Possible Solutions Offered For Foster Care System Problems

For many years West Virginia has led the nation in foster care rates, with more than 6,000 children currently in state custody. This year, the state legislature formed a work group to identify and address complaints of neglect and ineptitude in the state’s child welfare system. As Emily Rice reports, the work group reported their findings and recommendations to lawmakers this month.

West Virginia has led the nation in foster care entry rates since 2010  with more than 6,000 children currently in state care. 

A legislative workgroup was formed in March to identify and address complaints of neglect and ineptitude in the state’s child welfare system. During November’s interim session, the workgroup reported their findings and recommended solutions to the Joint Standing Committee on Health.

Foster parents turned advocates, lawmakers and state officials presented lawmakers with ongoing problems and possible solutions in the state’s troubled foster care system.

Foster Care System Workgroup Update

Del. Adam Burkhammer, R-Lewis, and Sen. Vince Deeds, R-Greenbrier, gave a presentation on the Foster Care System Workgroup’s findings.

“We wanted to investigate the entire system for quality, efficiency and effectiveness,” Burkhammer said.

They said the workgroup’s report was a cumulative effort from several Senators and Delegates, including Sen. Patricia Rucker, R-Jefferson; Del. Jonathan Pinson, R-Mason; Laura Kimble, R-Harrison; Del. Margitta Mazzocchi, R-Logan; Del. Michael Hite, R-Berkeley and Del. Scot Heckert, R-Wood.

The increase in foster care has been largely fed by the state’s Substance Use Disorder (SUD) epidemic.

“When we talk about the leading factors of that (entry rate) 80 to 90 percent would probably go to substance abuse, as well as in poverty, family instability and parental education can kind of be bundled into one there,” Burkhammer said.

In 2000, six out of every 1,000 West Virginia children entered foster care. In 2021, more than double that number, 13 of every 1,000 West Virginia children, entered foster care. West Virginia’s entry rate increased 117 percent in those 21 years.

Burkhammer cited similar statistics from the state’s Child Welfare Dashboard, operated through the West Virginia Department of Health.

“That (6,000 children) leads the nation per capita at 19.8 per 1,000 children, versus the national average of 5.1 per 1,000,” he said.

For that reason, the workgroup focused on evaluating the state’s preventative services, where they found a lack of long-term planning, insufficient resources and a lack of adequate staff.

“There are 79 openings out of 390 CPS workers,” Burkhammer said. “That leads to high caseloads. High caseloads lead to poor quality in those caseloads.”

There is a need for attorneys appointed by a judge to represent the interests of people who cannot protect their rights. Those attorneys are called guardians ad litem (GAL) in family court.

“We’re always discussing that we don’t have enough of those to represent everyone through this legal process, and as well as all of our service providers are short-staffed and understaffed, and again, lead to high caseloads, which I believe ultimately leads to poor quality and attention to our children,” Burkhammer said.

Pinson, another member of the Foster Care System Workgroup, testified before the committee that in 2023, there were 157 GALs for the state of West Virginia. This year, there are 191, which Pinson said was an improvement, but not enough.

“That’s a pretty large increase, percentage-wise, 191, though for the entire state of West Virginia,” he said. “In 2024, from Jan. 1 until Oct. 31, there have been 4,708 new juvenile abuse and neglect cases.”

Pinson said that figure did not include active cases that are pending, so the workgroup estimates there could be as many as 10,000 active abuse and neglect cases for 191 GALs to handle.

“That means every guardian ad litem has at least 41 active juvenile abuse and neglect cases, not counting all the other legal work that they’re doing,” he said. “So as we think about guardian ad litems, we need to consider an increase in compensation.”

Pinson said though they may be overworked, West Virginia’s guardians ad litem are excellent attorneys.

“If we’re going to retain excellent attorneys for the children that we take custody of, we’re going to have to pay them,” Pinson said.

Burkhammer said the workgroup found that these problems could not always be attributed to a lack of funding, but a lack of urgency.

“Sometimes the money is there and the bills are not being paid in a timely fashion,” he said. “It was an ongoing complaint from everyone from service providers all the way down to families, of not getting timely payment and then ultimately not being able to provide those services and care to children.”

But, according to Burkhammer, the lack of urgency doesn’t end with spending.

“There’s a lack of urgency when we’re talking about court-ordered services that our biological families are ordered to participate in,” he said. “There’s delays in getting those implemented. Another area is data collection. Some of our reports are out of date. So when we’re talking about trying to fix an ongoing problem, we can’t be looking at one-year, two-year-old data. We need to be looking at real-time data.”

