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An Epidemic in Appalachia

White House Takes on Opioids on Its Own Turf – the Mass Media

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On Thursday, the White House unveiled the first act in its effort to fight the opioid epidemic by harnessing the power of digital media and cable TV.  

A partnership between the White House Office of National Drug Control Policy, the Truth Initiative, a nonprofit previously focused almost exclusively on efforts against the tobacco industry, and the Ad Council created and premiered “The Truth About Opioids” ad campaign. The project aims to “close the knowledge gap” about the dangers of opioids and “empower people with the truth” to help them fight and prevent addiction.

The campaign kicked off with an airing of the first spot early that morning on the Today Show.

 

Soon after, during a phone briefing, the President’s Counselor, Kellyanne Conway, delivered a carefully crafted speech, in which she reiterated that the Administration understands the multifaceted nature of the opioid crisis and that the campaign is only a part of an effort aimed at “preventing new misuse and new addiction by raising awareness.”

Spearheaded by the Truth Initiative, best known for its aggressive anti-tobacco campaigns, “The Truth About Opioids” will target primarily young people between 18 and 24 years of age, across all digital media platforms.

Four short documentary-style video clips tell the real cautionary tales of four young adults who harm themselves in violent ways in order to gain access to more opioids.

The shock value is there, and so is the production value. The videos provoke that unpleasant sensation one gets from well-executed, naturalistic depictions of pain.

Every spot provides a backstory, probably the most important element of the whole endeavor, trying to show that opioid addiction is not — necessarily — a typical, recreational drug addiction.

The ads point to the systemic issues of over-prescribing and lack of proper medical guidance that leaves young people addicted and desperate.  

The campaign’s website provides a host of additional information with a clear goal of delivering easy to digest, basic knowledge on the issue. It’s hard to say just how successful these efforts will be.

We have written in the past about the potential pitfalls of following in footsteps of failed mass media campaigns, like the infamous Nancy Reagan initiative, “Just Say ‘No.’”

Robin Koval, CEO and President of the Truth Initiative, pushed back against that narrative. During the briefing, she pointed to extensive research conducted prior to the release, as well as Truth Initiative’s previous success in messaging to young adults.

Koval said that the Truth Initiative “tested over 150 different message possibilities, and pretested all of the advertising and the executions themselves.”

She also shared the criteria used to test the proposed messaging. “One, does it decrease intentions to misuse? […] Two, does it impact willingness to share with someone else?  Does it increase risk perceptions? […] do these ads compel you to want to learn more — as we say, ‘Know the truth, spread the truth’ — and do they compel you to want to share them in your peer network? […]” According to Koval, the final ads were the most successful with the targeted age group.

Facebook, Google, YouTube, NBCU, Turner, Amazon, and VICE are among the companies that chose to donate their resources – broadcasting time, research, or online targeting tools – to help disseminate the campaign and reach the desired audiences. These are powerful allies for the cause.

Although the acting director of the ONDCP, Jim Carroll, didn’t put a price tag on the entire project, Lisa Sherman, President and CEO of the Ad Council, revealed that ONDCP “has funded a very small amount of money to support some of the other hard costs of the campaign.”

Carroll did answer other journalists’ question, saying that the campaign did not tap into the $10 million pot dedicated to fighting the opioid crisis that was secured in the Omnibus spending bill.

Koval added that “We [The Truth Initiative] felt very strongly that, because we had the ability to donate this, we want other funds to go to those very, very urgent matters of prevention, of rescue, of recovery, which are the things that are happening on the ground, right now, every day.”

While we can state fairly conclusively that “scare them straight” types of campaigns have historically worked poorly in reducing harm, these new educational efforts combined with relatable messaging could hold some promise.

The funding structure and emphasis on donated resources by some of the biggest tech corporations also holds promise.

For once, the powerful algorithms that seem to be driving so much of today’s online media traffic and economy are said to be targeting one of the nation’s biggest health problems.

Yet, no matter how optimistic the prospects of the campaign, we should remember that there remains a number of unanswered questions. To the people of Appalachia, some are more interesting than others.

How will the modern, 21st century online-based campaign overcome the connectivity problems across Appalachia? Is the knowledge gap the true problem in poverty-stricken communities, where the black market for the opioids serves as a source of supplemental income?

Last, but not least, when asked during the briefing about the choice of the age range of 18-24 as a target audience, Koval said that the choice was driven by Truth Initiative’s experience and pre-built trust among young adults. “We chose to focus on the group that we know […] It’s an audience that trusts us, that we have relevance with, credibility, and where we can create impact.”

