The Opioid Crisis: Treating Opioid Use Disorder (OUD) in West Virginia

Almost ten years ago, in 2014, the Attorney General of West Virginia, Patrick Morrissey, published a press release about the dire nature of the substance use and overdose problem in the state. The opioid crisis had arrived. Rates of opioid use disorder (OUD) were among the highest in the nation, and rates of the gold-standard treatment for OUD, medication-assisted treatment (MAT) were among the lowest.

Here are the primary points he made in that press release:

• The drug epidemic in West Virginia knows no socioeconomic or geographic boundaries
• Opioid misuse and overdose has a negative impact on everyone in West Virginia
• Individuals, families, and communities all experience the negative consequences of OUD, opioid overdose, and drug overdose
• The substance use and overdose crisis creates a financial burden on businesses across West Virginia. Costs related to the crisis include:
• Increased health care costs
• Increased workplace injuries
• Decreased productivity
• Increased disability payments
• Some business report that high rates of substance use create difficulty finding and retaining employees

When we talk about the opioid crisis, the overdose crisis, and helping people with substance use disorder in our articles, blogs, and social media posts, we make it a point to emphasize the human component, not the financial one. However, in some cases and for some policymakers and public officials, financial motivations are more powerful than human motivations. Therefore, we present the financial component above. It’s also helpful for some people to see another set of quantitative data – in addition to the overdose statistics – to convince them that spending money now on the substance use/overdose crisis now will help save money in the future, and over the long-term.

We mention that because now, in 2022, whatever West Virginia did – whatever rhetoric they used – is starting to result in real change.

West Virginia: Positive News in the Opioid and Overdose Crisis

As of September of this year, West Virginia is one of only a handful of states to report a reversal of the nationwide overdose trend.

That’s significant, because over the past several years – because of a pre-pandemic influx of fentanyl, and then the pandemic itself – rates of overdose have increased nationwide. Here’s an overview of the national data for 2019-2021:

• 2019: 67,697 total drug overdose fatalities (50,178 opioid-related)
• 2020: 78,056 total drug overdose fatalities (69,061 opioid-related)
• 2021: 107,306 total drug overdose fatalities (73,453 opioid-related)

Here’s the data for West Virginia for 2019 and 2020:

• In 2019, 870 people died of drug overdose in West Virginia
• That’s a rate of 52.8 deaths per 100,000 people

That rate is 250% higher than the national average of 21.6 for 2019

• In 2020, 1330 people died of drug overdose in West Virginia
• That’s a rate of 81.4 deaths per 100,000 people
• It’s an increase of over 50%

That rate is 280% higher than the national average of 28.3 for 2020

• In 2021, 1,553 people died of drug overdose in West Virginia
• That’s a rate of 94.9 deaths per 100,000 people
• It’s an increase of 16%

Final national rate per 100,000 not available

Before we share the overdose data for 2022, we’ll discuss how West Virginia went from reporting some of the most shocking and alarming overdose statistics to reporting some of the first encouraging statistics seen in years.

West Virginia Responds: How They Did It

On one day in Huntington, West Virginia in 2016, health officials recorded 26 overdose deaths in four hours. In a report published by the Beacon Center of Tennessee, senior fellow for criminal justice Julie Warren – a native of Huntington, WV – said Huntington “…may well be the epicenter of the opioid crisis.”

The scope of the tragedy hit home, and galvanized the people of Huntington into action, including newly elected Mayor Steve Williams, whose first step was to accompany law enforcement on an early morning drug raid, in response to valid intelligence regarding of a large sale of heroin. However, when Mayor Williams arrived on the scene with police, almost all the heroin was gone – sold overnight, according to the drug dealers arrested at the time.

Mayor Williams had his turnaround moment then and there: he realized that across his town, hundreds – and maybe thousands – were preparing their first dose of heroin for the day.

And there was nothing he could do about it.

Here’s what he said in an interview about what he understood in that moment, and what he and his town needed to do to move forward and heal:

“I realized we couldn’t arrest our way out of this. If we were going to do this, we were going to have to take a more inclusive, more holistic approach that involves prevention, intervention, treatment — as well as law enforcement. The only way we were going to overcome this was if everybody in the community realized they had an assignment. Every one of us has to take responsibility…We realized we just had to start saving people’s lives”

What Mayor Williams didn’t realize at the time is that what he was describing was a relatively new approach to handling substance misuses, particularly opioid misuse and opioid overdose: harm reduction.

While he was reluctant, at first – because Huntington is a conservative community, historically – public health experts soon convinced him harm reduction was the best possible course of action. The town of Huntington then implemented two harm reduction strategies:

• Clean syringe programs
• Naloxone distribution programs

Huntington residents quickly utilized these programs wherever they were available. But Mayor Wallace knew he could do more. Here’s another quote from the interview above:

“That’s not saving their life, that’s saving them from dying. If you really want to save their life, you need to give them an opportunity to be productive again.”

At that point, he partnered with West Virginia public officials and private advocates working in non-profits to initiate various local, state, and national programs that prioritize harm reduction strategies over arresting and incarceration strategies. These programs helped West Virginia turn the tide in the opioid crisis for the first time since 2016-2017.

