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Drug Epidemic

In West Virginia, SNAP Benefits Out of Reach For Drug Felons



Inside the spotless industrial kitchen at Recovery Point, a long-term drug treatment facility in Charleston, Tracy Jividen helps to cook three meals a day for the nearly 100 women she calls her sisters. This space is her domain, and the irony isn’t lost on her: Last winter, she was stealing so she could eat.

At 37, Jividen has been locked up nearly all her life for crimes related to her addiction. She got her first felony drug conviction seven years ago, when police found a meth lab in her home. She stayed off drugs for more than two years after she was released from prison, completed drug court, got one of her kids back, had another child and got married. When her marriage fell apart, she became depressed, lost her job, her car and her kids. She started using heroin when she could afford it. And she wasn’t sure where her next meal would come from.

“There would be times I would walk around, and I would be hungry, and I would think, Man, can I just get a sandwich?” Jividen said.

SNAP Benefits Denied

Jividen can’t get food stamps for herself because she’s a drug felon in West Virginia. Increasingly desperate, she started shoplifting and writing bad checks she said were for food. Then one morning last November, she walked into a Piggly Wiggly, ate a sandwich in the store and tried to kit a check. Police said she had blank checks that didn’t belong to her, and they charged her with forgery.

Then, she walked back into jail.

“I said several times. ‘Mom, if they just gave me food stamps I would not have to do this.’ ”

Only West Virginia and two other states — South Carolina and Mississippi — still enforce a full lifetime ban on the Supplemental Nutrition Assistance Program, commonly known as food stamps, for people who commit drug-related felonies. Indiana had a lifetime ban, but just changed its law to lift it, effective in 2020.

West Virginia’s law does allow kids to get SNAP if their parents are drug felons, and in Jividen’s case, she chose to eat some of the food she bought with her kids’ benefits rather than go hungry.

“I was taking from them every day, and that’s not right,” Jividen, who’s from Charleston, said.

Emily Wang, a Yale School of Medicine professor who has treated those released from prison for more than a decade and has studied the ban’s impact, called such policies “punitive.”

“When people have served their time, done their time and come home and yet still have these barriers [that] is striking,” she said.

More than 2,100 drug felons were denied SNAP benefits in West Virginia in 2016, according to the state Department of Health and Human Resources. That figure doesn’t include those who didn’t apply knowing they’d be denied. The number has more than tripled during the past decade. For some comparison, Nebraska, a state whose population is similar to West Virginia’s, denied benefits to about 675 applicants in 2015 because of drug felony convictions.

DHHR didn’t have a breakdown by county available or more recent numbers.
W.Va. Numbers Significant

Observers called West Virginia’s numbers significant.

Marc Mauer, a leading expert on sentencing policy and director of the Washington, D.C.-based nonprofit, The Sentencing Project, called them “disturbing, especially in a place like West Virginia” considering its outsize opioid problem. The rationale behind rule law is flimsy too, he said, because it targets a single type of conviction.

“I could go to prison on three armed robbery convictions, but the day I get out, I could go and apply for food stamps, and if I met the income requirements I would quality. It’s not clear why this is only applied to drug offenses,” he said. “It places people that are on the edge … a big shove over the edge in many cases.”

Nearly a fifth of West Virginians use SNAP benefits, and five of its counties rank in the top 100 nationwide for the concentration of food-stamp recipients per capita.

Lawmakers passed a federal ban on food stamps for drug felons in 1996 under the Clinton administration, a small part of a package of major welfare reform laws. Under the rule, felony drug offenders can’t get other welfare benefits either. Mauer calls the provision an outgrowth of War-on-Drugs-era policies — but one not based on evidence.

“This particular provision was thrown in as a relatively minor provision. It received literally two minutes of debate,” Mauer said. “When one thinks about the tens of thousands of people in various states affected by it, two minutes of debate in Congress seems pretty shameful for such an important policy shift.”

The policy was designed to punish drug offenders and potentially deter would-be ones from committing such crimes, said Elizabeth Lower-Basch, an expert on federal and state welfare policy at CLASP, a Washington, D.C. nonprofit, who has studied the ban’s affects.

“I do think most states have, over time, recognized this isn’t helpful for the goal of reducing drug use,” she said. “Obviously, people who are suffering from addiction may not be thinking about the long-term consequences on many levels, and the added punishment does not seem to influence behavior.”

Indeed, most have either opted out of the ban or adopted some restrictions — for instance, in some states, drug felons might have to take a drug test or complete a drug treatment program to qualify for SNAP. The issue gained some traction in West Virginia in 2011 when Daniel Foster, a Charleston physician who served 10 years in the state Senate, became the lone sponsor of a bill that would have lifted it entirely. The Senate passed the measure 27-6, but it died in a House committee before the end of the legislative session.

