http://www.journal-news.net/opinion/editorials/2018/02/funding-key-in-treatment-of-nas West Virginia became the first state in the nation Tuesday to receive approval from the centers for Medicare and Medicaid Services to offer neonatal abstinence syndrome treatment services. One out of 20 babies born in… More
The opioid epidemic has spread to every corner of the country, but perhaps nowhere has been rocked so deeply as West Virginia. The city of Huntington witnessed 26 overdoses in less than four hours one day last year. A stretch of Interstate through the eastern panhandle is known as the heroin highway. Two drugstores around the depressed southern coal town of Kermit sold three million doses of pain medication in one year.
With a weak economy, the state has struggled to respond to waves of addiction and the aftermath. It has the nation’s highest opioid death rate and the highest percentage of babies born addicted.
Tucked into the hills of Morgantown, West Virginia University may not see the worst of the epidemic on its campus. But higher education holds certain commitments. And for a land-grant institution and the state’s largest university, the opioid crisis is its problem, too.
People here are marshaling resources to treat patients in recovery, study the mechanisms of addiction, help communities respond, and train future health-care providers in alternative pain management. The university has deliberately hired faculty members with relevant specialties and is seeking the resources to expand research, education, and treatment. Beyond the campus, the university is supporting overwhelmed agencies like police forces and clinics.“That’s the really scary part of the epidemic: It’s not one generation, it’s two. And we have to stop it before it’s three.”
To many academics, the mission is both a moral obligation and a practical necessity. The future doctors, business owners, teachers, and public officials who enroll at the university will all confront the crisis in one way or another. It is overburdening health-care systems, wreaking havoc on county budgets, and gutting the work force. The future of the state is at stake.But what progress can one university realistically make? “When I came in, everybody said, You need to solve the opioid problem,” says Clay B. Marsh, vice president and executive dean for health sciences. Two years ago, he created a substance-abuse task force to coordinate resources in the university’s health-care system and beyond. “What I’ve come to realize is that it’s a complex systems problem,” he says. “Everything in our world is completely interconnected.”
Opioid addiction has been called a disease of despair, and West Virginia has plenty of that. Cities and towns across the state have been devastated by the decline of coal mining and manufacturing, residents are plagued by poor health, and the labor-force participation rate is the lowest in the country.
A university, by contrast, represents opportunity. As some people here work on the front lines to stem the crisis, others are trying to come up with long-term solutions, like job creation and work-force development. E. Gordon Gee, WVU’s president, says his ambition is no less than the “total reinvention” of the state. The crisis reveals a breakdown in the health and education of communities and families, he says. “One of the ways to deal with that is to provide hope.”
West Virginia University has seen the opioid crisis unfold. When the institution first offered treatment for addiction, the biggest culprit was alcohol. By the early 2000s, it had shifted to opioids. Today the university’s Comprehensive Opioid Addiction Treatment program, the largest in the state, is a national model in patient care.
Opened in 2005, the program has treated thousands of people seeking to wean themselves from addictions that have taken over their lives. Many have driven hundreds of miles for weekly group meetings and for consultations with James H. Berry, an addiction psychiatrist, or his staff. Like most states, West Virginia is short on treatment programs. The university’s waiting list stood at 600 before it opened a second clinic this year. Now about 200 people are waiting for a spot.
4 Universities Take Steps Against Opioids
Ohio State University has asked its 200-plus extension educators to undergo training in mental-health first aid as well as in addiction and recovery. Extension agents are trusted resources in Appalachia, where close family ties and self-reliance are part of the culture, says William J. Martin II, dean of the College of Public Health. “This is not a health-care problem, it’s a community problem. The solutions have to come from the community.”
Clarion University of Pennsylvania this year created the state’s first certificate program in opioid treatment, for emergency-room personnel, school counselors, and family therapists, among others. Within weeks, 75 people enrolled, says Raymond F. Feroz, a professor in the College of Health and Human Services. “Part of what we want to do is help people understand it is a disease, not a moral failing.”
The University of Kentucky designed a multidisciplinary resource for pregnant women struggling with substance abuse, the Perinatal Assistance and Treatment Home program. Through nurse-led care and group counseling during and after pregnancy, the program has helped about 200 women since 2014 and will probably serve 100 more this year. “There’s really, unfortunately, no end in sight,” says Kristin Ashford, an associate dean at the College of Nursing and one of four women in the university’s health-care system who created the program.
