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“Just Say No” — Some Already Have. An Addiction Therapist in West Virginia Responds to Trump’s Opioid Plan



Recently, 100 Days in Appalachia published an interview with Christa Foster, an addiction specialist in West Virginia. Foster spoke at length about what she sees as appropriate and effective policies for combating the opioid epidemic, offering her assessment of some of President Trump’s new proposals, including the necessity for more adequate funding behind the proposed policies, as well as a holistic approach to the problem.

Today, the Administration offered some more insight into its understanding of the opioid crisis. According to a press release sent out Monday, nearly $1 billion has been dedicated to combatting the crisis since President Trump took office in January. A vague list of expenditures showed that around $800 million of that budget has been spent on “prevention, treatment, first responders, prescription drug monitoring programs, recovery and other care in communities, inpatient settings, and correctional systems.” This is the only time the word “prevention” has been mentioned in relation to the crisis, in no certain terms.

If the numbers reflect the actual funding dedicated to the problem, it could suggest that voices like that of Foster and others working on the  ground of the epidemic may not be being heard by the Administration.

Experts agree these areas are crucially important, but there seems to be an ongoing misunderstanding from the Administration that the problem could be solved exclusively through after-the-fact intervention.

When asked for clarification, the White House Press Office didn’t provide any more details, including the source of funding, or how it was allocated.

The press release did acknowledge that the severity of the opioid epidemic has been underestimated in the past. President’s Council of Economic Advisors (CEA) has released a report showing that costs of the crisis to the US economy are much higher than previously calculated.

According to the CEA, earlier estimates took into consideration only the opioid-related deaths resulting from the abuse of the prescription drugs. The new study included estimated costs of deaths from other types of opioids, as well as costs of non-fatal opioid abuse.

“Using standard economic techniques, the CEA estimates the cost of the opioid crisis in 2015 to be $504 billion, or 2.8 percent of GDP, once the lives lost due to opioid overdoses are accounted for,” stated the press release.

The full CEA report can be found here.

In October, President Trump recognized the opioid epidemic as a national public health emergency and promised “aggressive steps” and immediate government actions to counteract the newly diagnosed public health emergency. The solution, Trump asserted, lies in teaching every American that drugs are inherently “bad.”

Frank Ahrens took a closer look at the initial proposals for combating the drug epidemic in his story for 100 Days in Appalachia.

He proposed a “massive advertising campaign” intended to dissuade people, especially children, from taking drugs “in the first place,” in hopes that “they will see the devastation and the ruination it causes to people and people’s lives.” Swiftly denounced as a rehash of the  “Just Say No” campaign, critics pointed to the Surgeon General’s report revealing the  Reagan era DARE (Drug Abuse Resistance Education) program as a costly failure.

When asked about the difference between the President’s proposal and Nancy Reagan’s “Just say no” campaign of the 1980s, Chris Christie, Chair of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, had this to say:

“It’s much different. You heard the President of the United States up there today say we have no choice, but to help the millions of addicted people in this country to recover, that’s not ‘Just say no.’ Now, prevention is incredibly important. I think the President’s message to make sure that people don’t start is an incredibly important part of this. There’s three legs to this stool. There’s prevention that needs to start, in my view, in the middle schools in this country, in the fifth and sixth grades, before kids get anywhere near high schools. Second, there’s intervention, which the Justice Department is taking care of in form of Law Enforcement, and third is treatment. This President, firmly, loudly and directly, said that all three are necessary.”

100 Days in Appalachia reached out to Christa Foster, an addiction professional who has been working for decades helping those suffering from drug abuse and addiction in Appalachia, to see how Trump’s plans stack up against her experience in West Virginia — one of the states hardest hit by the opioid crisis. Now in private practice, Foster is skeptical of the Commission’s work and chances for any real policy change.

