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Recent Statistics Show Decline In Opioid Overdose Rates

According to provisional data, the state’s overdose rate fell from February 2022 to February 2023. The data shows that opioid overdose rates have dropped by approximately 8 percent, marking the most substantial decrease since the onset of the COVID-19 pandemic.

Recent data from the Office of Drug Control Policy has revealed a decline in opioid overdose rates, marking a positive turn in the fight against the ongoing drug epidemic.

West Virginia overdose rates are slowly falling to pre-pandemic levels. Advocates say while this data is preliminary, this improvement is in part credited to in-person harm reduction services resuming after the COVID-19 pandemic.

“Yes, we are seeing less people overdose, and I think there’s a variety of reasons for that,” Michael Haney, director of PROACT, said. “I think West Virginia has done an excellent job in keeping the substance use problem in sight.” PROACT is an addiction treatment center in Huntington.

Health officials attribute the positive trend to a combination of factors, including expanded availability of naloxone, a medication that reverses opioid overdoses, as well as the implementation of harm reduction programs. Harm reduction refers to a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.

“The drug problem has been there for decades. I think it really didn’t get people’s attention until you suddenly had people in large numbers dying, and you can’t attribute it to anything else, it was obviously the drugs doing it,” Haney said. “I think that calling attention to that, supporting treatment efforts, encouraging people to get into treatment. I think medication-assisted treatment has helped a great deal.”

West Virginia was one of only eight states in the nation predicted to see a decline in overdose fatalities in 2022. While the data is still preliminary, some advocates are encouraged by the success of harm reduction programs and public education since the end of the Public Health Emergency and COVID-19 pandemic.

According to the Center for Disease Control and Prevention’s Fatal Overdose Data Dashboard, West Virginia lost 1,453 people to overdose deaths in 2021.

A Changing Landscape

Lyn O’Connell, associate director for the Division of Addiction Sciences at Marshall University’s Joan C. Edwards School of Medicine, said it is important to note only four months of data are available for 2023.

“We do know that drug trends vary throughout the annual calendar year with some rhyme and reason and other times without much explanation,” O’Connell said. “We do suspect that drug overdose deaths are changing in that the type of drugs being utilized are changing.”

Of those deaths, 1,146 were attributed to illicitly manufactured fentanyl, 103 to heroin, and 295 to prescription opioids. Overdoses occur with other drug types as well, including stimulants, to which 949 West Virginians lost their lives in 2021.

O’Connell said PROACT, Project Hope and programs like it had made significant amounts of progress in her community in 2019.

“The pandemic destroyed that. We had to pull a lot of people out of public spaces,” O’Connell said. “In general, as a community, people resorted to substance use, because they didn’t have to get up and go to work. It’s often a disease of despair, and it was very easy to feel despair during 2020 and 2021 especially. People lost their jobs, so it might be easy to turn back to drug use or selling drugs.”

In 2019, West Virginia lost 870 lives to drug overdoses, according to the Centers for Disease Control and Prevention (CDC). During the COVID-19 pandemic, from 2019 to 2022, the state’s overdose death rate went from 870 to 1,453, a 67 percent increase.

“So we built on it over the past year, but it was going to take a while for us to see those things go into effect again,” O’Connell said. “I think the hope is that we do stabilize and or see a downward trend.”

Haney said isolation encourages use and is one of the major problems with substance use disorders. Alternatively, peer recovery programs like the ones offered at PROACT, encourage people with substance use disorder to interact with fellow peers in recovery.

“Now that we’re coming out of COVID, we’re back to doing in-person services, people are going too, and a lot of things happen when you do in-person services,” Haney said. “There is that sense of accountability that patients have when they’re going to treatment. They also get to see other people who are in treatment, and they have that sense of shared experience.”

Advocates say a rise in methamphetamine use is concerning and took the lives of 786 West Virginians in 2021.

