When we talk about the opioid epidemic, we always talk about the overdose deaths.
Huntington Fire Chief Jan Rader understands that. More than 880 West Virginians fatally overdosed on drugs in 2016. Huntington and the rest of Cabell County had more overdose deaths than any other county in the state. Rader can’t remember the last time a day went by without an overdose somewhere in Huntington.
But what if we looked at it another way? Rader counts lives saved. Her firefighter/medics have revived more than 1,100 people who overdosed. They administer an overdose-reversing drug called naloxone. People start breathing again.
Medics call those “saves.”
“As first responders, we fail to focus on what we need to be focusing on ... on the positive,” said Rader, a 20-year firefighter who rose through the ranks to become the first female fire chief at a non-volunteer department in the state. “We have people in recovery now that we probably [administered naloxone to] at least a dozen times. And they’re productive, taxpaying citizens again. So there is recovery.”
Rader is one of thousands of West Virginians staring down the opioid crisis. They are firefighters, police officers, social workers, paramedics, emergency medical technicians, nurses, doctors, pharmacists, counselors, emergency room workers, psychologists, detoxification center employees, public health officers, people in recovery, and families who’ve lost loved ones to addiction and now provide comfort and a helping hand to others. They’re all working to combat the opioid epidemic.
And they are the Gazette-Mail’s West Virginians of the Year for 2017.
Today, we are profiling five of those dedicated to the fight, but we wish to honor everyone on the front lines of the deadliest drug crisis in state history.
‘Taking a toll’
Rader used the word “Narcanned” to describe the administration of the life-saving drug naloxone.
Narcan is the brand name of a naloxone product that comes in a nasal spray. The brand name has evolved into a verb. You “Narcan” someone who has overdosed.
Marketers who study those kinds of things call it “brand verbification.” We “Xerox” copies. We “TiVo” our favorite shows. We “Google” information on the internet. We “FedEx” packages.
The verbifying comes after doing something a lot. And emergency responders are administering a lot of Narcan.
The state counts the number of times emergency responders administer naloxone — more than 6,000 in West Virginia this year. That number has tripled in just three years.
These days, one of every four emergency calls received by the Huntington Fire Department is for a drug overdose. Less than 9 percent of calls are for fires.
It’s wearing out some firefighters, especially the veterans. There’s frustration. You get called to an overdose, and it’s the same person who overdosed earlier that week, or sometimes the same day. And after you revive that person, after you save his or her life, he or she wakes up in an unpleasant state of mind. Some get violent.
“This is new territory,” Rader said. “It’s very difficult for an older first responder to accept that this is the new normal. It’s taking a toll.”
And the epidemic keeps changing.
“It’s hard to keep on top of,” Rader said. “First it was pills, then it was heroin, then fentanyl, now fentanyl laced with uppers like cocaine and methamphetamine. Along with the uppers come violent crimes.”
First responders bombarded by overdose calls cope in different ways. Some internalize it. Rader takes her dogs for long walks in the woods.
“You have to realize, you have to let it go,” she said.
A Netflix documentary called “Heroin(e)” spotlights Rader and two other Huntington women working to combat the opioid crisis. The film, directed by Elaine Sheldon, has been short-listed for an Oscar.
Rader said the documentary has “opened conversations that need to happen.” She has appeared on “Meet the Press.” She spoke at the first Obama Foundation Summit in Chicago. She has embraced the new role but remains a full-time firefighter.
“The stigma about drug abuse is driving the negativity,” Rader said. “If we can just be kind to each other, it would help tremendously.”
‘Epidemic of epidemics’
Dr. Michael Brumage has heard the complaints about heroin addicts who overdose two, three, four times, and the paramedics who must administer naloxone over and over again. At what point do you stop? Aren’t you enabling the addict? Why not stop treating them? Three strikes and you’re out.
“I fundamentally reject that notion,” said Brumage, executive director and health officer at the Kanawha-Charleston Health Department. “We would never think not to respond to a smoker with lung cancer or pulmonary disease by not taking them to the hospital because they refused to quit smoking. We would never respond to a diabetic because they refused to follow their diet or take their medications appropriately.”