The workgroup looked into the foster care system’s transparency, and Burkhammer said that the workgroup found that confidentiality requirements often hindered the process.

“We want to protect the confidentiality of children, but at times, we’ve noticed that that extreme use of that confidentiality statute might create unintended consequences downstream when we talked about the complexity of the system,” Burkhammer said.

In fact, the workgroup found that the people who do have access to this confidential information are not performing their duties.

According to West Virginia state code, an MDT (multidisciplinary team) must be established for children in abuse and neglect cases to assess, plan and implement a system of services for those children and their families.

Burkhammer said the workgroup found MDT meetings are underutilized and lacking participation in West Virginia’s system.

“I think we all recognize sometimes we can put some really good law and really good code and really good policy on paper, but we have to make sure that’s being implemented in the field,” Burkhammer said.

The workgroup recommends the system require the MDT-appointed professionals to attend and participate in (MDT) meetings to set up a plan forward through the child’s case.

“I think one thing that would really help there is potentially adding a mediator to the MDT meetings, there’s really no leadership in the meeting, depending on who shows up and doesn’t show up,” Burkhammer said. “So a lot of times, the loudest voice in a room rules the day.”

The workgroup also found varying implementation dates for different programs, which Burkhammer thinks can be attributed to a lack of experienced workers and workers not receiving updated policies throughout their training.

The workgroup also found communication system failures among CPS workers, advocates and court officials.

“When we’re talking about this complex web of individuals all trying to work together, there’s no joint communication,” Burkhammer said. “So we do everything from text, email, phone call, trying to get information together, and simply there’s just a breakdown of communication when you start trying to piece everyone together.”

Burkhammer highlighted the passage of House Bill 4975 during the 2024 regular legislative session as a step in the right direction to resolve communication issues throughout the foster care system.

“We’ve got to continue to make sure that is rolled out and implemented properly, and then I believe in its initial success, we can then expand it into all of the stakeholders that I mentioned that have the ability to communicate together and utilize technology to our advantage,” Burkhammer said.

He told the committee that the workgroup also recommends increased intergovernmental cooperation.

“We have to build a coalition together and realize we all play a vital part in this, in solving this,” Burkhammer said. “And so building that cooperation between us, the sharing of information, the sharing of data, and working together, is essential to that.”

Pinson said he has learned about the foster care system through this investigation and in real life. He said that in his experience, there was a total lack of communication and resources for children and families

“My family, my wife and I, we’ve taken in foster children, and most generally, they show up with maybe a change of clothes or two, and so now you’re trying to think about, okay, how do I provide clothing for them,” Pinson said. “How do I provide a car seat for them, a bed for them, a crib for them, all of these things that they’re needed and they’re needed immediately, also while you’re trying to get them enrolled in school and make sure that you’re working out all the new transitional decisions.”

According to Pinson, a foster child is supposed to arrive at their custody placement with a $375 voucher from the state to help get the child settled in a new home. But, he testified the workgroup found complications with foster families reliably receiving a voucher and children losing purchased clothing and items while being moved from placement to placement.

“We can set forth requirements that children who are in state custody, that as these items are being purchased with state money, voucher money that they’re being inventoried and kept with the child,” Pinson said. “These items should belong to the children.”

Pinson also testified that often the vouchers are only redeemable at the chain retail store, Gabe’s, which doesn’t always stock all the necessities of caring for a child.

“If you’ve been to one (Gabe’s), you probably realize that there’s not car seats available,” Pinson said. “Very rarely we find beds and cribs and these things, so limited supply there.”

The workgroup also found an overall lack of resources like drug rehabilitation therapy counseling, Individualized Education Programs (IEPs), transportation and visitation services.

“There’s just certain areas that are doing certain things really well, and other areas not doing some things really well, which creates kind of that resource service gap for really all families, whether it’s biological kinship or or foster families in there,” Burkhammer said.

The Workgroup’s Proposed Solutions

While the workgroup found many problems throughout the Foster Care System, Delegates Burkhammer, Pinson and Deeds presented their proposed solutions.

To address foster children’s clothing and necessities, the workgroup presented draft legislation that would solidify the voucher program and implement an inventory process so children can keep what belongs to them, even if their placement is changed.

To address staff shortages, the workgroup recommends increasing pay. Burkhammer said lawmakers need to prioritize increasing reimbursement for Child Protective Services (CPS).

“High caseload leads to poor quality,” Burkhammer said. “I think we can prioritize that through increased pay.”

Burkhammer said compensating providers and families needs to be prioritized as well.

“Those that are on the front lines need to be paid for the services they’re providing,” Burkhammer said.

