there is and that we have to do something.
"We had opiate addiction because of pain medications five years ago, now it's opiate addiction because of heroin," the judge said. "In Lincoln County, my god. Who in Lincoln County has ever done heroin in the past? Well, they are doing it now."
Reach Kate White at kate.white@wvgazettemail.com, 304-348-1723 or follow @KateLWhite on Twitter.