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The Lonely Drop Box: How Government Drug Take-Back Efforts Can Improve in Appalachia

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On the Lonely Drop Box’s website, eight red dots mark where Southwest Virginia residents can find pharmacies with permanent drug drop-off boxes.

Those dots — along with 17 blue dots representing law enforcement agencies with drop-off sites — are surrounded by gray markers showing pharmacies that don’t collect unwanted or expired prescription medication. Out of 217 pharmacies in a 26 county area, only eight offer a permanent box where customers can safely get rid of medicine, according to the project’s website.  

That’s a statistic the project is hoping to change. The Lonely Drop Box project is part of the Urgent Love Initiative, a strategy started by The Prevention Council of Roanoke County that aims to tackle the opioid epidemic and drug addiction more broadly.

In January, the Lonely Drop Box project started sending out postcards to the largest chain pharmacies in the area: Kroger, CVS, Walgreens and Walmart, urging them to install drop boxes. The idea was to flood CEO offices with 4,000 total postcards, each bearing the Lonely Drop Box — a cartoon mascot meant to remind executives of the only drug drop box provided through a chain store, which is at a Walgreens in Roanoke.

The group also began conducting research on which locations already provide drop boxes. Besides that Walgreens, they found one other drop box provided through a franchise pharmacy and six provided by independent pharmacies.

“We contacted every pharmacy in our area, which was not a small feat,” Urgent Love Initiative strategist Walt Boyle said.

The project’s goal is to give more residents the opportunity to drop off expired medication at the same place where they pick up new prescriptions. That gets unwanted medication out of people’s cabinets and out of reach of anyone who might want to use those drugs for recreational purposes, Boyle said.

“Holding on to them creates its own problems,” Boyle said. “Children, contractors, relatives, housekeepers get into these stashes and pick up a few pills and they can slowly drain away magically.”

Since 2010, the U.S. Drug Enforcement Administration has hosted national drug take back days in communities across the nation as a method of fighting prescription drug abuse. Every six months, residents can take their unused or unwanted medication to a designated location — usually a law enforcement agency — so it can be incinerated. On Oct. 14, 2017, the DEA collected 912,305 pounds of medication from 5,321 collection sites through the program, according to the department’s website. Nearly three tons of that were collected in the 26- county area that the Lonely Drop Box project is focusing on, Boyle said.

After the DEA’s program was introduced, some law enforcement agencies created permanent drop-off sites. In the Roanoke, Roanoke County and Salem area, there’s just two such sites: one at the Roanoke County Sheriff’s Office and one recently installed at the Vinton Police Department.

Roanoke County Sheriff’s Office Deputy Chad Beheler, who works as the department’s Community Outreach Coordinator, said a deputy empties 60-70 pounds out of the department’s drop box about every two weeks. Sometimes, if he sends a reminder about the drop box’s availability through social media, the box fills up in a single day.

But the presence of drop boxes in a few law enforcement agencies is not enough, Boyle said. With only 17 departments participating, residents in some counties like Craig, Amherst and Appomattox either have to wait for the next take-back day or just not donate the medication at all.

Boyle argues that the companies selling the drugs should do more to make sure they don’t fall into the wrong hands.

“Is it the responsibility of tax payers or law enforcement or the non-profit community to be working so hard to take these medications back?” he said.

The group’s idea has merit, according to Jeffrey Gray, an associate professor with East Tennessee State University’s Bill Gatton College of Pharmacy. He co-authored a 2015 study published in the American Journal of Public Health that analyzed eight permanent drug drop box locations in Northeast Tennessee over the course of two years. The results: 4,841 pounds of pharmaceutical waste, almost 240 pounds of which were controlled substances. While that accounts for less than 5 percent of the collected materials, it adds up to 106,464 dosages. Hydrocodone, tramadol and oxycodone were the top three controlled substances collected, according to the study.

Gray said there’s “no question” that drug drop boxes serve as a good method for removing medications that can be abused from communities.

I’m an advocate for patient options. The more options that patients have, the better, and the less likely that the medications will be used non-medically,” Gray said.

When Gray first began studying the drop off sites in 2009, collection of unwanted medication was limited to sporadically held law enforcement events. Now, Gray said, communities have more disposal options. Using a five-year National Institutes of Health grant, he and other researchers have continued their work. He said the group has discovered that the period between when a patient receives the medication and when they donate it has decreased during the time that the drop boxes have been in place. Researchers have also discovered that very few people are willing to go more than 10 miles to get to drop-off site.

“How far are you willing to travel to a pharmacy to pick up a medication?” Gray said. “It would make sense that they’re willing to donate it at an equal distance.”

Many people living in the Lonely Drop Box project’s 26-county focus area already have to travel a long distance before reaching a pharmacy, much less a drop off site, according to the data the group has collected. In Grayson County, two independent pharmacies are clustered near Independence, Virginia. The next closest pharmacy is near Galax, about 16 miles away. The group’s map also shows few pharmacies in Carroll, Floyd and Craig counties.

That lack of access is demonstrative of larger trends in Appalachia. According to a 2012 study prepared for the Appalachian Regional Commission, Appalachian counties have higher health care costs on average, as well as more coverage and access disparities, than other U.S. counties.

So far, Gray said the independent pharmacies in his research area seemed most receptive to the idea of installing drop boxes.

“They’re able to see the need in their community, and they don’t have to go through red tape and corporate policy to make those steps,” he said.

Boyle said the Lonely Drop Box project has also had more success engaging with independents. The group is currently working on ways to guide independents through the process of acquiring a drop off box.

