The Appalachian Regional Commission has awarded more than two million dollars to expand addiction treatment and recovery resources for women in rural regions of the Ohio Valley hit hard by the opioid crisis.
Ohio University received $1,100,000 for the Appalachian Recovery Project in Athens County, Ohio. WestCare Kentucky, Inc., received $1,136,000 for the Judi Patton Center for Families project in Pikeville, Kentucky.
The ARC found addiction recovery and economic recovery go hand-in-hand.
“There is clearly some correlation between economic distress and substance abuse,” ARC Federal Co-Chair Tim Thomas said. “So the commission though it appropriate that we use some of these resources from the POWER program to address this problem.”
Appalachian Recovery
Thomas was in Athens, Ohio, Wednesday to announces the grant as part of an update on the Appalachian Recovery Project.
The effort involves eight major collaborators working to turn the old Hocking Correctional Facility in Nelsonville, Ohio, which closed last year, into a treatment facility able to help 300 women at a time.
Tracy Plouck, an executive in residence at Ohio University and lead for the grant proposal, said it will be a year before the renovations are complete.
The ARC grant funds will help jump-start the program and make services available to women in the community and in the justice system this fall.
“We’re bringing different kinds of resources from the community to bear into a single network so that we can more effectively assist women who are trying to connect with recovery,” Plouck said.
Those resources include residential addiction treatment, music and art therapy, job training, and health workers to help navigate the program.
Family Treatment
The ARC grant will fund the renovation of a building in Pikeville, Kentucky, to house the Judi Patton Center for Families project.
The project is named after former First Lady of Kentucky and Pike County native Judi Patton. She is known for her work advocating women’s safety and child abuse prevention issues.
The facility will provide services through WestCare Kentucky to women seeking addiction treatment and their children.
“Patients will live with their children at the site while receiving treatment through professional, licensed, evidence-based, gender-specific programming for women,” according to a description of the program from the ARC. “Onsite therapeutic child care will provide a safe environment for children while their mothers obtain needed recovery services.”
The center plans to serve 300 patients each year and provide them with resources to sustain recovery and reenter the workforce.
Thomas says the ARC invests in projects like these because they believe solutions to the addiction crisis will be found when communities work together.
“We have to build a recovery ecosystem within the Appalachian region to help bring these people through recovery.”
The ARC has awarded over $148 million in POWER Initiative grants since its inception. An estimated $45 million will be made available via the POWER 2019 funding cycle.
Nationally, the agency disbursed $487 million as part of the supplement.
Members of Congress throughout the region praised the additional funding Thursday.
“The State Opioid Response grant will help our state continue to lead efforts to prevent drug abuse, treat individuals who become addicted, and help people get on a path to long-term recovery,” Ohio Republican Senator Rob Portman wrote in a joint statement with Ohio’s Democratic Senator Sherrod Brown.
HHS officials said an additional $933 million will be available later this year as part of the SOR grant program’s second-year awards.
The grant was created to help areas like the Ohio Valley, which leads the nation in drug overdose deaths but lacks available addiction treatment facilities in rural places.
Sue Meeks has worked with children for years as a registered nurse.
Meeks manages the family navigator program at Ohio University Heritage College of Osteopathic Medicine in Athens, Ohio.
Several years ago, she started noticing three and four-year-olds coming into the program with certain distinctive behaviors.
“Children that appear to be neurologically very overstimulated,” she said. “They often aren’t social in your typical way. They don’t respond to trying to calm them or trying to divert their attention to something else, laughing with them, or getting a response from reading.”
She saw delays in language and motor development. The symptoms did not line up with the typical presentation of autism or ADHD for children of that age.
But there was a common denominator: exposure to drugs in the womb.
Neonatal Abstinence Syndrome, or NAS, is the result of severe in-utero drug exposure. It has hit the Ohio Valley hard with more than 16,000 babies affected over the past five years in Kentucky, Ohio, and West Virginia.
Credit Ohio River Valley Addiction Research Consortium
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Ohio River Valley Addiction Research Consortium
A Univ. of Kentucky researchers’ images of infants with NAS symptoms.
West Virginia, for example, has one of the highest rates in the nation with more than 5 percent of babies born diagnosed with NAS in 2017.
