MARTINSBURG, W.Va. — Rachel Lambert was alone when she learned how Jimmy Horton died, and the news came — as so many other things now did — over a screen. The world’s attention was on the coronavirus, but the Facebook post Lambert saw as she sprawled in bed on a Sunday night said her old high school friend had been claimed by a more familiar epidemic: He had overdosed.

Fear, anger, despair — she was seized by all the emotions that grip one recovering drug user who learns that another has relapsed. But all she managed to tap out on her phone was an expression of disbelief.

“How do you know Jimmy OD’d?” Lambert wrote to the Facebook post’s author.

Drug deaths are not rare in the Eastern Panhandle of West Virginia, and Lambert knew the risk as well as anyone. She was 34, but had attended so many friends’ funerals that she sometimes felt much older. She herself had taken the hard road from tying off in gas station bathrooms to brewing coffee at 12-step meetings, and knew how easy it was to stray. Yet she was astonished and alarmed that Horton, a thriving electrician who had been clean for four years, would return to heroin.

It would be months before she understood more about what lay behind her friend’s relapse — and behind a record-breaking year of fatal drug overdoses, in West Virginia and across the country.

When Horton died on May 23, 2020, just 10 weeks had passed since America entered a state of emergency in response to covid-19. But Lambert was already beginning to grasp that a separate, less acknowledged emergency was unfolding in the hotbeds of the opioid crisis. And she would come to believe, alongside many others in her community, that efforts to protect people from one epidemic had put them in danger from another.

Human connection lies at the heart of addiction treatment. From the “inebriate homes” of the 19th century to the church basements later colonized by Alcoholics Anonymous, systems of mutual support and accountability have long been a vital part of achieving and maintaining sobriety.

When America shut down in the spring of 2020 in an effort to stop the spread of the virus, those systems disintegrated. Treatment centers closed, and recovery meetings went virtual. Former drug and alcohol users who had long been warned that isolation was a precursor to relapse were suddenly instructed not to leave their homes.

Experts say the crumbling of support systems, combined with widespread job loss during the pandemic and an increasingly dangerous supply of illicit drugs, help account for the 93,000 fatal overdoses estimated to have taken place in 2020 — the deadliest year in an opioid epidemic that has claimed more than 900,000 lives.

But long before the nation began to assess the staggering toll of opioids during the pandemic, Lambert and others in her corner of West Virginia understood what was happening.

In May of 2020, the same week Horton died, Tim Czaja was imploring officials in Berkeley County, W.Va., to reopen the government-run treatment center he oversees for recovering drug users in court diversion programs. Over the two months that the center was closed to in-person services under the governor’s orders, Czaja watched four of his clients fatally overdose and dozens drop out of treatment.

“Addiction makes you want to be alone. A large part of recovery is establishing a face-to-face connection — in person, not on a video,” Czaja, director of the Berkeley Day Report Center, later said in an interview. “For the large majority of this population, in my opinion, the covid restrictions — everything shutting down — is far more dangerous than covid.”

There were 106 fatal drug overdoses last year in Berkeley County, compared to 69 covid-19 deaths, according to state data. In the first six months of 2021 — a period that included much of Martinsburg’s winter surge in infections — total deaths from the virus nearly doubled, to 137. That number could spike again as the highly infectious delta variant makes its way to Berkeley County, where just 38 percent of the population has received at least one vaccine dose.

Estimates for drug deaths in the first half of this year have not been released, although county emergency services data show that overdoses have continued to rise. Horton, who lived near the southern edge of the county of about 120,000, was one of those lost during the pandemic.

Lambert had gone to Jefferson High School with Horton, an electrician’s son whose sunny temperament seemed immune to the stormy moods of adolescence. After graduation they had sometimes crossed paths on their mutual descent into heroin addiction, using together in the rocky hills that crowd Interstate 81 to the west of the Potomac River. When the coronavirus arrived in the United States in early 2020, both had seemingly extricated themselves from the human wreckage of drug abuse, with stable work and years of sobriety.

In the year that passed after Horton’s death, Lambert would put herself on the front lines of the worsening opioid epidemic, abandoning remote work to lead recovery groups in person at the reopened Day Report Center.

The decision was not without risk for Lambert, who lived with elderly parents, one of them suffering from heart disease, who were more vulnerable to covid-19. But she knew staying home — distant from others in recovery, scrolling Facebook as overdose deaths continued to mount — carried risks to her as well.