But Boyle still hopes to convince chain pharmacies to “do the right thing” and join the fight as well.

“We’ve been in touch with some of the folks inside a couple of the companies, but it has turned out to be more of a PR conversation,” he said. “This is a marathon, not a sprint for them. For us, it needs to be a sprint. There needs to be a sense of urgency.”

Tiffany Stevens (@tiffanymstevens) is a print journalist living in Southwest Virginia. Their newsletter, “Happening at Home,” rounds up great reporting from two different cities each issue.

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Fighting Addiction

ARC Funds Addiction Treatment For Women In Rural Kentucky And Ohio

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Key partners of the Appalachian Recovery Project meet at Ohio University Wednesday to provide updates on how the ARC Power grant will be utilized. Photo: Aaron Payne, Ohio Valley ReSource

This article was originally published by Ohio Valley ReSource.

The Appalachian Regional Commission has awarded more than two million dollars to expand addiction treatment and recovery resources for women in rural regions of the Ohio Valley hit hard by the opioid crisis.

Ohio University received $1,100,000 for the Appalachian Recovery Project in Athens County, Ohio. WestCare Kentucky, Inc., received $1,136,000 for the Judi Patton Center for Families project in Pikeville, Kentucky.

The funding comes from the ARC’s POWER Initiative, which was intended to boost economic development in regions affected by the decline of the coal industry.

The ARC found addiction recovery and economic recovery go hand-in-hand.

“There is clearly some correlation between economic distress and substance abuse,” ARC Federal Co-Chair Tim Thomas said. “So the commission though it appropriate that we use some of these resources from the POWER program to address this problem.”

Appalachian Recovery

Thomas was in Athens, Ohio, Wednesday to announces the grant as part of an update on the Appalachian Recovery Project.

The effort involves eight major collaborators working to turn the old Hocking Correctional

Facility in Nelsonville, Ohio, which closed last year, into a treatment facility able to help 300 women at a time.

Tracy Plouck, an executive in residence at Ohio University and lead for the grant proposal, said it will be a year before the renovations are complete.

The ARC grant funds will help jump-start the program and make services available to women in the community and in the justice system this fall.

“We’re bringing different kinds of resources from the community to bear into a single network so that we can more effectively assist women who are trying to connect with recovery,” Plouck said.

Those resources include residential addiction treatment, music and art therapy, job training, and health workers to help navigate the program.

Family Treatment

The ARC grant will fund the renovation of a building in Pikeville, Kentucky, to house the Judi Patton Center for Families project.

The project is named after former First Lady of Kentucky and Pike County native Judi Patton. She is known for her work advocating women’s safety and child abuse prevention issues.

The facility will provide services through WestCare Kentucky to women seeking addiction treatment and their children.

“Patients will live with their children at the site while receiving treatment through professional, licensed, evidence-based, gender-specific programming for women,” according to a description of the program from the ARC. “Onsite therapeutic child care will provide a safe environment for children while their mothers obtain needed recovery services.”

The center plans to serve 300 patients each year and provide them with resources to sustain recovery and reenter the workforce.

Thomas says the ARC invests in projects like these because they believe solutions to the addiction crisis will be found when communities work together.

“We have to build a recovery ecosystem within the Appalachian region to help bring these people through recovery.”

The ARC has awarded over $148 million in POWER Initiative grants since its inception. An estimated $45 million will be made available via the POWER 2019 funding cycle.

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Fighting Addiction

After Obamacare: The Affordable Care Act and one woman’s struggle for sobriety

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Wendy Crites is a single mom, a Christian and a recovering addict in the Eastern Panhandle of West Virginia. She’s on parole and receiving substance abuse treatment through the Jefferson Day Report Center. Crites has been using drugs since she was 13, intravenously since she was 15.

“Everyone has some kind of addiction,” she said. “I believe it’s that hole everyone has in their heart that you’re trying to fill — I’ve filled it with drugs. I think it’s really something only God can do. And I think he uses our weaknesses to bring us to him.”

Crites has a 26-year-old daughter, Ashley, and a 12-year-old son, Devin.

“I have the sweetest son – half of his life he’s saw me be strung out on drugs. He’s getting ready be a teenager, and I just want to be a good role model for him.”

Crites has worked a variety of jobs since she was 16-years-old but dreams of having a stable job with benefits that would allow her to save money and provide for her kids. That’s a tall order for anyone with felony charges, albeit nonviolent charges in her case.

She relies on her faith and her desire to be a good parent to motivate her through recovery.

She also relies on the services provided through the Jefferson Day Report Center. These services include transportation, mental and behavioral health, and various forms of medically-assisted substance abuse treatment — all covered under the Affordable Care Act. Through the center, Crites receives Suboxone, a medication used to treat opioid addiction by reducing withdrawal symptoms and the urge to use.

Crites in a waiting room at the Jefferson Day Report Center, where she receives counseling and medical treatment for addiction. (Photo: Rebecca Kiger)

“Between the meetings, the counseling, the Suboxone, and God … that program saved me.”

Without the support of these services, a simple misstep could jeopardize months or years of sobriety. Crites recently broke her ankle while working.

“My daughter, when she first found out I broke my foot, her first thought was: ‘I’m afraid mom’s gonna use again.’”

Crites with her 26-year-old daughter, Ashley, and 12-year-old son, Devin. (Photo: Rebecca Kiger)

Despite having a broken foot, lacking a vehicle, being denied food stamps because she’s a drug offender, and having to build a new social support system from scratch at 50 years old, Crites is, so far, maintaining her sobriety.

This story was produced in collaboration with Ohio Valley ReSource.

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