On Alzheimer’s Awareness Day at the West Virginia Legislature, the organization’s program director Terresa Morris said that more than half of those with the brain disorder affecting memory and behavior will – at one time or another – wander.
About 40,000 West Virginians live with some degree of Alzheimer’s dementia, according to the West Virginia chapter of the Alzheimer’s Association. There has been concern that recent legislation focused on law enforcement interacting with those suffering with Alzheimer’s did not go far enough.
On Alzheimer’s Awareness Day at the West Virginia Legislature, the organization’s program director Terresa Morris said that more than half of those with the brain disorder affecting memory and behavior will – at one time or another – wander.
Senate Bill 570 was signed into law in 2022. The measure required all new law enforcement and correction officers to undergo specialized training in how to identify and communicate with those living with dementia. Morris said that training proved as an eye opener for new recruits.
“When we talk about stories of people in the past that have had situations like this, I think it’s something that our new officers don’t always think about,” Morris said. “They just know that’s not what they’re taught, per se, so currently, we’re doing that through training at the State Academy for all the new officers.”
That law made Alzheimer’s awareness training voluntary for law enforcement and correction officers already on the force. However, few veterans stepped up to take the training.
Currently proposed Senate Bill 208 mandates that all law enforcement officers, new and old, take Alzheimer’s awareness training.
Morris said with stories of first responder confusion over intoxication vs. dementia still coming to light, across the board training becomes a community help as well.
“This is something fairly new,” Morris said. “We’re just at the point where we have increased awareness of dementia and Alzheimer’s and someone that maybe has been in the force five, 10, 20 years – they need this training, they need to know what they could potentially be dealt with or what they could be working with.”
The training also includes understanding the risks associated with Alzheimer’s, including elder abuse and exploitation.
With Alzheimer’s activists in attendance, the Senate suspended rules Thursday and passed Senate Bill 526, which would incorporate early detection, diagnosis and education efforts regarding dementia on its public health platforms. That bill now goes to the House of Delegates for consideration.
On Tuesday, the House of Delegates committee on the Prevention & Treatment of Substance Abuse heard that addiction continues to claim thousands of lives each year, but a bill that would have set up a pilot recovery program in Cabell County died in committee.
On Tuesday, the House of Delegates committee on the Prevention & Treatment of Substance Abuse heard that addiction continues to claim thousands of lives each year, but a bill that would have set up a pilot recovery program in Cabell County died in committee.
Senate Bill 147 would have created a pilot program for recovery residences in Cabell. It included an amendment to part of the bill covering the timing of eviction notices and set forth the format for a petition for wrongful occupation, or eviction.
Mark York, founder of Addiction Abatement Inc., has worked alongside White House Drug Czar Dr. Rahul Gupta on substance use abatement efforts in West Virginia, many of those connected to opioid lawsuits.
York told the committee that addiction is a national crisis, not just opioid abuse, heroin, cocaine, or meth, but drugs like fentanyl which he likened to a California wildfire.
“To put it in a context that you would easily understand, it’s 107,000 people dying every year from overdoses,” he said. “That equates to a Boeing 777 dropping out of the sky every day.”
He said despite those numbers, the stigma surrounding addiction prevents more efforts to mitigate drug abuse.
York called for state and local cooperation with a focus on continuum of care and incorporating opioid settlement dollars into creating a sustainable abatement model.
Collaborative entities could include faith based, law enforcement, political, and local treatment providers, among others.
As ground zero for the opioid epidemic, York said other states will follow West Virginia’s lead moving forward.
Addiction has taken a very public toll on West Virginia. Recent CDC statistics show a decrease in overdose deaths, but authorities face an uphill challenge in stemming the flow of fentanyl into the state.
Addiction has taken a very public toll on West Virginia. Recent CDC statistics show a decrease in overdose deaths, but authorities face an uphill challenge in stemming the flow of fentanyl into the state.
From its original intended use as a narcotic for severe pain in cancer patients, the controlled substance fentanyl is being exploited at an alarming rate. U.S. Drug Enforcement Administration Administrator Anne Milgram says mass overdose events – characterized as three or more overdoses within a close range of time at the same location – have increased.
One hundred times more potent than morphine and 50 times more potent than heroin, just two milligrams of fentanyl can lead to death when used with alcohol, or illicit drugs like heroin or cocaine.
Illicit synthetic opioids and their precursors are produced in countries like China and Mexico before they making their way into the U.S. In lab tests, 42-percent of pills tested in DEA labs contained at least 2 mg of fentanyl.
During his visit to West Virginia in August, White House Director of National Drug Control Policy, Dr. Rahul Gupta, said one American loses their life to drugs every five minutes.
“Not only do we see fentanyl, meth, heroin and cocaine,” Gupta said. “It’s possible now to create any number of concoctions if you have a creative chemist sitting in a lab.”