“One thing you don’t want to tell an alcoholic or an addict to do is isolate. And here I am being forced to isolate,” she said. “I felt helpless. I felt useless. Because my people are still dying.”

Lambert shared the impossible balancing act that confronted her community. If opioids and the virus were both lethal public health crises, and success against one risked failure against the other, which fight were they supposed to choose?

‘That loneliness’

The March evening was unseasonably hot, and the air system wasn’t working in the portable classroom building on the outskirts of Martinsburg. Coronavirus transmission was still high in Berkeley County, and vaccines were not yet widely available, but most of the 13 people who sat sweating around a table inside did not wear masks.

Face coverings were optional at Berkeley Day Report, which served a region where adherence to West Virginia’s indoor mask mandate had always been spotty. Nine months after the center had reopened, few participants or staff chose to wear them. The Centers for Disease Control and Prevention might have frowned on their decisions, but the men and women trying to stay clean at Day Report placed a premium on seeing one another’s faces.

Lambert jokingly called the groups she led “Recovery during ’rona,” and tonight — as they often did — her clients talked about how hard it had been to stay sober through the pandemic. Some spoke of their fear and stress as the virus had spread through West Virginia. But most had felt the impact of covid-19 through restrictions on social contact to prevent its spread.

There was Angel Peck, 25, who was clean and had been working for 11 months as a counselor at a residential rehab in Charleston when the virus hit. The facility locked down, and staff members were no longer allowed to interact in person with clients. Peck, who was pregnant, returned to Martinsburg. Soon she was using heroin again.

There was Walter Holliday, 47, sober for almost a year when he relapsed — a “direct result,” he said, of his feelings of loneliness and aimlessness during lockdown.

“Nothing to do with your time, you’re going to get high,” Holliday said.

“It screws with your head,” said Jerimi Shroades, also 47. “We had to do everything on Zoom. I couldn’t go to my meetings. It was rough.”

“Being in your own head —” Holliday grimaced.

“That is the last place that an addict can be, is in your own head,” Lambert said. “That loneliness, lack of meetings, isolation, all that stuff — that is a recipe for death.”

It was a truth that everyone sitting around the table understood. Their places at Berkeley Day Report had been purchased with addictions that nearly destroyed their own lives and the lives of those they loved, and they were the lucky ones: arrested, alive and given another chance through court-ordered treatment.

They were sons and daughters, parents and siblings, a cross-section of the victims in an epidemic that had left virtually nobody in the region untouched. They spoke of families riven by petty crime and suicide, of children born addicted to heroin. One of Lambert’s clients, Tyler McKee, had been revived with the overdose antidote Narcan 18 times. He was 26.

They were the people Lambert had come to help when she joined Day Report two months earlier, after leaving her old job performing outreach to drug users through a West Virginia University program.

The WVU position was the first job she had taken after earning state certification as a peer recovery coach. But her initial excitement had soured over the spring and summer of 2020 when her bosses told her that because of covid restrictions she would have to find a way to persuade people in active addiction to seek treatment — never easy, even when done face to face — without leaving her home.

“I understand that they were all concerned about our safety,” said Lambert, who lives about a 20-minute drive outside of Martinsburg. But there was only so much outreach to be done over social media and other digital channels, and it seemed like her work phone was ringing less and less as time went on.

“Overdoses were skyrocketing,” she said, “and I was sitting on my hands doing nothing.”

A friend put her in touch with Czaja, the director of Berkeley Day Report, known for his outspoken belief that in-person addiction treatment should continue through the pandemic. Within weeks she was hired as a counselor at Day Report.

The center had reopened in May 2020 when Czaja convinced the Berkeley County Council to exempt it from the health regulations that had forced its closure. In some places, pleas on behalf of recovering drug users might not carry much weight. Not so in Berkeley County. Czaja — a former heroin user who has been in recovery for two decades — was called to testify at a public meeting by county council president Doug Copenhaver, whose late son had descended into an opioid addiction before dying in a car wreck in 2011.

The county deemed Day Report an essential provider of medical services.

The threat of opioids, Copenhaver declared, was “no different than the virus.”