Specialists rushed to help these children when they were born. Advancements in treatment have helped relieve withdrawal symptoms for both mother and baby. Now researchers are turning attention to the potential long-term effects. Researchers especially want to better understand how NAS affects the ability to learn so that parents, schools, and communities are prepared to help these children reach their developmental milestones.
Complicated Problem
“It’s a multi-pronged mystery that I’m not sure that we will ever totally solve,” Meeks said.
The research can become complicated because not every child exposed to substances in the womb is diagnosed with NAS, and the severity of NAS symptoms varies from child to child.
Health experts can’t say for sure if developmental delays can be attributed to drug exposure, other factors, or genetics.
“There are many children in our general population that have [neurological disorders],” Meeks said. “So how much can you attribute to the drug use and how much was going to be there anyway?”
Credit Alexandra Kanik / Ohio Valley ReSource
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Ohio Valley ReSource
Ohio University and Nationwide Children’s Hospital operate an NAS clinic in Athens, Ohio, to research how often NAS causes long-term effects, and also how different drugs affect development.
Early research has mostly focused on opioids.
One of the first studies came from Australia in 2017, where researchers compared the academic progress of 2234 students who had a history of prenatal drug exposure with a group of students with similar demographics but not born with NAS.
The mean test scores of the children born drug-affected were lower than those of their counterparts. The results worsened as the students aged into high school.
Researchers in Tennessee more recently released a study in September that analyzed close to 7,200 children aged 3 to 8 enrolled in the state’s Medicaid program. That study found 1 in 7 children with a history of opioid exposure in the womb required services for developmental delays.
Development delays possibly related to other substances, however, did not seem to affect a child the same way as NAS caused by opioids did, according to Meeks.
“Not to say everything else has gone away, but we’ve seen an uptick in meth use,” Meeks said. “I can’t say it’s more dangerous to the infant, because we don’t know that, but it’s very detrimental.”
A increase in the use of opioids mixed with multiple substances has also complicated the issue as researchers work to figure out how that affects long-term development.
Ohio University is also a part of the Ohio River Valley Addiction Research Consortium, a group of colleges and universities, along with health professionals, law enforcement, social workers and advocates.
Credit Aaron Payne / Ohio Valley ReSource
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Ohio Valley ReSource
A regional research consortium focuses on NAS.
The consortium chose to focus on NAS as the first issue for their collaborative research.
OU played host to the group at its most recent meeting in November to discuss the latest research and discuss how they can better study long term-effects.
They hope to work together as this generation of children enters the public school system.
“Everybody knows in the next five to 10 years the school population is going to look very different,” Meeks said.
A Parent’s Perspective
Molly Sawyer is a doctoral candidate in education at Miami University, Ohio, and has 20 years experience as an educator from Montgomery County, Ohio.
She focuses on long term-effects of NAS and best practices for educators to help affected students navigate the school system.
The region’s public schools might face a tough challenge, according to Sawyer.
“I still think we’re trying to figure out right now, at this point in time, how are elementary age students affected?”
Sawyer is uniquely qualified to tackle this subject. She doesn’t just research the issue, she lives it as a foster and adoptive parent. One of her adopted sons was exposed to opioids in the womb.
Credit Courtesy Molly Sawyer
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Molly Sawyer has worked on NAS issues as a teacher, researcher, and parent.
She was inspired to pursue her study when she noticed that some of the research on NAS was lining up with the experience with her son.
“He was a great baby but just was experiencing the world a little different as an infant, and needed us to care for him and respond in a different way,” Sawyer said.
She draws on her studies and six years of experience with her son to help the local school system understand these students and what educators can do.
“The students may not acquire skills the same way others do,” she said. “So, more repetition, more time on task, more one-on-one with teachers may be needed.”
There are also programs that create trauma-informed schools. Teachers learn what these children have gone through and how it can possibly change their brain structure.
Medical professionals can also help these children in the classroom, according to Sawyer’s personal experience, by helping them manage behavioral issues like impulsiveness and hyperactivity.
“For him, there is no off switch,” she said. “There’s nothing you shouldn’t do or touch. There’s just nothing about him that tells him to slow down and think.”
Ultimately, Sawyer is optimistic about the school system’s ability to handle this issue as long as teachers continue to be willing to learn and create relationships with students who may just need extra attention.
Mother and Child Reunion
Elsewhere, treatment and recovery programs work to help mother and baby together.
