After the most isolating days of the pandemic, overdose death rates are improving.
West Virginia’s top addiction official says drug overdose deaths are on the decline.
Drug overdose deaths reached new heights from April of 2020 to April of 2021 in West Virginia, according to data from the Centers for Disease Control and Prevention. That’s an estimated 1,600 deaths in West Virginia over 12 months. That number decreased by 81 deaths, or 5 percent, over seven months.
Dr. Matt Christiansen of the state Office of Drug Control Policytold lawmakers Tuesday the state can keep up that momentum by expanding treatment and harm reduction. He said there is still hope for thousands of West Virginians living with substance use disorder.
“They’re living with a deadly disease,” Christiansen said. “They’re still alive, and they’re still with us. And we still have a chance to improve their lives, and keep those parents with their kids and those kids with their parents.”
Christiansen blamed the rising prevalence of fentanyl, in pill or other forms, for deaths.
“Experimentation is not experimentation anymore like it used to be. This stuff is deadly. And it’s everywhere,” he said.
Christiansen touted medication assisted treatment, which is used to transition someone off of IV drugs while managing opioid withdrawal. These treatments are proving to save lives, improve wellbeing and curb HIV and other infectious diseases, but 27,000 West Virginians with an addiction do not have access to these services.
“This is still a goal of ours to make sure that we are expanding treatment in areas that don’t have adequate access at this time,” Christiansen said.
Christiansen said outreach efforts have expanded in recent years due to state and community programs. Those include an uptick in drug diversion programs for those facing incarceration or child welfare cases, quick response teams, and naloxone distribution.
The state, with the help of harm reduction programs like SOAR in Charleston and the Milan Puskar Health Right in Morgantown, gave out almost 68,000 doses of the overdose reversal treatment in 2021. That’s three and a half times more kits handed out than in 2020.
Christiansen said state data show there is a correlation between increased naloxone distribution and a reduction in overdose calls to EMS.
Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.
West Virginia filmmaker Tijah Bumgarner is creating two projects that depict the experiences of women in recovery through film. Both are inspired by the life of Ashley Ellis, who passed away last November due to substance use disorder.
West Virginia filmmaker Tijah Bumgarner has looked at opioid addiction from every angle. It’s personal — she lost her father to an overdose in 2020. Recently, she’s embarked on both fictional and real-life narratives that highlight the experiences of women in recovery through film.
Both of these projects are inspired by the life of Ashley Ellis, who passed away at the age of 34 last November due to substance use disorder. Ellis helped write “Her Hope Haven,” a TV series in the works about a group home for women in recovery. The pilot episode premiered for a Charleston audience last month. Ellis is also the subject of the yet to be screened documentary “Picture Proof.”
“All Ashley and I wanted was to save a life,” said Debi Ellis, Ashley’s mother, who is another subject in “Picture Proof.”
Ashley told WVPB during the filming of “Her Hope Haven” that she wanted to be open and honest about her addiction and recovery. She hoped her story would fight against stigma and remind folks that recovery is possible.
Debi said for about three years, Ashley was steadfast in her recovery.
“Even when she’s doing well and somebody would ask me, ‘How’s Ashley doing?’ I’d say ‘She’s fine at this moment,’” Debi said. “I always tagged that, because the sad thing with addiction is it roars out of nowhere. I knew it was a possibility every single moment. I knew she could die every single moment.”
Courtesy of Tijah Bumgarner
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Lauren Brothers plays Rachel in the pilot of “Her Hope Haven”, an episodic series in the works based off the experience of Ashley Ellis.
Ashley’s Story
After getting out of rehab, Ashley started making a name for herself in the recovery community. She worked as a peer support coach for Recovery Point. In her free time, she would get up in front of exhausted grandmothers to offer advice on how to cope with addiction in their families.
That’s how filmmaker Bumgarner met Ellis. Bumgarner was looking for subjects for a documentary.
“I just sat there in awe of her. Even at that point, I was just like, ‘Oh, I love her,’” Bumgarner said.
Bumgarner was drawn to Ashley, and in turn Ashley and Debi offered complete access to Bumgarner.
“This story that we don’t get to hear as often in the media about a family that worked so hard to build back what could have been shattered,” Bumgarner said.