‘He’s dead’

As night falls in Martinsburg, ambulances start to thread the streets, their lights dancing over the shattered windows of the old Interwoven Mills textile factory. Ghostly figures walk the railroad tracks that once connected the city with more legal forms of commerce. A 7-Eleven downtown blasts the Queen of the Night aria from “The Magic Flute” outside the entrance to discourage loitering, with mixed success.

Angela Gray, nurse director for the public health agency that serves Berkeley and Morgan counties, understands the damage drugs are doing here. Gray led the effort to establish a syringe exchange and was among those fighting the opioid epidemic long before the federal government began to recognize the scale of the problem.

But Gray also worries that those she serves — many weakened by addiction or other chronic health conditions — are vulnerable to the coronavirus. She supported the closure of Berkeley Day Report early in the pandemic, and continues to urge a two-front war against the virus and opioids.

“It is a balance,” Gray said. “We’ve got to do both.”

A fresh wave of the pandemic fueled by the delta variant has renewed the debate. Some states have re-imposed mask mandates and social-distancing orders. No similar measures have been taken yet in Berkeley County, though infections are climbing, aided by low inoculation rates.

Even some who have witnessed the horror of the virus firsthand say there is no easy solution. Doris Burkey is still grieving for the 58-year-old husband she lost to covid-19 over the winter, and said it would be foolish for anyone to underestimate the disease or to refuse vaccines that protect against it. But as a nurse practitioner in Morgan County, Burkey has also seen the pervasive harm of opioids — harm measured not just in overdose deaths but in wasted lives and broken families.

“I’m torn, because I see one side as a health-care provider, and I see another as someone who had a family member who died from covid,” Burkey said. “I can’t really say what’s worse.”

The community’s efforts to weigh its public health priorities have extended beyond treatment centers like Day Report. Martinsburg High School has operated remotely on and off through the pandemic, as has its drug education program. The popular Crossroads Church began streaming services to the former users who would ordinarily gather in person to thank Jesus for sobriety.

It was an arrangement that never sat right with at least one parishioner: Jimmy Horton.

Horton was 27 when he struck a pedestrian one night in 2011 while driving a rental truck on Route 340 near Harpers Ferry. The 22-year-old man who was walking along the road died. Horton, who drove away, was later chased through his mobile-home park by sheriff’s deputies and arrested on charges that included leaving the scene of an accident involving death.

Four years later, in 2015, he left state prison on parole.

His family saw him begin to change with the clean time enforced on him during incarceration, but were still surprised by the person who emerged in place of the heroin user who had lost his ability to look them in the eye.

When he announced his intentions to follow in his father’s footsteps and become an electrician, “Big Jim” Horton was skeptical.

“I wasn’t going to be negative about it," he recalled. "But I thought, ‘This oughta be something.’”

Yet the company his son founded, Ace Electrical Services, prospered. Jimmy Horton reestablished close relationships with his two children and married a successful real estate agent. After a brief relapse with pills in 2016, he maintained his sobriety.

“It was like he was living his whole life in these five years,” said his sister Nicole Ainsworth. "He was — a grown-up. He finally grew up.”

Then the pandemic hit. Horton was never scared of the coronavirus, said his wife, Marisa Boone. But he struggled as the rituals and connections that defined his drug-free life abruptly collapsed.

The gym they attended together every morning closed. Horton’s company had been so busy that he regularly turned his phone off, unable to accept new jobs. Now Boone sometimes found him sitting on the couch in the middle of the day, waiting for a customer to call.

The closure of Crossroads Church, which they attended every Sunday, was a particularly hard blow. Horton did not regularly go to 12-step meetings, and relied on the sense of community he found in the congregation, which included many others in recovery.

“He absolutely loved it, and he said he felt accepted and comfortable there,” Boone said. “We tried to watch online, but he said he just wasn’t into it.”

No relapse into addiction is ever neatly explained. Boone said she is sure that pandemic lockdowns “played a huge role” in her husband’s return to drugs, but neither she nor other members of his family understood how badly he was slipping.

When he stayed overnight at his father’s house during Memorial Day weekend, Big Jim was unprepared for what he found the next morning upon opening the bathroom door.

“It’s something I can’t even describe,” he recalled. “I screamed at the top of my lungs, ‘He’s dead.’ ”

The news made its way a day later to Lambert’s Facebook feed. She knew that her grief, intense as it was, could not compare to that of Jimmy’s family, because she knew what they had already lost.

