Drug Overdose Story Archives - West Virginia Public Broadcasting

Decoding The Drug Epidemic

When it comes to decoding the language of the drug epidemic, advocates say compassionate language plays a crucial part in discussing the drug epidemic.

When it comes to decoding the language of the drug epidemic, advocates say using compassionate language is vital when speaking with the people behind the numbers.

This language is also medically accurate, as clinicians’ diagnostic manuals have changed.

“In behavioral health disorders there is, for the past several decades, there has been something called the DSM,” said Michael Haney, director of addiction treatment center PROACT, based in Huntington. “It’s the Diagnostic and Statistical Manual of psychiatric disorders, and there used to be a delineation between abuse and dependence which I think is where the whole idea of addiction dependence got confused because abuse is someone that was a problem user, but it hadn’t gotten to the point where they were truly considered as having a disease or sick.”

In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM 5 was released, removing terms like substance abuse for a more simple term.

“It’s simply use disorder,” Haney said. “And it’s like alcohol use disorder, mild alcohol use disorder, moderate or alcohol use disorder severe. And that really just depends on how much of an impact it’s having on you.”

Laura Lander has lived in West Virginia for nearly 20 years and watched the trajectory of the drug epidemic from a social work perspective as an associate professor at West Virginia University’s (WVU) Department of Behavioral Medicine and Psychiatry.

“And now, it’s really a kind of on a continuum,” Lander said. “So people have mild, moderate, or severe substance use disorder. So that’s the diagnosis. So addiction is really an umbrella term, which is not a diagnostic term, is really more of a descriptive colloquial term that we use.”

Lyn O’Connell, associate director for the Division of Addiction Sciences at Marshall University’s Joan C. Edwards School of Medicine, said avoiding derogatory terms and judgemental labels and instead employing person-first language can increase empathy and reinforce the idea that people are experiencing a health issue rather than a moral failing.

“One of the other reasons it matters is because, and we don’t use this term, but if we refer to someone as an addict, we don’t want to use that term, because it’s not person-centered, and it really dehumanizes the individual,” O’Connell said. “So we want to talk about a person with a substance use disorder because they are still a person. And so we want to refer to that person-centered language. The reason for doing that is also to try and reduce stigma to remind people that there is a person in the conversation.”

O’Connell said that with the understanding that language shapes perception and attitudes, adopting an empathetic approach can pave the way for more effective support systems and treatments.

“And although people might say, ‘well, that’s not going to change how someone enters treatment,’ it absolutely does. How we refer to programs, how we refer to people, how we talk about issues definitely impact our willingness to have treatment,” O’Connell said. “There’s no better example other than probably a needle exchange versus a harm reduction program.”

According to O’Connell, compassionate language not only benefits those directly affected by substance use disorder but also promotes a more inclusive dialogue among policymakers, health care professionals and the general public.

“Unfortunately, we haven’t done enough to combat that first piece of language, but we really want to make sure that, that terminology has impacted our willingness to treat people or provide funding or to legislate this overall,” O’Connell said.

Lander said using compassionate language doesn’t minimize the severity of the drug epidemic but rather acknowledges the humanity and inherent worth of every individual impacted by it. And it has practical applications as well.

“Previously, we had found there was a stigma around patients receiving Narcan,” Lander said. “Even though there was a state order in place that people did not need a prescription to receive it. It was hard for them to get it from the pharmacies. And now we have distributed so much free Narcan and it’s almost become like a household item, which on the one hand, you can think of as sad. On the other hand, you can think of as what an amazing thing we have done to really de-stigmatize a rescue medication, which allows people to live long enough to hopefully get into treatment and into recovery.”

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

‘Tranq Dope’ Arrives In W.Va.

Xylazine is a non-opioid agent linked to a growing number of overdose deaths across the country. As a non-opioid, the drug poses a threat to humans, in part because it does not respond to typical revival methods like Narcan.