“… I’ve always been on the suffering and recovery side of this equation, and so I can see why a cop would be excited because it gives his people more resources to make a small difference. I can see why a for-profit hospital is excited, because it’s a PR boom and it’s also an opportunity for his hospital to provide more resources to the community. They all have really vested interests in convincing people of their own effectiveness, and convincing themselves of their own effectiveness. I think denial plays a really strong part here. Unfortunately, […] I see the failures of the system. […] And I’m much more pessimistic because I’ve seen people fall through these cracks through six Administrations now. I catch the people who fall through the cracks when the people with vested interests are unable to cash in on what they’re hoping they can do.”

Having directly witnessed the failures of DARE’s ‘Just say no’ approach, Foster points to its inherent challenges. As with any health crisis, she notes that prevention “is the cornerstone of a good public health policy in any disease maintenance… in preventing heart disease, preventing diabetes, preventing substance abuse and addiction. I’m with that idea of prevention. However, when you tell people – particularly young people – to say ‘no’ to something, you must also give them something to say ‘yes’ to. You have to give them after-school programs, you have to give them preventative healthcare, because if people are taking opiates for pain for an injury, or illness, that could have been prevented through a better healthcare program — unless we’re giving people something to say ‘yes’ to, saying ‘no’ is irrelevant.”

“Unless we’re giving people something to say ‘yes’ to, saying ‘no’ is irrelevant.”

She sees very little, if any, attempts by the Administration to provide those alternatives and suggests there are several critical issues with the Commission’s proposals, most notably its lack of funding. At the core of every policy, she said, there has to be the appropriate funding allowing for its implementation.

“We could be on a precipice of a breakthrough, except that there’s no money behind it. As soon as you verbalize policy and you don’t fund it, it is no longer a policy, it’s an idea again,” she said of the apparent lack of a dedicated budget.

“As soon as you verbalize policy and you don’t fund it, it is no longer a policy, it’s an idea.”

There are proposals to shift some funding around and redirect some of the money already assigned to combating the problem towards more urgent needs. However, responsibility for long-term and adequate funding, at least for now, has been placed on Congress. Chris Christie told reporters that it is now on Congress to work with the Administration to put money in the Public Health Emergency Fund.

Beyond the question of funding, Foster raised additional concern for the continuing criminalization of people suffering from addiction and drug abuse. “Once people are in the throws of this illness, they are suffering from a disease — and up until this point, we were treating them as criminals. And that has not been helpful. It is not a criminal justice problem, it’s a public health problem, and we need to change our entire paradigm of how we approach it,” she said.

She doesn’t see drug courts, one of Commission’s recommendations, as a step in the right direction. She argued that by intersecting with the regular court system, drug courts would continue to put a class and poverty stamp on the problem.

Long before Trump’s announcement, Foster perceived the opioid epidemic as a public health crisis, as well as a class and poverty issue.

She notes that people of different age groups, races, socioeconomic status, and professions struggle with opioid addictions that differ slightly from one another. That’s why the approach has to be a holistic one, she said.

“When you have working, middle class, mainstream people struggling with addiction, it looks different…because they have access to different kinds of resources” Foster shared. “People like Rush Limbaugh, who came out about his opioid addiction, have access to doctors, have access to people coming into their home, different resources for gaining the substance… ” she added.

“Now if we’re talking about insurance programs covering treatment, then we are talking again about the ACA (Affordable Care Act) and about parity, mental health and substance abuse parity… So these [proposals] all sound really good but his [Trump’s] other policies are clearly in contradiction to what his Commission has proposed,” argued Ms. Foster.

The amount of suffering Foster has witnessed in Appalachia on a daily basis, after decades of failed policies, has left her skeptical and guarded. She acknowledges she is somewhat biased — It’s the sixth Administration she has watched making promises and drafting policies to help people struggling with drug addiction over the same time period that drug addiction has soared.

Different vantage points have created stark differences in attitudes among different professionals combating the opioid crisis, from the Chief of Police in Knoxville, TN to the neonatalogist in Charleston, WV, both of whom expressed more optimism towards the President’s plan. Of these radically different assessments of the proposals, Foster noted, “it is in having the extremes that we start to find the middle ground.”