The University of New Mexico started the Extension for Community Healthcare Outcomes, or ECHO, project in 2003 to let specialists in fields like addiction, pain management, and infectious disease work with doctors at clinics in underserved areas. The doctors present some of their most difficult cases via video conference and receive advice on the appropriate course of treatment. The model has expanded to dozens of academic and government medical centers, with the opioid crisis driving much of the momentum, says Miriam Komaromy, associate director of the project.
Recovering addicts often need medication to break their chemical dependence. But without support they can backslide, especially when entire communities are in the grip of drugs. About three-quarters of participants in the treatment program here have also experienced some sort of trauma, like neglect or sexual abuse.Built-in group therapy acts as a buffer against those forces by creating an alternative community. It also allows the university to treat more people at a time. About 50 percent of those who enter treatment are able to stay clean for 90 days and make it to the next level, where groups meet less frequently. Of those, 80 percent complete the program.
But people still suffer from underlying conditions like acute or chronic pain. So this year the university opened the Center for Integrative Pain Management, where specialists practice acupuncture, massage therapy, and behavioral feedback, among other treatments. It’s one way to try to reduce the role of opioids in health care.
Persuading insurers to cover such treatments is a challenge, says Richard Vaglienti, head of the WVU center. Another is to persuade West Virginians that they can take charge of their pain and their lives through alternative therapies and better choices. “Much of the addiction problem stems from a lack of sense of control, so they turn to drugs,” he says. “If we can convince them they have some control, that can help them get better.”
Serving the state also means thinking about West Virginians who can’t make their way to Morgantown. The university has expanded its reach through a national program, Project ECHO, or Extension for Community Healthcare Outcomes. Using telemedicine, faculty and staff members support primary-care physicians in nearly 20 health centers around the state.
At the Cabin Creek Health Center, in rural central West Virginia, physicians are often unprepared to deal with opioid problems, says Mary Aldred-Crouch, a longtime addiction counselor there. Some wean patients too quickly off prescription drugs that help break their addiction or fail to require counseling, which is critical to success. ECHO helps doctors avoid such mistakes and encourages family physicians to seek federal certification to participate in medication-assisted treatment programs, she says. “It gives them a sense of, OK, I’ve got backup.”
The university is reaching into West Virginia in other ways. Extension services, with a focus on healthy communities, provide natural inroads into counties wrestling with opioid-related problems. Several extension agents have collaborated on local addiction plans.
Elizabeth Reynolds is a nutritionist with the WVU Extension Service in Greenbrier County. She works with a nonprofit group, Fruits of Labor, that teaches culinary skills to recovering addicts in the drug court system. While the nonprofit group prepares people for jobs in food service, Ms. Reynolds teaches personal nutrition as part of a healthful lifestyle. In an area beset with obesity and diabetes, she explains how to cook quick, nutritious meals instead of heading to a fast-food drive-through. “I truly have compassion for these people who need a little bit of motivation,” she says, “a little bit of encouragement to do better.”Many academics see their work as necessarily engaged with real-world problems. At West Virginia University, that’s especially true, given the state’s historic struggles with poverty. And some researchers are motivated not just professionally, but also by dealing with addiction in their families and communities.
Public-health experts here are training first responders to use naloxone to reverse the effects of opioid overdoses, helping towns and counties design strategies for prevention and treatment, and talking to the public about the dangers of opioid misuse. Jeffrey Coben, co-chair of the university’s substance-abuse task force, was one of five public-health deans from the Appalachian region to brief members of Congress in June.
Judith Feinberg, a professor of behavioral medicine and psychiatry and a longtime HIV researcher, was recruited to West Virginia to focus her work on the opioid epidemic, after helping set up a needle-exchange program in Cincinnati. Dr. Feinberg is one of the leaders of a federally funded project to help nonprofit groups, churches, public-health agencies, drug-court judges, and others reduce the spread of infectious diseases like HIV and Hepatitis C among needle users.
Her work concentrates on eight of the state’s poorest and most addicted counties, places already at high risk for infection and for babies born drug-dependent. “That’s the really scary part of the epidemic,” she says. “It’s not one generation, it’s two. And we have to stop it before it’s three.”
Dr. Feinberg is optimistic that she can help find solutions. “West Virginia is a poor state,” she says, “but they have political recognition and political will.” She’s aware, however, that it’s hard for an outsider to get traction. “We don’t want to be carpetbaggers. We don’t want to come in and say, Do it our way.”