Appalachia’s ever-present and ever-evolving opioid epidemic has a new cutting agent on the block: xylazine, a sedative medication meant for veterinary use, that is now being mixed into illicit supplies of opioids and fentanyl.

The U.S. Drug Enforcement Administration recently issued an alert warning of a “sharp increase in the trafficking of fentanyl mixed with xylazine,” which is also known as “tranq” or “tranq dope.”

In January of this year, the New York Times reported from Philadelphia, an epicenter of xylazine use, on the devastating reality for people who shared first-hand accounts of using the drug, whether intentionally or not.

Leigh Brooks, medical director of the medically assisted treatment program at Bluestone Primary Care in Princeton, West Virginia, said she has seen positive xylazine tests in her patients since August 2022, noting that she never sees xylazine without fentanyl also present.

“When I talked to the patient about it, she had no idea that what she ingested was xylazine,” Brooks said. “So that kind of sparked my interest. As far as you know, if one patient’s got it, I’m probably going to have multiple patients that are going to come back with that xylazine.”

Brooks said her biggest concern is how to educate her patients to handle the side effects of xylazine, given its resistance to Narcan.

“It creates a longer lasting high when people do ingest it with fentanyl, even though we don’t think that they’re actually going out on the street saying, ‘I want xylazine,’” Brooks said. “On the streets, it is called tranq dope. What is happening is it’s just being cut with some of these illicit drugs. So people don’t really know that they’re ingesting them.”

Joshua Schrecker is the senior director of Clinical Affairs at Aegis Sciences Corporation, a toxicology and medication monitoring laboratory that has been tracking the use of xylazine for years.

“We had the prescription opioid epidemic, and then it became the illicitly manufactured fentanyl epidemic,” Schrecker said. “And now we’re seeing adulteration of illicit opioids, traditional illicit substances, like cocaine, with sort of a hodgepodge, or mixing of drugs, kind of at its foundation. The reason that these substances are oftentimes added to other drugs is they have somewhat similar effects on the end user.”

Some who obtain the mixture think they’ve purchased an opioid and are surprised to wake hours later, craving the opioid high more than ever, according to Brooks. The drug has also been shown to cause large open wounds when used by humans, sometimes leading to amputation.

“We do know that some of the side effects that happens is dry mouth, they get drowsy, at first, an increase in blood pressure and increase in heart rate, then heart rate, lowers blood sugar goes up, patients develop hypothermia, and then they go into respiratory distress,” Brooks said. “And also at the injection site, they can get necrotic tissue at those injection sites.”

Necrotic tissue means dead body tissues. Xylazine kills the tissue where the drug was injected.

“Where it’s not a human drug that was never designed for human use, it’s not on the controlled substance list, because it’s a veterinary medicine,” Brooks said. “And that’s another reason why it’s kind of like appealing for the illicit market to use xylazine in a mixture is because the fact that it’s not controlled, it’s lower costs, but also lower risk of law enforcement scrutiny.”

Federal lawmakers including Sens. Shelley Moore Capito, R-W.Va., and Joe Manchin, D-W.Va., recently introduced the “Combating Illicit Xylazine Act” to classify the drug as a controlled substance, among other measures.

“Prescription drugs very much stay the same over time, you know, there might be one or two new drugs that are approved, that we’ll begin testing for, but within the kind of subset of these novel and synthetic illicitly manufactured compounds, they shift and move all the time,” Schrecker said. “When a drug is either internationally or nationally scheduled, the pattern that we typically see is that scheduling occurs, that positivity will drop off, and it becomes replaced with a new substance that’s very similar, acts in a similar manner.”

While most experts agree that scheduling the drug as a controlled substance is the next step, researchers, scientists and physicians alike brace for the next new filler agent to emerge on the illicit market.

“No matter what they take off the street, what drug taskforce takes off the street, how they re-schedule, different medications, that illicit market is so financially driven from, like the cartels, and other illegal activity, that they bounce back with something with bigger, stronger, faster,” Brooks said.

