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Drug Epidemic

Unseen Impacts: Overdose Deaths Created a Shortage of Autopsy, Transportation Resources in W.Va.



This van is used by the JCESA to transport deceased who are non-medical examiner cases and who have no prior death arrangements. JCESA purchased this van in 2017 to tackle an increase in calls and manage a loss in local resources. Photo: Liz McCormick/WVPB

Opioid-related overdose deaths have doubled in recent years in West Virginia, according to the West Virginia Department of Health and Human Resources.

The latest data from DHHR shows that in 2017, there were 875 opioid-related overdose deaths in West Virginia. While in 2012, there were 473.

Anytime someone dies of a suspected overdose in West Virginia, an autopsy is required, and these are performed in Charleston by a state medical examiner, also called a forensic pathologist.

“The impact of the substance use epidemic has really been on the caseload,” Dr. Catherine Slemp said. Slemp is the state health officer and Commissioner for the West Virginia DHHR’s Bureau for Public Health.

“It really has changed operations in terms of the number of cases that our forensic pathologists are handling and the staff that are part of that,” she said. “We are doing autopsies sometimes six to seven days a week.”

In 2012, there were more than 4,000 autopsies done in West Virginia, but compared to last year’s cases, that number has almost doubled. Slemp said 70 percent of all autopsies performed by a forensic pathologist are substance use related. That could be drugs or alcohol.

There are only three full-time forensic pathologists in West Virginia and five vacancies.

In an effort to fill those positions, the West Virginia Legislature recently approved an increase in the wages for forensic pathologists from $180,000 a year to $255,000 a year. That change went into effect on July 1, 2019.

But even with a higher salary, it’s not easy to recruit qualified candidates.

“This is an area that there’s only about 20, 25 individuals that come out of training every year,” Slemp explained. “And yet, there are probably 40 or 50 vacancies at any one time.”

Slemp said that’s because forensic pathologists have to go through medical school and do a residency in pathology. They must also take part in an ongoing fellowship in that field. It’s about 16 years of training.

“They’re very special and unique individuals,” Matthew Izzo, Director of the West Virginia Office of the Chief Medical Examiner said. “They have a passion for what they do. They believe in what they do.”

Izzo’s office is the same office that houses the state’s forensic pathologists.

In addition to an ever-increasing workload, both Izzo and Slemp claim about 30 to 40 percent of working forensic pathologists in the United States today are nearing retirement age.

Transporting the Dead in Jefferson County

When someone passes away unexpectedly, we don’t often realize the chain of events that happen behind the scenes to safely transport the bodies. Add the increase in premature deaths from the opioid epidemic to this, and it gets more complicated.

About five or six years ago, Jefferson County emergency officials noticed an uptick in call volume for deceased persons, and it was an adjustment period for officials as they learned to navigate the issue in a new way. 

Inside the garage of Eackles-Spencer & Norton Funeral Home in Harpers Ferry, Jefferson County, there’s a space where both Jefferson County emergency officials and the local, county medical examiner can temporarily store a body until certain decisions are made in Charleston.

“What we’ve tried to do is make a place, provide a place, for the staging area and the stopping point in between,” Alan Norton, co-owner at Eackles-Spencer & Norton Funeral Home said.

Jefferson County is so small that it doesn’t have a county morgue, and about five or six years ago, that became a problem as local officials began to see an increase in calls for deceased persons while, at the same time, they were struggling with staff shortages, and they lost the location the dead would normally be taken – the local hospital.

“So, we contacted the state medical examiner and said, we now no longer have a place to take these folks,” Bob Burner, Operations Commander for the Jefferson County Emergency Services Agency said. “And this really isn’t an [Emergency Medical Services] thing anyway. Once a person is deceased, there’s nothing in our skill set to help them. It’s a medical examiner, health department kind of an issue.”

For a long time, when someone died in Jefferson County unexpectedly, and had no prior death arrangements, people like Burner would come to the scene, attempt to save the person, and if the person was truly dead, a local medical examiner would be called, and the body would be transported via ambulance to the local hospital’s morgue until certain decisions were made.

But as more calls started coming in, the local hospital said they could no longer transport or provide space for the bodies, due to limited room and safety concerns.