Feature Image: In 1986, Harpers Ferry, West Virginia was declared the first “Just say no” town in America at a rally for the Prevention of Drug Abuse targeting elementary school-aged children.  Nancy Reagan presented a “Just Say No” t-shirt to Harpers Ferry Bradley Nash during a visit to the town where she warned school children that even small-town America must fight against drug abuse. Three decades later, West Virginia has one of the highest overdose rates in the country. (AP Photo/Bob Daugherty)

Jan Pytalski is a Washington, DC correspondent for 100 Days in Appalachia. Jan is a recent transplant to the United States from Poland, where he began his journalism career working for the Reuters news agency in Warsaw. After moving to Washington, he continued working for Reuters as a stringer, helping with the White House coverage under the Trump Administration. Prior to his work as a reporter, Jan spent over a decade working as a translator with publishers and universities in Poland and the United States.

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Rural’s Connection to Environment Means Bigger Climate-Change Impact



Mainstays of rural American culture and economy – such as timber, agriculture, tourism, ranching, hunting, fishing, winter sports – could see major disruptions from climate change. The impact will be big enough to disrupt the national economy, a federal report says.

Rural communities face clear economic and environmental risks from a changing climate, according to the 2018 National Climate Assessment.  

The report documents changes in the timing of seasons, temperature fluctuations, increased incidence of extreme weather and change in rainfall – all patterns with the potential disrupt rural economic activities.  

Climate change in rural communities poses an outsized risk to the national economy, the report says. 

Although the majority of the U.S. population lives in urban areas, most of the country is still classified as rural. In this map, counties are classified as rural if they do not include any cities with populations of 50,000 or more. (Figure source: USDA Economic Research Service).

“Rural America’s importance to the country’s economic and social well-being is disproportionate to its population, as rural areas provide natural resources that much of the rest of the United States depends on for food, energy, water, forests, recreation, national character, and quality of life,” the report stated.  

While not all regions face the same impacts due to increased greenhouse gasses in the atmosphere, the assessment explains how increased volumes of carbon, methane and other greenhouse gasses in the atmosphere will lead to changing climatic patterns. The report’s authors predict that changes will likely increase volatility in agricultural commodity markets, shift plant and animal ranges, increase the number and intensity of droughts and floods, and increase the number and size of wildfires throughout the rural landscape.  

Tourism is often climate-dependent as well as seasonally dependent. Increasing heat and humidity – projected for summers in the Midwest, Southeast, and parts of the Southwest by mid-century (compared to the period 1961-1990) – is likely to create unfavorable conditions for summertime outdoor recreation and tourism activity. The figures illustrate projected changes in climatic attractiveness (based on maximum daily temperature and minimum daily relative humidity, average daily temperature and relative humidity, precipitation, sunshine, and wind speed) in July for much of North America. In the coming century, the distribution of these conditions is projected to shift from acceptable to unfavorable across most of the southern Midwest and a portion of the Southeast, and from very good or good to acceptable conditions in northern portions of the Midwest, under a high emissions scenario. (Source: National Climate Assessment).

For portions of rural America with an economy based on agriculture, climate scientists are most worried about shifting geographic suitability of particular crops and abnormal timing for planting and harvest. These changes may result in additional use of herbicides and pesticides, which could create additional health risks from chemical applications. Crop and pasture yields and profitability could also be affected by changes in rainfall, temperature and extreme weather events. Increased flooding could increase soil erosion and water pollution from agricultural runoff, according to the report.  

Rural communities with an economy based on recreation and tourism also face significant challenges due to climate change, according to the report. Rising seas could damage rural Florida’s multi-billion dollar recreational fishing sector and cause further ecological damage to the Everglades region.  

Coastal erosion and rising oceans throughout the nation could affect wildlife habitat, disrupting hunting, fishing, bird watching, and other wildlife-related activities. 

Rural places with significant winter recreation activities could face risks as snow-pack is expected to decrease.  

Forest-dependent rural communities are likely to face significant change as well. Forest geographies and species composition are likely to shift as the climate changes. The number of pests and disease will increase. These factors could decrease timber and pulp harvests in some places. Forest fires are also expected to continue to increase in number, intensity and cost.  

The report identifies certain demographic trends in rural communities that make climate change adaptation more difficult.  