Brooks said her clinic would be most helped by obtaining Clinical Laboratory Improvement Amendments (CLIA) status. To be CLIA waived means being able to test for all substances in the sample in a timely manner, in the office.

“In the state of West Virginia, I cannot do a point-of-care urine drug screen for fentanyl,” Brooks said. “We’re very much behind the curve, that right there is of the utmost importance that gets changed to where just my standard drug test cups will have fentanyl in it so I can be able to test for fentanyl because you never see xylazine without fentanyl.”

In medically assisted treatment settings, like Brooks’, these tests are vital to caring for her patients. A full panel would allow Brooks to treat her patients in a timely and effective manner.

“The illicit markets going nowhere,” Brooks said. “It’s here to stay. It’s one of the things where we have to manage it. And I really do think that you have to kind of look at it from an economic perspective of how to manage that market.”

Federal, State And Local Officials Warn Against ‘Tranq Dope’

Federal authorities are calling the emergence of fentanyl mixed with xylazine a public safety threat.

The U.S. Drug Enforcement Administration issued an alert Monday warning of a “sharp increase in the trafficking of fentanyl mixed with xylazine,” which is also known as “tranq” or “tranq dope.”

Xylazine has flown under the radar of federal officials because of its status as a veterinary drug. Meaning, it is not a controlled substance and therefore not subject to review by federal authorities.

The United States Food and Drug Administration (FDA) originally approved xylazine in 1972 as a sedative and analgesic for use in veterinary medicine.

Xylazine is a non-opioid agent that’s been linked to a growing number of overdose deaths across the country. As a non-opioid, the drug poses a threat to humans in part because it does not respond to typical revival methods like Narcan.

Leigh Brooks, the medical director of the medically assisted treatment program at Bluestone Primary Care in Princeton, W.Va., has seen firsthand the effects that xylazine and other novel psychoactive substances (NPS) have had on people’s lives.

“I see a positive xylazine test, probably one or two a week and this has been since August of 2022,” Brooks said. “But we do know that some of the side effects that happens, like dry mouth, they get drowsy, at first, an increase in blood pressure and increase in heart rate, then heart rate, lowers blood sugar goes up, patients develop hypothermia, and then they go into respiratory distress. And also at the injection site, they can get necrotic tissue.”

Federal authorities are calling the emergence of fentanyl mixed with xylazine a public safety threat.

Joshua Schrecker is the Senior Director of Clinical Affairs at Aegis Sciences Corporation, a toxicology and medication monitoring laboratory that has been tracking the use of xylazine for years.

The DEA reported 23 percent of fentanyl powder contained xylazine in 2022. Despite this alarming report and many others about the rise of xylazine, federal, state, and local law enforcement do not have the tools necessary to effectively monitor its spread or put prevention measures in place.

On Tuesday, federal lawmakers, including Sens. Shelley Moore Capito and Joe Manchin, introduced the “Combating Illicit Xylazine Act” to classify the drug as a controlled substance, among other measures.

The Combating Illicit Xylazine Act, if passed, would:

Classify its illicit use under Schedule III of the Controlled Substances Act.
Enable the DEA to track its manufacturing to ensure it is not diverted to the illicit market.
Require a report on the prevalence, risks, and recommendations to best regulate the illicit use of xylazine.
Ensuring all salts and isomers of xylazine are covered when restricting its illicit use.
Declaring xylazine an emerging drug threat.

Xylazine is essential in veterinary medicine with large animals. According to Sen. Manchin this legislation would not infringe upon the rights of veterinarians, farmers, cattlemen or ranchers.

“In the last year, more than 106,000 Americans and 1,400 West Virginians died from drug related overdoses,” Manchin said. “It’s heartbreaking to lose so many of our fellow Americans and West Virginians to this devastating epidemic, and Congress must take meaningful action to address the crisis, which includes the surging threat of the highly dangerous xylazine drug. I’m proud to introduce this bipartisan, bicameral legislation to ensure our law enforcement agencies have the tools they need to monitor and control the spread of illicit xylazine, while ensuring its continued access for veterinary medicine.”

