West Virginia’s low wages and high poverty rate have caused some residents to turn to illicit drug production, transportation, or distribution. Among the most significant drug threats to West Virginia are cocaine, diverted pharmaceuticals, marijuana, methamphetamine, and heroin. Following an executive summary and an overview of the drug threat to West Virginia, each chapter presents an overview of the five most salient drug threats to the State, offering information on the rate of local abuse; local availability; violence associated with the drug; and the production, transportation, and distribution of the drug. Cocaine, particularly crack cocaine, poses a significant threat to West Virginia. Cocaine is associated with violent crime in West Virginia; there were more cocaine-related offenses than for any other illicit drug in 2002. The number of treatment admissions for cocaine-related emergencies decreased from 1,199 in 1998 to 1,008 in 2000. The abuse of diverted pharmaceuticals is another serious problem in West Virginia, outpacing the abuse of cocaine in many areas. Pharmaceutically-related treatment admissions increased from 895 in 1998 to 1,274 in 2000. OxyContin, Vicodin, and Dilaudid are all easily obtainable, frequently abused, and associated with property crimes in West Virginia. Marijuana is the most widely available and frequently abused drug in the State. Violence is not associated with the abuse of marijuana, which makes it a less significant threat than cocaine and diverted pharmaceuticals. Most marijuana available in West Virginia is produced in Mexico, although a significant amount is produced locally and in neighboring States and is controlled by independent dealers and loosely organized criminal groups. Methamphetamine presents an increasing threat to West Virginia, particularly because of its availability throughout the State and its correlation to violence and environmental harm. Caucasian criminal groups are responsible for the production and distribution of most of the methamphetamine in the State. Finally, heroin poses a low but increasing threat to West Virginia, particularly in the larger cities where heroin is being abused as a substitute for OxyContin. In 1998, there were 214 treatment admissions for heroin-related emergencies and 160 in 2000. Predictions on the future outlook for the drug threat to West Virginia are offered. Map, tables, sources