“Modern rural populations are generally older, less affluent, and less educated than their urban counterparts. Rural areas are characterized by higher unemployment, more dependence on government transfer payments, less diversified economies, and fewer social and economic resources needed for resilience in the face of major changes,” the report states. That combination of an aging population with higher poverty rates increases vulnerability of rural people and places to changes in climate.  

“Emergency management, energy use and distribution systems, transportation and infrastructure planning, and public health will all be affected,” the study states. State, regional, local and tribal governments in rural communities tend to be under-funded and rely heavily on volunteers.  

“Even in communities where there is increasing awareness of climate change and interest in comprehensive adaptation planning, lack of funding, human resources, access to information, training, and expertise provide significant barriers for many rural communities,” the report concludes. 

This report is the fourth National Climate Assessment, and summarizes the impacts of climate change on the United States. The report process was established by the Global Change Research Act of 1990 and mandates that the U.S. Global Change Research Program (USGCRP) deliver a report to Congress and the president no less than every four years.  

A team of more than 300 experts guided by a 60-member Federal Advisory Committee developed the report. Scientists and researchers from federal, state and local governments, tribes and Indigenous communities, national laboratories, universities, and the private sector volunteered their time to produce the assessment. Information was gathered through a series of regional engagement workshops that reached more than 1,000 individuals in over 40 cities. Listening sessions, webinars and public comment periods also provided valuable input.  

This article was originally published by Daily Yonder.

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When Losing 14 to 1 is a Win — Sort Of



Matthew Ferrence is a writer and college professor who ran a 14-day write-in campaign against an unopposed Pennsylvania state legislator. He got clobbered but finds something positive in the results. Photo: submitted by the author
A last-minute write-in campaign against an unopposed Pennsylvania state representative yielded 900 official votes. It wasn’t nearly enough to win, but it was enough to show that there’s more to Appalachia than the average TV pundit claims.
Well, I didn’t win. Let’s get that out of the way.But on the night of November 6th, 2018, after launching a last-minute zero-budget Green Party write-in campaign against an unopposed Republican incumbent, in a Pennsylvania district that perpetually votes at about a 70 percent clip for even Republicans who get absolutely blasted in statewide races (see: gubernatorial candidate Scott Wagner, soundly defeated by Tom Wolfe), I wound up making a nearly 5 percent dent.

The how isn’t quite as important as they why, I think, but in brief: exactly two weeks before the election, I announced on Facebook my intention to mount a write-in campaign for the Pennsylvania House of Representatives, disgusted that for the fourth time in seven elections, the local incumbent — Brad Roae — faced literally no competition. Nobody squared off against him in the Republican primary and nobody ran on the Democratic ticket. In fact, only twice in his tenure has he faced opposition from Democrats, each of them throttled to the tune of 60-40 or thereabouts in the general election.

As an even sorrier indication of the state of political engagement in the rural part of Northwestern Pennsylvania where I live, only once has a Republican ever challenged him in a primary. It’s smooth sailing every two years, which leads to a tepid, basic and uninspiring legislative track record. Taxes are bad, he says. And, oh, let’s have some laws to weaken environmental protections for gas well drilling. He has made public media posts that appear to equate school boards to Hitler, and he has argued that state funding shouldn’t support students who major in “poetry or some other pre-Walmart major.”

Yeah, that’s who I lost to, my 900 votes or so to his 13,000. And that’s the guy who has gone to Harrisburg for more than a decade representing my home. Among the many things that gall me about his incumbency is the way that, outside of Appalachia, a lot of people would probably nod their heads and say, yup. Brad Roae is the kind of representative people think Appalachia embraces, is the kind of person so many non-Appalachians see as purely representative of who we are and what we stand for.

But here’s the thing. I’m finding hope in my two weeks as a candidate, and in the sudden flurry of interest and support. I ran because there had to be some opposition for democracy to have any chance at all, and when I did so I hoped I’d get 1 or 2 percent, not embarrass myself, shoot for the bar of 300 votes. That would be the same number of votes I would have needed as signatures to get on the ballot had I, say, planned ahead.