Brumage, who spent 20 years in the military before taking the job in Charleston, has received national recognition for starting a harm-reduction program in which people with addictions receive clean needles. He’s quick to give credit to Dr. Michael Kilkenny and Tim Hazelett at the Cabell-Huntington Health Department, the first in the state to start a needle-exchange program. And there’s Brumage’s staff — Amy Hoyer, Tina Ramirez, Ciara Rukse. The program keeps growing, even though there’s no sustained funding source.
It’s not just about preventing the spread of infectious diseases; it’s about getting people help. Those who come to the clean-needle program are five times more likely to seek treatment.
“We’re getting people in programs that will accelerate their recovery,” Brumage said.
Addicts often have bad interactions with law enforcement officers and with doctors and nurses in hospital emergency rooms. They’re treated like outcasts or modern-day lepers, Brumage said. Nobody wants anything to do with them. Most people with addictions don’t even like themselves, he said.
Brumage rejects all that.
“Our responsibility — and it’s really the basis of our program — is to treat people with dignity and respect,” he said.
Brumage walked into an epidemic when he took the job two years ago, retiring as an Army colonel, his last military stop at a base in Japan. Brumage called the opioid crisis an “epidemic of epidemics.”
West Virginians are overdosing in record numbers. Babies are being born drug-dependent. Parents are abandoning their kids. Hepatitis B and C and HIV are a growing threat. Discarded syringes in public places pose an environmental hazard. There’s a loss of productivity.
“The overall medical, public health, social and financial costs of this are almost incalculable because of the damage this causes to our society in West Virginia and the rest of the nation,” Brumage said.
More people across the U.S. fatally overdosed on drugs last year than died during the Vietnam War, which lasted nine years.
“We are fighting a war in our communities every single day, but we are not being equipped with the resources to fight that war,” Brumage said. “You would never send a soldier into battle ill-equipped, but our first responders, our behavioral health providers, our treatment facilities are all asked to fight this battle without adequate resources.”
‘An inside-out job’
Five years ago, he was in a downward spiral, homeless, sleeping in abandoned houses, alienated from his family and addicted to opioids.
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Matt Boggs tried several rehabilitation centers, but he kept dropping out. A friend suggested Boggs try The Healing Place in Huntington, now called Recovery Point.
Boggs felt comfortable there. He could share his struggles. He could listen to others share their stories. The program changed his life. He stayed clean.
And in 2015, Boggs was hired to run Recovery Point.
It’s a non-medical detox program. Participants trying to shed addiction receive counseling from those already in recovery. They aren’t treated with drugs like Suboxone or Vivitrol. Programs that use medications to treat people with addictions are proliferating in West Virginia. They’re gobbling up state and federal grants.
Recovery Point, which is almost entirely funded with private grants, has 340 treatment beds. Boggs said he believes what works for one person with an addiction doesn’t always work for another.
“We’re in the middle of a crisis,” he said. “There’s no room for trying to say our way is better than yours.”
Over the past year, Recovery Point has opened a 100-bed women-only facility on Charleston’s West Side, along with 24 apartments for women seeking housing. Recovery Point also has expanded into Parkersburg, where it opened an 80-bed facility for men. The nonprofit has additional treatment centers in Huntington and Bluefield.
“Each person is different, and each treatment plan needs to be different,” Boggs said. “It’s a community problem that requires a community solution, and we have to have an array of services available to people. There’s no one size fits all.”
Most Recovery Point patients are addicted to heroin, but people who use meth also are arriving in greater numbers.
“Addiction is addiction, and at the end of the day, it’s all about the underlying problems, trauma, the disease,” Boggs said. “Drugs and alcohol are people’s solutions to a lot of these issues. Once you take them away and the person has a clear mind and clear head, you can begin working on the inside. It’s an inside-out job.”
Boggs said he also hopes his transformation — from a person addicted to drugs to a treatment program graduate to program director — will help others.
“I hope that participants can see what a life of recovery has given me,” he said.
Data-driven overdose profile
Dr. Rahul Gupta and his staff are working with the Centers for Disease Control and Prevention on what he called a “post-autopsy autopsy.”
