The nation’s drug czar visited West Virginia University Thursday as the start of a multi-day tour of the state. The purpose of the trip is to discuss local and national efforts to address the overdose epidemic.
The nation’s drug czar visited West Virginia University Thursday as the start of a multi-day tour of the state. The purpose of the trip is to discuss local and national efforts to address the overdose epidemic.
Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy led a panel of lawmakers, university and student leaders, including Dr. Clay Marsh, to discuss the Biden Administration’s National Drug Control Strategy.
He said he was happy to be back in what he considered his home, and that West Virginia is leading the nation in its response to the opioid epidemic.
“For several years, I’ve seen the work grow, the treatment sites get better and better, specifically in West Virginia as a model for the nation,” he said. “When we think about treatment, we in the Biden administration, until now, about $15 billion dollars have come through to West Virginia.”
Gupta previously served as the Commissioner of DHHR’s Bureau for Public Health and State Health Officer before becoming the first doctor to lead the Office of National Drug Control Policy when he was appointed in 2021.
He said the landscape of the overdose epidemic has changed, shifting towards synthetic drugs and predominantly online access to them and requiring a multidisciplinary approach. Gupta compared the state of addiction medicine and policy to cancer in the early 20th century.
“This is one of the most significant shifts in drug policy we’re making in the last half century. The President’s strategy, my office, our defense, is looking at two key drivers: untreated addiction and the lack of treatment infrastructure,” he said. “That’s no different than when we were with cancer a hundred years ago. A disease that was highly stigmatized, poorly resourced. Today, if you look at it, we treat with compassion and empathy, we’re on top of the world when it comes to diagnosing, treating and preventing cancer. That’s where we need to be with addiction mental health.”
Much of the day’s discussion revolved around the issues of mental health at the core of the epidemic.
“We really need to be looking at this as itself a crisis, mental health, and then obviously its overlap with addiction as well,” Gupta said. “So I applaud the work that is happening here. I think more schools K through 12, as well as nurses have to be engaged in mental health because it is a true challenge.”
Gupta will continue his tour Friday in Charleston and in Lewisburg Saturday, where he will visit the West Virginia School of Osteopathic Medicine.
The holidays can be a difficult time for many people, including those in recovery from substance misuse.Monongalia County Health Department Threat Preparedness specialist Joe Klass sat down with reporter Chris Schulz to remind listeners of the accessibility and usefulness of the overdose-reversing drug naloxone.
The holidays can be a difficult time for many people, including those in recovery from substance misuse.
Monongalia County Health Department Threat Preparedness specialist Joe Klass sat down with reporter Chris Schulz to remind listeners of the accessibility and usefulness of the overdose-reversing drug naloxone.
This interview has been lightly edited for clarity.
Schulz:Joe, can you start off here by just explaining to us what naloxone is?
Klass: Naloxone will actually kick opioid molecules off receptors in the brain and get people breathing again after they’ve suffered from an opioid overdose. When someone takes too much of an opioid – opioids are central nervous system depressants – it’ll basically make someone get very tired, eventually pass out, the breathing will slow, and eventually it may stop. When naloxone is administered, it reverses that effect by binding to those receptors in the brain and kicking the opioid molecules off those receptors.
Naloxone has actually been around for a long time as a medication. But only recently have we really seen its use skyrocket as far as overdose reversal. Naloxone works very well, and it works very fast, which is really one of the great benefits of it, and it’s very safe. One of the big things when we do naloxone training is reinforcing the fact that naloxone, if it’s given to someone who’s not suffering from an opioid overdose, it’s really not going to cause any detrimental effects to the person, at least not in the dosages that these people are going to be giving out on the street.
Schulz: Why do you think it’s important or useful for the general public to not only be aware of these medications, but also be ready to use them?
Klass: Currently, naloxone is now in your tool belt with CPR, Stop the Bleed (a national program that encourages bystanders to become trained, equipped, and empowered to help in a bleeding emergency before professional help arrives) and other public trainings. Not just because of the opioid epidemic, but also because you never know when you may need naloxone. Whether it be a child gets into a medicine cabinet, it could be an older individual who’s taking their prescribed pain medication, they may take too many. You really never know when you may need naloxone.