According to a state foster care policy from May 2022, the monthly boarding care payments for foster children range from $790 to $942, depending on the age of the child.

The workgroup recommends improving the use and leverage of federal funds.

“We found some gaps in where we were not utilizing federal funding, maybe to its maximum potential,” Burkhammer said. “And so that’s not needing state money. That just needs some policy rewrote and some approval from the feds.”

Burkhammer said the foster care system needs to utilize data better to prioritize needs and determine what is and is not working.

“A lot of times we’re just kind of throwing stuff out there,” Burkhammer said. “Let’s get a priority. And I think that’s going to come when we can see what is being effective and what isn’t.”

Burkhammer told the committee the system needs to improve access to preventative services and treatment resources to prevent children from being removed from their biological families in the first place.

“Pregnant mothers that are struggling with substance abuse need access to rehabilitation that lacks throughout the state,” Burkhammer said. “So we have between 15 and 20 percent on average, our babies in West Virginia are being born drug affected with drugs in their system.”

Burkhammer explained that by providing pregnant mothers with recovery resources before they give birth, there will be less of a chance the baby will be born dependent on substances and taken from the mother’s custody at birth.

During questioning, Del. Mike Pushkin, D-Kanawha, asked Burkhammer to clarify the number and extent of infants born affected by substances in West Virginia. Burkhammer answered that 15 percent of all infants born in the state have some exposure to a drug.

“Some would be considered NAS (neonatal abstinence syndrome) addicted, others may just be exposed to the drug,” Burkhammer said. “So when you talk about NAS, that would require they have a dependence on it, and it requires a methadone type treatment to bring them off of that while some it may not be, it may be in their system, but not to the point of dependency.”

Burkhammer added that the experts he has spoken with have told him they believe the number of infants born exposed to drugs is much higher.

Pushkin expressed his support for the bill, saying he hoped it would pass both chambers unanimously.

“Unless we really address preventative services, we’re going to keep beating our heads against the wall,” Pushkin said. “We need to fix it on this end as much as we can for the kids that are in the system now.

Pushkin said that one of the root causes of the crisis needs to be addressed as well. 

“We’re going to keep getting more and more kids in the system if we don’t address the 15 percent of children born somehow affected by the drug epidemic,” Pushkin said. 

On the topic of mothers struggling with SUD, Burkhammer said lawmakers need to consider adding a “long acting reversible contraceptive” program to the rehabilitation process. He did not elaborate and no lawmakers asked about that proposal.

Next, Burkhammer said the state needs to make transitional living programs available to the 30.86 percent of the state’s foster children who are 13 to 17 years old. He said many of those children lack a sense of permanency from their time in state custody, turn 18 and age out of the system with no place to go.

“There’s some really good programs out there with transitional living that we need to expand to make sure we’re grasping them kids because if we don’t expand transitional living, we will expand our jails,” Burkhammer said. “It’s a given that there’s a higher potential for those kids aging out of the system to end up incarcerated if we don’t give them those resources as they’re leaving our system.”

West Virginia leads the nation in rates of kinship placement, an arrangement where a child is removed from a parent or guardian and placed with another relative or someone familiar to them.

“We place them with somebody that knows them and tries to create some sense of stability throughout that traumatic event, but those kinship family resources don’t flow through the child placing agencies the same for a foster family,” Burkhammer said.

He recommended outsourcing resources for foster families, possibly duplicating the models used by child-placing agencies serving kinship families.

Burkhammer said West Virginia needs to improve its Adoption Family Resources.

“When you adopt a child, you go to court, everyone gets their picture taken (and) a lot of your services through that you were getting through that child placing agency end,” Burkhammer said. “It’s now that family’s responsibility, and so we need to continue to provide services through adoption and beyond to do that.”

Burkhammer told the committee he knows a lot of people want to help fix West Virginia’s foster care system, but many do not know where to start. He thinks the state can start by building volunteer coalitions in their local communities, dedicated to providing resources to families.

“Being a foster parent, a kinship parent, is difficult, and we’ve got to build resources around these families in their communities, with community folks,” Burkhammer said. “This isn’t asking the government to provide anything. It’s simply saying building these volunteer coalitions in our communities.”

During questioning, Del. George Miller, R-Morgan, asked how the workgroup plans to get communities involved and volunteering. Burkhammer answered that he believes churches and faith communities are the resource to look to, mentioning Chestnut Mountain Village by name.

“There are folks out there that that want to want to build beds, folks that want to provide meals, folks that want to provide clothing, and start clothing closets and offering all of those volunteer services,” Burkhammer said. “I believe they are out there. I believe West Virginians are charitable people. They just need some direction and in some leadership in it.”

