As fentanyl overdose deaths rise nationally, West Virginia health care providers are looking for new ways to support veterans struggling with substance use disorder or mental health issues.
As fentanyl overdose deaths rise nationally, veterans face new challenges overcoming historic barriers to health care.
Mark Mann, chief of staff for mental health services at the Martinsburg VA Medical Center (VAMC), said that West Virginia’s veteran community has been no exception to this struggle.
“The VA is doing a good job of curbing that, but we still are losing veterans every year to poisoning from fentanyl and other things that are mixed into the drugs,” he said.
Veterans have long faced bureaucratic difficulties and stigma when seeking support for substance use disorder. But the rising prevalence of fentanyl has also tested current mental health resources for veterans, requiring new strategies.
In response, health care providers at the VAMC are working to expand current resources to better serve veterans struggling with substance use disorder and other forms of mental illness.
On Friday, medical professionals and members of the local community gathered at the facility for a summit on substance use disorder among veterans.
The event featured discussions from both national and local medical professionals, who discussed substance use disorder among veterans at large and specific services at the VAMC supporting veterans’ mental health needs.
Those resources include traditional medical resources, like residential inpatient services, intensive outpatient programs and medication-assisted therapies, Mann said.
But it also includes providing a full “continuum of care,” supplementing medical services with social interventions and support.
In 2022, Mann said staff members at the VAMC helped advocate for the creation of a three-digit hotline number for suicide and mental health crisis intervention, 988.
Joseph Liberto, national mental health director for substance use disorders at the Department of Veteran Affairs Office of Mental Health and Suicide Prevention, answers audience questions.
Photo Credit: Jack Walker/West Virginia Public Broadcasting
Some veterans who contact the hotline are put in touch with the VAMC, who can then provide follow-up services and ensure they are safe.
Mann said providing a simple and remote resource like this has helped the VAMC provide more immediate support to veterans in need, and keep lines of communication open once patients step off the facility’s Martinsburg campus.
The VAMC has also created on-campus resources that provide counseling, like a chaplain assigned specifically to support veterans with difficulties surrounding mental health or substance use.
Roosevelt Brown, chief chaplain at the VAMC, said that the creation of this position allowed the VAMC to directly help local veterans, and point them to resources specific to their mental health needs.
“Part of what we’re doing now is trying to say, ‘Hey, how can we make sure we open the door and let them know that we have services available for them?’” he said.
As chaplains, Brown said that he and his colleagues offer spiritual or emotional guidance to patients at the VAMC, and also encourage them to access specific resources that could support them through periods of difficulty.
Brown said that fewer people used the VAMC’s chaplain services during the COVID-19 pandemic, but that turnout has returned to pre-pandemic levels with the creation of these new resources.
He added that he hopes this trend will continue, and that the VAMC will be able to further support veterans struggling with substance use disorder.
“We’re motivated to do something about those who need help,” he said. “My hope is that what we can do is [bring] a better quality of life [to] veterans.”
This year every county in West Virginia, except Cabell County, is set to begin receiving opioid settlement funds, totalling over 400 million dollars from a nearly statewide lawsuit that was won in 2022.
Cabell County, and its largest city, Huntington, decided to bring their own joint lawsuit. They lost that suit in 2022, despite suing with the same claim that was used in successful state and nationwide lawsuits that the pharmaceutical companies had created a “public nuisance.”
This year every county in West Virginia, except Cabell County, is set to begin receiving opioid settlement funds, totaling over 400 million dollars from a nearly statewide lawsuit that was won in 2022.
Cabell County, and its largest city, Huntington, decided to bring their own joint lawsuit. They lost that suit in 2022, despite suing with the same claim that was used in successful state and nationwide lawsuits that the pharmaceutical companies had created a “public nuisance.”
The judge presiding over the case, U.S. District Judge David Faber, had a narrower interpretation over what constitutes a public nuisance than other judges on previous cases. The city and county appealed the decision.