Lifesaving Naloxone Kits Heading To W.Va. Campuses

Naloxone kits will soon be available at West Virginia colleges and universities statewide. West Virginia’s Drug Intervention Institute and the Collegiate Recovery Network have teamed up to supply the lifesaving opioid overdose reversal drug, often referred to by its brand name, Narcan.

Naloxone kits will soon be available at West Virginia colleges and universities statewide.

West Virginia’s Drug Intervention Institute and the Collegiate Recovery Network have teamed up to supply the lifesaving opioid overdose reversal drug, often referred to by its brand name, Narcan.

The boxes, called ONEbox, include two doses of intranasal naloxone, a mask, gloves and sanitary wipes.

Dr. Susan Bissett, president of the intervention institute, said more than half of all 26 state campuses have signed up for the naloxone kits. She points out that college campuses are often the center of a community and data shows students are prone to drug experimentation.

“We have a lot of data that suggests students misuse prescription as well as illicit drugs,” Bissett said. “And with the increase of fentanyl throughout the United States and West Virginia, I think it’s really important that we’re equipped and prepared to respond to an overdose.”

Bissett said the naloxone kit comes with a digital training link, but it also has video instructions.

“As soon as someone opens the box, Jan Rader, the former fire chief from Huntington, West Virginia comes down and walks the individual through how to respond to the emergency,” Bissett said.

If for some reason the video were not to work, there’s a QR code in a tappable area where you can pull the video up on your phone. Bissett said there are also written instructions that somebody can tear off and take with them to the person.

The kits will be placed in residence halls and student unions. Bissett said one school will put a kit in every building on campus. She hopes to soon expand the grant funded naloxone kit distribution project throughout the state, and the nation.

“I think schools, libraries, courthouses, and sporting venues would be great places to put kits,” Bissett said. “I think there are businesses, restaurants, parking garages, the possibilities are limitless.”

Bissett said naloxone is a key part of state and federal harm reduction efforts. She said people can’t recover if they are no longer with us, and what naloxone does is enable someone to breathe and gives them the opportunity to seek recovery.

W.Va. Overdose Deaths Slow Down As Pandemic Winds Down

Those in recovery have a phrase: the opposite of addiction isn’t sobriety, it’s human connection. That’s why federal and state officials say fatal overdoses rose to new heights during the early, most isolating days of the pandemic.

“There’s a clear correlation with regard to the pandemic and the isolation and the inability to access support services for folks who have [substance use disorder],” said West Virginia Secretary of Health and Human Resources Bill Crouch.

The Centers for Disease Control and Prevention estimated last November that fatal overdoses nationwide had risen to 100,000 a year, a new record. Data now suggest these deaths may be slowing down.

Provisional data show reported overdose deaths plateaued nationwide, and decreased 15 percent in West Virginia, from April to September of 2021. The CDC says it takes four months to estimate the number of deaths, and up to a year to accurately report these deaths.

Crouch said more treatment and wrap-around services are being offered in recent years with direction from the Governor’s Council on Substance Abuse and Prevention and DHHR’s Office of Drug Control Policy, led by Dr. Matthew Christiansen.

“In 2018, with the efforts we were going forward with, we had a 22 percent reduction in overdose deaths. In 2019, we had a 13 percent reduction in overdose. And then the pandemic hit,” Crouch said. “We ended up with a lot of folks who lost those contacts, lost those resources, lost a lot of the support mechanisms they needed to tackle this.”

Crouch said much of those services returned or even expanded last year. Record numbers of naloxone, an overdose reversal treatment, were distributed by state agencies, local health departments and grassroots volunteers.

“There are hundreds of West Virginians working every day, unpaid and largely unacknowledged, to get naloxone where it needs to be, and hundreds more doing the extremely emotional work of reversing overdoses,” said Dr. Robin Pollini, an infectious disease doctor specializing in substance use disorder. “It’s always good news when we hear fatal overdoses are down. That said, this is a marathon and not a sprint.”