For instance, it takes a long time to disinfect an ambulance after transporting a dead person – one to two hours, at least. And that can tie up calls where that ambulance is needed to serve the living.

“It’s not really appropriate to transport deceased folks who may have unknown pathologies in an ambulance where 20 minutes later, you’ll be transporting a newborn or an elderly person with a compromised immune system,” Burner said.

The hospital’s decision to pull back put Burner’s agency in a real bind, but he said he understood the reasoning.

So, Norton’s funeral home, the Jefferson County Emergency Services Agency and the local medical examiner formed a unique partnership to address the uptick in call volume and provide transport for the deceased.

“They can come on into our building, use our prep room, and we made a place for them to put their cooler,” Norton explained. “[This way] we can give them the space and the access and electricity, so that Jefferson County can have a staging area, and/or morgue in transit, while these bodies are getting to where they need to be.”

And the funeral home provides this service for free.

The Jefferson County Commission also joined this partnership and provided Burner and his agency $20,000 to purchase a van to transport a body to the funeral home. JCESA said, on average, they transport about 20 non-substance use related bodies in their van every year. These are folks who will not require an autopsy.

But if it’s a case that necessitates an autopsy, such as death by an overdose or foul play, Burner’s team worked with the state medical examiner’s office in Charleston, and the local ME, to contract a local fire department to transport the dead, first to Norton’s funeral home, and then to Charleston for a full autopsy.

It’s a lot of moving pieces.

And it’s usually a slow process that can take several hours from first arriving on scene, determining whether it’s a medical examiner case, and then transporting the body.

While Burner and other Jefferson County officials may have figured out a working system to transport the deceased, they hope the West Virginia Legislature looks at the issue and drafts legislation to clearly define what entity should be responsible for transporting the dead.

What’s the Cause?

Jefferson County officials agree, the opioid epidemic has played a role in the uptick in dead bodies, but they also say, population growth in the Eastern Panhandle region has likely contributed to it, too.

In fact, together, Berkeley, Jefferson, and Morgan Counties saw a nearly 20 percent population boom in the region between 2010 and 2018, according to the U.S. Census Bureau.

W.Va. DHHR’s data on opioid-related deaths in Jefferson County in recent years has fluctuated, but overall, has increased since 2012.

DHHR reported that in 2017, there were 27 opioid-related overdose deaths in Jefferson, 89 in Berkeley, and 10 in Morgan.

The counties with the most opioid-related overdose deaths in 2017 were Cabell County with 184 deaths and Kanawha County with 117.

This article was originally published by West Virginia Public Broadcasting.


Drug Epidemic

HIV Infection “Clusters” Put Focus On Harm Reduction Programs



Photo: Mary Meehan/Ohio Valley ReSource

This article was originally published by Ohio Valley ReSource.

Health officials in Huntington, West Virginia, say a cluster of HIV infections has grown to 71 confirmed cases. That’s in a city that usually sees about eight HIV infections in a year. As with an earlier such cluster in northern Kentucky, officials say the primary cause of infection is needle drug use.

Health officials say a harm reduction program is an effective tool against HIV infection. The programs usually offer a syringe exchange, access to addiction counseling and health screening services such as HIV testing.

The programs have expanded rapidly in the Ohio Valley, a region hit hard by the opioid crisis and at highest risk in the nation of infectious disease outbreaks due to needle drug use.

Credit: Alexandra Kanik/Ohio Valley ReSource

But many people remain wary of syringe exchanges, and health officials are concerned that a backlash means some programs will close just when they’re most needed. The Huntington cluster of HIV cases appears to be correlated with the controversial closure of a nearby harm reduction program.

“The boomerang effect, the recoil, is going to be if these programs start closing, you’re going to see explosions of blood-borne pathogens, specifically HIV,” said Dr. Michael Brumage, director of the Preventive Medicine Residency Program in the West Virginia University School of Public Health.

High-Risk Region

In 2016 the Centers for Disease Control and Prevention spotlighted the counties in the U.S. at the highest risk of an HIV outbreak. Of the 220 high-risk counties, about a quarter were in Kentucky, West Virginia and Ohio. The 10 counties CDC found at highest risk were all in Kentucky and West Virginia.

Public health officials in the region have been working to implement syringe exchange harm reduction programs, which are widely supported as the most effective tool in combating HIV and other infectious diseases associated with needle drug use.

