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Drug And Alcohol Abuse Counselors Bring Issues to Lawmakers

Recovery Advocacy Day at the capitol brought a sharper focus this year on the successes and challenges in helping those struggling with addiction get not just sober, but productive. Drug and alcohol counseling specialists from around the state came to petition delegates and senators, voicing support, opposition or clarification on at least 19 key legislative bills.

Joe Deegan is the Public Policy Director for the West Virginia Association of Alcohol and Drug Abuse Counselors. The organization opposes House Bill 2257. If it becomes law, the bill will create extended supervision for some drug offenders, in some cases up to ten years. Deegan said if a violator does their time and follows through on probation, extended supervision can be counterproductive.

“That creates a financial burden, it creates an undue burden for these folks to get back into normal society,” Deegan said.

After lengthy debate, HB 2257 passed in the House, and now heads to the Senate .

Deegan said the group supports House Bill 4457, providing tax credits for hiring those in recovery for substance abuse. He agreed employers do take a risk, but countered that they can reap rewards.

“I’m personally recovering myself, I got hired and feel like I’m a good employee. These days there are a lot of people out there that need a chance,” Deegan said.

Recovery Point West Virginia has 365 beds in facilities statewide. Their development director, Andrew Daniels, said a 25 percent increase in covid related expenses means following through on protocols, making continued legislative funding vital.

“The ongoing process is testing, getting cleaning supplies, changing our cleaning schedules to make sure everything is clean throughout the day,” Daniels said. “There was no budget, no expenses put aside for anything like that.”

Addiction specialists said they can’t help people get clean and sober without legislative understanding of the help they need.

Company Plans New Residential Substance Use Treatment Centers In Boone, Morgan Counties

Lotus Recovery Centers is set to open new operations in Boone and Morgan counties with major renovations of two existing structures, Gov. Jim Justice announced at a press conference Wednesday.

Justice discussed the benefits of providing treatment, noting that the opioid epidemic has hurt many West Virginians.

“If we can somehow bring them back, bring them back to the lives they had before they went down this path, what an incredible accomplishment,” he said. “And we need ‘em, we need ‘em back.”

The renovations at the old Bath High School in Morgan County and the Comfort Inn in Boone County will provide 30-60 day residential substance use treatment.

Economically, the renovations at Bath High School will cost $3 million. The facility will employ 50 to 60 people with an average salary of $55,000 a year. The Boone County facility will be a 60-bed facility, although the staffing there wasn’t immediately known.

Johnathan Frazier, a native West Virginian and executive director for the Lotus Recovery Centers’ West Virginia operations, said that Lotus is providing “quality care for those who need it and quality careers.”

In ‘Rx Appalachia’ Lesly-Marie Buer Explores Gender Inequities In Recovery In Appalachia

Lesly-Marie Buer was living and working Colorado when she became interested in substance abuse treatment and harm reduction programs. Buer grew up in East Tennessee, in the Knoxville area, but moved west and attended the University of Colorado where she got a master’s in public health.

“But then I was talking to friends who were going through treatment programs in East Tennessee, and they were telling me about them. Most of these were guys and most of the research I had seen [on recovery] was on guys,” Buer recalled. “I was looking for what was going on with women trying to make it through treatment programs in Appalachia and I just couldn’t find anything. So I decided that’s what I really wanted to look at for my dissertation.”

Buer moved back east to attend the University of Kentucky and soon began living alongside women in recovery in rural Kentucky communities, interviewing them in detail and trying to understand their struggles. Those interviews and her research resulted in “Rx Appalachia: Stories of Treatment and Survival in Rural Kentucky,” being released Tuesday, May 12. Buer spoke about the book and her research with 100 Days in Appalachia’s Taylor Sisk before its release.

***Editor’s Note: The following has been edited for clarity and length.

Taylor Sisk: You open your book with a quote from a book by Anne Pancake called Strange as this Weather Has Been. Could you read that quote for us and then tell us why you chose to open your book with it.