Bumgarner began filming moments of their lives. She captured sticky situations, like custody proceedings, and solemn moments, like when Ashley found out her friend died from an overdose. But Bumgarner also filmed uplifting milestones in Ashley’s life, like Ashley getting engaged and having her second child, as Ashley described for the documentary.
“I can feel my kid moving inside of me, and it’s really cool, because I’m like ‘my god’ he’s moving because he’s healthy,” Ashley said in a clip. “It’s just so different now, I have a lot of stuff to live for now and before I felt like I didn’t.”
Tijah Bumgarner
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Debi Ellis (left) walks with her daughter Ashley Ellis (right). They hold tight to Ashley’s children Asher and Piper (center).
No one can know exactly what Ashley was going through days and weeks before her death. But she did lose her finance to an overdose, and Debi knew Ashley was grieving and depressed.
“I was looking at some texts last night, and I’m asking her if she wants to go ‘home.’ And ‘home’ is our code word for the treatment center in Louisville, because they have a sign above their door, ‘Home Sweet Home’,” Debi said. “So that was our code for ‘I need treatment.’ All she had to say to me was `I need home’ and we’re on the road.”
Debi said in that text conversation, three days before her death, Ashley reassured her that she was doing okay. She was reaching out to friends.
“And so we thought she was okay, and then I got a call that she wasn’t okay,” Debi said.
Folks close to Ashley came to her home, even though there wasn’t anything that could be done at that point. Bumgarner also rushed over, this time, without her camera.
“Debi got there. And I just wanted to hold her and not let her go. And then Debi’s like ‘Are you filming this?’ And I was like ‘No.’ And she’s like ‘Oh, you’re not really a documentarian then are you?’” Bumgarner said.
Bumgarner said she reacted as a friend in grief before considering the project at that moment. But since then she’s had space to consider how the documentary will reflect on Ashley’s death. The film will disclose Ashley’s passing, but it will end on a scene of her alive with her two children, her mother, and her recovery community.
“It ends in this hopeful way, that I think it would just do a disservice to all of the work and love of this family to make it feel so finite, and maybe not leave enough hope for others as well,” Bumgarner said.
The Power Of Narratives
The Ellis family didn’t take much convincing to have their life caught on tape.
“But I did tell her, I have one rule throughout all this. And that was to be raw. And I want people to see how it really is,” Debi said.
The documentarian and the subjects believed the story could shape perspectives.
Director of the Opioid Policy Institute Jonathan Stoltman said the way addiction and recovery are portrayed in the media do have consequences. Alongside the West Virginia based news outlet 100 Days in Appalachia, Stoltman educates reporters on how to cover addiction in a way that is accurate and minimizes harm with the project Reporting on Addiction.
Stoltman said the public needs to know addiction is a treatable, chronic condition. If they don’t, policy makers won’t be pushed to find and implement solutions.
“If we still think about it as a personal failure, or moral failure, then I’m not out there advocating for services to help in my community. Or if a treatment center wants to open up in my neighborhood, I might be more likely to say ‘Hey, I don’t want treatment in my neighborhood, because that’s bad. These people just need to figure it out on their own,’” Stoltman said.
Without viewing Bumgarner’s complete documentary, Stoltman said the filmmaker’s approach to a tragic story is helpful in a number of ways. Personal stories convey the true impact of addiction and need for services better than numbers alone. Showing all the good years of Ashley’s life lets others know that treatment helps and recovery is possible, and that fact doesn’t change just because Ashley died.
“All medicine is designed to extend life and increase quality of life. You saw with Ashley that quality of life, it came back in spades for her. Unfortunately, that does not mean that you’re at no risk of returning to use,” Stoltman said.
Stoltman also said there should be hopeful and gritty narratives around addiction, and they don’t have to be mutually exclusive.
“When we talk about addiction, and treatment and recovery, there are so many different paths. And one of the paths, unfortunately, with opioid use disorder, is death. It’s not the most common path, but it is a path worth exploring and talking about the barriers that lead to that,” Stoltman said.
The Centers for Disease Control and Prevention says 100,000 people in the U.S. have died from a drug overdose in the past year, but millions more people are experiencing opioid use disorder.
