A Conversation with Michael Brumage - Director of the WV Office of Drug Control Policy

Mar 15, 2018

LOFTON: So, you are the new director of the Drug Control Policy Office. Previously, you were executive director and health officer of the Kanwaha-Charleston Health Department. You did deal with a lot of opioid issues at the Health Department previously. Will your strategy change in this new position?

BRUMAGE: Well I think some of my philosophies that I had when I was in my previous position at the Kanawha-Charleston Health Department will stay the same. But obviously, it's a lot different dealing with a community level and a county level than it is looking at in an entire state level. So, for instance, in my previous job, I did not have any jurisdiction over treatment or recovery beds – things like that –  where we interacted, but it's a lot different now. So in this new position, I'm kind of in a coordinating position among all the different bureaus and the Department of Health and Human Resources and I work directly for the secretary, Bill Crouch. And so I'll be coordinating with all of those different organizations within DHHR –  those different bureaus – but also working with community groups across the state and with health care organizations. So there's a lot of different contingents I’m going to be working with in my new position that I did not have to do in my prior position.

LOFTON: Recently, we've been hearing Mayor Danny Jones making noises about getting rid of the needle exchange program in Charleston and I know that was one of your pet projects. Talk to me a little bit about, kind of as you're leaving that position, what your reaction is.

BRUMAGE: Well, first of all, that is a program that has actually succeeded in what it was intended to do. So for the first time in 2017 hepatitis B and C rates in Kanawha County fell, as did the overdose death rate, which is really encouraging news. The mayor and the chief of police have very legitimate concerns about the number of needles in our environment. That was always a problem, but it seems to have gotten worse recently. We want to be a part of that solution. There is also the concern about bringing people in from out of town and having them go through Charleston disrupting businesses, which is really a major issue. So what we would like to do is to be able to continue to run the syringe service program. I'd like to see it continue after I leave but by tweaking the policies, procedures and by collaborating with city officials to help clean up some of the syringes and work it so that we can have people go elsewhere. And now we know that there is a statewide Harm Reduction Coalition and there's 14 different programs across the state – five new ones popping up – so people will have options of going closer to home, whereas before, Charleston and Huntington were really their only options in this part of the state.

LOFTON: I know that one of the initiatives you took on to try to combat the needles like in the parks and playgrounds was to put a bear box outside of the Kanawha-Charleston Health Department. Was that successful?

BRUMAGE: It was. So in the first week, we had a 38 gallon drum that was inside of that bear box filled up with needles. And so we didn't even count those among our return needles. So far, that program has actually had two tons of needles returned to it over time. Of course, we've also given out a lot of syringes too, to be fair.

LOFTON: So far this session there had been several bills discussed in the legislature about opioids and trying to combat the epidemic. Do you think that these efforts will make a difference in the fight against the epidemic in West Virginia?

BRUMAGE: Yes, I definitely do. The opioid reduction bill that went through the legislature to limit the number of opioids prescribed I think is one good example of that. And that really was attempting to conform practices in West Virginia of prescribing opioids with the CDC's opioid prescribing guidelines. And I think, many aspects of that bill have passed through, from my understanding, and they will make a difference over time. We need, when the sink is overflowing as someone told me yesterday, what's the first thing you do? Well you turn off the faucet. And so this is an attempt to turn off the faucet.

LOFTON: This is a relatively new office for the DHHR. What is the real purpose of the office and what do you hope to accomplish?

BRUMAGE: What I hope to be able to do is to help implement the opioid response plan that Dr. Gupta actually spearheaded. And it's a really robust response plan that deals with things like access to medication assisted treatment, harm reduction is one of those pillars and a lot of good recommendations that came from that. And the process by which that was developed was actually very robust. They include two different public comment periods and brought in a set of experts from Johns Hopkins, West Virginia University among other places, as well as Marshall University –  I want to make sure I mention Marshall too. But we also want to take a little bit of a step back and look at really what's driving this epidemic in the first place. Because while this is not just the office of opioid control policy, it's the Office of Drug Control Policy – what is it that's driving the demand for drugs. And at the end of the day, this is a demand driven problem. We often have focused in the past on supply restricting solutions. Law enforcement interdiction are absolutely essential, but at the end of the day it's really about how do we stop that demand and what are those factors? And so some of the things I carry forward from my previous job are looking at things like the social determinants of health, the things around the built environment, the economy and something called Adverse Childhood Experiences, which afflict many of the people who are using IV drugs as we found out from our Harm Reduction Clinic. And so all those things are going to be extremely important going forward.

The other thing that I'm very much interested in are ways to deal with pain that don't involve medications, or non-pharmacologic pain management, which we know there are many very effective and useful ways that we can modulate pain or live with pain in a way that doesn't require prescriptions at all. That's a cultural shift. It requires a cultural shift among not only providers but among patients as well because the expectation is – ‘I'm hurting, I'm going to the doctor I'm going to get a pill for my pain,’ when in fact, a lot of these other kind of modalities are very, very effective. We often call them alternative treatments but that's just really good medicine to be able to bring the best tools available.

LOFTON: So you mentioned the new Opioid Response Plan. Talk to me a little bit about how can West Virginians expect to see this impact our lives? I mean, we talk about every family in West Virginia has been affected by this epidemic.

BRUMAGE:  Well we're going to be working first of all to expand the number of beds available. You know the Ryan Brown program just got a review of that today there's expansion of the number of beds in West Virginia. A very exciting announcement from Highland Hospital that they're taking over the Sugar Grove Naval Facility that has been sitting dormant for the past three years and turning that into a recovery and treatment campus. Which is, will add 95 beds to begin with and will expand outward from there. It's really an exciting project. So that's one way that [the] opioid response plan will be put into effect as this expansion of treatment and recovery beds. Another way is the expansion of harm reduction, as we've talked about, because this helps reduce the risk that communities have for hepatitis B, hepatitis C. By the way, we lead the nation in hepatitis B, we're number two with hepatitis C, which is the number one infectious killer in the United States. Many of the viewers may not know, that recently, and the Center for Disease Control's MMWR, which stands for a Morbidity and Mortality Weekly Report – they reported on an outbreak of HIV in Southern West Virginia. And the counties in which they had the HIV outbreak did not have harm reduction with them. So that was very well contained. The Bureau for Public Health, working with the Centers for Disease Control, effectively contained that outbreak. But we also know that in northern Kentucky there is currently an outbreak of 40 cases of HIV, 20 of which are related to IV drug use.

So we know that this is a real and present danger. We don't want to become the next Scott County, Indiana, where they had 200 cases in a county of 24000 people, which will cost that county between 100 and 250 million dollars. Those are only two of the small parts I've talked about the Opioid Response Plan – expanding medication assisted treatment. There's a lot of suspicion that we're substituting one drug for another. But medication assisted treatment has shown to be extremely effective and has helped reduce people's cravings. It's not really to make them high. It allows them to function normally. People really talk about being able to return to a normal life on medication assisted treatment. And that's our goal. We want to take the people who are currently afflicted by this epidemic, knowing that people who are using and make them back into productive citizens, but also to be able to take care of the families, to reduce the stigma around the opioid epidemic and also to take care of our first responders, who are another population at risk with – that's not really part of the Opioid Response Plan. You know our population here really who are using are really treated like modern day lepers because they're outcasts from society. And we need to get over this notion that this is somehow different than any other disease. These are people who need our help and we need to provide compassionate care to these people.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Marshall Health, Charleston Area Medical Center and WVU Medicine.