That leaves large swaths of affected populations out of the campaign’s reach, often ones that — in sheer numbers — suffer the greatest loss of life due to the crisis.

According to CDC data, death rates due to drug overdoses are the highest among 35-44 and 44-54 age groups.

Here’s data accompanying the graph.

The promised scope of the campaign and the partnerships it managed to secure are impressive. Let’s hope the impact will be equally so.

An Epidemic in Appalachia

The Doctor And The Epidemic: Three Years At Ground Zero Of The Opioid Crisis

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Dr. Rahul Gupta in his office at the West Virginia Department of Health and Human Resources shortly after taking over as the commissioner for public health. Photo: West Virginia Public Broadcasting

When Dr. Rahul Gupta started work as West Virginia’s chief health officer his state was already ground zero for the opioid epidemic, with some of the nation’s highest rates of addiction and overdose fatalities.

That was 2015, and 735 state residents died from overdoses that year. 

Preliminary data for 2017 show there were 1,011 overdose deaths last year, a record high for the state.

“Not a day goes by that I’m not constantly thinking about it,” Gupta said. “We’re losing three, three-and-a-half West Virginians per day. So, the clock’s always ticking in my head.”

The epidemic takes an emotional toll on Gupta not only because the loss of life, but because he sees how it has impacted the loved ones of people with opioid use disorders.

“When I hear about parents that say ‘I’d rather have my child arrested and put in prison because that way I know that person will be alive.’ That’s the most heart wrenching part of this,” Gupta said.

After three years on the front lines of the crisis as commissioner of the Bureau for Public Health, Gupta is leaving West Virginia next month to become Senior Vice President of the March of Dimes organization.

Reflecting on the fight against the opioid crisis during his time in West Virginia, Gupta is hopeful that he is leaving behind tools that will allow the state to overcome the epidemic. And he says his experience has strengthened his resolve to continue advocating for solutions in his new position.

The Stigma Barrier

Like other health officials, Gupta has struggled with a lack of resources to address addiction treatment needs in rural communities. But he says the stigma surrounding opioid use disorder is perhaps the biggest barrier for public health workers.

Dr. Rahul Gupta signing an order expanding availability of the overdose-reversal drug naloxone. Photo: West Virginia DHHR

“This particular epidemic has taken really extreme toll in terms of dividing the country,” Gupta said. “Half of the country literally feels that it’s a disease of choice. Whereas, if you think about the science and the changes that happen to change the chemistry in the brain, you’re not the same person anymore.”

Research shows the words we use or the false ideas we hold about addiction can prevent us from implementing scientifically-back strategies to approaching the epidemic, such as medically assisted treatment or needle exchange programs.

“We all have an opportunity to behave differently, to empathize,” Gupta said. “But also help propagate that stigma, whether it’s the terminology we use or the actions we take.”

Gupta’s inward reflection on the way he addressed the epidemic made him believe eliminating stigma is the most important step toward progress.

Data Lessons

While the data surrounding the crisis are grim, the numbers are not entirely negative.

Preliminary data predict overdose fatalities for the state will rise again this year. But the rate at which they are increasing is slowing down. That means some steps the bureau has taken are working, such as expanding access to the overdose-reversal drug naloxone and supporting overdose follow-up teams. 

Another strategy Gupta says he is proud of is the creation of a data profile based on the 830 residents who fatally overdosed in 2016.

“We found some really interesting characteristics,” Gupta said. “We found that majority of these individuals, eight out of 10, were actually coming in contact with the healthcare system prior to their deaths, prior to the overdose.”

Credit: Alexandra Kanik / Ohio Valley ReSource

Gupta called this a “social autopsy” and local health departments call it one of the most important developments the health bureau made during Gupta’s tenure.

It helps identify who to look for and how to connect people to resources they need.

“It’s a lot easier if you can see a person or the representation of a person. Dr. Gupta allowed locals and the state to do that,” Kanawha Charleston Health Department Public Information Officer John Law said.

The Water Crisis

Of course the opioid epidemic was not the only challenge Gupta faced as a public health official in West Virginia. He served as executive director of the Kanawha Charleston Health Department from 2009 until he became the bureau’s commissioner.

There he dealt with another high-profile crisis when the coal-cleaning chemical MCHM leaked from Freedom Industries into the Elk River in Charleston, leaving 300,000 people in nine counties without usable water.

“Doctor Gupta was probably the acknowledged expert at the time in how to address the water crisis when he was here at the Kanawha Charleston Health Department,” Law said.