Only Ashley would know, but Debi suspects her daughter’s active, forward facing role as a recovery advocate put pressure on her.
“Yes, she did very well. She was clean. She was extremely, over the top active and accessible to anyone who needed her 24/7. But what happened was they put her on a pedestal. And anytime you are put on a pedestal, you get knocked off eventually by yourself,” Debi said.
Jonathan said that pressure is real. Peer recovery advocates take on the demands of social workers and have the pressure to be perfect in the eyes of those who admire their sobriety.
“You were the person that everybody talked about. And so now you’re not even like back to zero [days since drug use], you’re back to like negative 100. Because everybody looked up to you. In reality, that’s not the case of course, but it’s hard to get past that barrier that you’ve built for yourself,” Stoltman 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.
Senate Bill 419, sponsored by Sen. Ryan Weld, R-Brooke, will change up how addiction treatment centers are paid. Providers that offer the absolute best care and support to clients, will get paid more than others that don’t offer as much, or at least that’s the intent.
Amid the opioid crisis, West Virginia is introducing a new way to encourage addiction treatment providers to do better. That new idea is to pay providers based on how stable and sober their clients are months and even years after initial treatment.
“It’s not just a medical issue, it’s a societal issue … because you want to get these folks back in the workforce, paying taxes, staying clean, taking care of their kids,” said Sen. Ron Stollings, D-Boone.
Senate Bill 419, sponsored by Sen. Ryan Weld, R-Brooke, will change up how addiction treatment centers are paid. Providers that offer the absolute best care and support to clients, will get paid more than others that don’t offer as much, or at least that’s the intent.
“So it’s a carrot to provide what most people think would be best practices,” Stollings said.
Stollings thinks state lawmakers don’t always get it right when it comes to legislating around addiction. But he said the recent bipartisan bill that is now awaiting the governor’s signature is a step in the right direction.
“If we really want to get our arms around this problem, it’s going to require some investment … because this impacts all segments of society,” Stollings said.
Risks and Rewards for Providers
This new way of payment won’t be widespread anytime soon. The state will start with just 15 percent of treatment centers and study the new process in a three year-pilot program.
But at first glance, Dr. Jim Berry is excited about this. He studies and treats addiction at WVU’s Department of Behavioral Medicine.
“I think certainly the goal is a novel one,” Berry said. “Unfortunately, much of substance use disorder or addiction treatment, for so long has not had any real standards by which the public and regulators and payers could hold us accountable to. So in many ways, much of this has been the wild west for decades.”
Berry expects he, and treatment providers like him, will come out on top. The pay incentive won’t line his own pockets, he said.
It will help pay for more wraparound services, the extra things like mental health and peer support that don’t just keep people alive, but help them thrive. Berry said providers can’t just offer that through the kindness of their hearts. Insurers and Medicaid should help pay for it.
“So we shouldn’t be asked to do something without payment to provide those necessary resources as well,” Berry said.
Berry and other providers say the potential rewards also come with some risks. Providers can’t just show that they are offering these services, they have to prove that it’s making a difference in their clients’ lives.
“The devil is in the details,” Berry said “And it’s really important that we get this right, and that we’re measuring things correctly in order to do it.”
The metrics providers will be judged on specifically consider whether a client has stable housing, they have a job, and they are “drug-free” months or years after initial treatment.
Dr. Michelle Lofwall said these aren’t things doctors and nurses have much control over. Lofwall
runs an addiction treatment clinic in Kentucky and is a professor and researcher at The University of Kentucky.
“Addiction is a chronic disease. The medications help manage it, they don’t cure it … but the medication to help with an illness doesn’t make them into model citizens,” Lofwall said. “If this is what you’re being told that you have to do to to get payment, I think the provider would have to look really hard and say, ‘Am I going to be able to pay rent, pay my malpractice insurance, pay my staff?’”
Lofwall said addiction is messy and it looks different for everybody. Relapsing is a normal part of the process. And beyond the walls of treatment, there’s stigma at every corner.
If West Virginia wants folks to find jobs and secure housing, Lofwall challenges lawmakers to scrutinize how employers and landlords might discriminate against those with substance use disorder. For instance, someone well on the road to recovery may still have past drug charges that can hurt their chances of success in society.
