On August 15, 2016, Huntington, West Virginia, a small city of approximately 49,000 residents, which was previously best known as the home of the Marshall Thundering Herd, became known for something far less uplifting: 28 residents overdosed on heroin in a four-hour period.

To put this in statistical perspective, that’s about as many as overdosed every two weeks in New York City, which has 170 times as many people as Huntington.

What happened in those four hours from hell in Huntington differed only in degree, not in kind, from what is happening elsewhere in the country, especially in communities that have seen better days.

A year ago, I wrote about the heroin epidemic in what’s often called America’s “heartland.” The occasion for that piece was an HIV outbreak in a rural Indiana county linked to intravenous drug use. Austin, Indiana, population 4200, had 150 confirmed HIV cases, which, according to the Centers for Disease Control, gave it “a higher incidence of HIV than ‘any country in sub-Saharan Africa,’” and “more people infected with HIV through injection drug use than in all of New York City last year,” which has 2,000 times as many people as Austin.

As I also pointed out, heroin is a “fallback drug”—in this case, a fallback to semi-synthetic opiates like OxyContin and Opana. These drugs, as Sam Quiñones, the author of “Dreamland: The True Tale of America’s Opiate Epidemic,” has pointed out, are “molecularly very similar to heroin,” and, as you probably know, have been ravaging small towns and rural communities for a while now.

The switch to heroin occurred when opiate addicts found it harder and more expensive to maintain their pill habit. Heroin was cheaper, more potent, and often delivered much like pizza.

All of these opiates, whether “semi-synthetic” like the pills or “natural” like heroin, mean overdoses, lots of overdoses. In 2014, more than 47,000 Americans died from drug overdoses, according to the Centers for Disease Control. Three fifths died from overdosing pills and the rest from more “natural” sources, primarily heroin.

Put another way, drug overdoses killed one-and-a-half times as many Americans as automobile accidents or firearms. Nearly as many Americans died from overdoses that year as died in the entirety of the Vietnam War, 50 percent more than died in the Korean War. The sharp increase in overdose deaths is why the U.S. death rate rose for the first time in more than a decade last year.

Opiate overdoses are by far the leading “accidental” cause of death in the United States, except, of course, there’s nothing “accidental” about them. “Accident” doesn’t describe the way that the heroin got into the bodies of those 28 people in West Virginia any better than it describes how the Fentanyl got into Prince’s.

The obvious question is “What do we do about it?” If by “it” you mean stopping the flow of drugs and keeping people from using them, the most honest answer is, “beats me.”

As of the moment I typed these words, we have spent nearly $40 billion on the “war on drugs,” which is to say on interdiction and law enforcement. Yet heroin is cheaper, more potent, and more readily available than it probably ever has been. And the body count is steadily rising. So, going on the evidence, interdiction and law enforcement really aren’t the answers.

Likewise, no one, least of all me, has a clue about to do about the circumstances that predispose people to seek solace from these dangerous drugs. We don’t know how to revive the economies of these communities, at least not beyond the occasional feel-good story about a plant re-opening in Ohio or Indiana. The sad truth is that very few of the low-skill, good-paying-with-benefits jobs that made a middle-class lifestyle possible in these communities are coming back, no matter who is president.

And while it’s true that faith can provide people with hope and solace in even the most trying of times, if that’s all we have to offer, it brings to mind the words of James: “If one of you says to them, ‘Go in peace; keep warm and well fed,’ but does nothing about their physical needs, what good is it?”

Of course there are Christians doing a great deal more than this and we should support them. But we shouldn’t suppose that these kinds of programs are anything more than the proverbial drop in the bucket. There are simply aren’t enough of them to make a much of a difference.

Even if they expanded to the point where could be confident that they were saving, say, 2000 people from dying from drug overdoses every year, which is a very optimistic-to-the-point-of-being-incredible goal, that would be less than 5 percent of all fatal drug overdoses in 2014, the last year for which we have complete data. Given that the number of such deaths is rising by more than 5 percent, the impact is probably even smaller than I’m stipulating for purposes of discussion.

All of this leads me to the inescapable conclusion that our emphasis must increasingly be on harm reduction. Our ability to reduce opioid abuse, at least without serious unintended consequences, is limited, at best. But there are things we can do to reduce the likelihood that living in a place whose best days are 50-plus years in the rearview mirror doesn’t become a death sentence.

These include things like opioid substitution therapy, e.g., methadone maintenance, which, while not addressing the underlying addiction, at least keeps that addiction from killing the patient. The person may still be an addict, but a live addict at least has a chance of kicking their habit, while a dead one doesn’t.

There’s Narcan, an effective opioid overdose medication that has been proven to save lives. An increasing number of police departments are training their officers and other first responders in the use of Narcan. When coupled with “Good Samaritan Laws,” which shield people reporting overdoses from prosecution, Narcan can make a difference.

Harm reduction strategies are, to put it mildly, controversial. There are legitimate concerns about possibly enabling drug users and, in so doing, making the problem worse.

Portugal is no stranger to these concerns. In 2000, the country, infamous for sky-high rates of drug addiction and the health problems that accompany it, such as HIV infection and overdoses (sound familiar?), decided to go the harm reduction route. It decriminalized the possession of all drugs, from marijuana to heroin. (The sale and distribution of drugs remains illegal.)

Instead, offenders “receive a citation and are ordered to appear before so-called “dissuasion panels” made up of legal, social, and psychological experts.” Repeat offenders are “prescribed treatment, ranging from motivational counseling to opiate substitution therapy.”

Sounds soft, doesn’t it? That’s what critics said 16 years ago. They predicted that drug use would skyrocket and that Lisbon would become “a haven for drug tourists.”

None of this happened. Instead, “With some exceptions, including a marginal increase among adolescents, drug use has fallen over the past 15 years and now ebbs and flows within overall trends in Europe,” and the number of heroin users has been cut in half.

“The rate of new HIV infections in Portugal has fallen precipitously;” and “Portugal’s current drug-induced death rate, three per million residents, is more than five times lower than the European Union’s average of 17.3, according to EU figures.” By way of comparison, the United States’ is 135 (!) and West Virginia’s is 324 (!!!) per million.

So, not only is the Portuguese approach actually reducing harm, but it also seems to have had a possible impact on the actual usage rate. But there is a downside: Talking about harm reduction, dissuasion, treatment, and counseling isn’t as emotionally satisfying and politically popular as talking about personal responsibility and “getting tough.”

But it’s the right thing to do. Just ask Mike Pence.

As governor of Indiana, the Vice President-elect struggled with what to do about the aforementioned HIV outbreak in Austin, Indiana. On the one hand, there was the legitimate concern that passing out clean needles was enabling intravenous drug users. On the other hand, there was the legitimate concern that, without such an exchange, HIV would spread even faster and farther.

In the end, after praying about it, Governor Pence gave the go-ahead. He made it clear that his decision was in response to a “public health emergency.”

I would call 47,000 deaths (and growing) annually a “public health emergency.” It’s time to treat them as such.