U.S. Surgeon General Jerome Adams threw his support behind syringe exchange services as an important tool to address the Ohio Valley’s high risk of needle-borne disease associated with the opioid epidemic.
Adams visited Florence, in northern Kentucky, for an event to encourage more people to get trained to administer the overdose-reversal drug naloxone. Dressed in a full, dark uniform with gold stripes on his sleeves, Adams demonstrated his technique with the potentially life-saving nasal spray.
Credit Mary Meehan / Ohio Valley Resource
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Ohio Valley Resource
Adams with Jody Jaggers, Director of Kentucky’s Pharmacy Emergency Preparedness Program.
“Let’s show them how this works,” he told a crowd of health officials and media.
Naloxone training can help address one deadly aspect of the opioid crisis. But Adams’ visit to the Northern Kentucky Health Department also highlighted another: the outbreak of needle borne disease unfolding in the region.
Since January, state and federal health officials have been tracking a growing clusterof more than 40 HIV cases in northern Kentucky associated with needle drug use. It’s the latest evidence of the Ohio Valley’s high risk of disease outbreak associated with the opioid crisis.
An analysis by the Centers for Disease Control found that of the country’s 200 counties at highest risk for HIV and Hepatitis C outbreaks from needle use, roughly half of the counties are in Kentucky, Ohio and West Virginia.
As Indiana’s Health Commissioner, Adams learned how critical is is to properly monitor and contain those outbreaks.
“One of the reasons surveillance is so important is because anyone can be the next Scott County, Indiana,” he said.
Scott County was the scene of a 2015 outbreak of more than 200 HIV cases discovered in just a few months in that small, rural community. Adams managed the response to that crisis. He said the lessons learned from the Scott County outbreak shaped how emerging clusters of HIV are now handled in rural communities.
Adams said it is important to show that needle exchange programs can do much more than the name implies.
“Actually connecting people to care, serving as a valuable touch point to insurance, to testing for other disease,” he said. “We will be much more successful than if they think we are just giving needles to people with a habit.”
He said the focus for health officials is shifting to disease prevention through community-based harm reduction programs.
“We want communities to have a conversation about what their risks are,” he said. “That starts with the data. How many are people are overdosing? What their hepatitis rates are — because hepatitis is a marker for injection drug use. Once we do that we need to have a broader conversation about how we respond.”
Adams said stemming the outbreak in Scott County also showed the importance of broad community support.
“The most common theme that I see are partnerships,” he said. “You have to have support of the public safety community, the business community, and the faith-based community.”
During his visit, Adams met with local health experts including Ardis Hoven, a Kentucky doctor and a former president of the American Medical Association. Hoven said her state is at the epicenter of the problem and can continue to push for solutions.
“Kentucky has actually taken the lead in many of these areas,” she said. “We have much to be proud of, but the important thing is that there is so much work to be done.”
A new task force will track health care crimes in West Virginia.
U.S. Attorney for the Northern District of West Virginia Bill Powell announced the task force’s creation in a news release Friday. The Health Care Crimes Task Force will investigate prosecute illegal activities like fraud and opioid diversion.
Powell said one of his office’s priorities is prosecuting those who use professional licenses or health care businesses to disguise illegal activities.
West Virginia ranks highest in the country in terms of population enrolled in Medicaid benefits, at 31 percent. Twenty-three percent of residents are enrolled in Medicare. Powell says these statistics mean West Virginians are particularly vulnerable to health care fraud related crimes.
The task force includes federal and state agencies.
Greg Lee, Kentucky’s HIV/AIDS educator, starts the town hall on a somber note.
“How many people in this room know someone who has died of an overdose death?”
It is a standing-room only crowd. Most hands go up.
“Amazing,” he says, sadly.
The meeting is at the Bourbon County Public Health Department, just next to the county’s drug rehab center and down the hill from a playground where used needles are found far too often.
For two-and-half-years there has been fierce opposition and two failed votes over a needle exchange here. On this evening, the key players are gathering one more time for a third debate on the needle exchange proposal.
Mike Williams, judge executive of Bourbon County, has been pushing for a needle exchange since state legislation made it an option in Kentucky. Bourbon County was the first rural county, following Louisville and Lexington, to attempt to start an exchange. After the failed attempts, he hoped 2018 would be different
“I was determined there was going to be a vote,” Williams said.
Cecil Foley, longtime magistrate, represents the most rural parts of the central Kentucky county.
“I was dead against it, to be honest with you,” Foley said of the needle exchange.
Credit Mary Meehan / Ohio Valley Resource
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Ohio Valley Resource
Bourbon County Magistrate Cecil Foley.
Joe Turner is the founder of Recovery Warriors, a group that works for addiction treatment.
“I knew going into the meeting it was going to be an uphill battle,” he said.
