Southern West Virginia has become a Petri dish for the study of
opioid drug abuse, overdose deaths and social conditions that have
created an environment highly vulnerable to the spread of HIV and
hepatitis C.
Of the 220 counties in the United States that the Center for Disease Control and Prevention cited recently as at-risk for an HIV and hepatitis C outbreak, Raleigh County ranks No. 18.
Twenty-eight of West Virginia’s 55 counties were included in the list, including Wyoming (No. 16), Fayette (No. 27), Monroe (No. 47), Nicholas (No. 98), and Summers (No. 110).
After an outbreak of HIV infections related to injection of prescription opioids in late 2014 in the small, rural, Scott County community of Austin, Ind., the CDC became concerned about the possible rapid spread of disease in similar communities.
The CDC looked at a number of indicators including drug overdose death rates, prescription opioid sales and unemployment rates, to determine the at-risk counties.
West Virginia’s drug overdose death rate is more than double the national average — 34 drug overdose deaths were reported per 100,000 residents from 2011-13.
West Virginia’s prescribing rate in 2012 was the third highest in the country — 137.6 opioid prescriptions per 100 residents. West Virginia’s unemployment rate was 6.2 percent, 1.2 percent higher than the national average as of April this year.
“During the past decade, the U.S. opioid epidemic has fueled an increase in illicit, unsterile injection drug use and new hepatitis C infections, especially within non-urban communities,” the CDC report said.
Prescription opioids are the most commonly abused prescription drug, the report stated, and an estimated 10 to 20 percent of people who abuse prescription opioids escalate to injection of prescription opioids or heroin, creating risk of HIV or hepatitis C.
Rates of acute hepatitis C infection have increased steadily nationwide from 2006-2012, the CDC said, most notably east of the Mississippi River and particularly among states in central Appalachia. The counties identified in the vulnerability analysis were “overwhelmingly rural.”
The CDC said the outbreak in Scott County, Ind., was especially notable because of the absence or minimal availability of harm-reduction strategies to prevent injection drug use-associated HIV and Hep C infections, such as addiction treatment and rehabilitation, medication-assisted therapy (MAT), and syringe service programs (SSPs).
”This outbreak illustrated the need for harm-reduction strategies suited to the rural context,” the CDC report states. “Our analysis can help identify those rural areas at highest risk of infectious complications from IDU (injection drug use) where interventions can be prioritized.”
According to Help4WV literature from late 2015, 17 counties throughout the state have no treatment services or facilities available, including Wyoming County, which ranked No. 16 on the list. Only one treatment facility, Southern Highlands Community Health Center, is located in McDowell County, which ranked No. 2.
Needle exchange programs are currently available in four counties throughout the state — Cabell, Kanawha, Ohio, and Monongalia.
• • •
The first needle exchange program opened in September 2015 at the Cabell-Huntington Health Department.
Dr. Michael Kilkenny, physician director of the Cabell-Huntington Health Department, announced the program under an initiative called the Harm Reduction Program, which not only allows patients who inject drugs to trade used syringes for new ones, but also allows patients to speak with recovery coaches from Recovery Point of Huntington and HER Place.
Kilkenny said the cost of needle exchange is relatively inexpensive — each syringe costs 10 cents or less.
However, HIV treatment over the course of a lifetime costs $450,000 per patient. A cure for hepatitis C costs a minimum of $100,000, Kilkenny said, but if the patient goes untreated, liver failure could result, and a transplant costs roughly $500,000.
”If they get hep C, B, or HIV, not only does the state pay for those services, but private insurance pays for those. All employed, insured people share those costs. Nobody gets off free for paying for this.”
Just since the start of the program, needle sharing is down from 23 percent to 8 percent.
Whether or not the program has helped lower the spread of disease will take a few more years of data, but Kilkenny is confident in the program’s effectiveness.
When you get people to stop sharing needles, “You drop the spread of disease,” Kilkenny said.