Photo: Alexandra Kanik/Ohio Valley ReSource

Dr. Greg Corby-Lee is the strategist with the University of Kentucky’s Harm Reduction Initiative. He said community-based harm reduction programs can be a lifeline to those still using drugs.

“It takes a while for them to build that level of trust up to come in,” he said. “That’s their one bridge, where they can be respected, and be given nothing but help to stay healthy.”

Corby-Lee said HIV prevention is the primary focus.

“That’s what they were designed for. But there are a lot of other benefits that come with it,” he said, such as peer counseling and screening for other diseases, such as Hepatitis C.

HIV/AIDS educator Greg Corby-Lee talking about harm reduction. Photo: Mary Meehan/Ohio Valley ReSource

Corby-Lee said prevention and testing for HIV are becoming more widely available in the area, and stigma – which can thwart outreach, testing and treatment – is gradually diminishing.

But he and other health officials also worry about a backlash brewing in many communities, threatening the harm reduction programs. They fear that misconceptions about the programs may threaten the very communities at greatest risk of an outbreak.

Daniel Raymond is Deputy Director of Planning and Policy for the National Harm Reduction Coalition. He said that while harm reduction programs are generally expanding, some are closing in the communities where they are needed most. The programs can become the focal point for other problems associated with the addiction crisis, he said, such as litter from used needles, homelessness and petty crime.

“A lot of these programs have been starting in communities that don’t have a long history with harm reduction,” Raymond said. “So the programs that end up being at risk of closure are often the ones that are getting scapegoated for a community’s drug problem.”

Closure, Then A Cluster

Dr. Brumage says that’s part of the problem he encountered when leading a harm reduction program in Charleston, West Virginia. The program ended most of its services last year amid local political pressure and complaints about discarded needles.

“I think it’s a simplistic view to look at and blame one program for all of the city’s woes, with homelessness, with use, with all these other things,” Brumage said. “And I think that’s a trick that many politicians use very well, is to find a culprit scapegoat and to blame it rather than really looking at deeper issues.”

Dr. Michael Brumage directs the Preventive Medicine Residency Program at West Virginia University. Photo: Courtesy WVU

The deeper issue, he says, is that the HIV threat is real and not going away. Less prevention equals more sick people. In Huntington, one person in the HIV cluster has died. However, Brumage is concerned that some Huntington residents are now viewing the cluster of infections as evidence to close its harm reduction program as well.

“Currently, some people in that community are saying, ‘Well, look, we have the syringe program, and we still got HIV, maybe we just need to close the program,’” he said. “The fact that you have a fire doesn’t mean you should close the fire department. You know, you bring more trucks on the scene.”

Brumage worries that the closure of the Charleston program may have contributed to the rise in HIV infections Huntington is now experiencing. The two cities are less than an hour’s drive apart along Interstate 64. And Brumage argues that Huntington’s cluster of infections could be much worse without a syringe exchange in place.

“My guess is had Huntington not had a syringe program, this problem would have exploded far worse.”

Other health officials say the growing HIV cluster in Huntington is a cautionary tale.

“It’s the looming disaster that we were all afraid of,” West Virginia University School of Medicine Professor Dr. Judith Feinberg told Mother Jones magazine.

Signs of Hope

Still, harm reduction proponents remain optimistic. The National Harm Reduction Coalition says that for every program closing, 20 more open. Kentucky has witnessed rapid growth in such programs.

Van Ingram, who leads Kentucky’s Office of Drug Control Policy, said that has only been possible with a fundamental shift in thinking about drug use as a health problem instead of a problem for law enforcement. He admits he was skeptical that the programs could take root in Kentucky. But it’s happening.

Van Ingram Executive Director

“I never dreamed we’d have 56 programs,” he said. “I did not think as many communities would have said, ‘Yes, we have a problem, and yes, we’re addressing big issues.’ Those communities are much, much quicker in recognizing the problem than I thought they would. I’m glad to say, I was wrong.”

Bourbon County, Kentucky, is an example of the phenomenon Ingram is describing. After several failed votes the county approved a syringe exchange program last year. Judge Executive Mike Williams said he braced for the complaints and backlash.

“I got gas yesterday afternoon and had three conversations at the gas pump about three different things,” he said, but the syringe program was not one of the things people had concerns about.