In addition to the toll of overdose deaths, the Ohio Valley now also has some of the nation’s highest-risk areas for outbreaks of needle-borne disease such as HIV and Hepatitis C. Health experts say a needle exchange is a strong defense against both overdose and disease. But exchange programs face strong public opposition, particularly in culturally conservative communities.
Which way would Bourbon County go?
“Handouts” or Help?
A skeptical tone dominates the early discussion in Bourbon County’s meeting. One audience member says, “I see those people all over dumpster diving, they’ll just take the needles and sell them to their friends.”
Lee pushes back and says the exchange is provided to prevent that. The woman is unconvinced. “I don’t think it will,” she says.
Credit Alexandra Kanik / Ohio Valley Resource
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Ohio Valley Resource
Others in the audience say addicts are just looking for a handout.
But amid the skepticism there is sympathy as well. When Magistrate Foley uses the word “druggies” some in the audience push back.
“If we are enabling druggies to break the law, that’s illegal,” Foley says.
“These people aren’t druggies, they are human beings,” a man in the audience booms in response, followed by applause.
Foley said later that moment caught him off guard.
“I was surprised, to be honest with you, that they came back so hard,” he said in an interview after the meeting. “I know they are human beings. I’ve a nephew who is in jail right now for using drugs.”
.As the meeting continues, Turner, wearing a ball cap and a black “Recovery Warrior” T-shirt, makes his way to the microphone.
“I’ve been arrested more times than I’d like to admit by some of the very people in this room,” he says, drawing some knowing laughs.
Credit Mary Meehan / Ohio Valley Resource
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Ohio Valley Resource
That was before he got clean five years ago, he said. Now Turner’s helping others, including Foley’s nephew. He said he connects up to 10 people a week with treatment. His phone rings constantly as people ask for help.
Turner tells the audience that the people he works with don’t want the life of an addict.
“They want help,” he says. “They will bum a ride, they will take a bike, they will hot foot it to come here and get a clean needle. They beg me for help.”
Health experts laid out how quickly needle-borne diseases can spread and how often people can have full-blown AIDS before ever getting tested. Lee talks about how much it costs to treat cases of HIV and Hep C and how that cost falls to the taxpayers. The price of prevention is far lower.
Difficult Decisions
The difficult discussions over needle exchange programs are happening across the Ohio Valley. Public health officials, increasingly alarmed by disease outbreaks and the unrelenting toll of overdoses, promote needle exchange programs as a way to reduce harm, encourage addiction treatment, and offer disease testing services.
The 2015 HIV outbreak in Scott County, Indiana, which was fueled by needle drug use, is fresh in the minds of many public health practitioners. More recently, outbreaks in southern West Virginia and northern Kentucky have renewed concerns, and the Centers for Disease Control has identified many counties in the region as at high risk for disease.
But the health facts run up against deeply held opinions about the moral aspects of drug use and the notion that a needle exchange enables drug addicts to continue harmful behavior.
Some opposition is rooted in religious convictions. Some is based in fear that an exchange will draw addicts from the surrounding region and bring what was considered an urban problem to a small town.
Even some places that have established needle exchanges are now reconsidering, worried that such programs bring crime into their communities or that local efforts are helping people from other counties or states. Charleston, West Virginia, recently suspended its needle exchange program amid criticism and pressure from the city’s mayor.
But by and large, needle exchange programs have expanded rapidly in the past two years in response to the opioid crisis. At the end of 2016, there were 30 needle exchange programs in Kentucky, Ohio and West Virginia. By the end of 2017, the region established nearly 40 additional exchanges, more than half of which are located in CDC at-risk counties.
Ten more exchanges have already opened their doors in 2018. Ten more exchanges are slated to open in the coming months in Kentucky alone, bringing the total to 46 Kentucky needle exchange locations.
Personal Tragedies
For about an hour the Bourbon County meeting is adversarial, with little common ground apparent. The meeting’s tone starts to shift in hour two as folks like Magistrate Don Menke share personal tragedies.
“My brother-in-law died, overdose. My nephew just died, was missing for a week,” he says. “They found him in a hotel room. Overdose.”
At least five people rise to say they have a relative who is addicted or who has died. Judge Williams says he’s been to the funerals of the children of five friends since he first proposed the needle exchange more than two years ago.
Credit Mary Meehan / Ohio Valley Resource
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Ohio Valley Resource
A Bourbon County playground where used needles often show up.
“Those funerals are real,” he says. “That pain is real.”
At this point, Magistrate Foley seems to be having second thoughts about his opposition. But, he says, a needle exchange is still a tough sell for his constituents.
“I’m going to need your help,” he says to the room. “Where I live out in the county, nobody is in favor of a needle exchange. Y’all are going to have to help me tell this story that I heard here tonight.”