Fentanyl’s use has become so widespread that the CDC issued an advisory on its Health Alert Network (HAN) warning public health departments, first responders and others about an increase in overdose deaths and the need for bystanders to have access to the lifesaving medication naloxone (Narcan). The medicine reverses an overdose by blocking the effects of opiates on the brain and restoring breathing. Stronger opioids like fentanyl can take more than one dose.
J.T. Scroggs is the Special Agent in Charge of the United States Drug Enforcement Administration’s Louisville Field Division. In his role, he oversees all of West Virginia. He said narcotics and fake pills are more readily available than ever.
“It’s not a situation we can easily arrest our way out of,” Scroggs said. “We rely heavily on team work with local and state leaders, our partners in law enforcement, we have great relationships with a lot of the police departments around here, Charleston, Huntington, the Sheriffs’ Department.”
Drug traffickers use fentanyl to drive addiction by mixing it with other illicit drugs. Through seizures and drug tracking data, the (The) DEA is seeing fentanyl in street drugs, as well as in the new surge of counterfeit prescription pills. The chemical hits the market under the guise of prescribed medications like adderall, xanax and oxycodone. Scroggs said most overdose victims are unaware they’ve ingested fentanyl until it’s too late.
“The fake pills are coming out to look like and resemble the other ones,” Scroggs said. “So most of the time when people purchase pills even though it’s illegal and it’s illicit they don’t think they’re buying fentanyl, they’re not intentionally buying fentanyl.”
Scroggs said the majority of counterfeit pills resemble 30 mg oxycodone pills (M-30s), but can closely mimic other drugs and prescription medications.
He explained that Mexican cartels are producing meth and fentanyl in record amounts, flooding the U.S. market. Drug trafficking organizations are now targeting kids and teens with rainbow fentanyl – counterfeit pills in a variety of shapes and bright colors.
“They think they’re buying something else,” Scroggs said. “The problem with the pills are, like we said – 2 mg of fentanyl can be fatal. If they survive, the high and the rush is so great that they will go back again.”
For the profit driven trafficker, deaths from overdose are simply the cost of doing business. The money to be made is the driving force behind newer mixes of drugs hitting the market.
“They could care less if you get addicted or you don’t get addicted, or if you survive or you don’t survive, they’re preying on vulnerable people,” Scroggs said.
Fentanyl is cheaper to make than heroin. The high end price for a kilogram of fentanyl a few years ago was around $5,000.
Today Scroggs says a kilogram of fentanyl can be turned into 500 thousand pills with a profit of $1.5 million. In comparison a kilogram of heroin is worth around $65,000.
The drugs typically reach the West Virginia market through smaller independent operations and local distributors.
“West Virginia would be classified as an end user state from the point that typically we’re not supplying to other organizations or areas,” Scroggs said. “A lot of what we see in West Virginia is coming from out of state.”
Metropolitan areas like Columbus, Cleveland, Detroit, Chicago, Atlanta and Baltimore are considered major drug corridors to the state.
The DEA identifies distributors and traffickers through tips and informants. The organization uses other investigative methods but has recently reassessed its approach as drug cartels become savvier. Investigations at the federal level target the source of the supply to dismantle drug trafficking and money laundering organizations. The agency works with the U.S. Attorney General’s office as well as federal, state and local authorities and prosecutors.
With the advent of social media and increased use of the internet, Scroggs said drug dealers have a captured audience, particularly the younger generation who can readily access illicit drugs on their phones.
The DEA’s ‘One Pill Can Kill’ campaign in partnership with the substance misuse prevention program GameChanger is making a difference.
GameChanger Founder Joseph Boczek said educating kids, teachers, and parents about the risks and deadly consequences of ordering illicit and counterfeit drugs online is key.
“Our youth who are heavy users of social media and the internet have even developed a lingo of how to track where drugs are,” Boczek said. “And the bad guys, the drug dealers, although they’re still on street corners, they’re also in a corporate office building filling orders for illegal drugs.”
With the drug trade now a high tech business Boczek said the kids are taught that only prescribed medication that is dispensed by a registered pharmacist, is safe.
“The bottom line is they are using this to buy Adderall on the internet, which is laced with fentanyl, so they’re playing Russian roulette because they cannot tell when they get this stuff whether it’s fentanyl, or not,” Boczek said.
With DEA efforts to stop fentanyl at the federal, state and local levels, curbing the illicit drug and its precursor chemicals crossing U.S. borders relies on cooperation at all levels.
In August a U.S. congressional report criticized poor cooperation from Chinese authorities to curb increasingly sophisticated forms of fentanyl and its precursors from being shipped to the US.
With tensions between the two countries at a high it remains to be seen if that cooperation will improve.
