Opioid Emergency: How Trump’s Plan Will — And Won’t — Help The Ohio Valley

As bad as the opioid epidemic is across the nation, it is even worse here in the Ohio Valley.

Kentucky, Ohio and West Virginia collectively have a rate of opioid-related deaths that is more than twice the national average.

Last year 5,306 people died from opioid overdoses in the three states — 15 deaths a day. That means that 13 percent of all opioid deaths in the nation occurred in a region with just over 5 percent of the country’s population.

And overdose deaths are just part of the picture. The opioid epidemic reverberates through a community’s hospitals, workplaces, schools, families, even into the arriving generation, as babies are born affected by the drugs in their mothers’ bodies.

So when the president declared this crisis a public health emergency, people in the Ohio Valley were eager to know how that declaration might help with the specific needs of this region, where people struggling with addiction are often in rural, less-affluent communities.  

The president’s address included poignant examples from the Ohio Valley’s unfolding tragedy. But thus far the administration’s emergency plan includes frustratingly few specifics or funding options to meet the challenge in the place that is ground zero for the greatest drug crisis the country has ever faced. 

Presidential Recognition

The president’s address made clear that his emergency plan was inspired by the Trump family’s  experiences in the Ohio Valley.

“In West Virginia, a truly great state, great people, there is a hospital nursery where one in every five babies spends its first days in agony,” the president said. “Because these precious babies were exposed to opioids or other drugs in the womb.”

First Lady Melania Trump invited people who deal with addiction across the country — many from the Ohio Valley — to the White House in September to hear their stories.

She followed that meeting up by visiting Huntington, West Virginia, earlier this month to tour Lily’s Place. The clinic treats infants born drug affected and offers resources to both baby and family.

Credit Courtesy White House, Office of the First Lady
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First Lady Melania Trump with an infant born affected by opioids.

“I learned that to help babies succeed we must help their parents by placing priority on the whole family,” Trump said during her speech Thursday. “Lily’s Place is giving infants the best opportunity.”

West Virginia is one of the hardest hit areas for babies born with what’s known as neonatal abstinence syndrome. Five percent of babies born in West Virginia last year were born drug affected, according to data from the state’s Health Statistics Center.

Lily’s Place was the first facility of its kind and draws deserved praise for its pioneering work. However, elsewhere in rural parts of West Virginia there are few options for pregnant women who have substance use disorders. Only 23 percent of the state’s treatment facilities offer services for pregnant women, and the options have been declining.

Earlier this year, West Virginia had 24 substance abuse treatment facilities that were equipped to treat pregnant or postpartum women. Just 10 months later, that number is down to 20 facilities, with some counties losing their substance abuse treatment programs altogether.

Sixteen of the state’s counties have no treatment clinics of any kind.

Similar challenges exist in rural parts of Kentucky and Ohio, where tight budgets and transportation problems make it especially difficult to deliver addiction treatment.

Several key elements of the administration’s public health emergency declaration address rural treatment issues but the plan so far lacks the promised funding. That, coupled with a lack of communication and coordination with regional organizations on the front lines of addiction raise concerns.

Telemedicine’s Promise

The first item listed in the White House proposal released Thursday is aimed at using telemedicine systems to get treatment to rural areas, where waiting lists can be weeks or months long.

Some treatment centers in the Ohio Valley region have been offering telemedicine for some time for other aspects of their services.

Health Recovery Services –with treatment centers across southeast Ohio– uses video conferencing to deliver psychiatric services.

“It was useful,” former director Dr. Joe Gay said. “It did expand capacity.”

Part of Trump’s proposed expansion allows doctors to prescribe addiction treatment medication through telemedicine. Gay said the success of the initiative will depend on how well it is monitored.

“There’s a danger that could lead to more misprescription of the drugs used to treat opioid disorders,” Gay said. “Which can be a problem too.”

Credit Aaron Payne / Ohio Valley ReSource
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Ohio Valley ReSource
Dr. Joseph Gay said there is strong science supporting medication assisted treatment for addiction.