Jimmy had another sister, Cameron, who died of an overdose 16 years before him. Covid-19 had claimed nine lives at that time in Berkeley County. But the Hortons had now lost a second child to heroin.

Connection problems

The meeting that started in 15 minutes was not one Lambert could miss.

It was a Sunday in June, almost four years to the day after her arrest on drug possession charges during a traffic stop. The desperation of those first hours in jail was still fresh in her mind, as were the pained refusal of her parents — convinced that nothing else would save their daughter from drug addiction — to bail her out, and the stern attention of a sheriff’s deputy who told her she had a chance to change her life with a diversion program.

Lambert said yes, and what she found upon her release at the Jefferson Day Report Center — counterpart to the Berkeley program where she now works — was something that at last seemed worthy of replacing addiction.

There was her peer counselor Tho’mas Green, a former heroin user from Baltimore who could match every one of her shameful stories with his own. There were the men and women who wore shirts that said “HUGS,” embracing people who stood to proudly announce their time in recovery — 10 years, or five months, or two days — at Lambert’s first Narcotics Anonymous convention.

For the first time in years, she no longer felt she had to lie, or evade, or explain herself. They’re me, Lambert thought. I’m them. They get it.

That sense of liberation was what Lambert was supposed to be celebrating on this day. It was the weekly gathering of her “home group” — which she attended for the maintenance of her own sobriety — and in the tradition upheld by many 12-step meetings, she would be delivering an informal speech to mark the anniversary of her turn away from drugs.

If only she could get the Internet to work.

“What is happening here? I don’t know why it’s not — ”

Lambert was hunched over the laptop at her kitchen table.

“Technical difficulties,” she sighed.

This was the second in a row of her “sober birthdays” that Lambert would be attending remotely. Before the pandemic, her group had gathered on Sundays at a church in Charles Town. But today there would be no cake or coffee; no medal, or “chip,” presented to Lambert in honor of her clean time. She would count herself lucky if she could even log on to Zoom.

She abandoned the computer for the moment and picked up her phone. “Keep f---ing going” was printed on its case.

Vicki Lambert, Rachel’s mother, spoke up from her chair in the living room.

“Do you know when you guys are going to start resuming in-person meetings?” she asked.

“No,” Rachel said.

More than a year into the pandemic, there was no simple formula for calculating the benefits and risks of human contact, and Lambert’s support group — which included several elderly members — was still taking a more conservative approach than the one adopted at Berkeley Day Report.

Elsewhere in the area, a few meetings like this one had reopened. But Lambert was unsure they would be equal to the task at hand.

She had held on to her own sobriety through covid-19, though at times she felt she was running on fumes. But she thought about how West Virginia had now endured 15 months of lost chances for those who were like she once was — people who never tasted the doughnuts offered by another recovering user or got a hug or handshake to celebrate their clean time.

Before the pandemic, America’s war against opioids had been, at best, a stalemate. Now the fight was resuming, but was there any way to make up for the time that had been lost? The U.S. government had spent tens of billions of dollars to develop and deliver vaccines for the coronavirus. Nobody was expecting a similar moonshot to counter the opioid epidemic.

“There we go!”

Lambert had finally logged on through her computer. A mosaic of faces came to life on her screen, and she smiled.

“This morning we have Rachel,” said one of the group’s other members, “who is celebrating four years in sobriety.”

Lambert spoke about her path into addiction, recounting a happy and stable childhood that took a turn when she was prescribed painkillers for a volleyball injury in high school. And she talked about how she left it behind.

“I most definitely did not do this on my own,” she said. “I had to come and ask for help.”

A storm was moving over the region. It was barely noon, but daylight was draining from the kitchen as the clouds encroached. Thunder cracked as Lambert finished her speech. Her friends congratulated her, and told her not to get too caught up in saving the world.

In person, this meeting had usually included at least 30 people. Today there were perhaps half that. It did not take long for their camera feeds to wink out on the screen, leaving Lambert by herself, listening to rain fall on the roof in an otherwise quiet room.

Magda Jean-Louis contributed to this report.

correction

A previous version of this article included a photo caption about a billboard that erroneously said it was near Charles Town, W.Va. It is near Charleston, W.Va. The caption has been corrected.

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Story editing by Lynda Robinson. Photo editing by Mark Miller. Design by Tara McCarty. Copy editing by Frances Moody.