Lesly-Marie Buer: “I’ve learned something about times like these. And times like these you have to grow big enough inside to hold both the loss and the hope.”

I think that I’ve seen this with my generation growing up in Appalachia, but also in my research as well. Most friend groups have lost some friends to overdose death or to suicide, sometimes it’s hard to tell the difference which, and that takes a toll. You know, you start getting scared when you get phone calls from friends late at night thinking that it’s another death.

But at the same time, there’s so much beauty and activism here. And you see that with the youth and all the youth groups that are happening in Appalachia. They have these beautiful radical ways of conceptualizing what Appalachia is going to look like, and I saw a lot of that with the women I spoke to who are going through substance use treatment. They had all these imaginings of what life could be like and there was so much hope in those imaginings, yet there was so much hurt as well.

Sisk: The subtitle of your book is stories of treatment and survival and rural Kentucky. Why did you choose that title?

Buer: So, most the people I worked with and spoke with, they had really been placed in situations that were very risky. And so, so much of their life was focused on surviving, not really necessarily on thriving or moving past that, but just getting through the everyday and I was just catching them at a certain point with one of a big thing in their life was trying to survive treatment. And that was the one of the biggest hurdles.

So as they were trying to work through treatment, they were also trying to survive in their family and in their communities, which was no small feat for a lot of them as they were trying to deal with issues of child custody, not having jobs, you know, maybe not getting the child support they rode and just placed in these situations where it just seemed like not much was going right.

Sisk: You spent a lot of time in these rural Kentucky communities. Tell us about the course of your research.

Buer: One of my biggest focuses was just trying to be there. I have family in rural East Tennessee, I’m from East Tennessee, but that doesn’t mean I know what it means to be in rural Kentucky.

And so, I got a studio apartment there. I lived there, tried to go to community events. I went through a round of festivals for every vegetable and fruit you can think of. But when you start talking to people and saying what you’re doing, then you get all sorts of stories.

I would talk to treatment providers and walk through what treatment looked like for them, and if I was allowed in, go to some group sessions for treatment. I went to a lot of court sessions, just anything I could get my hands on that I thought would relate to this, church services, city council meetings, anything I could go to, to just try to feel what it was to be in that place.

And then I talked to a lot of women. I talked to 40 women at least once, most of those conversations were about an hour, hour and a half. Some went to three or four hours and those are the most the women I ended up going back to talk to a few times to try to really get their story, see where they were at in treatment and sort of followed them through.

Sisk: You chose not to use the real names of these women or the agencies they were seeking help from in the book so, in general terms, tell us who these women are.

Buer: Almost everyone I talked to were mothers. And there was a lot of hurt in people’s lives. So, about half the women had been sexually assaulted at some point, about half the women had experienced domestic violence. So just being placed in very at-risk situations, where oftentimes the options were either a bad option or a terrible option. And sometimes you just got to go with bad over terrible.

Most had a hard time providing economically for themselves and their families, and that’s not because of some lack of will or anything like that, but because there was just a lack of access to jobs, especially if they had gotten any sort of record either a criminal felony record or a record through Child Protective Services, it was really impossible for them to enter the workforce in those counties where the biggest sources of employment are oftentimes through some sort of health care or through the school system. And then they were regulated, they could not participate in that economy.

Sisk: You close the book with some recommendations on how to change the health care system. What are those?

Buer: Medicaid expansion has been very successful in addressing some issues in Kentucky and so I would love to see more support for Medicaid expansion in other Appalachian states. I’ve also seen a lot of success around harm reduction programs and I would like to see broader community support for those. When I talk about harm reduction, I’m thinking about programs that really meet people where they’re at and try to provide services that people who use drugs say they want, not just services that other folks think they need.

And then the last one is really stigma reduction. I would love to see less judgment on people just because of one behavior that’s in their lives, because people are a lot more things than just one behavior.

Sisk: So many of the women in your book are were facing drug offenses and you use the term a just alternative to incarceration. What would that look like?