“There’s other factors, there’s the use of methamphetamine, the use of xylazine, the use of alcohol or marijuana,” O’Connell said. “And so there are other things that impact how we can determine the effectiveness of, or if there is any decrease because there are just so many factors at play.”

Five of the most frequently occurring opioids and stimulants – alone or in combination – accounted for 71.5 percent of overdose deaths in 2021. Illicitly manufactured fentanyl and methamphetamine topped the list with 28.8 percent of deaths.

The use of multiple drugs at once accounted for 52.1 percent of 2021’s overdose deaths on opioids and stimulants.

Erin Winstanley is a research scientist in the department and associate professor at West Virginia University in the Department of Psychiatry.

She also encouraged vigilance, especially against new cutting agents appearing each day.

“I think many clinical researchers and researchers working in the field of addiction are concerned about the increasing number of people using illicitly manufactured fentanyl,” Winstanley said.

While the decline in opioid overdose rates is undoubtedly positive, experts caution against complacency.

“I think from the national perspective, it is too early to say whether overdose deaths are declining,” Winstanley said. “So it does appear that the numbers are on a downward trend. But it isn’t clear if they’re going to return to a pre-pandemic level.”

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

Lawmakers Weigh Opioid Treatment Options

Legislators heard from board members of the private donation-funded opioid treatment center Lauren’s Wish during the first interim session this week.

Between March 2021 and March 2022, West Virginia reported 1,403 fentanyl overdoses. In 2021 alone, there were 1,253 opioid overdose deaths in West Virginia, 83 percent of which were fentanyl-related.

Ed Boyle, director of Facilities at Lauren’s Wish, said his organization’s board members, all of whom have been affected by the state’s opioid crisis, found a gap in the opioid overdose recovery process.

“Through this pain and recovery process, these six directors met over a year-long process of studying where as a society we seem to be failing the youth of this state and our communities,” Boyle said. “We came up with the idea of Lauren’s Wish Addiction Triage Center.”

When an individual overdoses and is taken to the emergency room, they are given Narcan and stabilized. Some hospitals have peer recovery coaches to set the person up with a bed in a treatment center, but that bed might not be available for a week or more. That leaves the hospital to discharge the patient back into the environment in which they overdosed.

Boyle said the board of directors at Lauren’s Wish termed the pattern, “treat and street.” To avoid this cycle, Lauren’s Wish Addiction Triage Center was opened as a 28-bed facility at Hazel’s House of Hope in Morgantown.

Dr. Kevin Blankenship is the Medical Services Director of Lauren’s Wish and founder of Jacob’s Ladder, another private patient-centered recovery program located in Aurora, West Virginia.

“We’ve got lots of beds available in West Virginia but most of those are 30-day programs, at best,” Blankenship said. “What I saw was missing was long-term treatment and that’s what Jacob’s Ladder is. Jacob’s Ladder is a six-month treatment program, that then transitions into another three to six months of sober living. The reason for that is because addiction takes time to heal from. Your brain can heal from this, but you’ve got to give it the right environment.”

Blankenship noted the same gap in treatment between an overdose treatment in an emergency room and treatment and recovery bed availability. He also said 28 days is not enough time to heal from opioid addiction.

“If you’re a doctor or a lawyer or an airline pilot, you’ll be entered into a program for two to five years for your addiction, right? For everybody else 30 days, you should be good,” Blankenship said. “They’re not good and we’re not planning for them after they’re done with their 28-day program. So the program itself is too short. There’s nowhere for them to go afterward.”

Programs like Lauren’s Wish and Jacob’s Ladder need to be duplicated throughout the state, Blankenship recommended to lawmakers.

“This is a necessary program,” Blankenship said. “You probably need four or five of these around our state, regionally located so that different ERs and hospital systems can take advantage of that. It’ll take a load off of our EMS system, it’ll take a load off of our ERs, the folks in there can take care of the heart attacks and the brain bleeds that are coming into the door, instead of devoting all their time to this.”