Since opening the state’s second needle exchange program in December, Tina Ramirez, director of prevention and wellness at Charleston-Kanawha Health Department, said the department has distributed 33,000 new needles and taken in 15,000 used needles.
Currently, the program offers harm reduction services to approximately 475 patients, all of whom remain anonymous. Ramirez said the goal is to get people in the door, to exchange syringes first, then to talk about testing, recovery and immunization.
She expressed the importance of community partnerships. Recovery coaches from Recovery Point and Prestera have encouraged 15 individuals to enroll in treatment programs. Charleston Area Medical Center’s Women and Children’s Hospital also offers IUD services, which helps reduce the number of babies born with neonatal abstinence syndrome.
Patients are also given information about local Narcotics Anonymous and Alcoholics Anonymous meetings.
• • •
Last year, Huntington’s overdose death rate was more than 10 times the national average, but Kilkenny said efforts are being made to reduce those numbers. Huntington EMS now carries naloxone, which is a lifesaving drug used to reverse the effects of opioid overdose. The fire and police department carry the drug as well, and naloxone education classes are offered to community members.
”We still have a big overdose problem, but we’ve reduced it by 40 percent through education, awareness and naloxone.”
While Charleston and Huntington officials are almost universally on board, Kilkenny said he understands city leaders’ hesitation to tackle these situations; the admission that the city has a drug problem brings bad press.
”But sticking your head in the sand only makes the problem worse and hurts your community.”
Although the cost savings of the needle exchange programs are evident, Kilkenny said he knows some county health departments will struggle with implementation of harm reduction programs, especially with state budget cuts and the need to provide “core services.”
”I certainly can argue that the cost benefit analysis benefits are there and it’s the state’s obligation to provide assistance for these services, but you can’t get blood out of a turnip.”
The Cabell-Huntington Health Department has been successful with grant applications through the Benedum Foundation and private philanthropy. The Huntington Mayor’s Office has offered assistance with grant writing. A local pharmacy also donated syringes to get the program started.
The Charleston-Kanawha Health Department has received many donations from local hospitals and pharmacies to keep the program running.
”The biggest obstacle they’ll run into is funding,” Ramirez said of departments trying to start a harm reduction program. Some grant funds cannot be used to purchase syringes or materials that potentially promote drug use.
She said it’s key for everyone to realize health departments are not promoting drug abuse, nor are they providing drugs to use. It’s a matter of public health.
• • •
According to the Department of Health and Human Resources’ Bureau for Public Health, more than 700 West Virginians died from drug overdoses in 2015.
The West Virginia Controlled Substances Monitoring Program reported 4,863,000 million opioid prescriptions were distributed last year.
Dr. Rahul Gupta, commissioner for the Bureau for Public Health and state health officer, said people who are on prescription drugs are 40 times more likely to be addicted to heroin.
The closure of many pain clinics across the state and actions from the Board of Pharmacy have led to a reduced supply in the market, Gupta said, but the demand continues — that’s why West Virginia is seeing a demand for heroin, a cheaper alternative.
Although the Bureau for Public Health does not regulate any of the harm reduction programs, Gupta said many health departments across the state are reaching out for technical assistance.
”We’re trying to develop an evidence-based toolkit for harm reduction programs. Needle exchange is part of that, but it’s not just the act of giving needles to people. It’s part of a comprehensive program.”
From counseling, treatment and workforce training, Gupta hopes health departments will be able to offer all these services and more to residents in their area.
”It’s going to take a lot of partnerships to happen,” he said, noting the importance of supportive law enforcement and local healthcare providers.
Gupta pointed out that this heroin epidemic is much different from the usage in the 1950s and 80s. This time, the population is the “working age group,” 20 to 60 years old. Getting folks into treatment and getting them rehabilitated will allow them to re-enter the workforce, which could aid the state’s economy.
The CDC notes that financial stressors cause increased vulnerability to drug use; therefore, young adults in “economically deprived areas” may be more at risk to establish drug dependencies at a younger age than people in more economically privileged areas.