Medication assisted treatment is a critical element in a holistic addiction treatment plan. But the medications buprenorphine and methadone, frequently used to wean someone from addiction to heroin or painkillers, are also opioids. And they can further the cycle of addiction if not taken properly.

Offering telemedicine in the most remote areas being affected by the addiction crisis may present a challenge. Data show broadband internet required to host video chat is lacking in parts of the Ohio Valley.

“Most treatment programs would have the technical capacity to do it,” Dr. Gay said. “It could be some problem. But it could be an improvement, too.”

Maximizing Medicaid

Advocates say another proposal in President Trump’s plan could open up more treatment beds by rolling back some regulatory restrictions.

“We will announce a new policy to overcome a restrictive 1970s-era rule that prevents states from providing care at certain treatment facilities with more than 16 beds for those suffering from drug addiction,” Trump said.

What’s known as the Institutions of Mental Disease exclusion was established as behavioral health treatment was trying to move away from large institutions that “stuffed” patients in and neglected them.

Unfortunately, that well-intended exclusion now prevents federal Medicaid dollars from being spent on addiction treatment and recovery services in facilities with more than 16 beds. This creates a situation where there are waiting lists for services and available space at the same time.

Jeff Myers, CEO of Medicaid Health Plans of America, said the exclusion also led to a fragmentation in behavioral health, addiction, and physical health services needed to treat a person struggling with a substance use disorder.

“States are now realizing that that fragmentation leads to poor health outcomes and more costs,” he said. “And they’re moving all those things back together.”

The Centers for Medicare and Medicaid Services in 2015 offered states flexibility from the exclusion if they created adequate service delivery systems. 

West Virginia was one of the states that applied for the opportunity and received an acceptance letter from CMS earlier this month. Kentucky’s request is still pending. Ohio has no active or pending request.

President Trump vowed to issue waivers in a more timely fashion during his speech but it has not yet been included in any documentation from the administration. Repealing the exclusion altogether would be up to Congress. And legislation has been proposed that would lift the cap from 16-bed facilities to 40 beds.

Advocates say lifting the exclusion could open up residential treatment services that may have been limited before.

“One of the biggest things you have to do is get individuals [with addiction] out of their social milieu,” Myers said. “To get them separated and really looking at how to address their addiction.”  

Workplace Effects

The public health emergency plan also includes measures to address the effects the opioid crisis has had on the Ohio Valley’s labor force.

The Department of Labor will issue dislocated worker grants to help people who have been unable to reenter the workforce after reaching recovery.

Addiction treatment specialists say employment is an important aspect of long-term recovery because it provides people the means to deal with other difficulties.

“If the work problem can be solved, often the housing problem can be solved,” Dr. Gay said. “The people who seem to do the best are the ones that get back into the workforce.”

Some companies in the Ohio Valley have already embraced these workers in recovery as part of their drug free workplace policies.

The Ziegenfelder frozen treat factory in Wheeling, West Virginia, found their role in combating the epidemic by offering people in recovery an opportunity.

Credit Glynis Board / West Virginia Public Broadcasting
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West Virginia Public Broadcasting
Ziegenfelder employee Sonny Baxter helps coach workers with addiction

“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.”

The catch for Trump’s proposal is it states the grant availability is “subject to available funding.”

Money Matters

The Trump administration promoted the $1 billion already dedicated to the opioid epidemic, largely through the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act. However the emergency plan does not directly dedicate any new funding sources to meet what experts say is a multi-billion-dollar problem.

The fund for Public Health Emergencies is limited, as it was recently reported to have a total of approximately $57,000.

White House officials told reporters that they would be urging Congress to appropriate an unspecified amount of money into the fund for use in combating the opioid crisis in an end-of-year spending bill.

There is also the issue of how long the additional funding, if any, will last.

