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Heroin Trafficking in Berkeley County: Rampant, Devastating…Could Naloxone Be the Answer?

As law enforcement officials are increasingly turning their attention to the growing problem with heroin in West Virginia, many of them have strong…

As law enforcement officials are increasingly turning their attention to the growing problem with heroin in West Virginia, many of them have strong opinions on the legislation that provides greater access to Naloxone, an opioid antagonist that combats the effects of an overdose. That bill, which goes into effect Wednesday, will allow police officers to carry the medicine. But some law enforcement officials believe that increased access enables heroin users.

Kenny Lemaster is the sheriff of Berkeley County. We’re parked in a small parking lot across the street from a bar on the outskirts of Martinsburg. In the bar’s parking lot there’s a group of three young men wearing hoodies and jeans. They’re standing in a circle beside an old, rusting car. The sheriff pulls out his binoculars to get a closer look at what the men are doing. This small group could be totally innocent, but Sheriff Lemaster is suspicious. He says this scene could easily turn into an arrest for dealing heroin.

Lemaster didn’t end up making any arrests, but he says he doesn’t take any chances when it comes to certain areas in Martinsburg.

“It’s just another way to say it’s okay to use drugs, cause we’re going to treat you if you do. We’re going to help you if you are using drugs. It’s kind of like giving the nod saying, yeah it’s alright, we’ll take care of you. I believe in saving people’s lives, but at what expense do you keep giving in and allowing people to break the law to use such things?” – Berkeley County Sheriff Kenny Lemaster on Naloxone; the opioid antagonist.

Heroin trafficking in Berkeley County, specifically in areas of Martinsburg, has started to increase in the past ten years. As more and more businesses and families moved to the ever-growing region, so did heroin.

“I think it’s everywhere,” Lemaster noted, “It’s just more prevalent here, because of our location as far as DC and Baltimore, I mean I think Washington County, Frederick County, they have about the same thing with the same problems, or similar problems, it’s just that maybe those aren’t quite as bad. You know per capita, we probably have less police officers that are working on the issues compared to maybe those jurisdictions.”

To combat the growing heroin problem, Lemaster’s department has teamed with the State Police, Martinsburg Police Department and others to form the Eastern Panhandle drug task force. The sheriff says the size of the task force is a problem, though. Just 12 officers in the Eastern Panhandle have been given the special assignment.

U.S. Prosecuting Attorney William Ihlenfeld, from the Northern District of West Virginia, says heroin use in Berkeley County is the second highest in the state, right after Cabell County.

Both Ihlenfeld and Sheriff Lemaster say the heroin coming into the county almost exclusively comes from Baltimore, which Ihlenfeld believes could be the heroin capitol of the country.

“We have people from West Virginia who drive to Baltimore every single day – or to the outskirts of Baltimore every single day. And the reason why is because it’s cheaper to buy it in Baltimore than it is to buy it in West Virginia,” Ihlenfeld explained, “And so the user wants to go to a bigger city like Baltimore or Pittsburgh. They’re only gonna drive so far, but they will drive long distances, they will drive hours in the car, and they’ll travel to a bigger city cause they can get more for their money.”

Because it’s close to Baltimore, Philadelphia, and D.C., Ihlenfeld says Berkeley County is perfectly positioned for both addicts looking for cheap drugs and dealers looking for new customers.

But the same can be said for many areas of the state. Huntington in Cabell County is dealing with the same issues.

“We have become a distribution center here,” said Jim Johnson, the Director of the Huntington Mayor’s Office of Drug Control Policy, “You know, as you follow heroin if it comes Mexico to Phoenix to Chicago, Detroit, Toledo, Columbus, Huntington. We’ve become a distribution center and that’s why we say if we move drug dealers off of First Street in Huntington and they move to First Street in Kenova or Barboursville, we’ve still got the same problem.”

Johnson says Huntington has made great strides over the past few years in combating the flow of drugs into the area by working, much like they do in Berkeley County, with other law enforcement agencies as drug task forces.

High drug traffic comes with being a transient city, Martinsburg Mayor George Karos says. He believes movement through the county helps boost the local economy, but he says it helps boost the illegal drug activity as well.

“Back in the late 70s or early 80s, we had a fantastic drug problem here,” Karos explained, “Federal helicopters came in early in the morning, federal prosecutors were here, local DEA teams were here, the drug task force were here. They made several, several arrests early in the morning, took them to federal court, they were in prison, and it cleared up for a while. And I’m sure it’s going to happen with the heroin problem. It’ll get cleared up, but it’ll be a lapse, there’ll be a period there everything will be quiet, but it’ll come back again. It seems like it just moves from one area to another area or from one community to another community.”