Gupta encouraged anyone looking for treatment or resources in their area to reach out to Help4WV by calling 1-844-HELP4WV (1-844-435-0484) or visiting help4wv.com.
Of the 220 counties in the United States that the Center for Disease Control and Prevention cited recently as at-risk for an HIV and hepatitis C outbreak, Raleigh County ranks No. 18.
Twenty-eight of West Virginia’s 55 counties were included in the list, including Wyoming (No. 16), Fayette (No. 27), Monroe (No. 47), Nicholas (No. 98), and Summers (No. 110).
After an outbreak of HIV infections related to injection of prescription opioids in late 2014 in the small, rural, Scott County community of Austin, Ind., the CDC became concerned about the possible rapid spread of disease in similar communities.
The CDC looked at a number of indicators including drug overdose death rates, prescription opioid sales and unemployment rates, to determine the at-risk counties.
West Virginia’s drug overdose death rate is more than double the national average — 34 drug overdose deaths were reported per 100,000 residents from 2011-13.
West Virginia’s prescribing rate in 2012 was the third highest in the country — 137.6 opioid prescriptions per 100 residents. West Virginia’s unemployment rate was 6.2 percent, 1.2 percent higher than the national average as of April this year.
“During the past decade, the U.S. opioid epidemic has fueled an increase in illicit, unsterile injection drug use and new hepatitis C infections, especially within non-urban communities,” the CDC report said.
Prescription opioids are the most commonly abused prescription drug, the report stated, and an estimated 10 to 20 percent of people who abuse prescription opioids escalate to injection of prescription opioids or heroin, creating risk of HIV or hepatitis C.
Rates of acute hepatitis C infection have increased steadily nationwide from 2006-2012, the CDC said, most notably east of the Mississippi River and particularly among states in central Appalachia. The counties identified in the vulnerability analysis were “overwhelmingly rural.”
The CDC said the outbreak in Scott County, Ind., was especially notable because of the absence or minimal availability of harm-reduction strategies to prevent injection drug use-associated HIV and Hep C infections, such as addiction treatment and rehabilitation, medication-assisted therapy (MAT), and syringe service programs (SSPs).
”This outbreak illustrated the need for harm-reduction strategies suited to the rural context,” the CDC report states. “Our analysis can help identify those rural areas at highest risk of infectious complications from IDU (injection drug use) where interventions can be prioritized.”
According to Help4WV literature from late 2015, 17 counties throughout the state have no treatment services or facilities available, including Wyoming County, which ranked No. 16 on the list. Only one treatment facility, Southern Highlands Community Health Center, is located in McDowell County, which ranked No. 2.
Needle exchange programs are currently available in four counties throughout the state — Cabell, Kanawha, Ohio, and Monongalia.
• • •
The first needle exchange program opened in September 2015 at the Cabell-Huntington Health Department.
Dr. Michael Kilkenny, physician director of the Cabell-Huntington Health Department, announced the program under an initiative called the Harm Reduction Program, which not only allows patients who inject drugs to trade used syringes for new ones, but also allows patients to speak with recovery coaches from Recovery Point of Huntington and HER Place.
Kilkenny said the cost of needle exchange is relatively inexpensive — each syringe costs 10 cents or less.
However, HIV treatment over the course of a lifetime costs $450,000 per patient. A cure for hepatitis C costs a minimum of $100,000, Kilkenny said, but if the patient goes untreated, liver failure could result, and a transplant costs roughly $500,000.
”If they get hep C, B, or HIV, not only does the state pay for those services, but private insurance pays for those. All employed, insured people share those costs. Nobody gets off free for paying for this.”
Just since the start of the program, needle sharing is down from 23 percent to 8 percent.
Whether or not the program has helped lower the spread of disease will take a few more years of data, but Kilkenny is confident in the program’s effectiveness.
When you get people to stop sharing needles, “You drop the spread of disease,” Kilkenny said.
Since opening the state’s second needle exchange program in December, Tina Ramirez, director of prevention and wellness at Charleston-Kanawha Health Department, said the department has distributed 33,000 new needles and taken in 15,000 used needles.
