In the state of winding roads, endless hills and breathtaking seasons, prescription drugs, statistically, take the lives of one to two West Virginians daily.

For the past two years, West Virginia has been ranked as the state with the most drug overdoses, with 628 deaths from drug use in 2014 according to the West Virginia Department of Health and Human Resources (DHHR). Most of these overdoses are from prescription drugs, specifically Oxycodone and Hydrocodone, contributing to approximately 332 deaths in 2014. In Kermit, WV, a population of nearly 400 people purchased 10.9 million Hydrocodone from Sav-Rite Pharmacy.

With 31 deaths per 100,000 people in the state of West Virginia, prescription drugs killed twice as many people in the state as drunk driving.

Prescription drugs, however, aren’t the only killer. Heroin-related deaths have risen 20% since 2010 with 165 deaths reported in 2014, and 103 reported in 2015. In August, Huntington, W.Va., reported 27 heroin overdoses within four hours. Needle-sharing is also a common way of spreading hepatitis and HIV.

On Tuesday, when asked how to combat the drug problem in West Virginia, Senator Joe Manchin called for a reinstituted “war on drugs.” It’s been 30 years since Nancy Reagan’s “Just Say No” Campaign and 44 years since President Nixon declared a war on drugs. However, the “war on drugs” is largely ridiculed across the United States, with many states taking their own approach.

Manual labor based jobs and a high rate of unemployment across the state are directly linked to the coal dependent economy of West Virginia, but the dependency on coal is also a driving force for the opioid crisis affecting the Mountain State.

Coal mining, timbering and manufacturing heavily require manual labor and commonly leave employees with injuries.

Last year, John Temple, a professor at West Virginia University, reported to the Charleston Gazette-Mail, “In mining camps, the doctor is more likely to opt for the quick fix and give people pills to fix their pain and get them back into the mine.”

With approximately 18,000 coal miners in West Virginia, more people are prescribed opioids to counteract the hazardous work environment.

In 2009 the Appalachian Regional Commission claimed, “High rates of unemployment and job-related injuries are closely linked to abuse of alcohol, illicit drugs and prescription medications.”

In March, at the National Rx Drug Abuse and Heroin Summit in Atlanta with Governor Earl Ray Tomblin, Senator Joe Manchin and President Obama announced actions to give $1.7 million to community health centers in five counties in West Virginia in hopes to combat the drug crisis.