And the reason I think it’s really important to get that training for as many people as possible is not just because one, you never know when you’re going to encounter it, but two is naloxone works very well, and it’s as very safe. So it’ll most likely work and get that person breathing again. And you’ll give them another chance not only to live but, to get into recovery or get into other services they need.
Schulz: So, Joe, it is a holiday week here at the end of December as we speak. We often hear about the emotional impact of this time of year. Are you aware at all of any correlation between this time of year and overdoses?
Klass: I think there definitely is a correlation between holidays and increase in the potential isolation of individuals who don’t have family members or friends that they can kind of celebrate with. And obviously, that increased stress potentially is going to cause people to misuse substances or try to take solace in something else. And in some cases, that is going to be a substance that may hurt them.
Schulz: To the average person who may be interested in going through a naloxone training, what form would this medication come in?
Klass: There are multiple formulations of naloxone, both as far as the dosages and then also, as far as how they’re administered. It’s very common to have naloxone administered via the nose or intranasally, primarily because it’s pretty easy to administer it that way, and it works very well. It absorbs very quickly in the systemic circulation.
However, we also do have intramuscular, IM naloxone, which is given into a muscle basically like someone would get a vaccine or shot. There are a couple of different ways that can kind of be administered. Sometimes you can just draw it up from a vial and administer it that way. There are also different products that actually almost work like EpiPens, where it already has a dose drawn up for you and all you have to do is basically take the safety off and administer it.
I think really the most important thing is whether it be intranasal or intramuscular, it’s what do you have access to and what are you trained on using and what do you feel comfortable using?
Schulz: Part of the reason that I wanted to speak with you is that West Virginia Public Broadcasting recently received some information about one of these formulations that came kind of pre-packaged. And one of the things that was reported in that release was that with the increase in fentanyl related overdoses, there has been a need to sometimes double or triple the dosage of naloxone used when responding to an overdose.
Klass: From a general pharmacological standpoint, it absolutely is true that the more opioids you have in your system, and the higher the potency of the opioids, the more naloxone you’re going to need to reverse the effects. However, there are a lot of different factors that come into play as far as how many doses of naloxone will someone actually need to have the effects reversed because it has to be administered correctly. Depending on how much of an opioid the person took will dictate how fast it’s going to work.
If you do look at the data, it is true that we are seeing fentanyl in more and more things, and fentanyl is very potent. And there are, of course, numerous cases where people are having to administer more than one dose of naloxone whether it be intranasally or intramuscularly.
If you’re interested in naloxone training, contact your local health department for more information.
The Madison County health department in Kentucky has kept its harm reduction program open throughout the COVID-19 pandemic to continue its work against the other epidemic afflicting the region: the addiction crisis. Through the program, people can exchange needles, receive referrals for addiction treatment services, and get training to use the overdose-reversal drug Narcan.
Laura Nagle, a risk reduction specialist at the department, said they use a van to provide training and doses of Narcan in area communities such as Richmond.
“The mobile unit is a part of Madison County’s harm reduction team, but [the University of Kentucky] provides the Narcan. So we actually couldn’t do this outreach if it weren’t for the HEALling Communities project,” Nagle said.
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Ohio Valley ReSource
Anyone can request doses of Narcan and receive training from the Madison Co. Health Department’s Narcan mobile unit.
In 2019, the University of Kentucky was awarded the largest grant in its history — $87 million — to reduce opioid overdose deaths. Kentucky is one of four states chosen for the National Institutes of Health’s HEALing Communities Study. HEAL stands for Helping to End Addiction Long-term and communities in Massachusetts, New York and Ohio are also involved.
Although more overdose deaths have occurred during the pandemic compared to any previous year, across the Ohio Valley doctors and health workers have said the numbers of people seeking treatment have grown. Treatment practices like distributing overdose reversal drugs aren’t new. But the scale of efforts have increased and so has the focus on needs at the local level. The pandemic has also prompted new approaches to addiction treatment.
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Big Money, Big Goal
Overall, the HEALing Community Study’s goal is to reduce opioid overdose deaths by 40%. It will look at how evidence-based recovery, treatment and prevention practices work within mental health, primary care, addiction treatment clinics, county health departments and other settings within each community. Sixteen Kentucky counties, a mix of rural and urban, are divided into two waves of the study.