Karos believes the opioid antagonist bill approved by lawmakers this legislative session is the answer to many of Martinsburg’s drug trafficking issues.

The bill gives not just emergency responders, but also friends and family members of addicts access to a drug called Naloxone. Administered either through a shot or a nasal spray, the drug reverses the symptoms of an overdose, saving lives.

But Sheriff Lemaster is skeptical access to the medication will make a difference to the amount of drugs being brought across the state line.

Still, Mayor Karos is optimistic the drug problem in Berkeley County will clear up. After all, cities like Huntington are starting to make some progress. But he also says, the drugs will never fully go away, just be controlled.

Concerns Raised About W.Va. Naloxone Bill

A law that goes into effect on May 27 allows police officers and those close to addicts to carry the opioid overdose antidote drug Naloxone. While law enforcement officials generally agree that it’s a good idea to carry the drug, there are some questions about safety, training and exactly how the new law will be implemented.

“I totally agree with trying to address the problem at its root but there are a lot of other issues that have to be overcome along the way,” Morgantown Police Chief Ed Preston said.

When Preston found out earlier this year his officers could be asked to not just carry, but also administer a drug that reverses an overdose, he was a little cautious.

“You have to look at it on a much broader scale of how do you implement it, how do you train it, how do you acquire it, how do you pay for it and how do you maintain the program after you get it?” he said.

And those same questions are being asked by law enforcement officers across the state.

Naloxone training

Backed by Gov. Earl Ray Tomblin and approved by lawmakers this session, a new law taking effect in West Virginia calls on all first responders — EMTs, firefighters and police — to carry Naloxone. Administered either through an autoinjector or a nasal spray, the prescription medication reverses an opioid overdose and, if followed quickly with more intense medical care, can save a person’s life.

Medical professionals, including Dr. Michael Mills, say if the drug is administered to a person who is not overdosing, there is no harm. Mills is the medical director at the West Virginia Office of Emergency Medical Services. He said that if there is an adverse effect from Naloxone, it’s usually caused by an allergic reaction to the preservatives in the medication.

“In my 33 years of using this medication, I’ve never had one allergic reaction,” Mills said.

But law enforcement officials across the state, like Chief Preston, are still apprehensive. Preston believes there is a risk of cardiac arrhythmia, so he wants to make sure his officers are taught to recognize the signs of a heart attack, as well as how to administer Naloxone.

Overcoming Resistance

Gary Tennis said the uneasy feelings some West Virginia law enforcement officials are displaying are common.

“Historically across the nation, there has been some resistance on the part of police,” he said.

Tennis is the Secretary of the Pennsylvania Department of Alcohol and Drug Programs. His agency has overseen the distribution of Naloxone to police departments across that state for the past 6 months, police departments that at first also pushed back.

“Any resistance on the part of police is overcome when the facts are laid on the table,” Tennis said.

So to curb the concerns in Pennsylvania, his office put together a training course on how to use Naloxone. West Virginia is in the process of doing the same.

Training

Because EMS personnel have been carrying the drug in the state for some time, the West Virginia Office of Emergency Medical Services was tasked with developing the state’s training program.

“We will be talking about side effects, we will be talking about what happens when the patient begins to regain consciousness,” Mills said. “We will emphasize that they need to dial 911 as they administer the medication so that more advanced care can arrive and treat other injuries or other aspects of the overdose, complications and then transport the patient to the hospital.”

OEMS educators began training contractors how to administer Naloxone on May 18. Those contractors will then go out into their regions of the state, conducting trainings with first responders.

Paying for Naloxone

While the training will cover both forms of Naloxone, West Virginia police departments will be encouraged to carry the nasal spray over the autoinjector, partially because of price. The injectors can cost up to $400, while the spray can cost up to $60.

In Pennsylvania, Secretary Tennis says he is paying for their program by soliciting donations from insurance companies. So far, the state has collected more than $400,000 to purchase Naloxone since November. In West Virginia, the funding part hasn’t been worked out just yet.

Chris Stadleman, a representative from Gov. Tomblin’s office, said Tomblin has written to U.S. Department of Health and Human Resources Secretary Sylvia Burwell about potential federal funding, but nothing has been secured. Private funding is something the office is still looking into.

A Police Officer’s Caution

“There’s times you’ll give Narcan, it’ll react with whatever they’ve taken and they’ll become extremely violent, which could pose a danger to the public and other people around,” said Officer Andrew White, of the Whitesville Police Department in Boone County.