Now the U.S. 4th Circuit Court of Appeals, which is considering the case, has asked the West Virginia Supreme Court of Appeals to answer a critical question: “Under West Virginia’s common law, can conditions caused by the distribution of a controlled substance constitute a public nuisance and, if so, what are the elements of a public nuisance claim?”
If the Supreme Court determines that those conditions do constitute a public nuisance claim then the case can proceed. Otherwise, the case against the pharmaceutical companies is dead.
Huntington Mayor Steve Williams said the nearly 100 million pills that were distributed to his city of less than 45,000 residents led to thousands of overdose deaths — and he hopes the courts see it that way as well.
“We remain hopeful that the court will find that under West Virginia law,” Williams said. “The City of Huntington and Cabell County had the right to file its claim that distributors of opioids can be held accountable for flooding the market with opioids and the resulting devastation of the opioid epidemic.”
Huntington was one of the hardest hit communities by the opioid epidemic. According to city officials, 1 in 10 residents is currently, or has been addicted to opioids. Williams said he is happy that the effort is still alive, so that the community can continue to heal.
“The reason that we need a settlement is to be able to rebuild and build back our community,” Williams said. “In a way that we can create a level of resilience to be able to overcome the curse that was placed on our community as a result of the greed of those companies.”
West Virginia Public Broadcasting reached out to the three pharmaceutical companies in the lawsuit, AmerisourceBergen, McKesson and Cardinal Health, but did not hear back in time for broadcast.
Authorities said Joel Smithers headed a drug distribution ring that contributed to the opioid abuse crisis in Kentucky, Ohio, Tennessee, Virginia and West Virginia.
A Virginia doctor who was sentenced to 40 years in prison after prescribing more than half a million doses of highly addictive opioids in two years has been granted a new trial by a federal appeals court that found the instructions given to jurors at his trial misstated the law.
Joel Smithers was convicted in 2019 of more than 800 counts of illegally prescribing drugs.
During his trial, prosecutors said patients from five states drove hundreds of miles to see him to get prescriptions for oxycodone, fentanyl and other powerful painkillers. Authorities said Smithers headed a drug distribution ring that contributed to the opioid abuse crisis in Kentucky, Ohio, Tennessee, Virginia and West Virginia.
In a ruling issued Friday, a three-judge panel of the Richmond-based 4th U.S. Circuit Court of Appeals vacated Smithers’ convictions and ordered a new trial.
Jurors at Smithers’ trial were instructed that in order to find Smithers guilty of illegally prescribing drugs, they must find that he did so “without a legitimate medical purpose or beyond the bounds of medical practice.”
But the appeals court found that that jury instruction was improper, citing a 2022 U.S. Supreme Court ruling that said a defendant must “knowingly or intentionally” act in an unauthorized manner to be guilty of that charge. Even though the jury convicted Smithers in 2019, his case was subject to the 2022 Supreme Court decision because his appeal was still pending when that ruling was issued.
Justice Roger Gregory, who wrote the 3-0 opinion for the 4th Circuit panel, cited Smithers’ testimony at his trial, when he said almost all of his patients had had significant car or workplace accidents and that he believed there was a legitimate medical purpose for each of the prescriptions he wrote. Gregory wrote that even though “a jury might very well not have believed Smithers’ testimony that he acted with a legitimate medical purpose,” the defense provided evidence that could have led to a finding of not guilty on each of the unlawful distribution charges against Smithers.
“In sum, because there was evidence upon which a jury could have reached a contrary finding, the instructional errors were not harmless,” Gregory wrote.
During Smithers’ trial, a receptionist testified that patients would wait up to 12 hours to see Smithers, who sometimes kept his office open past midnight. Smithers did not accept insurance and took in close to $700,000 in cash and credit card payments over two years, prosecutors said.
“We understand the 4th circuit decision following a recent change in the law and look forward to retrying the defendant, ” U.S. Attorney Christopher Kavanaugh said in a statement Monday.