Public health emergencies expire after 90 days. The Health and Human Services Secretary can renew the declaration until the targeted issue is deemed under control.

Advocates say these initiatives will need large and sustained funding if they are going to be successful.

For example, if more states receive the exclusion waivers for Medicaid payments, more facilities will be charging Medicaid for their service. And that will require more funding in Medicaid. 

“We would hope there would be additional financial resources to allow the states to use them when appropriate,” Myers said.

Trump and the Republican-led Congress have attempted to roll back Medicaid expansions in their attempts to repeal the Affordable Care Act.

Addiction specialists worry that if Trump’s campaign promise of repealing Obamacare is successful the Medicaid expansion that facilitated more access to treatment will go away.

Data from a Harvard/NYU study indicates that in Kentucky, Ohio, and West Virginia nearly 215,000 additional people were able to seek mental health and addiction treatment after the Medicaid expansion.

Little Coordination

Some advocates are also disappointed in how the emergency declaration was developed.

The idea gained traction when President Trump’s commission on opioids released an interim report in May suggesting a national emergency or public health emergency.

A national emergency declaration is different from a public health emergency in that more funding is available to be distributed faster. It also would have allowed for more regulatory power to immediately implement initiatives to combat the opioid crisis.

Trump told a group of reporters in August that he intended to declare the opioid crisis a national emergency. This was two days after then-secretary of HHS Tom Price said such a move was unnecessary.

Months passed with no action on the matter.

Most of the state health officials and drug control organizations the ReSource spoke to had not heard from the White House seeking input specifically for this declaration.

Credit Mary Meehan / Ohio Valley ReSource
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Ohio Valley ReSource
David Shadd and Stephanie Raglin run substance abuse programs in Lexington, KY, treating 700 people.

Thursday was the first time many working in addiction and recovery had heard what the plan was.

Stephanie Raglin directs Women’s Hope Center, which offers recovery services in Lexington, Kentucky. She is cautiously optimistic about the emergency plan. But she will be one of many who wait to see what follow up actions the administration takes.

“Hopefully he will listen to those who are out in the field who are doing the leg work,” she said.

Trump said he will have more action on the issue soon as a presidential commission on the opioid crisis issues its final report, perhaps as soon as the first week of November.

Trumps Cite Ohio Valley Experience In Opioid Emergency Plan

President Donald Trump outlined on Thursday his long-awaited plan to address the opioid crisis as a national public health emergency. Part of that plan was based on experiences in the Ohio Valley region.

In an address at the White House Thursday both President Trump and First Lady Melania Trump mentioned efforts in the Ohio Valley region to help infants affected by the crisis.

Trump said that a hospital nursery in West Virginia treats one in every five babies for symptoms of addiction.

“Because these precious babies were exposed to opioids or other drugs in the womb,” he said.

According to data from the West Virginia Health Statistics Center, 5 percent of babies born in West Virginia last year were born drug-affected.

First Lady Melania Trump spoke about her recent visit to a Huntington, West Virginia, treatment center for infants and mothers called Lily’s Place.

“I learned that to help babies succeed we must help their parents succeed,” she said. “By placing priority on the whole family, Lily’s Place is giving infants the best opportunity.”

Lily’s Place director Rebecca Crowder was in the audience for the address.

The president’s public health emergency declaration could encourage additional resources for treatment facilities. The White House has not yet released details of the emergency plan or how the programs will be funded.

The rate of deaths from opioids in West Virginia, Kentucky and Ohio is more than twice the national average. On average last year, 15 people died each day in the three-state region from opioid overdoses.

Little Regional Coordination As Trump Unveils Delayed Opioid Emergency Plan

  Many lawmakers from the Ohio Valley region say they’ll be at the White House Thursday as President Donald Trump is expected to unveil a long-awaited emergency declaration to address the opioid crisis. The president is scheduled to speak on the issue 2 p.m. Thursday afternoon.

However, health officials and addiction treatment experts in Kentucky, Ohio and West Virginia — among the states hardest hit by the epidemic — say they’ve had little contact from the Trump administration as it developed the emergency response.