The ARC grants total $12 million for 33 community organizations in 11 states. West Virginia will receive nine of those awards.
The Appalachian Regional Commission has awarded millions of dollars in grants to support addiction recovery.
The ARC grants total $12 million for 33 community organizations in 11 states. West Virginia will receive nine of those awards.
God’s Way Home in Rainelle got $500,000. Mountain Health Network in Huntington also got $500,000.
Aspire Service Center in Morgantown and Semper Liberi Incorporated in Martinsburg each got more than $400,000.
The Community Education Group in Lost City, the Rural Appalachian Development League in Mullens and the Randolph County Housing Authority in Elkins also got more than $400,000.
Other awardees include Libera in Morgantown and New Vision Renewable Energy in Phillipi.
Virginia and Maryland received one award each. Pennsylvania and Ohio received three awards. Kentucky got six.
The courses are Office-Based Medication Assisted Treatment and Nursing Competencies in Addiction Care. Both emphasize a non-judgmental, empathetic and compassionate approach to their patients’ recovery, according to the course description.
Course facilitator, Dr. Susan McKenrick, leads one of two Comprehensive Opioid Addiction Treatment clinics at Milan Puskar Health Right.
“No matter what venue a nurse is working in, she (or he) is going to encounter persons with substance abuse disorder (SUD), ” McKenrick said. They really need to be able to care for them not only in an educated way, but in a thoughtful way.”
McKenrick said the courses are a direct response to the prevalence of substance abuse in West Virginia.
“Particularly in the southern part of the state, the opioid epidemic – it really is at crisis level.”
While the triggers that lead a person down the road to addiction are countless, McKenrick cited depression, anxiety and other mental health illnesses as top reasons many people choose self-medication to numb their pain.
Watching her patients struggle to become sober is not easy. McKenrick said often patients are exposed to family members or friends who are still in addiction. For many, the temptation can be overwhelming. For others, the determination to remain sober is key to their success.
“To be able to watch them make those major milestones, and get to the point where they’ve accomplished three months, then six months, and get to a year of being sober,” she said. “It’s just amazing.”
Despite the toll of addiction on families in West Virginia, McKenrick is optimistic there is hope at the end of the tunnel. The Addiction Nursing Care courses are not the antidote to substance use disorder but through specialized nursing care they offer people in addiction a fighting chance.
Both courses teach nurses how to care for people with substance use disorder by treating addiction as an illness. McKenrick said restoring a patient’s dignity through compassionate care is key to substance use recovery.
In addition to general medicine, the program offers nurses the opportunity to learn about the intricacies of pain management and the administration of treatments like suboxone and newer non-narcotic non-addictive treatments like vivitrol for opioid dependence. Nurses also learn how to effectively counsel and educate patients in crisis to help them recognize, avoid, and manage high risk situations that expose them to drugs.
Both self-paced nursing courses are $50 and offer 29 hours of continuing education credit including 8 hours of pharmacology.
One model made a big difference in Iceland, where the percentage of teens who got drunk at least once a month dropped from 45 percent to just 5 percent.
Home to the New River Gorge National Park and Preserve, Fayetteville, West Virginia, is known for its outdoor recreation.
An avid outdoors woman, Katie Johnson moved there in 1993 after years of living out West.
“I love the climate and the Appalachian mountains, and Fayetteville brings a community of people to me who seem very real and very close,” Johnson said.
Recently, Johnson organized two days worth of outdoor activities for about 900 middle schoolers in Fayette County. Kids tried out skateboarding, banjo picking, and water sports. West Virginia-based groups that host these activities year round helped out.
The event exposes kids to lots of different activities, hoping kids choose one as a regular hobby.
“So many people, if they can find their passion and follow it with their heart, they’re too busy and just too focused to want to experiment with risky things,” Johnson said.
Hailey Carte
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F.I.T. Media
Drums and string instruments were a hit at Project Adventure, an event organized by the Integrative Community Engagement (ICE) Collaborative in Fayette County.
Johnson’s work at the Fayette County Health Department focuses on preventing kids from smoking, drinking or using other substances. Johnson looped in others to join the Integrative Community Engagement (ICE) Collaborative to implement the Icelandic model of prevention, which had major results abroad.
At a quiet pond, 11-year-old Adriana Abarra is fishing.
“One thing it really helps with is patience. I figured out that whenever you fish you get a lot more patient,” Abarra said. “Whenever you get the fish on the line there’s always this really big thrill. It’s awesome.”
What Abarra has gotten from fishing is exactly what organizers in Fayetteville are hoping for. Fishing teaches her emotional lessons and gives her a natural high. It’s also a time she gets to spend with her mom and papaw.