Transparency And Accountability Draft Legislation

Sen. Vince Deeds, R-Greenbrier, opened his testimony by telling the committee that every one the workgroup talked to wants the best for the state’s children. 

“I can report to you beyond a shadow of a doubt that everyone that we have spoken to, and this includes all, whether it’s the law enforcement, community, education, health care, Department of Human Services, everyone wants the best for our children,” Deeds said. 

The draft legislation Deeds presented addresses child welfare transparency by setting up abuse and neglect reporting procedures that allow for reports to be made by email, fax, or an in-person printed form. He said this could supplement the 24/7 Centralized Intake Hotline currently used by the Department of Human Services.

Furthermore, the legislation would require that the person reporting suspected abuse or neglect receive an identifier number to track their report through the system. These other forms of reporting would be required to be treated the same as those that arrive through Centralized Intake.

Deeds said there would be no fiscal note for the new Centralized Intake supplemental program.

“So also, as you know, of course, there’s no cost on this as far as that goes, because, of course, it’d be part of their normal workload, and they can also the critical incident review team, can also, if they have the need, they can ask for outside experts for guidance,” Deeds said.

Deeds then discussed the screening out of reports by mandatory reporters, certain professionals that are legally required to report suspected abuse and neglect. The new draft legislation does not allow for any mandated reporter’s report to be screened out.

“I know, in my area, we have a lot of educators that file a lot of reports and they should, because they spend, they’re the one loving, caring adult that this child may see,” Deeds said. “They have an opportunity to see how this child is doing, and they would be a credible source of information, so need to be investigated by filing these mandatory reports.”

The workgroup also found that audio files from calls to Centralized Intake are not stored or cataloged They recommended keeping them on file for a year.

“That way, you can go back and review,” Deeds said. “If a person said, ‘Well, I called in and reported this.’ Well, what’s the identifier number? ‘I don’t have the identifier number.’ Well, you can go back and check the audio files and see if there actually was a file reported. And so it’d be really helpful to track that as well.”

Deeds said the same transparency bill would allow the foster care ombudsman broader authority to review certain information in abuse and neglect cases.

The Ombudsman reports information to the public and the legislature.

The transparency draft legislation would also require timely submission of a fatality or near fatality case to be reported to a new data dashboard. 

Currently in West Virginia, the Critical Incident Review Team reviews fatalities or near fatalities of children known to the child welfare system in the last 12 months. The team meets quarterly to examine each case practice, policy and training needed to make program improvements. 

The review is meant to identify areas that, if improved upon, may have prevented the death or severe injury of a child. They release a critical incident report annually. 

In 2023, the team reported 16 fatalities of children known to the child welfare system, five of which are attributed to abuse and/or neglect.

“If there’s an incident that happens in our areas, you know, we have a lot of public outcry for it, and there’s a lot of misinformation that comes from that because of the delay in time,” Deeds said.

The draft legislation aims to resolve incidents where miscommunications may have cost a child’s life.

Earlier this year 14-year-old Kyneddi Miller was found dead, her grandparents and mother were later charged with felony neglect and abuse. There were conflicting reports about the actions of state agencies involved in the case and calls for accountability.

Police officers claimed they saw the now deceased Miller nearly a year before her death. They said they were concerned about the girl’s well being, so they went to Boone County’s Child Protective Services (CPS) office to file a referral. However, CPS, which is a division of the Department of Human Services, said they have no record of that.

GPS data, police reports, and audio obtained from the police officer who visited Kyneddi in 2023, all corroborate the police officer’s claim that they went to CPS to make a referral after completing a welfare check on the child.

During a June press conference on the incident, Brian Abraham, Gov. Jim Justice’s chief of staff, said he interviewed the police officers and came to the conclusion that they did visit CPS, but that the officers may have not followed the proper protocol; the officer failed to call the 1-800 number the department had provided him to report the abuse and neglect.

Miller’s mother and grandparents were indicted on charges of murder of a child by parent, guardian or custodian by failure or refusal to supply necessities, and child neglect resulting in death on Sept. 17, 2024.

Deeds said the child’s initials, sex, age, ethnicity, county of residence and the date of the incident would be listed on the new dashboard under the purview of the Office of the Inspector General.

“We don’t want to take away from the criminal investigation or the civil investigation, but we just want to be able to list, yeah, there this happened in this area, and there will be a follow-up with the critical incident review team,” Deeds said.

Deeds said the workgroup found shortcomings in the Critical Incident Review Team, so they included an expansion of the team in their draft legislation.

“It would establish a team with requirements to review fatalities and near fatalities in the child welfare system and make recommendations for prevention and intervention,” Deeds said.