Beau Brindley, an attorney for Smithers, said that since the 2022 Supreme Court decision, “only one thing decides a doctor’s guilt or innocence: his own subjective beliefs about his prescriptions.”
“Under this new legal standard, with the focus now solely on his intent, Dr. Smithers looks forward to being fully exonerated at trial,” Brindley said in a statement.
In the mountains of Eastern Kentucky, jobs are scarce, and an opioid crisis continues to inflict pain throughout the region. But where many see hopelessness, Doug Naselroad, a master luthier from Hindman, Kentucky, sees an opportunity to help those in need.
In the mountains of Eastern Kentucky, jobs are scarce, and an opioid crisis continues to inflict pain throughout the region. But where many see hopelessness, Doug Naselroad, a master luthier from Hindman, Kentucky, sees an opportunity to help those in need.
Naselroad founded a nonprofit instrument manufacturer, The Troublesome Creek Stringed Instrument Company, to train and employ people in recovery, helping them find purpose and belonging as they work their way through recovery.
This short film explores Doug’s mission and the positive impact he and his team have had on a region and its people.
Watch this special Folkways story below:
The Troublesome Creek Stringed Instrument Company strives to make beautiful handcrafted instruments, including dulcimers, guitars and mandolins.
Credit: Curren Sheldon/West Virginia Public BroadcastingTroublesome Creek employee Anthony works on a guitar.
Credit: Curren Sheldon/West Virginia Public BroadcastingFounder and master luthier Doug Naselroad checks the sound of a guitar in progress.
Credit: Curren Sheldon/West Virginia Public Broadcasting
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This story is part of the Inside Appalachia Folkways Reporting Project, a partnership with West Virginia Public Broadcasting’s Inside Appalachia and the Folklife Program of the West Virginia Humanities Council.
The Folkways Reporting Project is made possible in part with support from Margaret A. Cargill Philanthropies to the West Virginia Public Broadcasting Foundation. Subscribe to the podcast to hear more stories of Appalachian folklife, arts and culture.
School mental health professionals from across the state had the opportunity to learn how to address mental health challenges and more in their classrooms.
The state Department of Education hosted a conference in Charleston to raise awareness of trauma, opioid addiction, and mental health challenges in schools, and to provide teachers, school counselors and other professionals with tools and strategies to address these issues.
The Student Support Conference is being held Nov. 29 through Nov. 30 at the Charleston Coliseum and Convention Center.
David Lee is the director of student support and wellbeing for the West Virginia Department of Education. He said teachers, and especially new teachers, aren’t always equipped to handle what they see in a classroom.
“So how do I know what to look for, for the emotional problems of a child? How do I address those issues? How do I learn to de-escalate situations in my classroom?” Lee said.
The conference is a chance to support professionals who are working in schools by teaching them ways to identify and address mental health and trauma in their students to better help them succeed in school and life.
“We’re dealing with kids that are coming from very difficult situations at home, and they’re walking in school, and we’re expecting them to just be normal, and that’s not possible with some of the situations that they are facing,” Lee said. “So how do we address that? How do we work with the counselors? How do we work with communities and schools?”
According to Lee, student mental health issues continue to rise because of the ongoing opioid epidemic in the state and recovery from the global COVID-19 pandemic.
“We’ve got to start teaching behaviors because we got kids that come to school that have no clue about behaviors,” Lee said. “Did COVID have a lot to do with that? It did, yes. But we’ve had these problems before. They’ve been masking a lot of ways, but now they are really showing their true colors right now, because of the isolation that kids went through.”
Lee said he hopes this training makes teachers proactive in their classrooms and teaches them to act instead of react to potential behavioral issues that may arise from problems at home.
“You’re not gonna solve all the problems in high school right now, that’s not going to happen,” Lee said. “But you’ve got to start a building block and I really think in the K through three, teaching those behaviors, modeling those behaviors and what it should be like, is a good foundation.”
Kim Holstein is the lead for the Quick Response Team — an organization with Boone County Health — that follows up with people who are struggling with addiction in the community. A cardiac arrest call was dispatched, but since Narcan was given, they will follow up within 48 hours to see if the individual will consider going to a substance use treatment center.