Researchers say such activities made a big difference in Iceland, where the percentage of teens who got drunk at least once a month dropped from 45 percent to just 5 percent.
Kids in Fayette County have been regularly surveyed about their substance use and related risk factors. Locals like Johnson and researchers at West Virginia University found three quarters of kids weren’t part of organized clubs or sports. Changing that could delay when kids start smoking or drinking.
“The later we can delay the initiation, even by one or two years, the less likely that person is to become addicted. If they should try drugs later in life. And the more likely they are to graduate from high school,” Johnson said.
Jessica Sharp
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F.I.T. Media
About 900 fourth and fifth graders spend half a day at the Fayette County Park as part of Project Adventure.
Where Prevention Went Wrong
In theory, substance use prevention could save money and a lot of heartache, but it’s gotten a bad wrap. Education campaigns like “Just say no” and the D.A.R.E program didn’t work.
“These were built around the idea that youth don’t know about the dangers of substances. And so if we simply educate them, they will make healthy decisions,” said Dr. Wilson Compton, deputy director of the National Institute On Drug Abuse.
Experts now say that idea was myopic and flawed. It didn’t get at the root causes of why kids end up using substances: neglect, problems at home, poor emotional skills, lack of healthy activities, and hanging out with peers that drink or smoke. Compton said these programs even backfired.
“One of the messages that underlies that educational campaign was that these are common, frequent behaviors. Well, if you’re a 12-year-old, you don’t want to be left out of something that all of your peers are doing,” Compton said.
Compton said the best prevention programs don’t harp on drug use but rather work to change family, school and after-school environments for kids. That sounds a lot like the Icelandic model of prevention.
“The work isn’t about drugs. It’s about healthy life and healthy communities,” said Alfgeir Kristjansson. He is a researcher at WVU studying the Fayetteville pilot program. He’s also Icelandic and was involved in the model from its near inception.
Kristjansson said Icelandic parents, schools and policy makers shook up the world kids lived in. It wasn’t just one D.A.R.E. class a week. Kids spent a lot more time with their families and playing sports, mostly soccer.
It took some heavy lifting. Most notably, Iceland set a nationwide curfew for teens that’s still in effect today.
Kristjansson said the curfew isn’t a requirement of the model. It’s just one way the Icelandic public sought to fix the problem. The model says communities, not experts, should find policies and interventions that folks can get behind.
“If parents are able, or caregivers are able, to come together and engage with one another and see, well, we’re all in the same boat, everybody is just wanting the best for their kids, we are much more likely to see positive outcomes,” Kristjansson said.
Keith Humphreys is an addiction researcher at Stanford and a Morgantown native. He chaired a team that reviewed hundreds of research publications regarding the opioid crisis, including the Icelandic model of prevention.
Humphreys said there’s some room for speculation. While Iceland saw a reduction in teen substance use, so did other Scandinavian countries that didn’t implement that model.
“It’s possible that Iceland’s model works better for them than it would for us,” Humphreys said.
Still, he sees the ICE Collaborative in Fayette County as a major investment in his home state. While D.A.R.E. failed if it didn’t curb substance use, but all the rewarding activities the Icelandic model promotes have a host of benefits for child and adolescent development.
“For one kid, that investment may turn into them not starting to be involved in drugs. And for another kid, it’ll be that they don’t get depressed, or they have better social connections, or they do better in school,” Humphreys said.
Investment and Buy-in
The Icelandic model changed teens’ behaviors abroad, and it could work in Fayette County. But it’s the adults that will have to make the big changes.
The ICE Collaborative is supported by a five-year grant from the Centers for Disease Control and Prevention. However, Johnson and Kristjansson said the change won’t be easy, or quick.
“We need to change their environment. And that takes time. And it absolutely has to include a lot of local buy-in and local involvement,” Kristjansson said.
On the ground in Fayette County, Johnson said more parents could be on board, plus funders.
The program has caught the attention of state policy makers. Kristjansson spoke to state lawmakers in 2020 about the efforts.
Brian Gallagher, the chair of the Governor’s Council on Substance Abuse Prevention, thinks the state could run with this model. The council works directly with the state Office of Drug Control Policy.
“If we can implement some things like this that actually work in our state, it would be a total game changer. And I applaud the people in Fayetteville for wanting to get something like this started in our state,” Gallagher said.
With tens of millions of dollars in opioid litigation settlements, Gallagher said this kind of prevention effort would be well worth the money.
“Addiction is an on and off switch. Once you turn it on, you can’t turn it off…So preventing people from getting this disease in the first place is really essential to our work,” Gallagher said.
Recovery from addiction is possible. For help, please call the free and confidential treatment referral hotline (1-800-662-HELP) or visitfindtreatment.gov.
Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.
Brian Gallagher also served on West Virginia Public Broadcasting’s Friends Board.