Gupta, the state’s public health commissioner, is compiling data to develop an “overdose profile” that identifies factors shared by the 881 West Virginians who fatally overdosed on drugs last year.
It’s a huge undertaking. Gupta said he hopes the project will provide a blueprint for saving lives.
“We wanted to learn from people who passed away to avoid what’s been happening year after year,” Gupta said. “What we’re finding out is that, while we may only have a single chance, there appear to be opportunities to prevent fatal overdoses in the state.”
So far, Gupta and his researchers have discovered 86 percent of those who fatally overdosed had interacted with health care providers within the past dozen months — at places like a doctor’s office, hospital emergency room or health clinic. Many of those had two or three interactions. All were opportunities to steer people into drug treatment.
Of those ages 25 to 34, about half of those who overdosed and died had spent time in jail during the previous 12-month period.
“There might have been missed opportunities to work with them at the time of their release,” Gupta said.
Other preliminary findings:
70 percent of West Virginians who fatally overdosed were covered by Medicaid within the past year.
65 percent had received prescriptions for controlled substances like pain pills within a year of their death. About 40 percent had such prescriptions 30 days before they overdosed.
West Virginia has the highest overdose death rate in the nation. This year’s total is expected to surpass last year’s record number of overdoses.
“Oftentimes, we end up just counting deaths,” Gupta said. “But now we’re trying to learn from those who passed away.”
This year, Gupta and his office also established a panel of public health experts to develop a “rapid opioid response plan.” The plan is due in mid-January.
The office has distributed 16,000 doses of naloxone to emergency responders, developed standards for syringe exchange programs, set up an Office of Drug Control Policy and worked with a national group that represents health officials to share West Virginia’s opioid-fighting efforts, such as the analysis of people who overdosed.
“The deaths are the most important piece we can do something about immediately,” Gupta said. “It’s an attempt to utilize an evidence-based, data-driven approach to reduce the overdose deaths.”
‘We are all talking’
In school auditoriums, churches and meeting halls, everywhere he goes to speak about drugs, Chad Napier brings along photos of Bubby and Artie — his two boyhood pals from Boone County.
After high school, the three took different paths. Napier became a cop, a deputy with the Boone County Sheriff’s Department, then on to the Charleston Police Department and the Metro Drug Unit, a 20-year distinguished career locking up bad guys. Neither Bubby nor Artie made it past their 31st birthdays. They both died of drug overdoses.
“We were as tight as can be,” Napier recalled. “They were good kids. They just made some bad choices.”
So when he travels the state and talks to parents and students about staying off drugs, he shares his personal story about his two best friends. He’s done hundreds of these talks, first while a drug crime investigator and now as a prevention officer for Appalachia High-Intensity Drug Trafficking Area.
In a two-day stretch earlier this month, Napier stopped at schools in three counties in West Virginia’s Northern Panhandle and then headed south to Logan County to meet with law enforcement officers. The job also takes him into Kentucky and Virginia.
“If you would have told me 10 years ago that I would be doing prevention work, I probably would have laughed at you,” said Napier, who fed off the adrenaline of undercover work and high-profile drug busts. “When I took over the drug unit, I realized I wanted to do more than just the prosecution side of things.”
This is where Napier said he believes he can make a difference in the opioid epidemic. He takes part in programs to help children deal with trauma (Handle With Care), raises awareness about opioid addiction with the FBI and Drug Enforcement Administration (Chasing the Dragon), and hands out free drug-testing kits to parents (Give Me a Reason).
“We kind of view the take-home drug test as a fire extinguisher,” Napier said. “You hope you don’t have to use it, but it’s there if you need it.”
The kits give teens a reason to reject pressure from their friends to do drugs.
“They can say, ‘Hey, my mom’s got one of them kits,’” Napier said. “It gives them a way out, an excuse.”
Napier doesn’t advocate for stopping the prosecution of drug crimes. You have to lock some people up to make communities safer, he said. He’s locked up a lot of criminals. He just thinks attacking the drug problem requires much more than that.
“You also have to have the education, the prevention and the treatment all working together,” he said. “This epidemic is terrible. But if it’s done anything, we are all talking, we are all working together, and I think we’re going to get this going down the other side.”
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