According to Boyle, Lauren’s Wish has had 152 clients go through their system and be placed in an aftercare or recovery process like a sobering center or medium or short-term rehabilitation stays.

Blankenship said the Jacob’s Ladder program has been in existence for seven years and has a success rate of 75 percent. He credits the program’s success to the time they give their patients to heal, noting the first two weeks of a 28-day stay would be spent in withdrawal.

“There’s something to be said about time when you’re talking about healing the brain and that’s what addiction is, it’s a brain disorder that can be healed with time and the appropriate treatment,” Blankenship said.

Del. Heather Tully, R-Nicholas, asked Blankenship how Jacob’s Ladder is able to keep track of their patients years into their recovery in order to study the outcomes of this type of treatment.

Blankenship credited the strength of the alumni community of Jacob’s Ladder for a portion of their long-term success but also noted the organization has weekly and monthly contact with each person and is able to tell if they’ve relapsed or struggling.

“That doesn’t mean that none of them relapse,” Blankenship said. “The difference in a relapse from a graduate from Jacob’s Ladder, for instance, versus someone who had spent 28 days, is you find out about it immediately, as soon as they use they’ve picked up the phone, someone’s noticed something, they didn’t make a meeting, they didn’t make a commitment that they had. We know pretty early on. And it’s so much easier to deal with that type of a bump in the road, rather than a full-blown relapse, where you’re out six months, using again.”

Blankenship said the cycle of the 28-day treatment model is inefficient and costly.

“The unfortunate part about the 28-day [treatment], and I hate to even suggest this, but they’re incentivized to have folks relapsed and come back because they can just keep billing, you know, you can’t go for longer than 28 days,” Blankenship said. “But if you relapse next week, come back, I got four more weeks I can bill for. So they don’t really have the incentive to make sure that these folks are out there doing healthy things for the next 10 years, which is what our goal is.”

Del. Amy Summers, R-Taylor, referenced a presentation from an earlier meeting of the Legislative Oversight Commission on Health and Human Resources in which Cindy Beane, commissioner of the Bureau for Medical Services, testified to the implementation of Senate Bill 419 from the 2022 West Virginia Legislative session.

“It’s very difficult for a residential provider to basically track that person who is now not even in the county that they treated the person in a whole other county that might be across the state,” Beane said. “So it’s very difficult for the expectation of the bill for somebody to basically track somebody three years down the road.”

Senate Bill 419 directed the state Department of Health and Human Resources, through the Bureau for Medical Services, to establish a pilot project to evaluate the impact of certain post-substance use disorder residential treatments in West Virginia.

“We had a presentation yesterday through a committee where recovery treatment centers, as you say, are possibly incentivized to have people come back because that’s how they make money,” Summers said. “They think that it’s too difficult to be able to follow people because they say when they leave, they leave and they don’t have the technology to do it. It sounds like you make a phone call.”

Blankenship said the graduates of Jacob’s Ladder are like a family and schedule face-to-face time with one another to check in for coffee or lunch. Also, to enter into the program, the person has to be serious about their recovery. He also noted that 80 percent of people who go through a 28-day program will relapse within three months.

Senate President Proposes Death Penalty For Fentanyl Wholesale Distributors

State Senate President Craig Blair, R-Berkeley, said he plans to draft legislation that calls for the death penalty after conviction for the illicit manufacturing or wholesale distribution of the illicit drug fentanyl.

This is a developing story and may be updated.

Updated on April 18, 2023 at 8:13 a.m.

A sentence was removed on April 18, 2023 at 10:04 a.m due to a lack of verification

“It’s devastating our children, it’s devastating our schools, exhausting our teachers, overwhelming our foster care system, stressing out emergency services, our hospitals, our law enforcement and more,” Blair said. “And worst of all, it’s destroying our families and our communities.”