Buer: I think in critiques of how the response to opioid use versus crack use and heroin use in the past there’s been this idea that some people– especially in rural areas– are seeing a just alternative to incarceration, but what I saw in eastern Kentucky was in no way just.

A lot of the women there were not being incarcerated, or at least being incarcerated for long periods of time, but they were being processed through state systems that were very punitive, whether that was punitive social services or punitive Child Protective Services, and so while we’re looking at trying to decriminalize drug use or at least not incarcerate as many people [for it], I hope we don’t fall into the pit of just sending people through underfunded state programs that still marginalize people even though it may not be incarceration.

I think a just alternative is really meeting people where they’re at, seeing what they need, what they say they need and trying to supplement people’s resources, especially when they don’t have access to an economy or a social situation where they can provide for themselves and their family. The last thing we want to do is forcing people through programs that just further hurt them. So we really need to be about reducing harms and not increasing harms.

Lesly-Marie Buer is a harm reductionist and medical anthropologist living in East Tennessee. She has a PhD in anthropology and a graduate certificate in gender and women’s studies from the University of Kentucky and a master’s in anthropology and master’s in public health from the University of Colorado.

West Virginia Gets OK to Expand Medicaid Drug Treatment

State health officials say they have received federal approval to expand addiction treatment for West Virginians covered by Medicaid.

The waiver from the U.S. Centers for Medicare and Medicaid Services was requested to improve care and outcomes by expanding services for those diagnosed with a substance use disorder.

The Department of Health and Human Resources says it allows West Virginia to cover methadone, naloxone, peer recovery support, withdrawal management and short-term residential services to all Medicaid enrollees.

The waiver is more than 80 percent funded by the federal government.

West Virginia led the nation with 41.5 overdose deaths per 100,000 people in 2015. State officials say they rose nearly 18 percent last year, killing 864 people.

About 525,000 of West Virginia’s nearly 1.8 million people are enrolled in Medicaid.

Heart Of The Matter: Needle Drug Use Brings Spike In Heart Infections

The Ohio Valley’s addiction crisis has brought another health problem, as rising numbers of needle drug users are contracting a serious form of heart infection called endocarditis. The rate of endocarditis doubled in the region over a decade, and many patients require repeated, expensive treatment and surgery as they return to drug use and once again become infected.

According to the Centers for Disease Control and Prevention, annual Medicaid spending on endocarditis is more than $700 million, a number likely to rise if treatment does not change to also address the growing health impact of substance abuse.

Doctors at the University of Kentucky are creating a team approach to address endocarditis and the addiction contributing to it. It’s a challenge that has forced them to change traditional practices, break down walls between different medical practices, and get to the heart of the problem.

Sharing or even reusing syringes can build up the bacteria causing endocarditis.

An Emerging Problem

Endocarditis is a result of bacteria accumulating around and infecting a heart valve. It can appear initially as mild, flu-like symptoms or chest pains and extreme discomfort. Emergency surgery to replace heart valves is required in the most extreme cases, but standard treatment involves weeks of sustained doses of antibiotics to make sure the infection is completely cleared.

University of Kentucky researcher Jennifer Havens documented a spike in endocarditis cases.

Since 2008, University of Kentucky researcher Jennifer Havens has tracked the health of hundreds of addicts in Hazard, Kentucky. She said that in the last few years she’s seen a spike in endocarditis cases.

“They may or may not be sharing needles but they’re reusing the same syringes, which accumulates bacteria, which they’re basically shooting into their bodies,” she said.

Havens said traditional cardiac units aren’t designed to treat addiction so the patients frequently return to previous, dangerous habits.

“If you’re not treating their substance abuse issue in the hospital they can potentially go right back out and infect themselves,” Havens said.

According to the CDC, addicts with endocarditis are 10 times more likely than other patients to die or require a second surgery months after initially leaving the hospital. Research has also shown that addicts tend to leave the hospital more often before the weeks-long series of antibiotics that is necessary to complete treatment.

