By Adam K. Raymond
President Donald Trump’s October declaration of the opioid epidemic as a public health emergency was set to expire today. Despite calls for more drastic measures when it comes to treatment and prevention, the Trump administration has failed to do more than offer a 90-day extension on the emergency declaration, with the bulk of federal dollars earmarked for the opioid crisis being directed to law enforcement.
In Appalachia, ground zero for the epidemic with West Virginia and Ohio leading the nation in overdose rates, the emergency declaration, which made $57,000 in federal funds available to public health efforts (less than $1 for each of the 64,000 Americans who died of an overdose in 2016), has had little to no effect on the crisis. Meanwhile, Jeff Sessions’ DOJ has responded by announcing $12 million in grants for local law enforcement and, earlier this month, establishing a new DEA field division in Appalachia.
These actions by the Trump administration beg the question: Is the president serious about solving the opioid epidemic?
We spoke to a number of people fighting the epidemic at ground level in Appalachia, including the head of the region’s new DEA field division — the agency’s first new field office in nearly two decades — which will have jurisdiction across West Virginia, Kentucky, and Tennessee.
While DEA Special Agent in Charge Christopher Evans did not criticize the Trump administration for what appears to be its singular focus on law enforcement as the solution to the problem, he did admit that a more comprehensive approach is required.
“It’s not just a simple law enforcement issue, it’s a public health issue,” says Evans, whose new field division, headquartered in Louisville, Kentucky, has 90 special agents and 130 field officers focusing on the opioid epidemic across Appalachia. “We are really looking to partner with treatment and prevention folks.”
But despite similar appeals made by Trump as a candidate — including a plan that would have expanded Medicaid’s reach in the most vulnerable communities and increased access to treatment, drug courts, and the anti-overdose drug naloxone — the White House has thus far failed to commit serious funding beyond law enforcement. In November, the president’s own commission on “combating drug addiction and the opioid crisis” called on him to expand access to treatment and put naloxone into the hands of first responders, among other suggestions. To immediately fund these measures, the commission called on Trump to declare a national emergency, which would have allowed the federal government to tap into FEMA disaster funds of more than $1 billion. But Trump never went beyond the public health emergency declaration and its comparative pittance of $57,000.
“It’s not just a simple law enforcement issue, it’s a public health issue.”
Nancy Carter Daniels of Tennessee Overdose Prevention, a grassroots group of advocates working to save lives in Eastern Tennessee, is frustrated with the Trump administration’s inaction.
“They’ve not supported any legislation or proposed anything in response to their own opioid commission’s recommendations,” she says. “Thousands of people have died in the meantime. I don’t think they have the sense of urgency.”
Matt Boggs, executive director of Recovery Point, which has hundreds of beds across West Virginia for recovering opioid abusers, says the region needs much more than a new DEA field division.
“It takes all of the resources across the full continuum,” says Boggs. “We’ve got to help future generations avoid making the choices that so many of the people who are drug addicted now have made. But we also have to provide pathways for treatment. And we’ve got to continue to build the recovery movement so that people are supported post-treatment.”
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The origins of the opioid explosion in Appalachia can be traced back to 1996, when the powerful painkiller OxyContin hit the market. It quickly became a blockbuster, thanks to an aggressive marketing push by manufacturer Purdue Pharma. In its first six years on the market, sales of OxyContin ballooned, increasing from $45 million in 1996 to $1.5 billion 2002.
Purdue’s profits came with severe consequences for some patients, who found OxyContin more addictive than its manufacturer let on. Years later, executives would admit that they lied about the risk of addiction and were forced to pay a $635-million fine for the misleading claims.
But it took more than a money-grubbing pharmaceutical giant to create this crisis. Doctors were complicit too. Some were careless and prescribed patients a month’s supply of opioids when a week’s worth would have sufficed. Others were malicious, setting up so-called pill mills that distributed opioids for problems that didn’t require them.
It was a nationwide problem, but Appalachia proved particularly fertile ground for the promise of quick and sustained pain relief. Dominated by physically taxing industries such as coal and timber, rural areas in southeastern Ohio, West Virginia, Kentucky, and Tennessee were soon flooded with opioids. As those industries purged jobs, economies collapsed, leaving a crush of poverty and despair in their wake. By 2008, the link between opioid abuse and economic despair became clear when the Appalachian Regional Commission found that communities with a history of coal mining were disproportionately affected.