Project Hope for Women and Children in Huntington, West Virginia, is a residential facility where mothers struggling with addiction can live with their children as they get help.
“We’re building healthy attachments,” Lyn O’Connell, Associate Director of Addiction Sciences for Marshall Health, said. “We’re allowing mom to be there for those developmental milestones so she’s not building more guilt from being disconnected.”
Marshall Health operates Project Hope in partnership with the Huntington City Mission. The program’s goal is to fill the gaps in care for mothers with substance use disorders.
Evidence-based treatment, recovery programs, job training, housing, and parenting courses are just some of what Project Hope offers to mothers. They are also invested in the health of the children, monitoring them for developmental delays.
If a child appears to struggle with meeting a milestone, the staff will instruct the mother how to help.
“Maybe she can encourage more reading in the evening, or maybe they need to help with crawling,” O’Connell said. “We’re helping to strategize to meet those developmental goals. Because we’re not just focused on mom, we’re focused on mom as a parent.”
Project Hope just opened its doors in December and now has seven families living in the 18- apartment complex.
The goal for now is to bring in more families to the Huntington location and then later look into expansion to other regions.
Overcoming Stigma
Children and mothers affected by NAS also face challenges from the stigma attached to substance use disorders. Treatment experts hope the country has learned lessons from a previous epidemic.
The rise of cocaine use in the 1980s and 1990s came with a societal worry over “crack babies.” Women struggling with cocaine addiction and their children, predominantly people of color and low socioeconomic status, were subject to shame and ridicule.
Research showed that predictions about prenatal cocaine exposure were overstated, but the stigma still had an impact.
“This moral panic may prevent mothers who use drugs from accessing prenatal care because they are afraid of being judged or mistreated by medical professionals, or of being forced into the child welfare system,” according to the Substance Abuse Mental Health Services Administration.
Specialists around the Ohio Valley urge the public to keep this in mind when discussing mothers and children of the opioid crisis.
“Infants are not born addicted, they’re born with exposure,” O’Connell said. “We don’t want the narrative continuing throughout that child’s life that they were a ‘drug baby.’”
Researchers may not know how many children will experience the long-term effects of prenatal drug exposure or the challenges they will face.
But there are people around the Ohio Valley ready to embrace them and help them overcome those challenges.
“What we want to do is set them up for success,” O’Connell said. “Early intervention is key.”
President Donald Trump’s call to implement the death penalty for drug traffickers grabbed headlines Monday. But public health officials within the Trump administration are stressing other elements of the president’s plan to address the opioid crisis.
Acting Director for the Centers for Disease Control and Prevention, Dr. Anne Schuchat, outlined her agency’s plans for the Ohio Valley, which has some of the nation’s highest rates of addiction and overdose deaths.
Prevention Focus
President Trump took a “get tough” stance in his address on the opioids crisis but a portion of his speech Monday was dedicated to prevention efforts.
“The best way to beat the drug crisis is to keep people from getting hooked on drugs to begin with,” he said.
That includes taking action on over-prescribing of opioid painkillers that fueled the crisis in the Ohio Valley region. The Charleston Gazette-Mail has extensively reported on small towns in West Virginia, such as Kermit, where drug companies shipped 9 million pills for 392 residents over two years.
Schuchat said the CDC will focus on improving data about over-prescribing.
“Working with the clinical community and states to improve prescribing, using tools like the prescription drug monitoring programs,” she said.
Schuchat said Kentucky is a model of success for these drug monitoring programs. Schuchat said Kentucky is a model of success for these drug monitoring programs. One of the strengths of the Kentucky All Schedule Prescription Electronic Reporting system is it is programmed to pull data from surrounding states.
Credit James Gathany / CDC
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CDC
Dr. Anne Schuchat, acting director for the Centers for Disease Control and Prevention (CDC).
“Certainly in the Ohio Valley so many people cross state borders every day that having information available to clinicians about neighboring state’s prescriptions will improve the safety of the prescribing for patients,” she said.
Schuchat also sees a potential bright spot in data on emergency room visits. The agency recently began gathering data related to emergency room visits involving all opioid overdoses instead of just fatal ones. Researchers reported reported earlier this month that these visits were trending up nationwide, with some exceptions.
“In Kentucky, we saw a 15 percent decrease in the emergency department visits for opioid overdoses,” she said. “We need to follow that trend out to see if it persists or if it was a temporal fluctuation.”