Here’s a list of the programs they implemented:

• Quick Response Teams (QRTs), designed to give overdose victims the opportunity to engage in MAT program with 24-72 hours of the overdose event. Quick response teams include:
• A paramedic
• A counselor
• A law enforcement official
• A faith leader
• Jobs & Hope West Virginia:
• Vocational training
• Job placement
• Sobriety Treatment and Recovery Teams (START)
• Program targeted at parents in recovery
• Focuses on improving care for kids during treatment
• Law Enforcement Assisted Diversion (LEAD)
• Connects individuals arrested for low-level drug offenses to treatment and rehabilitation rather than prosecution and/or incarceration

We’re almost ready to share the encouraging data from West Virginia. First, though, we’ll offer some clues as to why this data is so important: the primary reason is the increased risk of overdose and addiction people in rural areas experienced during the pandemic.

The Opioid Crisis: Increased Risk in Rural Areas

In February 2022, research scientists published a study called “The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings.” The goal of the study was to identify how living in a rural area might increase vulnerability to opioid misuse, opioid overdose, and fatal drug overdose, with a focus on the impact of the pandemic on treatment and support for OUD.

The researchers identified several factors living in rural areas that were associated with increased risk of opioid misuse, opioid overdose, and fatal drug overdose:

• Elevated levels of poverty
• Geographic isolation
• Reduced access to essential resources, such as:
• Health care
• Transportation
• Insurance
• Social/family support
• Social support
• Elevated levels of housing insecurity
• Reduced access addiction treatment
• Chronic job insecurity and unemployment
• Reduced access to mental health treatment
• Chronic hunger/food insecurity

Another study – this one published by the University of Kentucky in 2021 – adds weight to the bullet points above related to addiction treatment. The paper “Perceived Ability to Treat Opioid Use Disorder in West Virginia” showed that before the pandemic:

• 48 out of 55 counties in West Virginia reported inadequate mental health infrastructure
• 18% of eligible physicians in rural areas completed the necessary paperwork to initiate MAT with buprenorphine
• Significant stigma around MAT existed among patients and providers
• 80% of prescribers who completed the necessary paperwork to initiate MAT did actually prescribe a medication for opioid use disorder (MOUD) to patients diagnosed with OUD

That last bullet point may be what turned the tide: despite remaining stigma around MAT, physicians in rural West Virginia who obtained DEA paperwork and waivers, and initiated lifesaving treatment to patients who needed it.

Let’s take a look at what happened in West Virginia when officials implemented the harm reduction measures – including MAT – that we list above.

The Good News: Overdose Rates Decline in West Virginia

The CDC published a report in October 2022 with details on rates fatal overdose for the 12-month period in May 2022. Within that report, state officials in West Virginia found the positive, encouraging data we hint at throughout this article.

Here’s what they found:

• For May 2021 – May 2022, there were 1,300 reported overdose deaths
• For May 2020 – May 2021, there were 1,518 reported overdose deaths
• That’s a decrease of 14.3%

Other states reporting reduced overdose rates include Arizona, Maryland, Michigan, New York, New Jersey, North Dakota, Ohio, California, Pennsylvania, Utah, and Virginia. Among those states, West Virginia shows the greatest reduction in raw percentage, at 14.3 percent, as indicated above. The state with the next highest reduction in raw percentage is Virginia, with a reduction of 11.1 percent in total overdose for the 12-month period ending in May 2022.

The fact that eleven states report reductions in the overall overdose rate is the first encouraging news about the overdose and opioid crisis we’ve read in years – and that’s no exaggeration. This is particularly good news coming out of the pandemic, for two important reasons:

1. Record Numbers

• The crisis got worse during the pandemic. Over 100,000 peopled died of overdose in 2020 for the first time since we’ve kept records, bringing the total fatalities related to the overdose/opioid crisis over one million

2. Harm Reduction

• The harm reduction measures implemented at the federal, state, and local levels – despite the pandemic, despite strong headwinds of stigma – appear to be working in these 11 states.

We cannot place enough emphasis on the importance of this success. However, we have to put that success in context: nationwide, experts estimate an increase in fatal overdose for 2022, projecting a total of over 108,000 deaths for 2022.

Therefore, when we talk about success, we must realize we have a very, very long way to get in order to bring the overdose crisis under control. For context, there were 16,849 overdose deaths in the U.S. in 1999. The latest figures – 107,306 overdose deaths in 2021 – reveal an increase of 537 percent. That’s why we temper our enthusiasm with reality: we’re making progress, but we have a long way to go before we begin to think we have the crisis under control.

How Do We Move Forward?

Mayor Wallace from Huntington, West Virginia observes that even if, by some miracle, not a single additional opioid prescription were written ever again, and if not a single person engaged in illicit opioid use ever again, we’d still be dealing with a devastating addiction crisis for decades to come. He’s one hundred percent serious: individuals currently in treatment will need to stay in treatment and engage in a lifelong process of recovery, and the families affected by addiction and overdose will likewise hav e to manage the fallout for years.

Healing from addiction happens. It takes time and effort to achieve balance and restore wellness and health to individuals, families, and communities. That time and effort is well worth it, though, because it saves lives.

The stakes are high and the work is demanding.

Why do we do it?

We’ll allow Mayor Wallace the final word, because he gets it:

“Addiction affects everything: health care policy, social policy, even foreign policy. It is tearing cities apart. It’s eating us away at our core. It creates homelessness, it destroys families, it destroys businesses. This has been going on for 20 years now, so it’s affected two generations. You have babies who are born affected by these substances.”

Almost the final word.

We do it for the individuals and their families currently experiencing the harm caused by the overdose and opioid epidemic.

We also do it for the children born into the crisis. Every day, we work to make their future better by improving the communities where they live. One person at a time, one day at a time.

Learn about our West Virginia residential treatment program.