evidence: Many of the counties with the highest fentanyl death rates — in hard-hit states such as West Virginia, Kentucky and Ohio — started out with alarmingly high doses of prescription pills per capita, according to a Washington Post analysis of the DEA data and federal death records. [...] Synan, a member of the Hamilton County Addiction Response Coalition, recalled that the toll was grim — in one week in 2016, emergency responders dealt with nearly 200 overdoses, in which three people died. That year, 282 people in Hamilton County died of heroin, fentanyl or both. The following year, the number had jumped to 384, with a rate four times higher than the national average, according to CDC data. [...] He cycled in and out of treatment and jail for the next three years. In 2016, Armstrong overdosed on what he thought was heroin. He was out cold for six minutes, saved by CPR from a friend and a shot of the opioid antidote naloxone from paramedics. That was the year he got sober. Armstrong, who now works as an outreach coordinator for the Kathy Ireland Recovery Centers and Wise Path Recovery Centers, survived where many others did not. In 2017, Cabell County had far and away the nation’s highest death rate — 135 out of every 100,000 people — from heroin and fentanyl overdoses, according to The Post’s analysis of CDC data.