Currently, the program offers harm reduction services to approximately 475 patients, all of whom remain anonymous. Ramirez said the goal is to get people in the door, to exchange syringes first, then to talk about testing, recovery and immunization.
She expressed the importance of community partnerships. Recovery coaches from Recovery Point and Prestera have encouraged 15 individuals to enroll in treatment programs. Charleston Area Medical Center’s Women and Children’s Hospital also offers IUD services, which helps reduce the number of babies born with neonatal abstinence syndrome.
• • •
Last year, Huntington’s overdose death rate was more than 10 times the national average, but Kilkenny said efforts are being made to reduce those numbers. Huntington EMS now carries naloxone, which is a lifesaving drug used to reverse the effects of opioid overdose. The fire and police department carry the drug as well, and naloxone education classes are offered to community members.
”We still have a big overdose problem, but we’ve reduced it by 40 percent through education, awareness and naloxone.”
While Charleston and Huntington officials are almost universally on board, Kilkenny said he understands city leaders’ hesitation to tackle these situations; the admission that the city has a drug problem brings bad press.
”But sticking your head in the sand only makes the problem worse and hurts your community.”
Although the cost savings of the needle exchange programs are evident, Kilkenny said he knows some county health departments will struggle with implementation of harm reduction programs, especially with state budget cuts and the need to provide “core services.”
”I certainly can argue that the cost benefit analysis benefits are there and it’s the state’s obligation to provide assistance for these services, but you can’t get blood out of a turnip.”
The Cabell-Huntington Health Department has been successful with grant applications through the Benedum Foundation and private philanthropy. The Huntington Mayor’s Office has offered assistance with grant writing. A local pharmacy also donated syringes to get the program started.
The Charleston-Kanawha Health Department has received many donations from local hospitals and pharmacies to keep the program running.
”The biggest obstacle they’ll run into is funding,” Ramirez said of departments trying to start a harm reduction program. Some grant funds cannot be used to purchase syringes or materials that potentially promote drug use.
She said it’s key for everyone to realize health departments are not promoting drug abuse, nor are they providing drugs to use. It’s a matter of public health.
• • •
According to the Department of Health and Human Resources’ Bureau for Public Health, more than 700 West Virginians died from drug overdoses in 2015.
The West Virginia Controlled Substances Monitoring Program reported 4,863,000 million opioid prescriptions were distributed last year.
Dr. Rahul Gupta, commissioner for the Bureau for Public Health and state health officer, said people who are on prescription drugs are 40 times more likely to be addicted to heroin.
The closure of many pain clinics across the state and actions from the Board of Pharmacy have led to a reduced supply in the market, Gupta said, but the demand continues — that’s why West Virginia is seeing a demand for heroin, a cheaper alternative.
Although the Bureau for Public Health does not regulate any of the harm reduction programs, Gupta said many health departments across the state are reaching out for technical assistance.
”We’re trying to develop an evidence-based toolkit for harm reduction programs. Needle exchange is part of that, but it’s not just the act of giving needles to people. It’s part of a comprehensive program.”
From counseling, treatment and workforce training, Gupta hopes health departments will be able to offer all these services and more to residents in their area.
”It’s going to take a lot of partnerships to happen,” he said, noting the importance of supportive law enforcement and local healthcare providers.
Gupta pointed out that this heroin epidemic is much different from the usage in the 1950s and 80s. This time, the population is the “working age group,” 20 to 60 years old. Getting folks into treatment and getting them rehabilitated will allow them to re-enter the workforce, which could aid the state’s economy.
The CDC notes that financial stressors cause increased vulnerability to drug use; therefore, young adults in “economically deprived areas” may be more at risk to establish drug dependencies at a younger age than people in more economically privileged areas.
Gupta encouraged anyone looking for treatment or resources in their area to reach out to Help4WV by calling 1-844-HELP4WV (1-844-435-0484) or visiting help4wv.com.
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