Seven years later, Foster maintained that the law “doesn’t put West Virginia in a good light.”

“It just seems like penalizing folks in this way doesn’t provide any real benefits to society.”

Transition Back into Society Already Difficult

West Virginians with felonies, drug-related or otherwise, have a tough time transitioning back into society as it is. The Legislature passed a law last year that allows people with non-violent felony convictions to ask a court to reduce them to misdemeanors — but they have to maintain a clean record for 10 years first.

Other barriers remain: A so-called “Ban the Box” bill that would have prevented public employers from asking job applicants about their criminal records stalled in committee in February. And many felons can’t get public housing, although each West Virginia county housing authority has such discretion.

Shawn Tackett remembers feeling bereft of a support system when he was released after 10 years in federal prison.

Tackett, 40, runs a sober-living home in Cross Lanes called the Rock. He’s been off drugs for five years, but he did two stints in lock-up, including a sentence for conspiracy to distribute and manufacture meth.

“I look at it now and think of all the poison that I put on the streets, and the families that I destroyed, and the people that I hurt. And sure, I deserved it,” he said.

In prison, he said, he earned several trade certifications and was done with drugs, ready to reunite to with his sons. But he said even with those new skills, he couldn’t get work in those fields once people saw his criminal record. Without a driver’s license, he said it didn’t make sense to take a bus to a minimum-wage job. He stayed with a friend in St. Albans and applied for public assistance.

A DHHR representative called back with bad news: He was eligible only for a Medicaid card.

“First thing she said was, ‘What kind of charge?’ I said a drug charge. She said, ‘There’s nothing I could do for you,’ ” he recalled. “I’ve been behind a wall for 10 years. The world has changed dramatically. Just help me to help myself.”

Tackett visited food banks and pantries for months. Eventually, he went back to making meth and got locked up again.

Stories like Tackett’s and Jividen’s are exactly what policy analysts worry about. Research shows the ban disproportionately affects poor people and also sets up drug offenders to be rearrested.

“Blocking the formerly incarcerated from basic nutrition assistance after they have served their debt to society is a form of extended punishment, which leaves them more vulnerable to food insecurity and may put them at risk of returning to illicit activity to meet their basic needs,” Elizabeth Wolkomir wrote in March for the left-leaning Center on Budget and Policy Priorities.

Seth DiStefano, policy outreach director of the West Virginia Center on Budget and Policy, put it this way: “If you put people in a position where they have no other choice but to fall back to a life of crime in order to feed themselves or feed their families — if that’s the only option you give them — don’t be surprised when that happens.”

Opting out of or modifying the policy would require a change in the law.

DHHR collected the numbers of drug felons receiving SNAP for Delegate Kelli Sobonya, R-Cabell, as part of a larger, general request she made into what kinds of benefits drug felons receive in West Virginia. She said any change in the policy would require “parameters.” That could include consideration of benefits on a case-by-case basis or at least some temporary assistance to those recently released.

“When you come out without support,” she said. “I don’t think that serves anybody very well.”

This article was originall published by West Virginia Public Broadcasting.

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Drug Epidemic

How Many Americans Really Misuse Opioids? Why Scientists Still Aren’t Sure



With rates of prescription opioid use disorder and opioid-involved overdose deaths on the rise, the U.S. opioid crisis appears to be continuing unabated.

Data on overdose and death are pretty reliable. But there’s still much that’s unknown about opioid misuse that doesn’t lead to an adverse outcome such as overdose.

Drug surveys are reseachers’ main method of collecting data on opioid misuse. I’ve been in drug survey research for almost two decades, but in recent years I’ve learned that collecting accurate data on opioid misuse in particular is difficult. Why? Because many people underreport misuse, while others unintentionally overreport misuse.

Colleagues have been asking me how to ask about opioid misuse on surveys. I’m finding that there’s no easy answer. But one thing I’ve learned in my research is that many people may misunderstand the basics about opioids, preventing researchers like myself from understanding the full scope of the epidemic.

Medical use and misuse

Drug surveys are already difficult to conduct, as many people lie about use. For example, some people deny use to appear more socially desirable, and others simply try to finish the survey quickly without really reading it. But opioid surveys are especially challenging.

A friend of mine recently took my drug survey. She texted me the next day, saying she believed she incorrectly answered my opioid questions. Even though my survey asked only about using to get high or using without a prescription, she admittedly didn’t read the directions and reported misuse of dilaudid, a pain medication.

Situations like this lead some researchers to distrust reportedly high rates of opioid misuse. For example, a few years ago, my colleagues and I estimated that 12 percent of high school seniors have ever misused prescription opioids. However, some of my reports focusing on such national data have (perhaps rightfully) been questioned, but we are limited by what people report.