To help build relationships, she plans to work with Rita Colistra, a faculty member in the university’s Reed College of Media and a West Virginia native who has helped rural communities develop branding campaigns. “You need to be able to get people to trust you and listen to you,” Dr. Feinberg says.
Inside the university’s laboratories, researchers are busy on another front, seeking to answer questions at the heart of the epidemic. Is there a genetic predisposition for addiction? Why doesn’t medication-assisted treatment work for everyone? Is it possible to make opioids less addictive?Vincent S. Setola, a neuroscientist who runs a laboratory on the genetics of substance abuse, has recruited volunteers in the Comprehensive Opioid Addiction Treatment program to see if they’re more likely to have known genetic markers linked to addiction. Many were eager to participate, he says, as they recounted family histories of drug or alcohol abuse.
Using DNA swabbed from the inside of their cheeks, Mr. Setola wonders if, someday, physicians will be able to test patients for those markers and tailor treatment accordingly. His work gets funding from the university’s Clinical and Translational Science Institute, which focuses on crucial public-health concerns, including addiction.
Such work doesn’t always command respect. Addiction can be seen as a personal weakness, and those who succumb unworthy of help. As one professor puts it, the sense is, “Why would you want to work with a bunch of junkies?” But in response to the state’s continuing crisis, WVU has prioritized this research.
Mr. Setola and David Siderovski, chair of the department of psychology, pharmacology, and neuroscience, are studying genetically modified mice that are resistant to some of the effects of psychostimulants. Marina Galvez Peralta, in the School of Pharmacy, is exploring why some patients don’t respond to opiate-addiction treatments like buprenorphine and naloxone.
Her colleague Marie Abate is working with the state medical examiner’s office to track patterns in drug-related deaths in West Virginia dating back to 2005. She has found that many people with a history of drug abuse had legal prescriptions at the time of their death. How does that happen? Can the university better train pharmacists to be on the alert for drug users’ doctor shopping?
As elsewhere, much of what West Virginia’s researchers can do depends on the national funding picture. Although President Trump has declared the opioid epidemic a national emergency, it remains unclear how the government will direct funds and other resources.Researchers say policy makers could learn from the AIDS crisis of the 1990s, when coordinated federal strategies and increased funding helped turn the corner on research and treatment. More people died of all drug overdoses in the United States in 2016 than of AIDS at its peak, Mr. Setola points out: “I think it’s time for politicians to bring their A game.”
Such an agenda could also help reduce the stigma of addiction, which experts say can make people avoid seeking treatment, never mind inhibit the flow of money to research. Addicts may command more attention and resources if their problem is seen not as moral but medical.
Sustaining progress in the opioid crisis means adequately preparing health-care professionals to counter it. In that sense, the epidemic presents a reckoning for educators.
The problems began, after all, when physicians ramped up opiate prescriptions in the 1990s under the misimpression that the new formulations were not highly addictive. Drug makers may have underplayed the potential harm, but educators say prescription opioids were ripe for abuse. A 2011 study found “limited, variable and often fragmentary” training on pain management in schools of medicine, nursing, and pharmacy. A more recent study, at the University of North Texas, found that only two hours of course time, on average, is devoted to the subject of opioids.
Health professionals nationwide are training to better navigate the complexities of patient care. Some medical schools require students to sit in on an Alcoholics Anonymous or Narcotics Anonymous meetings to try to understand addiction, or to role-play a visit by someone suffering from chronic pain to discuss alternative treatments and lifestyle choices.
Mark Garofoli, in WVU’s pharmacy school, has been reviewing the curricula in all five of the university’s health-related schools to see what training students get in addiction and pain management. Educators are also looking to add more cross-disciplinary, real-world experience. One project brings together pharmacy and nursing students to talk to middle- and high-schoolers about substance abuse.
Instructors in other fields increasingly focus on the problem in class. Public-administration students discuss the impact on local governments. The counseling department is creating an addictions minor, the first of its kind in the state. Frankie Tack, a clinical assistant professor coordinating the new program, says the “assistance” part of medication-assisted treatment is often overlooked, in part because counselors may not understand the science and behaviors of addiction.