In the draft legislation, the new configuration of the critical incident review team would include a mixture of personnel from the Department of Human Services, the judicial system, law enforcement, a Senator appointed by the President of the Senate and a Delegate appointed by the Speaker of the House.

“They are there as monitors to see the information come in, and it is completely confidential,” Deeds said. “You know, there’s no FOIA requests, and it’s written very clearly in the bill that everything is, to be examined and not open to FOIA requests as well.”

Deeds said the hope is that the expanded critical incident review team will be able to identify patterns of abuse and neglect, but they would have no voting power.

Medical Information Draft Legislation

Burkhammer presented the workgroup’s second draft bill, which aims to ease foster and kinship parent’s access to the medical records of the children in their custody. This bill would expand on the 2024 regular session’s House Bill 4320, which passed both chambers, but stalled out on March 8 before completing legislation.

“We need to know if kids are taking medication, what that medication is, how often, what doctor they’ve been seeing,” Burkhammer said. “So oftentimes kids come into your care, you’re essentially starting back over.”

The legislation would also allow managed care providers and child placement agencies access to the child’s medical records.

“We want to allow our MCOs, our managed care provider, and our CPAs, our child placing agencies, to have access to that information, still in a confidential manner, but allows for proper care as children move throughout the system there,” Burkhammer said.

During questioning, Del. George Miller, R-Morgan, asked if there was a need to change the states interpretation of a federal privacy law, the health insurance portability and accountability act of 1996 or HIPAA,  laws would need to be changed to accommodate the draft legislation.

“West Virginia is kind of using the extreme side of the HIPAA law and not allowing parents in as well, not allowing their MCO and their CPAs to see that so we can stay within the bounds of federal HIPAA and still allow some flexibility in that,” Burkhammer answered.

Lawmakers will be able to consider those draft bills during the regular session in the spring.

W.Va. Agencies Participating In Drug Take Back Day

Local and state law enforcement agencies will collect unused medication and responsibly dispose of it on Saturday for Drug Takeback Day.

Local and state law enforcement agencies will collect unused medication on Saturday, Oct. 26 for Drug Takeback Day.

Twice each year, the Drug Enforcement Administration (DEA) sponsors events nationwide to collect unused or expired prescription medications and responsibly dispose of them to prevent abuse of the substances.

From 10 a.m. to 2 p.m., collection sites will accept tablets, capsules, patches and other solid forms of prescription drugs. Syringes and illicit drugs will not be accepted. Also, liquid products, such as cough syrup, should remain sealed in their original containers. The caps must be tightly sealed to prevent leakage.

A collection site locator and other information is available at DEATakeBack.com.

Since its start in 2010, Take Back Day has removed more than 66 tons of medication from circulation in West Virginia, according to a press release from U.S. Attorney for the Southern District of West Virginia, Will Thompson.

“The non-medical use of prescription drugs is the second-most common form of drug abuse in America,” Thompson said in the release. “Safely disposing of old, unwanted and unneeded prescription drugs is an effective way to prevent accidental poisoning, overdosing and abuse.”

Nationally, the DEA has collected 9,285 tons of medication in 14 years of take back days.

On Oct. 22, Attorney General Patrick Morrisey announced his office will partner with law enforcement and substance abuse prevention groups across West Virginia to provide staffing for collection sites on Saturday.

“Events like this are a key part of the work our office does to keep potentially dangerous drugs from being misused or abused,” Morrisey said in a release. “If anyone has unused or unwanted prescription drugs, especially opioids and other pain medications, I encourage them to bring them in to be safely discarded and destroyed.”

The Attorney General’s office has participated in Drug Take Back Day since 2013 and is coordinating with Capitol Police and the State Department of Homeland Security at a Take Back location at the State Capitol Complex Zone, adjacent to the Culture Center at the Greenbrier, Washington Street entrance.

The Capitol Police provide a year-round disposal box in Building 1, Room 152-A at the Capitol Complex.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.

Rehab Facility Sued For Medicaid Fraud

An investigation into alleged Medicaid fraud at a substance use treatment facility in Wood County led West Virginia Attorney General Patrick Morrisey to file a lawsuit against the facility.

Attorney General Patrick Morrisey announced his office is seeking more than $236,000 from a Wood County drug rehabilitation facility for alleged fraudulent Medicaid claims at a press conference Wednesday morning at the Wood County Courthouse.

However, the facility, Clean & Clear Advantage, LLC said in a statement provided to West Virginia Public Broadcasting Wednesday afternoon, that the company is also a victim of fraud.