Since the syringe program opened, helping about 100 people, he said he’s only heard concerns from three people.

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Drug Epidemic

After Years of Struggling with Opioids, This W.Va. Town Is Facing a Not-So-New Epidemic: Meth



Charles Glover outside the Clarksburg Mission, where he serves as a mentor. Photo: Jesse Wright/West Virginia Public Broadcasting

Charles Glover doesn’t mince words when assessing Clarksburg, West Virginia, the town where he was raised and still lives today.

“It’s not Clarksburg anymore,” Glover says. “It’s Methburg.” 

Methburg. As in methamphetamines, a drug that ravaged his community more than a decade ago and today is coming back just as strong. 

Listen as Taylor Sisk discusses his reporting with West Virginia Public Broadcasting’s Kara Lofton

Glover, 49, known as “Preacher” to his friends, says that come late afternoon, the downtown streets of the city of about 16,000 – most especially the blocks that surround the Clarksburg Mission, above which a neon cross avows “Jesus Saves” – metamorphosize. 

A cross hangs above The Mission on 4th Street in Clarksburg, W.Va. Photo: Jesse Wright/West Virginia Public Broadcasting

“People just come out of the woodwork,” he says. By 4 in the afternoon, give or take, the streets have opened for business. And methamphetamine is the principal commodity, Glover says.

Glover’s a familiar face at the Mission, a mentor. A self-described “recovered cocaine addict,” today he’s seeking help in getting his son, who he recently caught injecting meth in the bathroom of their home, into an inpatient rehab program.

Glover is frightened not only for his son, but for so many to whom he ministers.

Data from the U.S. Centers for Disease Control and Prevention indicates that overdose deaths from methamphetamine climbed from 547 in 1999 to 10,333 in 2017. Far more people continue to die from opioid-related overdoses – 47,600 in 2017 – but as the street price of meth continues to drop, health care professionals in Appalachia and beyond are deeply concerned by the trend. Meth is linked to hepatitis C infection, stroke and, of particular concern to law enforcement, psychosis. 

Clarksburg stands testament to a worsening crisis. Glover says he began seeing the return of meth, after peaking in the ’90s, about three years ago, “and then it just started escalating.”

“It’s like whack-a-mole,” Lou Ortenzio, the Mission’s executive director, says of the litany of drugs that have cycled through his community over the past two decades. “You figure that you’ve got something taken care of, and something else pops up.”

“Our public safety officers warned us two years ago that meth was on the way back,” he says. “The first assistant deputy sheriff came to one of our recovery meetings and said meth is coming back, you guys need to be prepared.” 

“I know that there’s a demon in this that’s making this happen to everybody,” Glover allows. “And it’s not just the person that’s using that it’s affecting. It’s affecting the whole family of that person.”

It’s affecting, in fact, an entire city.

The Edge

Main Street Clarksburg, W.Va., with the Harrison County Courthouse and Chase Building, where the Harrison County Day Report Center is housed, on the left side of the street. Photo: Jesse Wright/West Virginia Public Broadcasting

There’s a rough-hewn quaintness to Clarksburg, situated halfway between Charleston, West Virginia, and Pittsburgh. The glass industry once nourished middle-class neighborhoods that now show their age. That industry is long-since departed, the economy in steady decline.

Then this, the litany: prescription painkillers, heroin, synthetic heroin, methamphetamine. 

Clarksburg is “a great town to be born and raised in,” Gary Hamrick, head of the Harrison County Community Corrections Program and a school board member, says from personal experience. “But right now, we’re on the edge.”

Gary Hamrick, head of the Harrison County Community Corrections Program, talks about the rising methamphetamine addiction problem he’s seen in the Clarksburg, W.Va., area. Photo: Jesse Wright/West Virginia Public Broadcasting

Methamphetamine is a drug that stimulates dopamine receptors in the brain, rendering a euphoric effect. It’s injected, smoked, snorted or swallowed. Those under its influence are likely to experience sudden mood swings, paranoia, insomnia. 

Then there’s the tweaking, which comes as that euphoria abandons the body and the craving descends. Your skin begins to crawl; hallucinations creep in. These are tense, potentially violent hours.