He is also an EMT and said he has experienced the violent aftereffects of pulling someone out of an intense high using Naloxone. White calls it by the brand name Narcan.

But Tennis said that in the 6 months the program has been in place in Pennsylvania, none of his officers have experienced that type of violence.

"Well, this drug saves lives and that's the most important thing we need to focus on." -Dr. Michael Mills

“I’ll tell you in Delaware County where there have been over 40 saves, the police have had zero instances of people being violent,” Tennis said. “Sometimes they’re agitated, sometimes they’re upset and disoriented, but no instances of violence.”

Storing Narcan

And then there’s the issue of storing Narcan in a police cruiser, which depending on the season, could be extremely hot or extremely cold. The manufacturer recommends the drug be stored between 59 and 86 degrees Fahrenheit.

“So the Troopers have to bring the kit in and out of the vehicle before and after every shift,” said Trooper Adam Reed, who is a public information officer with the Pennsylvania State Police Department.

Implementation

With all of the reassurances that West Virginia officials expect to come through proper training, though, there’s still one issue.

The timeline.

The bill was signed March 9, the first training was offered May 18 and the law officially takes effect May 27.

“It’s just not going to happen,” Morgantown Police Ed Preston said. “It’s just too quick of a timeframe for an agency like us. And I’m pretty sure that most of the agencies in the state are in the very same boat that we are.”

That is one concern the state hasn’t considered yet. But Dr. Mills said the Office of Emergency Medical Services plans to offer its training courses on Naloxone indefinitely.

“Well, this drug saves lives and that’s the most important thing we need to focus on,” Mills said.

Bill Expanding Access to Life Saving Drug Takes Effect Wednesday

As Republican lawmakers prepared to take the helm of both the state House of Delegates and Senate for the first time in more than 80 years this…

As Republican lawmakers prepared to take the helm of both the state House of Delegates and Senate for the first time in more than 80 years this legislative session, they were questioned over and over again about their priorities. Those priorities became clear on the first day of the session when Speaker Tim Armstead and Senate President Bill Cole introduced the first 15 bills their party would pursue.

Number nine of those 15: the Opioid Antagonist Act.

“So many families have been affected by [addiction],” Armstead said of the bill. “Addiction to drugs is a huge challenge for our state and if we’re going to really put our house in order and move our state forward, we have to address it.”

While versions of the bill were introduced that first day in both chambers, the bill lawmakers ultimately approved came from Democratic Gov. Earl Ray Tomblin, whose family has also been affected by the drugs.

The Legislation:

Expands access to Naloxone from EMTs and paramedic to all first responders, including police.
Allows family members and friends of addicts to obtain a prescription for Naloxone from a health care provider.
Calls on that health care provider to prescribe the medication “in good faith,” meaning that the person receiving the prescription intends to use the drug for a good reason.
Provides immunity from any legal action to both prescribers and administrators of Naloxone.

Naloxone is an opioid antagonist, meaning the drug reverses the effects of an opioid overdose. Opioids include drugs like oxycodone, hydrocodone and heroin.
It can be administered either through an autoinjector or nasal spray and, once in a person systems, coats the opioid receptors in the body blocking the drug. If followed with more medical treatment, the drug can save a person’s life.

“The leadership team thought this saves lives,” Senate Majority Leader Mitch Carmichael said, but not everyone saw the passage of the bill that way. Some lawmakers thought the expansion of Naloxone looked as if they were condoning drug use.

“Other states have done this and implemented it. It’s not like we’ve got some radical agenda here,” Carmichael said, “and it was the right thing to do.”

The bill takes effect Wednesday, May 27.

Data Viz: As Overdose Deaths Increase in West Virginia, So Do Administrations of Naloxone

A bill aiming to stave off West Virginia's problems with heroin and prescription opioid overdose deaths goes into effect Wednesday. The Opioid Antagonist…

A bill aiming to stave off West Virginia’s problems with heroin and prescription opioid overdose deaths goes into effect Wednesday. The Opioid Antagonist Act expands access to the life saving drug Naloxone, allowing addicts and family members the ability to purchase the medicine through a prescription.

For years, paramedics and EMTs have administered the drug to those who’ve overdosed. But with heroin and other opioid overdose deaths on the rise, the West Virginia Legislature decided to allow for greater access.

“So many families have been affected by [addiction],” House Speaker Tim Armstead said of the bill. “Addiction to drugs is a huge challenge for our state and if we’re going to really put our house in order and move our state forward, we have to address it.”