The room goes silent as Judge Executive Williams calls for the vote.
All eight magistrates cast their ballots. Foley votes, “Yes.”
There is a pause while the tally is made. The final vote: 6 to 2 in favor.
“The measure passes,” Williams says to thunderous applause.
What Works
In follow-up interviews, Foley, Turner and Williams, still all a little surprised at the outcome, reflected on why the measure was approved.
Foley said that if more people heard the whole story behind an exchange program, they would change their minds like he did.
“It’s more of a safety issue and it’s meant to stop the spread of disease and to save money.”
Turner said it’s crucial that support is homegrown.
“Most people from small, rural towns, they don’t like outsiders,” he said. “It’s got to be grass- roots.”
Credit Mary Meehan / Ohio Valley Resource
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Ohio Valley Resource
Bourbon County Judge Executive Greg Williams listens to comments on the needle exchange.
Williams said he was jubilant at the outcome. But it was hard to tell from reading his face during the meeting. He said he didn’t want to react too much because he knew many people still were strongly opposed. He offered this advice to other community leaders: Persevere.
“It took us three times,” he said. “Don’t give up, and keep presenting the facts.”
The Bourbon County needle exchange program begins operating in May.
Dr. Michael Brumage resigned today as director of the West Virginia Department of Health and Human Resources’ Office of Drug Control Policy after less than two months on the job.
In an email, Brumage said that it “was clear that the distractions of the Charleston syringe service program were overshadowing my work” and that he feels he’ll be better able to serve the state in another capacity.
The Kanawha-Charleston Health Department’s needle exchange program has recently come under fire from Mayor Danny Jones and Police Chief Steve Cooper.
The DHHR issued a press release Friday morning in which Brumage says that he is committed to the health and well-being of all West Virginians and “can do so best through my work with the West Virginia University School of Public Health, away from the distraction of recent events.”
Susie Mullens, program manager of DHHR’s Office of Drug Control Policy, will assume the role of interim director.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Marshall Health, Charleston Area Medical Center and WVU Medicine.
West Virginia’s U.S. senators say Marshall University and West Virginia University will get federal grants to support clinical internships and field placements in mental health and drug addiction services.
Sens. Shelley Moore Capito and Joe Manchin say the Department of Health and Human Services training grants are $319,000 for West Virginia University and $213,000 for Marshall.
Last week the Senate Appropriates Committee advanced legislation with $50 million for the program nationally.
Capito, who sits on that committee, says she advocated for expanding treatment especially in rural and medically underserved areas.
If you’ve ever enjoyed a Budget Saver twin popsicle on a hot summer day, you can thank the employees of the Ziegenfelder frozen treat factory in Wheeling, West Virginia.
Floor operator Sonny Baxter keeps the line of popsicles going in the cherry-scented worksite.
“You have to have a comprehension of how the line works, how to make them run as smooth as possible” he said. “You have to supervise the line workers that are bagging the popsicles. You’re a friend. You’re a leader.”
But Baxter’s job goes beyond keeping the popsicle line moving. He also uses the training in addiction counseling he received outside of work to help Ziegenfelder employees who are in recovery from addiction and re-entering the workforce.
“You have to really have a healthy level of empathy for people from different circumstances and different environments,” Baxter said.
Addiction specialists say employment helps in the recovery process. And here in one of the areas hardest hit by the addiction crisis, some employers are stepping up their efforts to bring these people back to work in hopes of chipping away at the epidemic.
“Businesses really need to step to the plate and participate in changing our environment,” President and CEO Lisa Allen said. “We don’t necessarily go out and search for a certain person re-entering. We search for great people.”
Credit Courtesy Ziegenfelder Frozen Treat Co.
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Ziegenfelder CEO Lisa Allen wants businesses to “change the environment” of the addiction crisis.
The company estimates that around a third of their employees come from a local temp agency and some of those employees were on probation and living at the local halfway house.
Ziegenfelder managers also knew some of their long-term employees had a “background.” But they did not take an interest in those workers’ stories until several years ago.
Production Manager Matt Porter saw the toll the opioid epidemic was having on the Ohio Valley. He said he felt the company could be a force for change by giving people affected by the crisis another chance.
“Whether we chose to face it head on and realize that there’s an epidemic going on in the Ohio Valley or we ran from it, ultimately it’s going to find us,” he said.
That thinking led to the decision to become a “Drug-Free Workplace.” The company takes measures to avoid drug-related hazard while offering assistance instead of punishment to employees who approach them about their struggles with addiction.
Loyal Employees
An consultant agency based just outside of Columbus, Ohio, is working to help companies implement drug free workplace policies.
Working Partners tailors these policies to meet the needs of both major corporations and small businesses.
Working Partners advises employers to protect themselves from liability. But companies should also offer a helping hand rather than a slap on the wrist to employees who approach managers about addiction.