In the six years spanning 2007 to 2012, pharmaceutical distributors shipped 780 million opioid pain pills into West Virginia alone.
With addiction flourishing across the region, pill mills proliferated. Drug manufacturers, distributors, and even doctors were more than happy to play along. In the six years spanning 2007 to 2012, pharmaceutical distributors shipped 780 million opioid pain pills into West Virginia alone. That’s 433 pain pills for every man, woman and child in the state, according to the Charleston Gazette-Mail.
Eventually, states got wise to the criminals in white coats and began cracking down. Then in 2010, a year in which OxyContin accounted for just under half of all drug overdose deaths, the notorious painkiller underwent a dramatic change. In April of that year, the FDA approved an “abuse-deterrent” version to “discourage misuse and abuse.”
It worked, but it came with a downside. OxyContin abusers found a replacement in the cheaper and often more intense highs from heroin and the synthetic opioid fentanyl. Now those two drugs are the primary drivers of the opioid crisis. Fentanyl and its analogues were the leading causes of overdose deaths in 2016, followed by heroin and prescription pills. Taken together, those three types of opioids killed 50,000 people in 2016, more than all of the combat deaths in the entire Vietnam War.
That the problem was allowed to get as bad as it did is an indictment of our leaders, contends Jon Caulkins, drug policy expert at Carnegie Mellon University.
“We have probably never been more badly served by our government than its extremely slow response to this disaster,” says Caulkins, who has his theories for why the response from Washington remains so inadequate. Among them is the physical location of the regions hit hardest. “It happened first in the ‘flyover’ states. I think that makes a difference.”
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If there’s hope to be found in all this despair, it’s in the people fighting on the ground in Appalachia, where overdose deaths occur at a rate 65 percent higher than the rest of the country.
People like Carter Daniels of Tennessee Overdose Prevention, who’s used her own retirement money to purchase naloxone and put it in the hands of addicts. “If you’re really trying to save lives so they have a chance at recovery, that’s who you want to get it to,” she says.
Dr. Robert Pack, executive director at the Center for Prescription Drug Abuse at Eastern Tennessee State University, takes a different approach in an attempt to reach the same people. In September, Pack helped open Overmountain Recovery, the first-ever methadone clinic in Northeast Tennessee. The clinic practices medicated-assisted recovery, which relies on drugs that stave off withdrawal symptoms and is much more effective than abstinence-only programs. But they’re rare around the country and especially in Appalachia, where using drugs to get off drugs is seen as weakness.
“It’s very much a bootstrap mentality here, and there’s a lot of stigma associated with mental health issues,” says Pack, who grew up in the region. At its most pernicious, this mindset leads people to blame addicts for their own poor decisions. It allows them to write off medication-assisted treatment as a crutch. And it leads them to dismiss needle exchange programs as tacit endorsements of drug abuse.
“We have probably never been more badly served by our government than its extremely slow response to this disaster.”
Slowly though, those perceptions are changing. In some communities, like Kentucky’s Letcher County, even law enforcement officials are now pushing to adopt needle exchange programs to prevent the spread of disease and bring opioid abusers into regular contact with healthcare professionals.
According to Boggs of West Virginia’s Recovery Point, in addition to Washington funding such programs, it should devote resources proportionally to those areas most in need. “I think the chips are stacked against us because a lot of funding from the federal level is based on population,” he says. “We need the federal resources. We in West Virginia don’t have the tax base necessary to support a lot of the infrastructure that’s needed for an effective continuum of care.”
They could also put serious people in charge, offers Carter Daniels, who laughs at the mention of Kellyanne Conway as the leader of the Trump administration’s efforts to combat opioids. “That’s pretty much a joke,” she says, adding that it was also recently revealed that a 24-year-old campaign worker was helping craft drug policy for the White House.
As for the new DEA office in Appalachia, Boggs doesn’t dismiss it entirely.
“We have to have all the different elements working together to create change,” he says. “It can’t just be law enforcement and it can’t be treatment. Everybody has to come together.”