Among Hamrick’s responsibilities is the operation of the county’s Day Report Center, an alternative to incarceration that provides substance-abuse counseling, GED preparation and other services. Everyone who enters the program must be drug screened.

Hamrick calls the Day Report Center “ground zero.” 

“When a new drug comes to town, we’re probably the first ones that are going to see it,” he says. What they’re seeing most prevalently today is meth.

“Probably for every 20 drug screens that are positive, two would be opioids and 18 would be meth,” Hamrick says. “You may have both in there, which is kind of mind blowing. But the majority – probably at least 80 percent of every positive or more – is going to be meth.”

‘I Go Crazy’

“I’ve got close to 20 years wrapped up in methamphetamine use, heroin use, benzos and alcohol,” says Rodney Weaver, 37. 

Weaver was born in the nearby town of Spelter, a community just north of Clarksburg with a population of less than 400. “I started using drugs whenever I was 13,” he says. “Started smoking weed, started drinking beer. I know that’s young. By the time I was 16, I started using pain pills.” 

Rodney Weaver. Photo: Taylor Sisk/100 Days in Appalachia

He began injecting at 17 and transitioned into “mainly a benzos and methamphetamine user.” Weaver was partial to the rush of meth. “It’s just that I’d rather go fast than sleep. You do enough sleeping when you die, was my theory on it.”

Weaver has spent more than a decade in prisons, mental institutions, rehab facilities and halfway houses. “I’ve not got to spend much of an adult life doing anything [productive].”

“I come from a mom and dad that love me to death,” he says. “I see some people that’ve had bad childhoods, and it’s like, ‘Well, I understand that. That makes sense.’ …Whereas, I grew up having everything; I didn’t want for nothing.”

“At 17, I started riding Harleys,” Weaver says. “I started hanging out with the wrong crowd of guys.” 

He’d work intermittently on drilling rigs in the Great Plains and Colorado. He says meth was prominent in that region of the country at the time, more readily available than any other drug. “So, I’d be out there with those guys doing that and I would bring it back home with me.”

He was also running afoul of the law. “Most of my charges are violent charges. That’s meth-induced psychosis. I get on those drugs and I go crazy.” 

When Weaver was 24, he held some people hostage in a house for 26 days in response to money he was owed, culminating in a 14-and-a-half-hour standoff with police. He served four and a half years.

Meth is a high-velocity vehicle, the diametric opposite of heroin, a distinction of significance to Hamrick at the Day Report Center.

“We have to be a little bit more vigilant,” he says of meth users in his facility. “They’re kind of on the edge.” 

“I hate to say you want one over the other,” Hamrick says. “But opioid addiction is much easier on a facility like us, because with meth, I don’t know what they’re going to do. It’s more dangerous.”

But heroin is more expensive on the street than meth. When Weaver began using it nearly two decades ago, meth cost $1,500 dollars an ounce. Seated in the Mission today, he says, “I can leave right here, right now, walk out that door, not go very far off in this area and get an ounce of that drug for 250 bucks.”

A view of Glen Elk, the neighborhood in Clarksburg that houses the Mission. Photo: Jesse Wright/West Virginia Public Broadcasting

Now 17 months drug free, Weaver is plenty worried about what the meth users in his community are consuming. “What these guys around here are doing is what they consider ‘grow dope.’” It’s made in a bucket or cooler. “It’s Joe Schmo up the road [who] dug a three-foot hole in the ground and put a five-gallon bucket in it.” Thompson’s WaterSeal, charcoal, ammonia, mop strings, a few other inexpensive ingredients – meth made cheap and easy.

“Twenty-eight days later,” Weaver explains, “they go out and pull it out of the ground, wash it off, and they start selling it to these guys.” 

And it’s clear who’s using. “It’s the thousand-mile stare,” he says. “It’s that look of there’s nobody home, because there’s not.”

The Right Place

Lou Ortenzio was once a family practitioner in Clarksburg. He operated a free clinic and was named Citizen of the Year in 1992. A Vicodin addiction took him down. He lost his family and, in 2005, after a conviction for writing fraudulent opioid prescriptions, his medical license. By that point, he’d re-emerged, quit using and forged a new path, one dedicated to others’ recovery.