According to the statement, in 2021, a man named Clifford Marlowe forged his credentials and documentation to Clean & Clear Advantage, LLC, and the company argues, took advantage of the turbulent COVID-19 pandemic to get a job as a therapist.

Marlowe did not have the required degree and was not a licensed master-level therapist. He also did not hold a healthcare license from the state.

“From the moment this deception was uncovered, Clean & Clear has fully cooperated with the investigation conducted by the West Virginia Attorney General’s Office,” the statement reads. “Clean & Clear is a victim of Mr. Marlowe’s egregious fraud, who targeted the facility at a time of great difficulty for us and the entire country, and we are working diligently to support state authorities in holding him accountable.”

Marlowe was indicted in September and charged with two felony counts of Medicaid fraud and fraudulent schemes.

Morrisey alleges claims for 52 patients, totaling nearly $79,000, were filed by Marlowe. He said his office was tipped off and his Medicaid Fraud Control Unit investigation found fraudulent claims submitted to the state’s Medicaid program from May 2021 through January 2022.

“We believe that this individual was not qualified to render the services he did under the Medicaid law, and then, because the company did not take the steps to return the money that the company also is civilly liable to the Medicaid program for damages,” Morrisey said.

Morrisey acknowledged that Clean & Clear attempted to pay the $79,000.

“There was an effort made by the company to simply send a check in, in order to pay for the underlying amount that was alleged to have been improperly billed,” Morrisey said. “But that’s not how this works. If you allegedly violate the law, you’re not only subject to the simple money that you may have obtained improperly from overpayments. You’re likely to be subject to penalties as well. So that’s part of this process.”

Morrisey said his office is seeking three times the amount claimed as a signal to those who might try to take advantage of opioid settlement money flowing into the state.

“Anytime there’s a disaster and people are donating charitably, scammers come out to play,” Morrisey said. “But we want to send a message that that’s not going to be tolerated here in West Virginia.”

Morrisey is running in the 2024 General Election as the Republican nominee for Governor of West Virginia.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.

National Drug Czar Says Overdose Decreases Positive, But More To Do

Early Center for Disease Control (CDC) data shows a dramatic fall of 12 percent in overdose death rates across the U.S. in the last year. During the same period, West Virginia’s drug overdose rate fell almost 11 percent, nearly keeping pace with the nation.

To gain insight into this encouraging development, Appalachia Health News Reporter, Emily Rice, spoke with West Virginia’s own Dr. Rahul Gupta, the nation’s director of the Office of National Drug Control Policy (ONDPC). Here is that conversation.

The transcript below has been lightly edited for clarity. 

Rice: At the end of your statement, you say the decline in overdose deaths is both a beacon of hope and an urgent call to action. The advocates that I’ve spoken with here on the ground in West Virginia also see it as a call to action but are hesitant to celebrate these numbers because they are provisional and because they say one overdose death is still too many. So in speaking about the drug epidemic, how should we interpret this provisional data from the CDC?

Gupta: I think we should look at this in the same way we have always looked at this type of data. When President Biden and Vice President Harris took office in January of 2021 this similar type of data showed that drug overdose deaths were increasing at 31 percent year over year, 31 percent. And this is the reason that from day one, President Biden and Vice President Harris made it a top priority, and made historic public health and public safety efforts over those last four years to reduce our drug overdose deaths across the country. So now you look at this data, and we can see the latest version of data showing that 10 percent reduction in overdose deaths. This is, again, in the reverse direction of what we were seeing with this similar type of data of a 31 percent year-over-year increase. Now, having said that these aren’t just numbers. These are lives, and we didn’t get from the number of drug overdoses increasing by more than 30 percent year after year, to decreasing by accident. It has not been an accident. It is because President Joe Biden and Vice President Kamala Harris made this issue a top priority on day one, and set out to transform the way our nation approaches this epidemic through a whole of society response. So over the past year, the Biden/Harris administration has taken more historic action and made more unprecedented investments that I want to talk about than ever before, ever before in the history of this country to address this crisis head-on. 