“If they already have a criminal record with lots of felonies, and it’s not hard to pick up a felony for having a pretty modest amount of illicit drugs on you … it’s really hard to get a good job.” Lofwall said.
Benefits and Risks for Clients
This new law is calling for value-based payments. This payment model isn’t a brand new idea, but it isn’t prevalent either.
“So the idea is that you can tie payments to some sort of quality measures,” said Tom Bias, a professor of health policy at WVU’s School of Public Health. He’s most familiar with this model in hospital settings, where possible goals are to prevent patients from having to be readmitted for preventable infections.
But Bias said quality has to be in balance with equity. Patients with compounding mental health, substance use or financial difficulties are more likely to end up in emergency departments again, but that doesn’t mean they don’t deserve care.
“So we have to be careful when we structure those types of payment programs to make sure that not only are we rewarding quality, which is obviously important, but also that maybe we’re taking into consideration the population that’s being served,” Bias said.
When addiction treatment providers take notice that some folks might have a harder time getting hired or approved for apartments, they might not take those clients, said Sharon Reif, a behavioral health researcher at Brandeis University. Reif has co-authored several publications that look at value-based payments for substance use disorder treatment.
“We call this in the research world ‘gaming’ or ‘cherry picking’. You choose the people who you think are going to succeed, because you’re being measured on success,” Reif said. “If you’re not careful on how you set up those performance metrics, and set up the payment system, you may have that kind of danger.”
Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.
Nine months ago, Angie Johnson of Nicholas County got a call that would change her life.
Johnson, a mother of two, had just relapsed after temporarily losing custody of her infant daughter. She was back in an addiction treatment facility when someone from the local courthouse called and asked if she would like to give the new “family treatment court” program a try.
Through family treatment court, parents facing addiction have another option to resolve any abuse and neglect cases against them that could lead to permanently losing custody of their children.
The program connects its adult participants to treatment options, job training, housing, parenting classes and other resources for recovery — all while allowing for regular contact between parents and kids.
More than 180 adults had interacted with one of eight family treatment court programs in West Virginia by the end of April, according to the state Supreme Court of Appeals. By Thursday, 24 adults in five counties had successfully completed the program, including Johnson.
“Today means everything to me,” Johnson said after her graduation ceremony. “Because I am a good mom, I just made really bad decisions. To be 11 months clean, back to work, with reliable transportation and a home to put my girls in, it means everything to me.”
Johnson and her daughter were joined by four other Nicholas County families Thursday afternoon at the local courthouse. An area photographer had taken family portraits of the graduating families, and the framed results stood behind each participant as they accepted their certificates.
Two Different Courthouses
Meanwhile, about 90 miles west in Charleston, officials for Cabell County and the city of Huntington gathered at a different courthouse, arguing before a federal judge that three of the nation’s biggest opioid distributors should be on the hook for their role in the state’s addiction crisis.
The trial has been hailed as a major stepping stone for thousands of communities nationwide seeking similar damages.
“It did start off with opioids,” said attorney Denise Pettijohn, one of a few guardians ad litem in the Nicholas County family treatment court who represents the interests of the children involved.
“Nicholas County was a huge mining county, and that just all dried up. You have a lot of people who probably started off with prescriptions to opioids, to handle the pain of that very hard and rigorous job, and then we made it harder to get those. And they switched.”
To harder drugs. Court officials said Thursday the parents they work with are mostly dealing with addictions to fentanyl and methamphetamines.
Nicholas County Circuit Judge Steve Callaghan oversees the local family treatment court.
Emily Allen
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West Virginia Public Broadcasting
Nicholas County Circuit Judge Steve Callaghan oversees the local family treatment court.
As a judge Callaghan couldn’t speak about the federal trial in Charleston, but he spoke at length about the difference he thinks family treatment court programs are making in the state’s struggle with addiction and the separation of families.
“Before treatment courts, the only thing we had was law enforcement, and probation,” Callaghan said. “There was some rehab, but not a whole lot. But now, after treatment courts, we have a new way to try to solve the problem.”