Lou Ortenzio in his office at the Clarksburg Mission, where he serves as executive director. Photo: Jesse Wright/West Virginia Public Broadcasting

“It’s God’s provision, God’s job for me to do,” Ortenzio says of his work at the Mission and at Celebrate Recovery – a national ministry that operates out of Clarksburg Baptist Church, a few blocks away – where he oversees recovery coach training. “I was a contributor to the opiate epidemic and an early casualty. Now I’m trying to make a difference.” 

“I’m still in health care,” he says. “I used to be prescribing pills. Now I prescribe recovery.”

Ortenzio describes a subculture occasioned by meth – a subculture of backpackers, wandering the streets with their every possession, often carrying a baseball bat for protection and/or persuasion. 

Homelessness has worsened in Clarksburg, he says, so much so that its increase was cited as a reason members of the city council voted to suspend its city manager this month. 

“In spite of all our efforts, in spite of a housing-first program, trying to get people rapid-recovery housing, permanent-supportive housing and all these HUD programs – homelessness nonetheless has increased,” Ortenzio says.

As for Weaver, he’s where he feels he should be, rooming in a dorm at the Mission with Scotty Cottrill, 35, originally from Shinnston, 20 miles north of the city on a two-lane highway. Cottrill’s now 200 days in recovery (“a great victory,” Ortenzio says). 

“A lot of people get clean and they forget where they come from,” Weaver says. He’s eager to share what he’s experienced. “I’m raw, I’m blunt, and I stay out here on the streets.”

Several days ago, around the corner, he attempted to break up a fight between a man and a woman. The man pulled a gun on him.

The Clarksburg Mission (right side of street) occupies several buildings, including offices, dormitories and thrift shop, on North 4th Street in Clarksburg. Photo: Jesse Wright/West Virginia Public Broadcasting

“Seventeen months ago, I would have beat that boy to death right there where he stood. That gun would have never scared me. And the other day, it scared me.” It was the threat of losing so much gained that frightened him.

“I realized I’d take myself away from a bunch of people who love me,” his community. “One thing I’ve never had in my life is relationships. I’ve had reaction-ships. Today, I have relationships.” 

Weaver knew he wasn’t the only one grappling with fear on the street that day. “A lot of these guys around here are scared,” he says. “They’re doing a drug that makes them extremely paranoid. They’re doing a drug that makes them completely separate themselves from reality.”

“I’ve been a taker for so long, the best thing I can do is give. I can give something.” 

‘The Pain Ends’

Gary Hamrick fears that his community is “at the breaking point of frustration.” 

West Virginians are, generally speaking, “of a hospitable nature,” he says. But “there are folks in this town who I know as being compassionate, very community oriented, very people oriented that have kind of reached their breaking point.”

Weeds grow on the top floor of an abandoned building near U.S. 50 in Clarksburg, W.Va. Photo: Jesse Wright/West Virginia Public Broadcasting

Burglaries, bicycles stolen off your porch, shrubbery uprooted, copper stripped from your air conditioning unit – compassion ebbs. “Something kicks in, and you say, ‘I’ve had enough.’ I worry that we’re coming to that.”

What further worries Hamrick is this: “We’ve allowed the government to come in and say, ‘You have an opioid crisis.’ Yeah, we did.”

And that crisis in Clarksburg looked like it did in most Appalachian communities – overprescribing doctors, a crackdown on prescriptions followed by the proliferation of heroin on the streets. 

“The good thing is that our drug task forces around the area have been able to run those pills out. And then of course, the heroin comes in, and they’ve done a good job of eradicating that.”

Hamrick isn’t downplaying the gravity of the opioid crisis. But what happens if one day the federal government declares victory over opioids? Does Appalachia then lose its funding for prevention and treatment, for peer recovery coaches? Those resources were directed to his community to aid in the opioid crisis. But though the drug of choice has changed, addiction persists.

“We don’t have an opioid problem, we don’t have a meth problem,” Hamrick says, “we have a drug problem.” One not likely to soon dissipate.

“I fear for everybody out there who’s addicted,” Charles Glover says.

Ask him – ask Hamrick, Ortenzio, Weaver – where the solution lies: more effective coordination of services, more treatment facilities, vocational training, housing, transportation, the will to recover. All of the above.

“There’s always a path out,” Hamrick says. 

Meanwhile, Rodney Weaver offers an aphorism of hope: “Hold on; the pain ends.”

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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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