You know, if you see the President’s 2022 strategy, it was very clearly outlined that if we have a clear strategy on policy, and we invest in those, we will see this type of progress. So this is why the president really looked at this and the vice president as how to best address two key drivers: One is untreated addiction. The other is the trafficking profits. On the untreated addiction side, under the leadership of President Biden and Vice President Harris, now we have removed decades-long barriers to treatment for substance use disorder. We’ve invested more than 40 percent more than the previous administration in funding for treatment in communities all across the country, especially in West Virginia. And we’ve expanded access to life-saving overdose medications, overdose medications like Naloxone, which is not only available over the counter but at the lowest price cost it has ever been in history. Now on the public safety side, we’ve seized more fentanyl at the port of entry in the last two years than in the past five years combined. We’ve also added more drug detection machines at the border to stop the flow of fentanyl, and sentenced hundreds of targets involved in drug trafficking, from the illicit Chinese chemical companies to drug cartels to their lawyers and enablers. And then we finally also work to strengthen the international efforts to disrupt the entire global illicit drug trade. So this progress that we’re seeing is important to take this milestone. But also remember, we have so much more work ahead, but at this point in time and history, we seem to understand what policies do work and why they have to be invested in. And this is exactly why the President and the Vice President are not going to stop. They have American’s backs, and they will continue to fight, both in Congress and with anyone that does not believe in the unity agenda, as Biden would say that this is not a red state or blue state issue. This is America’s issue, and we need to make sure that we are addressing this as a country together.

Rice: What do you think has been the most effective measure in decreasing overdose deaths that the Biden-Harris administration has implemented since January 2021? While I know it will take time more data and research to determine which substance use disorder initiatives were most effective, do you think some of those can be attributed to the ready availability of Narcan and Naloxone approved by the FDA, over the counter, etc?

Gupta: Well, certainly, I think there’s been a number of aspects, both on the public health and public safety side, that includes approving, as you mentioned, the overdose medications for over the counter purchase and making sure that they are affordable. So an historic investment in getting those life saving medications to the community no matter where you are. For instance, the State Opioid Response (SOR) and Tribal Opioid Response (TOR) programs have delivered nearly 10 million kits, 10 million kits of these overdose reversal medications to communities. We’ve convened the U.S. drug manufacturers who have FDA approval of overdose reversal medication through different ways and how they access and have the affordability to save more lives. We’ve also, in addition to expanding treatment access, we now have 15 times more providers across the country than we did before in the prior administration. We have also made sure that there is telehealth available for methadone in the long term, and the barriers to methadone is lifted. 

When you look at the prevention, the early intervention, and harm reduction approach that’s been the first time in the history of the United States that it has been federally, not only policy, but also been funded, then you look at treatment expansion in historic ways, and finally, the recovery we have been working to develop a recovery ready nation, through recovery ready businesses, all of these combined with historic seizures of fentanyl at the border and destroy the border having are separate but combined and integrated action that has worked, just as a strategy has mentioned, addressing those two key drivers of untreated addiction, as well as the drug trafficking process.

Rice: Speaking to your home state, one of the hardest, if not the hardest, hit by the opioid epidemic, what are some steps that can be taken by West Virginians working in prevention and treatment of substance use disorder to ensure overdose rates continue to fall?

Gupta: Well, thank you for asking that. I was just back home a couple of months ago, and we met with the One Box initiative….this goes back to the holistic approach. I mean, when they reminded me that when I was a commissioner, we had funded $120,000 for this program and now we’re seeing the graduates of this program, the work of the program, and have peer recovery support specialists become available. It is this type of work. And then we saw 13 new commitments to the White House challenge to save lives from overdoses from colleges and universities working across West Virginia. Then we also had meetings with local officials and representatives from the students and other bodies, as well as including police, schools, community and health and partnerships. So you know, it’s heartwarming for me to see that we are making progress in my home state, but at the same time, it is really important to understand those we have lost and learned from them, as well as leave no stone unturned to make sure that we’re saving the next life that we can save. So it’s important to put all tools in the toolbox in order to, you know, save every life possible that we can through these evidence based, data driven policies that have now demonstrated, there’s clear demonstration that you know what the agenda that Vice President Harris and President Biden set out to do is having a positive impacts for the state, but we have so much more work to do.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.

ARC Awards Millions To Address Substance Use Disorder

The investments aim to address the impact of substance use disorder in Appalachia by supporting projects that create or expand services in the recovery ecosystem leading to workforce entry and re-entry.

Money for projects to address substance use disorder in West Virginia is coming from the Appalachian Regional Commission. 

The ARC has awarded nearly $11.5 million for close to 40 projects in nine states. The money is awarded through ARC’s Investments Supporting Partnerships in Recovery Ecosystems (INSPIRE) Initiative. It aims to address the impact of substance use disorder (SUD) in Appalachia with investments in projects that create or expand services in the recovery ecosystem leading to workforce entry and re-entry.

In West Virginia, seven projects will receive close to half a million dollars each, for a total award of $3.5 million.

Projects include a mentorship program for at-risk young women, opioid recovery and workforce reentry programs for those in recovery.