On surveys, opioid misuse is sometimes defined as using without one’s doctor telling you to do so. Other times, it’s defined as using without a prescription. The most accurate definition is use not directed by a doctor, including using opioids without a prescription or using greater amounts, or more often or longer than directed.

It’s important to include definitions of opioids and misuse on surveys. However, such definitions are meaningless if those taking the survey refuse to read them.

Misuse is also a confusing concept, as it is possible to use as prescribed and still enjoy the feeling resulting from use.

Lack of knowledge

Even though the public is now largely familiar with the term “opioids,” many people still don’t appear to know which drugs are opioids and which are not. For example, my colleagues and I discovered that a over a third of high school seniors who reported nonmedical Vicodin or OxyContin use denied using opioids nonmedically overall. This suggests many users may be unaware that these drugs are opioids.

Opioids are commonly referred to opiates, painkillers, pain relievers, narcotics and analgesics. While “opioid” now appears to be the most common term, an individual familiar with the term may become confused when asked about different terms such as prescription painkillers or narcotics. The term “narcotics,” for example, can lead to confusion, as the Controlled Substances Act also includes cocaine as a narcotic.

Confusion may also arise regarding drug names. For example, OxyContin misuse may be overreported by individuals who used weaker oxycodone formulations. Codeine misuse may also be overreported by those claiming misuse of Tylenol III, which contains codeine, when they only used regular Tylenol.

I’ve also noticed that many people also don’t know the difference between methamphetamine, a potent stimulant, and methadone, an opioid. I learned about such confusion firsthand, after receiving multiple questions about methadone from social workers during a presentation I was giving about about methamphetamine.

Concoctions that contain opioids, such as “Sizzurp” (also known as “Lean” or “Purple Drank”), typically contain codeine cough syrup in a soft drink such as Sprite. Many users of this concoction likely deny codeine misuse.

It’s difficult to determine whether estimates of U.S. opioid misuse are too high or too low. Accuracy of these statistics is important, as they guide research, prevention, harm reduction and policy.

Researchers can use surveys to help educate people about opioids while collecting data. But first we need to figure out how to get people to read the questions.The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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An Epidemic in Appalachia

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



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.

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Drug Epidemic

Exchange of Ideas: How A Rural Kentucky County Overcame Fear To Adopt A Needle Exchange



Greg Lee, Kentucky’s HIV/AIDS educator, starts the town hall on a somber note.

“How many people in this room know someone who has died of an overdose death?”

It is a standing-room only crowd. Most hands go up.

“Amazing,” he says, sadly.

The meeting is at the Bourbon County Public Health Department, just next to the county’s drug rehab center and down the hill from a playground where used needles are found far too often.

For two-and-half-years there has been fierce opposition and two failed votes over a needle exchange here. On this evening, the key players are gathering one more time for a third debate on the needle exchange proposal.

Mike Williams, judge executive of Bourbon County, has been pushing for a needle exchange since state legislation made it an option in Kentucky. Bourbon County was the first rural county, following Louisville and Lexington, to attempt to start an exchange. After the failed attempts, he hoped 2018 would be different

“I was determined there was going to be a vote,” Williams said.

Cecil Foley, longtime magistrate, represents the most rural parts of the central Kentucky county.

“I was dead against it, to be honest with you,” Foley said of the needle exchange.

Bourbon County Magistrate Cecil Foley.
Photo by Mary Meehan/Ohio Valley Resource.

Joe Turner is the founder of Recovery Warriors, a group that works for addiction treatment.

“I knew going into the meeting it was going to be an uphill battle,” he said.

In addition to the toll of overdose deaths, the Ohio Valley now also has some of the nation’s highest-risk areas for outbreaks of needle-borne disease such as HIV and Hepatitis C. Health experts say a needle exchange is a strong defense against both overdose and disease. But exchange programs face strong public opposition, particularly in culturally conservative communities.

Which way would Bourbon County go?

“Handouts” or Help?

A skeptical tone dominates the early discussion in Bourbon County’s meeting. One audience member says, “I see those people all over dumpster diving, they’ll just take the needles and sell them to their friends.”

Lee pushes back and says the exchange is provided to prevent that. The woman is unconvinced. “I don’t think it will,” she says.

Photo by Alexandra Kanik/Ohio Valley Resource.

Others in the audience say addicts are just looking for a handout.

But amid the skepticism there is sympathy as well. When Magistrate Foley uses the word “druggies” some in the audience push back.

“If we are enabling druggies to break the law, that’s illegal,” Foley says.

“These people aren’t druggies, they are human beings,” a man in the audience booms in response, followed by applause.

Foley said later that moment caught him off guard.

“I was surprised, to be honest with you, that they came back so hard,” he said in an interview after the meeting. “I know they are human beings. I’ve a nephew who is in jail right now for using drugs.”