The DEA defines fentanyl as a potent synthetic opioid drug approved by the Food and Drug Administration for use as an analgesic (pain relief) and anesthetic. It is approximately 100 times more potent than morphine and 50 times more potent than heroin as an analgesic. An Associated Press report notes that since 2000, West Virginia has had by far the highest rate of opioid-related deaths in the nation. Blair said the deadly inclusion of fentanyl into other drugs is pervasive and growing.

He said capital punishment would be the ultimate deterrent for those bringing fentanyl into West Virginia.

“Most of the time, these people aren’t addicts that are actually manufacturing and or distributing on the wholesale level,” Blair said. “What they’re doing is they’re just making profits off the very people that are addicted to it. I want to tell everybody that is actually using heroin and fentanyl that it’s time to get help, get clean, or get out of the state of West Virginia.”

Blair said there would need to be a line of demarcation defined between a street user and a distributor. Currently, W. Va. Code § 60A-4-414 says:

(1) If the net weight of fentanyl involved in the offense is less than one gram, such person shall be imprisoned in a correctional facility not less than two nor more than ten years.

(2) If the net weight of fentanyl involved in the offense is one gram or more but less than five grams, such person shall be imprisoned in a correctional facility not less than three nor more than fifteen years.

(3) If the net weight of fentanyl involved in the offense is five grams or more, such person shall be imprisoned in a correctional facility not less than four nor more than twenty years.

“A pound of fentanyl would kill every person in any given county in this state,” Blair said. “So yes, you’re gonna have a line of delineation. I’m not looking for the guy on the street, that’s a drug addict who can get help.”

West Virginia abolished the death penalty in 1965, the last execution was in 1959. Blair says reinstating capital punishment for manufacturing or wholesaling fentanyl could come with legislation.

“The legislature would actually have to pass a statute,” Blair said. “There’s nothing in our constitution that prohibits it. And I wouldn’t even be opposed to putting a constitutional amendment on the ballot and doing it.”

Blair said those found guilty under his bill should be put to death by a lethal injection of fentanyl.

He said he will spend the next couple months putting a comprehensive plan together on a death penalty bill for fentanyl wholesale distribution, with a goal of setting a national example.

“With this law, West Virginia will become a leader once again in the nation on how we’re dealing with the problems that we have in this state,” Blair said.

New WV-ACLU President Danielle Walker issued the following statement regarding Blair’s death penalty proposal:

The death penalty is state-sanctioned murder, period. West Virginia wisely abolished this form of cruel and unusual punishment nearly 60 years ago, and there is no reason to resurrect it now. There is no evidence that capital punishment deters crime and plenty of evidence that it kills innocent people. The ACLU will use every tool at our disposal to make sure the death penalty never returns to West Virginia.

‘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.”

New Book Highlights 100 Things To Do In The Mountain State On This West Virginia Morning

On this West Virginia Morning, “100 Things to Do in West Virginia Before You Die” is a new book to help locals and visitors explore the Mountain State. Inside Appalachia Producer Bill Lynch spoke with Melody Pittman, who co-authored the book with Angela Richards.

On this West Virginia Morning, “100 Things to Do in West Virginia Before You Die” is a new book to help locals and visitors explore the Mountain State. Inside Appalachia Producer Bill Lynch spoke with Melody Pittman, who co-authored the book with Angela Richards.

Also, in this show, the future of a West Virginia power plant has become an issue in Kentucky’s Republican gubernatorial primary. Curtis Tate has the story.

And 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.” Appalachia Health News Reporter Emily Rice has more.

West Virginia Morning is a production of West Virginia Public Broadcasting which is solely responsible for its content.

Support for our news bureaus comes from West Virginia University, Concord University, and Shepherd University.

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

Assistant News Director Caroline MacGregor produced this show.

Listen to West Virginia Morning weekdays at 7:43 a.m. on WVPB Radio or subscribe to the podcast and never miss an episode. #WVMorning

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.”