One of the first actions Gupta took after MCHM was discovered in the water supply was to shut down the area’s restaurants as a precaution.

“He, in a really innovative way, started making plans for reopening the restraunts a couple of days later,” Law said. “They had to submit a plan about how they would use water that didn’t come through the system. But we got those places back open.”

He then continued to spearhead the discussions about the water crisis, including a meeting in Washington D.C. at Sen. Joe Manchin’s office with the Centers for Disease Control and Prevention.

Law said whether it was the water crisis, the opioid epidemic, or the recent surge of Hepatitis A, it was Gupta’s clear vision for public health that made him an asset to the people of West Virginia.

“I think Dr. Gupta will take his public health vision and his knowledge of public health policy on a national level and be successful wherever he goes,” he said.

Marching On

Gupta hopes to keep working to combat the opioid epidemic in the Ohio Valley in his new role at the March of Dimes. He plans to help the organization focus on mothers with opioid use disorder and their babies born affected by the drugs in the mother’s body, a condition known as neonatal abstinence syndrome.

Credit: Alexandra Kanik/Ohio Valley ReSource

Data from last year show nearly 51 babies out of every thousand live births in West Virginia were found to be affected by drugs, the highest rate in the Ohio Valley and among the highest rates in the nation.

“Every baby may cost up to a million dollars to the state in terms of all the care that has to be provided in the first few years of life,” Gupta said. “And we don’t even know the long-term impact as of yet.”

West Virginia has been Gupta’s home for nearly a decade. He worked alongside his neighbors to tackle some of the states most challenging health problems.

And what he learned about the people leads him to believe they will one day overcome the addiction crisis. 

“People who are the most resilient, that spring back and fight for the right reasons, and, at the end of the day, are able to find solutions when we feel that there aren’t any,” Gupta said.

Gupta’s last day with the Bureau of Public Health is November 4.

The state Department of Health and Human Resources has announced a nationwide search to find his replacement.

This story was originally published by the Ohio Valley ReSource.

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An Epidemic in Appalachia

New Ohio Data Show Sharp Increase In Overdose Deaths From The Opioid Fentanyl

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Photo: Mary Meehan/Ohio Valley ReSource

New official state data from the Ohio Department of Health show 4,854 people died of drug overdoses in 2017, a 20 percent increase from the previous year.

The new data add to evidence from around the Ohio Valley showing deaths related to the opioid crisis continued to rise in 2017 as state records begin to reflect the fatalities related to the powerful drug fentanyl.

Fentanyl Fatalities

Ohio Department of Mental Health and Addiction Services Director Dr. Mark Hurst said illegally produced fentanyl was the driving factor in the fatality increase.

“Not only the fentanyl alone, but also fentanyl which is sometimes mixed with other street drugs like cocaine, heroin and methamphetamine,” he said.

The data show fentanyl was involved in 71 percent of all overdose deaths. Cocaine-related  deaths increased 39 percent and methamphetamine deaths were up 130 percent.

A recent report from the Kentucky Office of Drug Control Policy found 1,565 died from drug overdoses last year, up 11.5 percent from 2016.

Fentanyl played a factor in more than half of the overdose cases in which a toxicology report was available.

“Fentanyl is the deadliest and most addictive drug our nation has ever seen,” Van Ingram, KODCP executive director, said in a news release. “The fact that people continue to use it – despite the obvious risk – shows just how addictive these drugs are. That’s why we have to make every effort to intervene with a comprehensive treatment response.”

Preliminary data in West Virginia indicate there were 1,011 overdose deaths last year, a record high for the state.

Statistics indicate the grim totals will not decrease this year.

West Virginia’s Chief Health Officer Dr. Rahul Gupta said the total number of fatal overdoses so far in 2018 indicate a higher toll in his state than last year.

Glimmer of Hope

But the news is not entirely bleak.

In Ohio, deaths related to prescription opioids and heroin were reported at an eight-year and four-year low, respectively.

Ohio Gov. John Kasich said it’s important to highlight successes in the fight against the epidemic.

“That doesn’t mean we fly a banner that says ‘Mission Accomplished.’ But every once in a while I think it’s important for the public to see that there are bright spots,” Kasich said.

Kasich attributed the decrease to statewide efforts to reduce the supply of misused prescription opioids.

In West Virginia, the projected rate of increase in overdose fatalities appears to be leveling off, according to Gupta.

“From ‘17-’18 it’s projected at about 6 percent [increase],” he said. “So we’re certainly seeing a flattening of the curve. Up, but they’re not as up as they were from ‘16 to ‘17.”

