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I find myself thinking about a train as we near World AIDS Day, honored yearly on Dec. 1. But this isn’t a scenic, tourist train ride. Instead, this is a steam locomotive chugging slowly and dangerously through the rolling hills of Appalachia.

The engine of this train is substance use. In West Virginia, we have seen an evolution of drug use from folks beginning to take opioid pills in the early 1990s to today, when we are experiencing an epidemic of opioid injection and other substances.

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A. Toni Young is the founder and executive director of the nonprofit Community Education Group, headquartered in Lost River.

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