According to data provided by the West Virginia Department of Health and Human Resources, nearly 6,000 doses of Naloxone have been administered since 2012. Statewide totals of the medicine’s use have increased yearly.

Hover over/click on a county on the map below to see yearly numbers and 2012-2014 totals for administrations of Naloxone. Click outside of West Virginia on the map to reset the view.

What is an Overdose? ER Doctor Explains

Derek Harman practices family medicine in Logan County, but he's also been an emergency room physician. He got his medical degree in 2008 from the School…

Derek Harman practices family medicine in Logan County, but he’s also been an emergency room physician. He got his medical degree in 2008 from the School of Osteopathic Medicine, in Lewisburg, and completed his residency in Virginia, in 2013.

Even at a young age, Harman has seen his fair share of overdoses.

Heroin is a respiratory depressant, and Harman said people who overdose can have shallow breath and a low number of breaths.

“You do not have enough oxygen to feed the body,” Harman said, “and usually opioid overdoses, and heroin overdoses included, people succumb to respiratory distress and then arrest and then death.”

But diagnosing an overdose can often be tricky.

“Anytime someone comes into the emergency room, there’s a whole slew of things that you go through,” he said. “It’s very algorithmic.”

Harman described looking for things like track marks, pain patches and talking to paramedics or any friends or family members that might be present for more information about the patient.

“Someone could have a stroke that could present similarly. Low glucose can present in a very same fashion. But it is a guessing game at the beginning,” he said.

Still, Harman said, time is of the essence when dealing with an overdose. That’s why he often relied on the opioid antagonist Naloxone, or Narcan, in the emergency room. The drug coats pain receptors in the nervous system, allowing an overdose patient to start breathing again, but one injector is not always enough.

“An initial dose of Narcan at home for example is often not enough to overcome the complete dosage of heroin or opioids,” he said. “So, these patients if given Narcan in the field still need to come to the emergency room because those opioids can again reattach to those receptors after Narcan has worn off.”

A state law taking effect Wednesday, May 27, will allow family members and friends of addicts to get a prescription for Naloxone. The bill also calls on all first responders, not just EMTs as in the past, to carry the drug.

Data Viz: When Did West Virginia's Heroin Problem Begin? Which Counties Are Hurting the Most?

As the stories airing this week on West Virginia Morning illustrate, West Virginia is in the midst of a heroin epidemic. According to the state Department of Health and Human Resources’ Drug Overdose Database, heroin has claimed the lives of more than 600 West Virginians since 2001.

But what else can we glean from this information? When did it all begin? And which counties are seeing the highest rate of deaths related to heroin overdoses?

The interactive map below paints a dark picture of the state’s problem with the drug in recent years and also shows other key facts as medical professionals, emergency officials, law enforcement officers and lawmakers all attempt to find solutions.

When did this problem begin?

From 2001 to 2006, DHHR data shows that West Virginia reported less than 15 heroin overdose deaths per year. But, from 2006 to 2007 the number of deaths doubled–from 11 to 22–in just one year. The following year in 2008, that number jumped again to 38 but leveled off until about 2011, when 41 were reported. Since then, the number of heroin overdose deaths has skyrocketed, with 67 reported in 2012. As of April 2015, 157 heroin overdose deaths have been reported for 2013 and 151 have been coded as such for 2014.

Notes from the DHHR state that the numbers for 2012 are preliminary (but, the agency says that year’s totals are substantially complete). However, numbers for 2013 and 2014 are likely to increase once causes of death are known and properly coded.

Which counties have the biggest problems?

Just last week, The Herald-Dispatch reported that Cabell County’s 30 heroin overdose deaths in 2015 is nearly 13 times the national average, which also puts them on track to break a record for overdose deaths in a single year. Clearly the problem continues to worsen in some counties, but which ones have been the most affected?

According to data from the DHHR, these counties have the highest heroin overdose death rates* from 2001 to 2014:

1. Cabell County 109 deaths (113.2 per 100,000)

2. Berkeley County: 109 deaths (104.6 per 100,000)

3. Brooke County: 23 deaths (95.6 per 100,000)

4. Morgan County: 13 (74.1 per 100,000)

5. Jefferson County 28 (52.3 per 100,000)

(*Heroin overdose death rate calculations were based on the total fatalities for the years and data provided, as well as the 2010 U.S. Census)

Hover over/click on a county on the map below to see yearly numbers, heroin overdose death totals and a rate per 100,000 from 2001 to 2014 (as of now). Click outside of West Virginia on the map to reset the view.