Kimberly Holstein’s morning starts off by comparing charts turned in by first responders. Every day she arrives at the office, located in the Boone County Health Department, before anyone. She sips coffee, and compares two spreadsheets.
She looks for signs of a drug related call. She points to an EMS call dispatched for cardiac arrest, but then discovers that on the Narcan report, it shows Narcan was administered at that address shortly after the call.
She said this is common because people are too ashamed or afraid to admit that the call is for an overdose.
“I think it’s also just the stigma of being truthful with the situation in your home, especially for a parent,” Holstein said. “What parent wants to call 911 and say that their son is unconscious in the bathroom, and that they are using heroin in your home? That’s probably a really hard phone call for a mother to make.”
For Holstein, this work is personal. Her step-daughter and brother suffer from addiction to opioids.
Credit: Briana Heaney/West Virginia Public Broadcasting
Holstein is the lead for the Quick Response Team (QRT) — an organization with Boone County Health — that follows up with people who are struggling with addiction in the community. For the cardiac arrest call, since Narcan was given, they will follow up within 48 hours to see if the individual will consider going to a substance use treatment center.
They also receive recommendations to check on people from police officers or community members who witness signs of drug use.
The Team
At 8 a.m., the peer support team comes in and circles up for a morning meeting. Holstein tells them where and who they need to go check in on. Many of them are in recovery themselves, and they are all from Boone County.
Barry Stowers, one of the peer support specialists, is an animated guy, with glasses and a beard.
“I feel like we’re kind of like a middleman, we exist to help connect people to the type of treatment that they need,” Stowers said. “We follow up on these overdoses and they don’t always take us up on the first time around. But that’s why we meet with them multiple times.”
Casie Dillon (left) and Barry Stowers (right) both work on the quick response team. They are both in recovery from opioid addiction. They said this work takes a toll on them but is gratifying when they can help someone.
Credit: Briana Heaney/West Virginia Public Broadcasting
He and the five-person team travel around the county handing out food, Narcan, hygiene supplies — and they talk to people about options for recovery.
“If they say that they’re fine with us coming back, we kind of put them in the driver’s seat. So we don’t force them to do anything that they don’t want to do. But we let them know there’s options,” Stowers said.
That day, they visit the man who overdosed the night before and received Narcan. Holstein knew him and calls to talk to him. The QRT had taken him to a treatment facility before. It wasn’t a good fit, he tells her, because it was a hospital and he had a lot of stress from being in the hospital before. But he said he was ready to try a new place, so she tells the QRT about their discussion in that morning’s meeting.
“Called him with no answer,” she explains to the team. “But it doesn’t mean he backed out because the last conversation I had with him on the phone was to go ahead and take a shower and start getting ready, because we’re gonna figure out a bed [for him] no matter what.”
The team heads out to talk to him, and possibly take him to a substance use facility. These things are tentative Holstein said, he could back out. Holstein opens his file and writes that, for future reference — he does not want to go to a hospital.
The team works with people’s preferences and takes them places they will feel comfortable. They never send someone to a place they have not checked out themselves.
“It’s really important we vet the facility before we take someone from our community there,” Holstein said.
Boone County has nearly 21,000 people and 508 square miles. These binders break it down to four zones. They keep track of who is where, and what they need. It’s where Kim writes down preferences of community members they have worked with.
Credit: Briana Heaney/West Virginia Public Broadcasting
The Courts
Holstein then goes to the county courthouse. She works closely with the courts, advocating for, and weighing in on, court decisions for people the QRT is trying to help.
“So this last year the magistrate court here in Boone County, between Magistrate [Danny] Moore and Magistrate [Niel] Burnside, has allowed us to send 59 people to treatment through their courtroom,” Hostien said.
This morning she has a meeting with Moore. He said working with QRT has given him more options for rehabilitation for some of the people he sees in his courts – and has helped the community in doing so.