CEO Dee Mason believes it’s ethically the right thing to do. But there are also economic benefits for the employer.
“If that person stays the course and you’ve actually thrown them a life ring, those people will come back and be some of the most loyal employees you’ve got,” she said.
She said a good policy consists of five elements:
A legal document outlining detailed procedures
A drug safety education program for employees
Training for supervisors to detect the signs of addiction in employees
A system for drug testing
An Employee Assistance Program for when treatment is needed
Mason said employers see the benefits of this approach when it is explained “in a language that they understand, which is ‘Let’s do the math.’” A 2009 study in the journal Psychiatric Services found that when an employer pressures an employee to seek addiction treatment, it “gets people to treatment earlier and provides incentives for treatment adherence.”
When the employee returns from treatment, the employer saves “up to $2,607 per worker annually,” according to survey results posted in March by the National Safety Council. The savings are estimated based on missed work days and healthcare costs incurred by employees in active addiction.
Other benefits for employers include a discount on workers compensation insurance premiums in certain states (in Ohio and Kentucky) and the opportunity to take government contracts.
West Virginia lacks a state-managed drug-free workplace program. However, recent legislation taking effect in July expands circumstances in which workers can be tested for drugs, and testing is required for workers in all public works projects.
The opioid epidemic has increased demand for Working Partners’ services in both urban and rural areas. Mason said rural communities present unique challenges in getting employees treatment.
“We’re raising the awareness of the employers. But now we’ve got to figure out how to find services that they can rely on. There aren’t enough services,” Mason said.
Data Gap
Working Partners is also trying to get data on the impact opioids are having on employment in Ohio.
Working Partners is in the process of collecting survey data from over 5,000 employers gauging their perception of the issue.
Mason said the study was motivated by the frequent complaint from employers who claim they can’t find workers who could pass a drug test.
“We kept looking at the national statistics of positivity rates for drug testing and going ‘Really? You can’t find workers? Okay,’” Mason said. “Let’s blow this out and see what’s really going on.”
While there are some national data on which industries are most affected by substance use disorders, there is no scientific data on a local scale.
It can be difficult to track when some employers don’t keep an official record of drug test results.
“If they say, ‘Well, we have a positivity rate of 20 percent for our applicants coming in the door.’ We want to know if that’s an opinion or data driven,” Mason said.
Mason plans to combine the results with secondary data from community leaders and national statistics for a complete look at the issue.
‘They Work Hard’
Other organizations across the Ohio Valley are working to fill in the service gaps and prepare those in treatment programs for workforce re-entry.
Employment is a major part of the journey to continued recovery at LifeSkills in Bowling Green, Kentucky, which develops employees who who may have never been in the workforce before.
“Some of these people haven’t worked in 10 or 20 years,” Seth Pedigo, a Re-entry Specialist with LifeSkills said. “They’re wanting to go back into the field.”
The nonprofit mental health and addiction institution incorporates job training as part of its recovery program and advocates for clients to potential employers.
The difficult part for LifeSkills is the stigma employees in recovery carry.
“They relapse, yes, at times, and they lose their job,” Pedigo said. “They’re fired on on the spot. No appeal process. Nothing, depending on the company.”
The advocates work with employers to create workplaces that understand relapse is not the same as failure.
“Let’s talk about it, because if you fire them you’re going to unravel all the work they’ve put in,” Pedigo said. “And they work hard.”
In his view, another chance can make all the difference.
Not ‘Part of the problem’
Sonny Baxter can attest to that.
Ziegenfelder gave him another chance after he served time in federal prison for crimes he says were related to the addiction crisis.
“I was technically part of the problem,” he said.
But he changed while serving his sentence. And he was determined to become part of the solution.
He trained to become an addiction counselor in hopes of helping others.
“I was told a long time the things you learn are not yours to keep,” he said. “I place that responsibility on myself.”
Baxter began work at the frozen treats factory the day after completing his sentence in 2015.
He also took an interest in computer programing. He taught himself to code from books while incarcerated and then enrolled in a class upon release.
He’s acquired some freelance technical support work but he would like to use his skills for Ziegenfelder. He’d like to create an app drawing on his work experience.
“I’m thinking like a Candy Crush-type thing where you got an assembly line and you have to create an assortment [of popsicles],” Baxter said. “I’m working on it.”
People who had a past involvement in the addiction crisis can be valuable to society. And Baxter hopes he can be an example of that.
“People don’t realize how successful, how stable, and how goal-oriented you can be working in the factory. So I play an example to different types of people,” he said. “People that don’t realize the type of opportunity, resources that are available here that you can take advantage of and use as a stepping stone to be progressive in the community.”
ReSource reporters Glynis Board and Becca Schimmel contributed to this story.