Schuchat said the data can be used to develop programs in hospitals that meet people soon after they overdose, including naloxone training or adding navigators to the departments that guide people to addiction treatment.
Data Dive
Meanwhile a new data mapping tool released this week shows just how deeply the region’s opioid crisis is intertwined with other social and economic challenges.
The Appalachian Regional Commission worked with the NORC at the University of Chicago to produce the Appalachian Overdose Mapping Tool, which shows hot spots of opioid overdoses in relation to other factors such as poverty, unemployment, education levels and disability.
“The Appalachian Region has been taking a disproportionate hit in overdose deaths in relation to the rest of the country,” ARC executive director Scott Hamilton said in a press release. “This tool puts overdose statistics in socioeconomic context, which can be valuable to communities developing comprehensive strategies to address the epidemic.”
Credit ARC and NORC at Univ. of Chicago
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The mapping tool shows that many of the counties with the highest rates of overdose deaths also strongly correlate with the counties with the highest rates of poverty and people on disability and the lowest rates of educational attainment.
The ARC and NORC data show that compared to the country as a whole, Appalachian residents are 55 percent more likely to die from drug overdoses, with the highest death rates in central Appalachia.
A 2017 report from the ARC and the NORC’s Walsh Center for Rural Health Analysis, titled Appalachian Diseases of Despair, drilled down further into the statistics on overdose deaths by age group. In 2015, Appalachians in the prime working years of 25 to 44 years-old had overdose death rates that were more than 70 percent higher than for the same age group in the rest of the country.
Public Awareness
The CDC’s role goes beyond data gathering, of course. Schuchat said the agency will also be working in the region to raise awareness about the dangers of addiction to prescription painkillers.
“We also have a consumer-facing public awareness campaign called Rx Awareness,” she said. “It’s actually been running to some extent in Kentucky and earlier piloted in West Virginia.”
The advertising campaign shares stories of people affected by prescription opioids. Schuchat said she believes with President Trump’s announcement the CDC can expand this campaign and other efforts in the Ohio Valley.
“We know that small towns in Appalachia have really been hard hit, we want it to be easy for them to get the resources they need.”
Deaths related to opioid abuse in West Virginia have more than doubled in the past decade, according to the most recent data from the West Virginia Health Statistics Center.
Opioid deaths in W.Va. have risen from 369 in 2006 to 756 in 2016. The last couple years have seen a large spike, with the difference between 2015 and 2016 being 116 deaths.
The data suggests that counties with big cities have rising numbers, while rural counties tend to have about the same amount of deaths. In Cabell county, opioid deaths over the decade quadrupled. Cabell county is the county with the biggest difference–from 30 deaths in 2006 to 121 in 2016. It’s followed by Kanawha county, with 36 deaths in 2006 and 103 in 2016.
Meanwhile, deaths in counties in the center of the state remained low. Pendleton County had a total of 3 deaths over the decade–one in 2006, 2008, and 2009.
Most people who overdose on opioids have seen a health care provider in the last year, and many had recently been released from jail, according to a new study from West Virginia Department of Health and Human Resources.
This suggests that overdoses can be prevented with the right intervention.
Eighty-one percent of people who died of overdose interacted with at least one type of health care provider in the 12 months prior to their death.
Ninety-one percent of all those who died had a documented history within the West Virginia Board of Pharmacy’s Controlled Substances Monitoring Program. In the 30 days prior to death, nearly half (49 percent) of females who died filled a controlled-substance prescription in the 30 days prior to death, as compared to 36 percent of males.
Those who died of overdose were three times more likely to have three or more prescribers, compared to the overall CSMP population. Those who died were more than 70 times likely to have prescriptions at four or more pharmacies, compared to the overall CSMP population.
Seventy-one of those who died of overdose used emergency medical services within the 12 months prior to their death. Only 31 percent of those who died had naloxone administration documented in their EMS record.
More than half (56 percent) of all those who died of overdose had been incarcerated. They were at an increased risk of death in the 30 days after their date of release, especially in those with only some high school education.
Males working in blue-collar industries with a higher risk of injury might be at an increased risk for overdose death.
On this week’s Front Porch podcast, we discuss how we can intervene to prevent overdoses. In addition, we talk about a proposal to log in W.Va. State Parks, and another to eliminate multi-member Delegate districts in West Virginia.