DHHR recommends anyone with substance use disorder looking for help to contact HELP4WV, which offers 24/7 confidential support and resource referrals through call, text, and chat lines. HELP4WV also offers a Children’s Crisis and Referral line. Residents may call HELP4WV at 844-HELP4WV, text at 844-435-7498, or chat at www.help4wv.com.

Drug Overdoses Climbing Year After Year In U.S., W.Va.

Last year set a record for overdose deaths but federal officials forecast 2021 to be even more tragic. In West Virginia, that outlook is even more bleak.

The Centers for Disease Control and Prevention released preliminary data Wednesday that estimates 100,000 people died in just a 12-month span — from March 2020 to March 2021. During those months, 1,600 West Virginians passed away.

That provisional data represents a 29 percent increase in the nation from one year prior. In West Virginia, deaths increased twice that rate at 62 percent. Vermont is the only other state to see a more significant increase at 70 percent.

“This translates to an American perishing from a drug overdose death every five minutes,” said Dr. Rahul Gupta, the nation’s recently confirmed drug czar and former West Virginia state health officer in a news conference on Wednesday.

Health experts say the pandemic and a rise in the dangerous, synthetic opioid fentanyl caused drug overdoses to peak last year when 93,000 people died. In its latest data set, the CDC says fentanyl was involved in a majority of fatal overdoses.

“The amount of illegal fentanyl in our country has risen to an unprecedented level this year alone,” said Anne Milgram, an administrator with the Drug Enforcement Administration. She said her agency has seized 12,000 pounds of the substance this year, including 14 million fake prescription pills.

Elected officials weighed in on the news today, with grief and calls for action.

“Today’s heartbreaking milestone makes it crystal clear that we have not done enough,” said Sen. Joe Manchin in a statement.

Manchin said he supports more treatment options in the Mountain State and making fentanyl a Schedule I controlled substance permanently.

The Biden administration spoke with reporters today to tout how it plans to tackle the ever-increasing drug crisis. The president is calling for a $670 million increase in next year’s budget for research, prevention and treatment.

Biden may be the first president to advocate for harm reduction, which is an evidence-based approach that hopes to keep active drug users as safe as possible before they even enter treatment. For the president, that means more access to fentanyl testing strips, clean syringes and overdose reversal treatments, namely naloxone.

Naloxone can restore a person’s breathing and consciousness, preventing death and potential brain damage. EMS can administer this medication, but so can friends or bystanders.

Federal officials released a model law Wednesday that states could adopt to provide more access to naloxone. It recommends ways to make the life-saving medication affordable and accessible, such as handing it out in correctional and educational settings.

While convincing state legislatures, especially Republican-led ones like West Virginia, to adopt a Biden backed bill might be a hurdle, those in addiction services say the suggestions are good ones.

“These are things that we could already be doing in West Virginia under current law,” said Robin Pollini, a substance abuse and infectious disease epidemiologist at West Virginia University. “Physicians can legally prescribe naloxone anytime they like, and pharmacists can co-dispense naloxone… Yet this is rarely done.”

Pollini said one of the best things the federal government could do is make naloxone available over the counter.

Harm reduction programs, grassroots groups and state agencies do distribute naloxone throughout West Virginia, with many doses coming from the state’s Office of Drug Control Policy. The office has distributed over 33,000 naloxone kits so far this year. About 8,000 doses were handed out by volunteers during Save-A-Life Day events this year.

“I’m supportive and the office is supportive of all the initiatives that the Biden administration has proposed around distributing naloxone,” Director of ODCP Dr. Matthew Christiansen said.

He thinks the state is being proactive on this front, and has eliminated some barriers. West Virginia has a good Samaritan law that shields anyone administering naloxone from repercussions if they’re acting in good faith. The state also has a standing order saying a pharmacist can dispense naloxone without a doctor’s prescription.

“We know that it’s effective in reversing overdose, and we know that it enables people to enter into successful long-term recovery in a way that allows them to really be productive members of society,” Christiansen said.

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