Then a funny thing happened. I started making videos introducing myself and my ideas, and put together a platform paper, and people started sharing these materials on Facebook, and I had to work through the anti-Russian Bot regulations the social media site now has so I could finally “boost” two of those posts on the morning of the election, and even before all that the organic sharing of an electorate dying for something, anything, that pushed against Appalachian political stereotypes meant 9,000 people had seen my stuff. Then, even though people had to first know I was running and then actually bother typing my name in, I fared okay. I earned about 65 votes for each day of my campaign. And I spent $50 on stickers, $20 on my Facebook ads.

Brad Roae poses in the Pennsylvania House chamber with Pennsylvania dairy princess LeeAnn Kapanick. Roae has represented the 6th House district since 2007. The district covers parts of Crawford and Erie counties in the state’s northwest corner. Photo: Pennsylvania State Legislature webpage

Official county returns compiled right before Thanksgiving gave me 851 votes. The Monday following, I reviewed the official computations and found another 60+, if I include misspellings like Matt Terrance and, Michael Ferrence, and Matthew Fetterman (for a voter who maybe confused me with our Democratic Lt. Governor candidate John Fetterman), and That Guy Whose Name Starts With F, as well as The Guy on Facebook Ask (name redacted), as well as a litany of close-but-no-cigar last names coupled with Matt or Matthew: Ferrer, Ferraro, Fetter, Farreah, Ferrenc, Ferrous, Ferris, Ferentz, Ferrick, and DeFerence. I got 14 votes in neighboring state districts, and four votes for the U.S. House Race. Among other write-ins, I beat a slew of names that received a single vote or a handful, tough competitors like Brad Roae (who a few people wrote in, even though he was on the ballot), Stephen Colbert, Anyone But Him, Anyone Else, Jesus, God, and Red Breasted Nuthatch.

Look, my day job is writing and teaching. I’m a professor at a small liberal arts college, chair of the Department of English, writer and teacher of creative nonfiction. I was born in southwestern Pennsylvania, among the played out coal fields and strip mines an hour east of Pittsburgh. I earned a Ph.D. at West Virginia University, where I specialized in Appalachian literature. I wrote a memoir about my brain tumor, and the geology of the Allegheny Plateau, and the curious exile of inhabiting the weird position of Northern Appalachian, which means you’re not quite normal American and not quite Appalachian. None of that adds up to politician, but all of it adds up to frustration. I’ve spent most of my life, other than brief adult stints in Arizona and France, living in a region that skews way right, even as that right continues to exploit and degrade the people and place. All Appalachia ever has been allowed to be is exploited. That’s it. And that’s all the rhetoric of the GOP offers, when you boil it down. Let’s Make America Great Again, like when black lung wrecked lives on the regular and, newsflash, is now roaring back to life since the unions have been busted, and the economy of the region stayed busted, so the people crawled down into mines without the protections hard fought with blood and love by the striking workers of Blair Mountain, and the striking workers of Pittsburgh steel, and the striking auto workers of the Rust Belt.

Ferrence knocked on some doors and created a Facebook page to promote his campaign. He did several short videos to explain why he ran and discuss issues. Photo: Matthew Ferrence for PA House, District 6 Facebook page

Public historian Elizabeth Catte gets it right (she’s the author of “What You’re Getting Wrong about Appalachia”) when she argues that Appalachians have been socialists all along. They just don’t know it. They gathered together. They fought the power of industrial dominion. They powered America with their coal, yes, but they also fueled the national movement for respect and dignity for labor. Then the GOP figured out how to weaponize hatred and fear, and there you go. You get Joe Manchin, alleged Democrat. And you get a region that votes more than 2/3 for Trump and Trump-esque troglodytes like Pennsylvania’s GOP gubernatorial candidate Scott Wagner, who claims that global warming is probably just accumulated body heat from a larger human population or happens because the earth is getting closer to the sun, and campaigns by saying he’ll dance on the governor’s face while wearing golf spikes.