Gupta anticipates fewer overdose fatalities in future months due to evidence-based approaches to the opioid epidemic across the region. Those include the availability of naloxone, increased medication assisted treatment and the reduction in opioid prescriptions.

This story was originally published by the Ohio Valley ReSource. 

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An Epidemic in Appalachia

Addiction Treatment Funding in Question as U.S. Health Secretary Promises a Fight Against Opioids

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West Virginia’s opioid overdose death rate is two and a half times the national average, the highest in the country. Last year, 864 West Virginians died from an overdose, up by more than 17 percent from the year prior.

West Virginia Department of Health and Human Resources Sec. Bill Crouch shared those statistics at a press conference Tuesday. Crouch hosted U.S. Health and Human Services Sec. Tom Price for a closed-door meeting about the state’s struggle with substance abuse and what the federal government can do to help.

“We are losing a generation of West Virginians,” Crouch said, “and in some cases with an addicted mother and her newborn baby, I worry we are losing two generations.”

Price said President Trump is committed to battling the opioid epidemic, not just in West Virginia, but across the country.

Shortly after taking office, Trump created a bi-partisan commission on drug addiction, led by New Jersey Gov. Chris Christie, and last month announced nearly $500 million in federal grants awarded to states to combat substance abuse.

Counselor to the President Kellyanne Conway says that’s Trump’s plan- to support efforts on the frontlines.

“This will not be solved from Washington, D.C.,” she said during the press conference. “This will be ameliorated and annihilated at the state and local levels.”

Price said the president’s push to support local efforts is why Price traveling the country to meet with state officials, but it’s also why the administration is supporting two essentially budgetary actions that seem to put substance abuse treatment at risk in West Virginia, at least for some populations.

The first is health care: 170,000 West Virginians received Medicaid coverage when former Gov. Earl Ray Tomblin chose to expand the program as a part of the Affordable Care Act. According Crouch, some 50,000 of those West Virginians also suffer with an addiction.

Medicaid does cover substance abuse treatment, but a Trump-backed plan to repeal and replace the Affordable Care Act would also put an end to Medicaid expansion and result in the potential loss of treatment for those 50,000 West Virginians.

“We have serious concerns about what is going to happen with that population,” Crouch told reporters. “Our crisis right now is difficult to deal with. If we have an additional 50,000 individuals with no coverage, no way to get treatment, we think our problem is going to get light years more difficult.

Considering those difficulties, Crouch was asked about his ability to convince federal officials to keep the expanded version of the program, but the secretary said the ACA repeal comes with something that’s good for West Virginia.

“As a state that wants more flexibility in terms of Medicaid and how we utilize Medicaid monies, that’s very welcome to us,” he said.

“We believe it’s wholly possible and the opportunity exists to provide states the flexibility, the appropriate resources,” Price said of the changes he sees as necessary to the Medicaid system, “so that we can have better outcomes and better coverage for individuals in the Medicaid population.”

The repeal and replace bill that allows for state flexibility, but also ends Medicaid expansion coverage, made it through the U.S. House of Representatives last week, with three supporting votes from West Virginia’s delegation. As it heads to the Senate though, both Senators Joe Manchin and Shelley Moore Capito have expressed concerns.

The second action that may put some substance abuse programs at risk comes in the form of a funding proposal for a federal office. Trump’s administration announced a significant cut to the Office of National Drug Control Policy last week—a 95 percent reduction in his proposed 2018 budget.

Price said while the administration has proposed cutting funding to the office, it is committed to increasing spending to combat the opioid epidemic elsewhere, including through the Department of Health and Human Services, but when asked if the cut was a result of failed outcomes from the office, Price said that was what he was asking state officials.

“That’s exactly what we’re asking and what the commission is going to be asking: what is the federal government actually doing that’s solving the problem, that’s assisting in getting better outcomes and what is it the that the federal government is doing in wasting federal dollars and resources?” Price said.

Under President Obama, the Office of National Drug Control Policy was responsible for coordinating efforts between public health and safety officials to reduce drug use across the country. The office, which is overseen directly by the White House, does not currently have a page on the administration’s website.

The proposals and their effects have some West Virginia advocacy groups speaking out, attempting to sway West Virginia’s leaders to take a different approach.

Members of the group West Virginians for Affordable Health Care stood outside Price’s Charleston meeting in an attempt to speak with him Tuesday, but were denied access to the listening session.

This story was originally published by West Virginia Public Broadcasting. 

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