Sharon Walsh is a professor of behavioral science, pharmacology and pharmaceutical sciences and the principal investigator of the UK study. Walsh also directs UK’s Center on Drug and Alcohol Research. Walsh said meetings between researchers and community coalitions were just set to begin last year in order for communities to put treatment and prevention plans in place. That was March 2020. Then the first pandemic shutdown orders were issued.
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Sharon Walsh, principal investigator of the HEALing Communities Study at the University of Kentucky.
But that led to an unexpected benefit — meetings shifted online — which sped things up, Walsh said. More than 500 meetings took place from March to November of 2020.
“In retrospect, if we really thought that we could have done all that in person, we would have been buying campers and sleeping on the side of the road; we would have never been able to achieve so much without having gone virtually,” Walsh said.
Plans to implement addiction treatment vary between communities participating in the study.
“But what they have in common is that they all include evidence-based practices around our three critical elements of preventing opioid overdose deaths,” she said. The plans include ways to expand naloxone distribution and overdose education, make treatment programs more accessible and improve opioid prescribing practices.
Last spring, the pandemic pushed Ohio and Kentucky study participants to fast-track the distribution of the opioid overdose reversal drug naloxone. Walsh said the effort was “to make sure we could get naloxone into people’s hands, who were leaving jails, who are coming to the syringe service programs, who were coming to treatment programs, so that they would have that life saving medication.”
By November 2020, Walsh said, approximately 12,000 doses had been distributed to communities in wave one.
Some counties didn’t have any drug disposal dropboxes — sites where unused or unwanted prescription opioids can be dumped. So Walsh said community and partner agencies installed drug disposal kiosks in pharmacies. That’s one way the study is working within communities.
“We’re having meetings with all of our treatment partners to figure out what it would require of them in order to, for example, be able to treat another 50 people,” Walsh said. “What is it that they need? What are the barriers to doing that?”
Thinking Flexibly
The Ohio State University received $65.9 million to lead Ohio’s HEALing Communities Study. Dr. Rebecca Jackson, the study’s principal investigator, said they’ve used mail to make naloxone more widely available.
To provide information about opioid education and naloxone distribution, Jackson said the team looked at different ways to reach the public. In Athens County, in the southeast of the state, broadband internet is not widely available. So they looked at the heavily traveled thoroughfares instead.
“And so they made a decision to use some of their communication funds and work through that and to use billboards because they could get that message out because, in fact, that was where they knew that the largest number of people would actually see that.”
In addition to the HEALing Communities Study, last August, Ohio received $96 million in State Opioid Response grants from the U.S. Department of Health and Human Services. Of that funding, $58.8 million was granted directly to county Alcohol, Drug Addiction and Mental Health Services boards throughout the state.
Susan Shultz, executive director of ADAMH board of Adams, Lawrence and Scioto counties in southern Ohio, said the $2,051,788 million allows the board to contract with local behavioral health providers that treat substance use disorders.
Four agencies will receive the latest round of funding to provide a range of services: substance use disorder outpatient treatment services; an opioid response team that shows up in the emergency department to offer treatment for anyone treated for an overdose; peer support ; and a vocational training program.
“They have an electrical program, they have plumbing, they have the barge, deckhand program, and they’re going to be adding some new vocational programs to that,” Shultz said. “So that’s a really great thing to get the people certified to be able to then get work once they graduate programs.”
In West Virginia, the state widely distributed Naloxone and organized free rides for people in treatment last summer.
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Ohio Valley ReSource
Federal Changes
When someone decides to get medicated assisted treatment for opioid addiction, usually the first step involves visiting a doctor’s office to be prescribed a medication such as buprenorphine that stabilizes them.
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Addiction medicine specialist Dr. Kelly Clark.
Dr. Kelly Clark, an addiction medicine specialist and psychiatrist in Kentucky, said that in-person evaluation by a doctor is required to start treatment, but the pandemic has forced some changes.
“There is a temporary relaxation by the federal government of these requirements during the COVID emergency,” Clark said. “So now, if you’re looking for treatment, which the core piece of opioid addiction treatment is medicine, you can call, do audio visual and start medication with buprenorphine using telemedicine.”