In many cases, the patients are in withdrawal from opiate addiction during treatment. The intense atmosphere of post-surgery care only amplifies the anxiety and pain of withdrawal from opiates, said UK infectious disease specialist Dr. Saritha Gomadam.

“It definitely affects us,” she said. “Our heart just goes out when we see a really young patient in their 20s crying that they want to quit.”

Overall, the median age of endocarditis patients is rising slightly. But at UK and other hospitals treating a large population with substance abuse disorders it is younger patients who are more often returning in need of multiple surgeries. Gomadam said the question of how to treat them most effectively “is something we talk about almost every time we are on service.”

“There is sort of a moment where you both sit there and you know you have to do something,” she said.

There are also physical limitations to how much the body can take.

“Any kind of surgery has its risks,” she said. “There comes a point where there’s only so many times that their body can be opened up.”

The scar tissue from repeated surgeries can make valve replacement difficult and dangerous.

Teachable Moment

When the patient comes into the hospital with endocarditis it offers an opportunity for the team to have a discussion about substance abuse treatment, said Dr. Laura Fanucchi, who specializes in internal medicine and addiction. She is working with Gomadam to create the new treatment method.

“I believe — and our data support this — that coming to the hospital being very sick from a complication from untreated substance abuse disorder or untreated opioid addiction can be a moment where we can really reach that patient and help them start positive changes,” said Fanucchi.

Dr. Laura Fanucchi said addiction treatment “has been siloed from general medical care.”

But addressing the social challenges around addiction requires skills outside of traditional endocarditis treatment.

“If we don’t work together we are not going to be successful because the patient has problems that my antibiotics will not cure,” said Gomadam.

Gomadam and Fanucchi are in the early stages of creating a unique team approach for endocarditis after seeing the same young, addicted patients again and again.

“We are working closely with internal medicine, cardiology, cardiothoracic surgery” Gomadam said, with each group bringing in a particular expertise.

Breaking Silos

Such an approach requires education for both patients and providers.

“A lot of patients with untreated addiction feel very stigmatized by the health care community,” Fanucchi said.

That distrust can result in patients being even reluctant to say they have a problem abusing drugs.

On the other hand, health providers often see the ravages of addiction but very few people in recovery. That takes its own toll, especially on health care providers.

“I think seeing for a long time the complications of untreated substance use disorder some health care professionals start to feel hopeless, and that will engender a culture of frustration,” Fanucchi said.

She said the answer lies in creating communication across medical and addiction services that have traditionally operated independently of each other.

“I think it’s long standing in treatment of addiction that it has been siloed from general medical care,” said Fanucchi. “It’s not historically been part of general medical education and residency. So we’re going to address that.”

The approach has been well received, she said, but it is a big shift that will take time.

Fanucchi said another key in finding the right treatment focus is recognizing the need for sustained medical intervention and recognizing relapse as a part of the disease process.

“Trying to be successful, particularly with opioids, with detox only or abstinence only is part of the reason that we are in this problem that we are in, unfortunately,” she said.

That means bridging the hospital stay with drugs that help with withdrawal, such as naloxone and buprenorphine, plus counseling or treatment.

“The analogy is that someone comes into the ER sick from diabetes and you send them home and tell them not to eat sweets but don’t give them any insulin,” she said. “And we wonder when they come back why their diabetes is a problem again.”

Lawmakers Vote to Add Addiction Treatment Beds

West Virginia lawmakers have voted to increase beds available at state-supported drug treatment facilities in response to the state’s opioid addiction epidemic.

The Senate’s unanimous vote Friday follows an earlier House vote to add beds and establish an addiction prevention and recovery fund.

It comes as lawmakers and Gov. Jim Justice remain divided over budget and tax plans with the legislative session scheduled to end Sunday.

West Virginia currently has more than 1,100 treatment beds but struggles to meet demand.

Unlike an earlier version, the latest bill doesn’t specify establishing 600 more treatment beds.

Funding would include settlements of lawsuits that accused wholesale drug distributors of flooding the state with prescription pain pills.

The state attorney general’s office has settled with 11 distributors for $47 million.