Expanding To More Counties
Nicholas County celebrated its graduation ceremony weeks after the governor signed House Bill 2918 into law, allowing the state supreme court to assist more counties in creating their own family treatment court programs.
Callaghan said he invites any interested counties to his courthouse to observe the process, and that it’s not a program that a county can build overnight.
“You have to get the right people, you have to get the right providers and the right lawyers, the right guardian ad litem, the right probation officer. It takes putting together a team,” Callaghan said.
One of the tenets of family treatment court is regular contact between parents and their children, through supervised visits, phone calls and eventually reunification.
“We just did what we could to make it happen,” Pettijohn said. “There was a lot of FaceTime. We did a lot of Zoom visits … And when we were able to open up and start visits again, I think those visits were all the more meaningful for the kids and their parents.”
Emily Allen
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West Virginia Public Broadcasting
Family Treatment Court Coordinator Stephanie Smith speaks at a graduation ceremony for the first five families to successfully finish Nicholas County’s program.
Throughout lockdown, the court itself still maintained consistent contact with parents. They regularly visited the Nicholas County Day Report Center, and Family Treatment Court Coordinator Stephanie Smith still conducted in-person visits with participants every week, even if those meetings had to be outside.
Smith said that she and her team will continue to support the families they help, even after graduation.
“When we call this their safe place, their support system, I mean, it’s not just like a nice thing to say at the end,” Smith said. “It really is still there for them.”
Purdue Pharma, the bankrupt drug company that makes the opioid painkiller OxyContin, is paying its attorneys up to $1,050 per hour to block the release of court records filed in Putnam County two decades ago.
In two months, the Philadelphia-based Dechert law firm has charged the bankrupt drug maker more than $210,000 to fight a push to unseal the documents that were part of a class-action lawsuit against Purdue in 2001, bankruptcy documents show.
Dechert, an international law firm, has billed for “strategy” sessions, reviewing court files, speaking with a Charleston-based lawyer and filing a pleading that aims to keep secret some of the court records. At least seven Dechert lawyers are being paid by Purdue to prevent the blanket release of documents in the Putnam case.
Three of those lawyers charged $12,810 to watch a virtual hearing in late January that lasted two hours and 20 minutes. The attorneys said nothing during the hearing, and billed for four hours of their time. They charged another $36,935 to prepare for the hearing before Putnam Circuit Judge Phillip Stowers, according to bankruptcy records.
“It is unsurprising that Purdue Pharma would stop at nothing to silence the truth,” said Charlotte Bismuth, author of “Bad Medicine” and expert on the Purdue bankruptcy. “The amount of money dedicated to that effort, however, is absolutely shocking, especially because it is coming out of a disputed estate, with so many grieving families in need who are waiting for compensation and an opioid crisis that rages on, unabated.”
The bankruptcy court approved Purdue’s payments to Dechert.
“Purdue has been committed to transparency in its bankruptcy from the outset and has made millions of documents available to creditors,” the company said in a statement to Mountain State Spotlight. “Consistent with this commitment, the vast majority of information subject to the media organizations’ motion to unseal has now been publicly filed, with Purdue proposing only limited redactions or withholdings for privileged, commercially sensitive or personally identifiable information.”
A Dechert spokeswoman did not respond to a request for comment.
Purdue Pharma filed for bankruptcy in 2019, and the company recently pleaded guilty to federal charges over its role in sparking the opioid crisis.
In December, HBO, The Washington Post and a documentary film company asked Stowers to unseal the Purdue Pharma record from the 2001 lawsuit that accused the drug manufacturer of failing to supervise the use of its highly-addictive painkiller OxyContin. The drug often was diverted to the black market, and West Virginians overdosed and died. The case was settled for an undisclosed amount in 2007.
At the start of the case and as part of the settlement, Purdue Pharma and the lawyers representing the West Virginia families suing the drug company agreed to a “protective order,” which allowed both sides to turn over information and keep it confidential while the case was being litigated and later closed.
Purdue struck similar deals across America, essentially buying silence from the families that sued the company and ensuring information about its deceptive sales practices wasn’t made public.