Andrew Caryl is helping to change that. A master’s-degree student in rehabilitation and counseling, he battled his own addictions to pills, alcohol, and methamphetamine for years. Now clean, he wants to help others. He spoke to the first class in the new minor this fall. And he works at Serenity Place, home of the university’s Collegiate Recovery Program for students who have struggled with addiction. He plans to become a licensed counselor on substance abuse.
“I feel compelled to be part of the solution,” says Mr. Caryl, whose hometown, Martinsburg, has been overrun by the heroin trade. As he sees it, the university must also play a role. “It makes sense that one of the biggest employers would need to step up and be part of the effort to deal with this,” he says. “Because it’s eating up the state.”
This year’s David C. Hardesty Jr. Festival of Ideas will present a panel discussion on the state’s opioid crisis. The event, which is free and open to the public, takes place on Feb. 20 at 7:30 p.m. in the Charleston Civic Center’s Little Theater. The festival is sponsored by West Virginia University and the Charleston Gazette-Mail. Dr. Clay Marsh, vice president and executive dean for WVU Health Sciences, will moderate the panel.
Dr. Michael Brumage, assistant dean for public health practice and service at the West Virginia University School of Public Health, will lead the effort against West Virginia’s opioid drug crisis. Brumage has served as Executive Director of the Kanawha-Charleston Health Department since 2015. In addition to his role with the School of Public Health, he serves as an Assistant Clinical Professor of Medicine at WVU’s School of Medicine.
Buying opioids on the street “isn’t like buying Tylenol,” said Marc W. Haut, chair of the WVU School of Medicine’s Department of Behavioral Medicine and Psychiatry. “You don’t know what you’re buying. People may think they’re buying something that’s just an opiate, but it may have fentanyl in it, and it may have cocaine.” His findings are published in the current issue of the Annals of Internal Medicine.
From Vox: There has been no move by Trump’s administration to actually spend more money on the opioid crisis. Key positions in the administration remain unfilled, even without nominees in the case of the White House’s drug czar office and the Drug Enforcement Administration (DEA). And although Trump’s emergency declaration was renewed last week, it has led to essentially no action since it was first signed — no significant new resources, no major new initiatives.
Chuck Ingoglia, a senior vice president at the National Council for Behavioral Health, which advocates on addiction issues, summarized the general takeaway of experts and advocates: “A lot of talk, little action. It’s great that the president says this is a priority… But too little has happened to actually do anything about it.”
“They were a third of the size of maybe a grain of rice,” that is how West Virginia Gov. Jim Justice described a micro-implant treatment that is being developed at the West Virginia University Rockefeller Neuroscience Institute during his State of the State address last week.
“We would like West Virginia to be one of the premier states in the country that is taking the opioid crisis and dealing with it head-on,” explains Dr. Ali Rezai, the director of the institute. Additionally, Rezai says, the institute is working on a wearable medical sensor. It would work by measuring brain activity — establishing which patterns indicate a patient is at high-risk for exercising addictive behavior. Rezai says the goal is to be able to warn family, friends, and others in an addict support system, in real time, about when they are at the highest risk of abusing drugs.
A West Virginia University researcher is calling for expanded treatment and a sustainable statewide naloxone distribution program after the Centers for Disease Control and Prevention released a report today (Dec. 21), which highlights the mounting public health crisis surrounding drug overdose deaths. The Mountain State continues to have the highest drug overdose death rate in the nation.
Data collected from the National Vital Statistics System found that there were more than 63,000 drug overdose deaths in the United States in 2016. The national overdose death rate was 19.8 per 100,000 people. West Virginia’s overdose death rate in 2016 was 52.0 per 100,000 people, up from 41.5 in 2015. This is a substantial increase in overdose deaths in a single year.
“This is a 25 percent increase in the overdose death rate in West Virginia in just one year,” Robin Pollini. That is totally unacceptable. We need a sustainable statewide naloxone distribution program, and we need to expand treatment capacity so that people who want to stop using drugs can get the treatment they need. ”
Dr. Pollini joined West Virginia University’s Injury Control Research Center earlier this year, and has been conducting research on drug overdose since 2003.
The WVU ICRC is one of 11 ICRC’s across the United States funded by the Centers for Disease Control and Prevention National Center for Injury Prevention and Control. The mission of the WVU ICRC is to advance the science and practice of injury prevention and control through research, education, outreach and service. The WVU ICRC has industry-leading experts in the fields of substance abuse, suicide, and childhood violence.