The President called opioid addiction “an emergency” in early August, but Trump’s address will be the first time many of the people combating the crisis hear what is in the administration’s emergency plan.

Some Hints

Women’s Hope Center Director Stephanie Raglin works in addiction treatment in Lexington, Kentucky. She said federal help is welcome but it concerns her that few seem to know who was at the table providing input for the emergency plan.

“We don’t even know what the plan looks like,” she said. “So the hope is to see what President Trump has to say and hopefully he will listen to those who are out in the field who are doing the leg work.”

None of the state health and drug control organizations the ReSource spoke to had heard from the White House seeking input specifically for this declaration.

But some recent activity hints at what Trump’s emergency plan might include.

First Lady Melania Trump invited those working in addiction from the region to the White House in late September to hear their stories. She followed up by visiting Lily’s Place in Huntington, West Virginia earlier this month to discuss treatment for babies born affected by opioids taken by pregnant mothers.

congressional oversight hearing Wednesday included five federal organizations working to combat the opioid crisis.

Dr. Anne Schuchat with the Centers for Disease Control and Prevention cited efforts in Kentucky to improve the monitoring of opioid prescriptions.

“Prompts were added to the prescription drug monitoring program to alert to high doses, which resulted in a 25 percent reduction in opioid prescribing to youth,” she said.

National Institute on Drug Abuse Director Dr. Nora Volkow pointed to work underway to create longer-lasting versions of the addiction treatment medication buprenorphine.

 “That would be a real game changer,” she said. “Especially for people who live in rural communities and face significant logistical challenges accessing treatment.”

“Can’t Afford It”

Regardless of the details the emergency measure will require one key ingredient:  proper funding.

West Virginia Republican Rep. David McKinley said in Wednesday’s hearing that securing federal funding has been an issue for small, rural towns that have been hit hard by the epidemic.

“Are we telling these little towns that have 200 to 300 people, ‘You have to get a grant writer to submit something for you?’” he asked. “They can’t afford it.”

The Ohio Valley region has a rate of opioid-related deaths that is twice the national average. In 2015, on average, 90 people a day died from a drug overdose in the US. Of those, 12 came from Kentucky, Ohio, or West Virginia. As of 2016 that number climbed to 17 deaths a day in the region — 15 of those due to opioids. 

The three state region is responsible for 13 percent of all opioid-related deaths in the country. About 85 percent of overdose deaths in the region involve an opioid. 

Melania Trump Tours West Virginia Infant Drug Rehab Center

First lady Melania Trump has toured a West Virginia drug addiction recovery center for infants in the heart of the nation’s opioid epidemic.

Trump visited Lily’s Place in Huntington on Tuesday. The nonprofit facility, the first of its kind in the nation, works with addicted mothers’ newborns who are enduring the torment of drug withdrawal. It also offers treatment to parents.

Lily’s Place Executive Director Rebecca Crowder was part of a group of experts and people affected by drug addiction who were to the White House last month.

During her trip Tuesday, the first lady told Crowder, “I want to hear what I can do to help.”

According to the Centers for Disease Control and Prevention, West Virginia has the nation’s highest rate of babies born addicted to drugs.

Melania Trump to Visit Lilly's Place in Huntington

First Lady Melania Trump is coming to West Virginia to visit a drug treatment facility for infants born to addicted mothers.

West Virginia Congressman Evan Jenkins says he’s grateful that Trump will bring attention to Lily’s Place in Huntington on Tuesday.

The long-term, privately operated facility opened in 2014. The facility works with newborns enduring the torment of drug withdrawal. It also works with addicted mothers in the hope that infants can be sent home to safe environments.

According to Jenkins, Lily’s Place Executive Director Rebecca Crowder talked to Trump last month during a White House event.

Two weeks ago, the first lady heard from experts and people affected by drug addiction whom she invited there for a discussion.

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