  • Region 4 Development Council in Summersville, West Virginia, for the Therapeutic Landscapes and Aquaculture—Workforce 
  • Williamson Health & Wellness Center in Williamson, West Virginia, for the New Heights Recovery Continuum project. 
  • Libera, Inc., in Morgantown, West Virginia, for the Expansion of Libera Mentorship Program for At-Risk Young Women in WV. 
  • Marshall University Research Corporation in Huntington, West Virginia, for the LevelUP Program. 
  • Rural Appalachian Improvement League, Inc.,(RAIL) in Mullens, West Virginia, for the Remote Readiness Resource Network, R (3) N project. 
  • Randolph County Housing Authority in Elkins, West Virginia, for the Cultivating Recovery Employment and Training Education (CREATE)
  • The REACH Initiative in Charleston, West Virginia, for the WV REACHback Recovery / Reentry Navigator Program project. 

“Substance use disorder is a region-wide epidemic that impacts Appalachian families and community workforces,” said ARC Federal Co-Chair Gayle Manchin in a press release. “I commend our 2024 INSPIRE grantees for their dedication in helping Appalachians who have struggled with substance use disorder regain a sense of hope and purpose by enabling them to rejoin their communities, bolster workforce development, and make positive impacts on the region.”

Early Data Shows Dramatic Fall In Overdose Death Rates; Advocates Advise Caution

A Sept. 1 analysis of provisional overdose death rate data from the Centers for Disease Control and Prevention (CDC) shows a rapid decrease in the number of drug overdose deaths in the U.S. and this time West Virginia appears to be keeping pace.

However, advocates working on the ground directly with communities affected by the substance use disorder (SUD) crisis, say to be cautious of preliminary data and that there’s more work to be done and policy changes to be enacted.

“If you were to compare these numbers to pre-COVID, they’re still very massively up,” said Sarah Stone, co-director of the Charleston non-profit group, Solutions Oriented Addiction Response (SOAR). “So it feels to me like we’re still very much in the thick of everything.”

Stone also noted that this data is provisional, meaning, these are not finalized figures for the year.

West Virginia’s drug overdose rate fell nearly 11 percent from April 2023 to April 2024, according to provisional CDC data. The same report showed the nation’s drug overdose death rate fell by a reported 12.2 percent during the same period.

A screenshot of the CDC’s Provisional Drug Overdose Death Counts. Accessed on Sept. 18, 2024.

While falling overdose death rates are good news, advocates like Stone say even one drug overdose death is too many.

“Every one of the numbers from the data that we’re looking at is someone’s kid, is someone’s mom, is someone’s somebody, somebody celebrated when that number was born,” Stone said. “Until that number is zero, which is a goal, I can’t celebrate it.”

Stone said SOAR considers every drug overdose death a policy failure and that community recovery advocates feel like they are working against the state of West Virginia to make drug overdose death rates fall.

“If numbers are going down, we want to feel good about that, right? And it’s easy to feel good about that if you don’t make the connection that the number as a person and the number as a policy fail,” Stone said.

Stone is referencing policy decisions that have challenged the goals of those who work in West Virginia harm reduction in recent years. 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), harm reduction refers to an evidence-based approach to treating SUD with a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.

“People want to show up to keep themselves more safe, and we should be able to provide that for them, but because of restrictive laws, we cannot,” Stone said.

In 2021, the Legislature passed Senate Bill 334, which requires licensing for syringe distribution, programs offering syringe exchanges to host many other harm reduction services, made programs deny clean needles to those who did not return with their used needles and only allowed them to serve clients with state IDs.

“I do celebrate the wins,” Stone said. “I know how hard we’re working, but it’d be cool if lawmakers would make things more accessible to folks.”

SOAR hosts four naloxone boxes across the city of Charleston and holds monthly mutual aid fairs to distribute the supplies they legally can to help people suffering from SUD stay safe.

On Sept. 26, SOAR will participate in the largest day of naloxone distribution to date. Save-A-Life Day began in 2020 with a two-county pilot project in Kanawha and Putnam counties. By 2021, the project expanded to 17 counties, then all 55 counties participated in 2022.

Last year, all 13 Appalachian states participated, hosting more than 300 events and distributing more than 45,000 naloxone doses in a single day.

Just four years after the project’s two-county start, 2024’s Save-A-Life Day events will be held in every state east of the Mississippi River, and a few beyond.

“We’ve heard of same-day saves,” Stone said. “So that, of course, is impactful, getting naloxone out, but it’s also making people think, ‘How can we make this more available in our community? How can we like, go deeper? How can we get it to people who we don’t even see on Save a Life Day? So it’s energizing to folks, and it is a day to celebrate.”

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.

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