Although buprenorphine appointments may be conducted online, methadone intake appointments must still occur in person, Clark said. But the newest rules give doctors the option to let patients have more take-home doses of the medication to reduce the number of in-person appointments.
“The doctors are allowed to say that if patients are stable enough, they can more rapidly get more take-home, Clark said. “So instead of coming every day, for months and months, they might come every week or every two weeks.”
Being able to check in with a doctor or therapist online has also prevented patients who don’t have transportation from missing appointments. But the availability and affordability of the internet is an issue for much of the Ohio Valley.
“We’ve heard stories of people who literally set up their own or patients and communities — literally setting up their own hotspots in fields, in parking lots, so that people can come together and utilize that in order to make the connections to counselors and their prescribers of medication,” Clark said.
Shultz said the reach of telemedicine has helped in Ohio, too.
“Telehealth services have been probably a godsend for our areas. So they’re able to do a lot of their treatment online,” Shultz said.
Dr. Redonna Chandler, with the National Institutes on Drug Abuse, directs the HEALing Communities Study. She said isolation has been a substantial issue since the beginning of the pandemic.
“We were hearing about isolation and relapse of individuals that had not been using drugs, as well as the fact that people who were using drugs, were using in isolation alone in many instances,” Chandler said. “And so we also started to see, as the months went forward in the spring, an increase in overdose events and overdose fatalities.”
A change to telemedicine policy could remedy challenges like isolation and transportation.
“And there is a big push to try to make this something that is permanent,” Clark said. “The genie’s out of the bottle with telemedicine during this pandemic.”
As the HEALing Communities Study continues, ultimately treatment models may serve as blueprints that can be tailored to fit community needs across the country.
“What the study is doing is putting the power in the community to be able to figure out their unique assets, gaps, issues, to address the problem themselves, as opposed to coming in with something and saying, well, this is what you need to do and this is how you need to do it.” Chandler said.
If you are struggling with addiction, the Substance Abuse and Mental Health Services helpline operates year round. 1-800-662-HELP (4357) Narcotics Anonymous hosts online meetings year round.
The Ohio Valley ReSource gets support from the Corporation for Public Broadcasting and our partner stations.
Jim Johnson has been named director of the West Virginia’s new Office of Drug Control Policy.
Department of Health and Human Resources Secretary Bill Crouch announced Johnson’s appointment Thursday.
The Office of Drug Control Policy will combat substance abuse and will be overseen by the Bureau for Public Health.
West Virginia has the nation’s highest drug overdose death rate, with 41.5 deaths per 100,000 people in 2015. State health officials say overdose deaths rose nearly 18 percent last year.
Johnson was director of Huntington’s Office of Drug Control Policy from 2014 until his retirement this year. He was a police officer and interim police chief in Huntington.
A West Virginia city’s lawsuit against a drug company has led to a dispute over which is at fault in the opioid epidemic.
The Charleston Gazette-Mail reported on Wednesday that one of the nation’s largest drug wholesalers is attempting to dilute responsibility for the opioid crisis after Huntington filed a lawsuit against it.
According to its federal court filling, Cardinal Health asserts nearly 2,000 organizations, businesses and medical professionals could potentially be held accountable for the epidemic.
Huntington alleges that prescription painkiller shipments from Cardinal and other distributors helped fuel the problem, which has led to record numbers of fatal overdoses.
A jury may be asked to assign percentages of blame if the case goes to trial, but only named defendants could be held liable and required to pay damages.
West Virginia Attorney General Patrick Morrisey has organized another regional meeting with clergy in a faith-based initiative to involve more churches in dealing with drug abuse.
Morrisey says the second regional session is set for next Tuesday at South Ridge Church in Fairmont. The first meeting was held in Parkersburg in June. Additional meetings are planned in Charleston and Huntington.
West Virginia has the nation’s highest drug overdose death rate, with 41.5 deaths per 100,000 people in 2015. State health officials say overdose deaths rose nearly 18 percent last year, killing 864 people.
The goal is to provide churches with information about addiction treatment and services, especially in areas where they are lacking, and connect them with police, first responders and treatment groups.