In November, a federal judge approved a $8.3 billion settlement proposal between Purdue and the U.S. Justice Department. The agreement, which hasn’t been finalized, requires the company to reorganize as a “public benefit trust” that would use any profits to provide free or low-cost opioid addiction treatment and overdose-reversing drugs.
Members of the wealthy Sackler family, owners of Purdue Pharma, have agreed to pay $225 million in fines to the federal government and divest from the company. The Sacklers haven’t faced criminal charges.
Stowers has appointed Hurricane lawyer Mark Barney to review the 20-year-old court file, work with the media outlets and Purdue, and recommend what filings should be released.
Last week, a Purdue attorney sent a letter to Barney, asking that hundreds of documents in the Putnam case remain under wraps. The filings include medical records, hearing transcripts, depositions, motions to dismiss, handwritten notes from doctors, proposed judge’s orders, letters, settlement details and information about former Purdue employees. The company said it would not oppose releasing other court files.
Morgantown lawyers Pat McGinley and Suzanne Weise are representing the media companies seeking to unseal the Putnam County court records. Weise serves on the Mountain State Spotlight board of directors.
Reach reporter Eric Eyre at ericeyre@mountainstatespotlight.org
West Virginia consistently has one of the worst rates of drug overdose deaths in the nation, and Centers for Disease Control and Prevention data show that toll has only been increasing in recent years. The West Virginia Center for Budget and Policy released a report on the economic toll of drug-related deaths and illnesses on the state. The center estimates that in 2019, that amount was more than $11 billion.
June Leffler spoke with one of the report’s authors, Jill Kriesky.
This interview has been lightly edited for clarity.
Leffler:Jill, your report estimates the cost of the drug crisis in West Virginia at $11.3 billion for the year of 2019. And $1.7 billion for Kanawha County specifically. You looked at fatality and non-fatality costs. Can you start by telling me what are the costs that a community incurs when someone dies?
Kriesky: So what it is, is an estimate of what that person would have earned had they continued to live. If that person isn’t there, he or she is not earning money to contribute to the state’s economy, or on a smaller scale to their family’s well being.
Leffler: So while fatality costs make up a huge portion of the costs incurred due to the drug crisis, there are non-fatality costs too. Give me a sense of what those entail?
Kriesky: People who are using drugs incur costs from healthcare, law enforcement, and from social services in a given year. Non-fatality costs are quite a bit less, because people who are using drugs may continue to work, they have the potential to earn income. So it is a much smaller piece. But with that said, even the people who develop these estimation processes say if you’re going to try to look at what it costs, to have people using drugs, you shouldn’t just look at one year, you should look at the lifetime cost. So for example, we know that there are a number of people who contract HIV or hepatitis C. And at least with HIV, there are lifetime costs of well over $400,000 to treat that person. But all that would show up in this estimate is the cost of treating them in that one year you’re looking at.
Leffler: The report also makes a good point that it’s not just that individual person who is incurring those medical costs. Everyone bears some of that brunt. Can you explain that concept?
Kriesky: When people are treated in the hospital and they aren’t insured there will be costs that aren’t covered. The hospital bears those costs initially. But ultimately, they’re going to cover those costs through increased price for procedures. That kind of filters on to insurance companies that are going to say, ‘Wow, healthcare is costing more, so premiums should be higher.’ I wouldn’t say that it’s just drug related illnesses that end up costing us more, but it’s any illness that poor people get essentially, or that requires a lot of treatment and is expensive. It gets spread out over the entire population.
Leffler: And you look at Kanawha County specifically, just tell me why you’re interested in Kanawha County? What does this report recommend to county and local officials there?
Kriesky: Kanawha County has very high numbers of cases of overdose deaths. It also has not figured out how it’s going to address this issue. All county policymakers need data to make their decisions, and the data is here. That’s why we did it. And if they want to know how they can reduce these enormous costs, well, it kind of seems like a no brainer to me that comprehensive syringe services programs are known to reduce hepatitis C and HIV by half. So all those costs from those illnesses would be reduced. People who enter these programs, new entrants into the programs are five times more likely to enter programs to try to get off of drugs and three times more likely to quit than people who don’t. So it’s a subject that needed to be addressed so that policymakers can work off of statistics, rather than hearsay.