It boils down to this: I am so tired of waking up on November Wednesdays in Appalachia, seeing election results and, worse, national punditry that says this is all we are and all we’ll ever be. The election map of my state is bright red, other than around a few urban centers, just like most of Appalachia. That seems to translate to the same conclusion we get over and over and over again: dumb hillbillies voting for the worst. That conclusion seems to be supported by the simple math of our state politics, where more than half of state legislators run unopposed in their general elections, and our incumbency rate is about 90 percent. Few candidates ever put up a fight to change that.

So what’s an Appalachian creative writing professor to do? You run a last-ditch campaign. You tilt against the windmills in a manner that is both impotent (because you get crushed at the polls) and, at least for me, hopeful. Because having a choice, any choice, other than the incumbent mattered to the 2,000 people who either voted for me or tossed in a symbolic protest write-in. Because people stopped me when I walked by, and messaged me on Facebook, and were angry when they learned about the campaign only after they voted because, damn it, they couldn’t vote for the incumbent, and leaving it blank is just what the GOP has wanted for so long. The story of Appalachian politics has been about that blankness, a cultivation of the sense — and you can read this in almost every national outlet at some point in the last two years, usually with a quote from that faux-Appalachian pseudo-pundit J.D. Vance — that there’s nothing but right-wing fools in these hills and hollers. Appalachia is given up for dead again, this time just as a tarnished example of the hatred and backwardness of politics in this strange, strange land.

That’s just not how it is. That’s not the Appalachia I know nor the one I saw in my brief campaign. Heck, I ran this mini-campaign focused specifically on lefty sustainability, as in ecology and tree-hugging, as well as economies that stop repeating the boom-bust cycles of our past, and I drew a mighty good swipe of votes all at once, in the end. There are a lot of people in my county who believe in the value of the environment, and the necessity of fine educations, and the rightness of universal healthcare, and the imperative of social justice, and the glory of love in all its forms. There are progressives in these hills, you know. And a lot of them, but also a lot who hear those same old stories and worry about what the neighbors will think, so they don’t vote, or accept the inevitability of political monoculture. Thus the slam happens again. And again. And again. Unopposed Republican. Platforms of no taxes. Tacit acceptance of the Confederate Battle Flags that flutter on too many once-Union farmhouses.

Yeah, I got creamed. But I think we also won something that night. And we’ll keep coming back for more, riding a blue wave tinged with green, fighting for a change in the rural center of America that so many figure is lost forever. You know the joke, about Philadelphia and Pittsburgh and a lot of Alabama in between. Well, Alabama has a Democratic Senator, and so does Pennsylvania. We can do more, do better, push against the dogged stupidity of a right-wing cultural war that makes us all weaker and worse off. We can step into these races, and we can square off and say, hit me, and we can get hit, and eventually we can win. I know I’ll give it another shot – with my name printed on the ballot next time. I’ll need at least a couple of months next time, to get enough votes to be competitive, if history holds. But I’ll vow, and I hope others will too, that no one gets to run unopposed anymore. No one gets to spit out tired political bullshit and not get called out. This is our Appalachia too.

This article was originally published by the Daily Yonder

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There’s a Tool that Claims to Predict Potential for Criminal Behavior. Should PA Judges Use It?



Allegheny County Courthouse in downtown Pittsburgh. Photo: Connor Mulvaney/PublicSource

The Pennsylvania Commission on Sentencing is considering a “risk assessment” tool, which, according to social justice activists, would reinforce existing bias in the criminal justice system. But the tool’s designers say it would give judges more data to base sentencing decisions on as opposed to primarily relying on uniform guidelines.

The commission is hearing public feedback about the risk assessment tool on Thursday, Dec. 13, from 10 to 11:30 a.m. at the Allegheny County Courthouse (436 Grant St., Pittsburgh).

How would the “risk assessment” tool work? Say you’re facing a criminal charge. In addition to the usual information about your present and past — as in the crime for which you are on trial and your prior record, if any — the judge also has a report trying to predict your future. On a scale from 0 to 18 points, an algorithm has indicated how likely you are to reoffend, based on data about recidivism rates.

Read more about how the risk assessment tool is used to calculate sentences from PublicSource.

This story was originally published by PublicSource based in Pittsburgh.

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