“Allowing them to step in and offer help has made a tremendous turnaround,” Moore said. “That’s the reason why you see some of the numbers going down in this county.”
In this meeting, Moore and Holstein figure out a plan for one of the people in the court system, to have charges dropped if she graduates from her rehabilitation facility.
“He told her that if she graduated with no issues that he would consider wiping that out because it was trespassing. She’s estimated to be [graduated by] Dec. 27,” Holstein said.
The Police
Holstein leaves the magistrate court and heads to the sheriff’s office for a meeting with Sheriff Chad Barker. They discuss different families and people in the area.
Barker said the QRT has worked with the police force and helped change attitudes about drug use in the area. He said at first officers were hesitant about the QRT, and it was hard to get every officer to carry Narcan with them. Now, officers are happy to work with QRT and reach out to them often.
This is one of the vehicles the team takes out.
Credit: Briana Heaney/West Virginia Public Broadcasting
At the end of the meeting, Barker asks Holstein to check on a woman in the community he saw when responding to a call at a house down the street. Barker said the woman looks like she may be in crisis.
Holstein heads down there. The woman doesn’t answer, so they leave a note on her door handle. If she needs anything, she can call them.
The Money
The QRT team is entirely grant funded. Holstein found out earlier that day that the team received a grant to fund transportation for people coming out of recovery. Soon the QRT will be able to give rides to doctor’s appointments, prescription fills or jobs.
Holstein wants the QRT to be able to do more to help keep people off drugs and to help prevent drug use in the area through education. But they need more money to do it.
One option is the $1 billion opioid settlement money coming to the state. Boone County expects $2 million to $3 million, according to West Virginia First settlement documents.
A bulletin board featuring photographs of the many efforts of Boone County’s QRT workers.
Credit: Briana Heaney/West Virginia Public Broadcasting
“I hate how this money came about, and that so many people lost their lives for this money to be available,” Holstein said. “On the other hand, I have to look at how many lives can change because of that.”
Holstein said the next step for the QRT is to focus on more assistance for those coming out of rehab by strengthening programs that connect them to housing and jobs, and even access to mental health care.
“We’re gonna keep them in sobriety for X amount of time. But where are they gonna go past that? Once that court case is over? What options do we have?” She said, “Right now, our county has none.”
Many families in Boone County have been affected by the opioid epidemic. Holstein said it’s not uncommon for a child to be living in a home with a family member who is struggling with addiction.
“We also need to focus on just the mental health side. These kids, they have PTSD. They went through addiction with their family, sometimes multiple generations of addiction. They have experienced the worst of the worst,” Holstein said.
Boone County QRT won the West Virginia Exemplary Program of the year by West Virginia Department of Health and Human Resources.
Credit: Briana Heaney/West Virginia Public Broadcasting
Between 2014 and 2020, Boone County was at the epicenter of the opioid epidemic, with one in four residents holding an opioid prescription.
The West Virginia First Foundation, which is responsible for distributing the money from the opioid settlement, had its first meeting Nov. 6.
The Winding Road Back
On the drive back to the office, a little red Volkswagen bug stops in the middle of the street. Holstein stops, too.
Out of the Volkswagen came a tall young man, with dark blond hair. He looks back at Holstein, his arms open in an embrace.
“I’m headed down to the courthouse,” the man said. “I got to head down to the courthouse and get my dismissal papers.” This is Hunter Gillispie — he’s someone the QRT helped into recovery.
“Okay good deal, see you soon!” Holstein said as they exchanged a hug and held up traffic for a few seconds.
Both Gillispie’s parents were addicted to opioids. As a teenager, he had been shot in the face by his uncle in a dispute over drugs.
After their embrace, they both get back in their vehicles.
“Him and his sister went through recovery at the same time,” Holstein said. “They are the first ones in three generations who’ve made it.”
Now, Gillispie is a year sober and works on a river boat. Holstein said he is one of QRT’s success stories. She said people like him are why she works so hard everyday to expand her program.