.As the meeting continues, Turner, wearing a ball cap and a black “Recovery Warrior” T-shirt, makes his way to the microphone.

“I’ve been arrested more times than I’d like to admit by some of the very people in this room,” he says, drawing some knowing laughs.

Photo by Mary Meehan/Ohio Valley Resource.

That was before he got clean five years ago, he said. Now Turner’s helping others, including Foley’s nephew. He said he connects up to 10 people a week with treatment. His phone rings constantly as people ask for help.

Turner tells the audience that the people he works with don’t want the life of an addict.

“They want help,” he says. “They will bum a ride, they will take a bike, they will hot foot it to come here and get a clean needle. They beg me for help.”

Health experts laid out how quickly needle-borne diseases can spread and how often people can have full-blown AIDS before ever getting tested. Lee talks about how much it costs to treat cases of HIV and Hep C and how that cost falls to the taxpayers. The price of prevention is far lower.

Difficult Decisions

The difficult discussions over needle exchange programs are happening across the Ohio Valley. Public health officials, increasingly alarmed by disease outbreaks and the unrelenting toll of overdoses, promote needle exchange programs as a way to reduce harm, encourage addiction treatment, and offer disease testing services.

The 2015 HIV outbreak in Scott County, Indiana, which was fueled by needle drug use, is fresh in the minds of many public health practitioners. More recently, outbreaks in southern West Virginia and northern Kentucky have renewed concerns, and the Centers for Disease Control has identified many counties in the region as at high risk for disease.

But the health facts run up against deeply held opinions about the moral aspects of drug use and the notion that a needle exchange enables drug addicts to continue harmful behavior.

Some opposition is rooted in religious convictions. Some is based in fear that an exchange will draw addicts from the surrounding region and bring what was considered an urban problem to a small town.

Seach for needle exchange programs with our interactive map >>

Even some places that have established needle exchanges are now reconsidering, worried that such programs bring crime into their communities or that local efforts are helping people from other counties or states. Charleston, West Virginia, recently suspended its needle exchange program amid criticism and pressure from the city’s mayor.

But by and large, needle exchange programs have expanded rapidly in the past two years in response to the opioid crisis. At the end of 2016, there were 30 needle exchange programs in Kentucky, Ohio and West Virginia. By the end of 2017, the region established nearly 40 additional exchanges, more than half of which are located in CDC at-risk counties.

Ten more exchanges have already opened their doors in 2018. Ten more exchanges are slated to open in the coming months in Kentucky alone, bringing the total to 46 Kentucky needle exchange locations.

Personal Tragedies

For about an hour the Bourbon County meeting is adversarial, with little common ground apparent. The meeting’s tone starts to shift in hour two as folks like Magistrate Don Menke share personal tragedies.

“My brother-in-law died, overdose. My nephew just died, was missing for a week,” he says. “They found him in a hotel room. Overdose.”

At least five people rise to say they have a relative who is addicted or who has died. Judge Williams says he’s been to the funerals of the children of five friends since he first proposed the needle exchange more than two years ago.

A Bourbon County playground where used needles often show up. Photo by Mary Meehan/Ohio Valley Resource.

“Those funerals are real,” he says. “That pain is real.”

At this point, Magistrate Foley seems to be having second thoughts about his opposition. But, he says, a needle exchange is still a tough sell for his constituents.

“I’m going to need your help,” he says to the room. “Where I live out in the county, nobody is in favor of a needle exchange. Y’all are going to have to help me tell this story that I heard here tonight.”

The room goes silent as Judge Executive Williams calls for the vote.

All eight magistrates cast their ballots. Foley votes, “Yes.”

There is a pause while the tally is made. The final vote: 6 to 2 in favor.

“The measure passes,” Williams says to thunderous applause.

What Works

In follow-up interviews, Foley, Turner and Williams, still all a little surprised at the outcome, reflected on why the measure was approved.

Foley said that if more people heard the whole story behind an exchange program, they would change their minds like he did.

“It’s more of a safety issue and it’s meant to stop the spread of disease and to save money.”

Turner said it’s crucial that support is homegrown.

“Most people from small, rural towns, they don’t like outsiders,” he said. “It’s got to be grass- roots.”

Bourbon County Judge Executive Greg Williams listens to comments on the needle exchange. Photo by Mary Meehan/Ohio Valley Resource.

Williams said he was jubilant at the outcome. But it was hard to tell from reading his face during the meeting. He said he didn’t want to react too much because he knew many people still were strongly opposed. He offered this advice to other community leaders: Persevere.

“It took us three times,” he said. “Don’t give up, and keep presenting the facts.”

The Bourbon County needle exchange program begins operating in May.

This article was originally published on Ohio Valley Resource.

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100 Days