*This article contains details from the documentary that some may consider spoilerific*

In many ways, Louis Theroux's visit to Huntington, West Virginia (the titular 'Heroin Town') goes down in a very similar way to his time spent in Fresno, California ('The City Addicted to Crystal Meth'), but there's an even stronger impact with this documentary owing to the fact that a line can so simply be drawn between cause and effect.

There's no confusing mix of poverty, economics, geography and luck that allows politicians to successfully obfuscate here but a very simple formula:

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Patients have illnesses or accidents. They are prescribed strong opiates. These opiates are eventually cut off by the doctor. Dependent, these patients are forced to turn to heroin just to feel okay.

It's as simple as that, and it's shocking to see how this swift trajectory has demolished the lives of thousands of Americans.

No addict is deserving of more pity than others - addiction is a disease - but, nevertheless, it's astonishing and terrifying as we encounter zombified individuals who were quietly living a middle-class life just months earlier. One man Louis speaks to in a woodland area that has become a spot to pick up and shoot up, explains that he has a degree and was previously running a network auditing business and clearing $200,000 a year.

Pain and disbelief are everywhere in Huntington, where one in four people are addicted to some form of opiate and it's not uncommon to find a respectably dressed corpse on the street - overdosing users falling down in public like statues blown over in a wind. Tragic stories Louis encounters include a newly clean mother hoping her unborn baby will live in spite of her drug use early in the pregnancy, a man so delusional in his addiction and so convinced that heroin is wonderful that he doesn't even want to get clean (in spite of his bleak accommodation - a littered tent), a young woman caught in a cycle of domestic abuse being kept as a pet by her dealer, and, perhaps worst of all, a healthy, 20-year-old girl with a designer handbag who "just uses occasionally". Looking on as she picks up, Louis and the viewer know that the next time they see her she will likely have sold that bag for drugs and be missing some teeth.

As ever, Louis has an uncanny ability to establish a rapport and seem humble and sympathetic even when he's asking the toughest questions. "Have you sucked a dick to get high?" he asks a reformed addict, and manages not to get punched in the face.

His interactions with victims are as thoughtfully conducted as they always are, but - with only 60 minutes to play with - this comes at the expense of other interesting and important elements of the story. Heroin Town never fully explains the impact of fentanyl, heroin's 100 times as strong cousin, the emergency services' losing battle with the drugs, and barely touches on the guilt and inaction of pharmaceutical companies and the ignorance of politicians. There isn't the empiricism or expert opinion of a slick Netflix documentary here, but I guess that's not what Louis is going for, and as an insight into the reluctant, begrudging daily existence of an opioid user, Heroin Town is a powerful documentary.

Louis Theroux: Dark States - Heroin Town is on BBC Two Sunday 8 October at 9pm.

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