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The report didn’t bring good news. In 2017, the Centers for Disease Control and Prevention said doctors in Martinsville, Virginia, gave out more opioids per person than any other city or county in the nation. It wasn’t a slight difference. 

The year prior, Martinsville reported 399.9 opioids prescribed for every 100,000 people that lived there, according to CDC data. By comparison, the U.S. average in 2016 was 66.5. 

A year later, journalist Beth Macy released her book “Dopesick: Dealers, Doctors, and the Drug Company that Addicted America.” In it, Macy covered not just the situation in Appalachian Virginia – like that in Martinsville – but also why it came about. This month, a scripted Hulu series with the same name based on Macy’s writing debuted to largely positive feedback from critics

But for Appalachians who have lived and continue to live in communities strained by the predatory practices of a pharmaceutical industry giant, their stories won’t be reflected on the small screen. Their struggles didn’t end when the director said cut. They are still working to solve the problems Purdue Pharma brought to their hometowns.  

Part of a Bigger Problem

Two years after the CDC released its report placing Martinsvlle at top of the opioid prescription rate list, residents began to learn about how they got there.

In May 2019, Dr. Joel Smithers was convicted on more than 800 counts of illegally distributing opioids. The doctor, who was based in Martinsville from 2015 to 2017, prescribed more than 500,000 doses to patients from Kentucky, Ohio, Tennessee and West Virginia, as well as local residents. 

Smithers didn’t operate in a vacuum. Other local doctors prescribed opioids as well and in potent doses. Medical professionals use the term morphine milligram equivalent units to rate how potent a painkiller is, compared to morphine. That 2017 CDC report said doctors in a typical city or county prescribed a person 640 mme units of opioids each year from 2010 to 2015. In Martinsville, the number was 4,086.9. 

Martinsville doesn’t rank first in opioid prescriptions anymore. Based on the 2020 data, the city dropped to third last year in the rate dispensed per every 100,000 people. 

Martinsville’s situation, however, is a familiar one. Cities and counties across the country are dealing with the same issues, stemming from America’s opioid epidemic. 

Starting in the late 1990s, pharmaceutical companies marketed opioids heavily, claiming they were less addictive than regular pain medication. They sponsored medical-education courses, created ads and sent sales representatives to doctors, often giving free samples. As a result, in 2015, U.S. doctors prescribed three times more opioids than they had in 1999, according to the CDC

In 2007 and 2020, Purdue Pharma pleaded guilty to misleading doctors and the public about how addictive OxyContin was. Company officials admitted that Purdue paid doctors through a speakers program, encouraging them to write more opioid prescriptions. They also admitted paying a medical records company to send information on patients to doctors as another way to encourage opioid prescriptions. 

This past September, Purdue’s owners, the Sackler family, reached a bankruptcy settlement with the federal government. They’ll pay $4.3 billion and give up control of Purdue. But in exchange, they’ve been given immunity from future civil lawsuits over the harm caused by their opioid products. 

And as NPR reported earlier this month, the 138,000 people who filed a claim against the company don’t expect to see much of that settlement money. Ninety percent of that cash is supposed to go to states and local governments to help prevent future problems. But that doesn’t help places like Martinsville clean up the damage already done. In an effort to find their own solutions, locals started making a list.

Asking For Help 

After the 2017 CDC report came out, Martinsville residents had questions. An opioid task force had been formed the previous year to fight overdoses in the city, but they needed help. 

They connected with a research group called Engaging Martinsville and brought in academic researchers from Virginia Tech for support as well. It wasn’t just a project for members of Engaging Martinsville, some had personal reasons to help. 

Toni Noe lost both her parents to opioid overdoses. The Engaging Martinsville member wrote in a 2020 research paper about the project that she joined “to help prevent others from experiencing what I have. I watched both of my parents struggle with [substance use disorder] from a young age and saw firsthand the effect on them and my family.” 

In 1999, the CDC reported 3,442 overdose deaths from prescription opioids across the country. By 2017, that yearly death rate had climbed to 17,029. And even as doctors scaled back prescriptions, an average of 38 people died each day in the U.S. from prescription opioids in 2019. That added up to more than 14,000 deaths. 

In places like Martinsville, part of the problem involved the system. You went through “a brief stint in the hospital and then a referral to an already overrun community agency with no follow up,” Noe wrote, sharing what her mother went through. “This allows those struggling to fall through the cracks. Even the ones that want to get the help they need have limited options in the community.”  

And that’s where the research project came in. 

Virginia Tech received a $99,705 federal grant to research the situation. But this wasn’t a simple report. After all, the community already knew what the problems were. They wanted workable ways to tackle them. 

“We looked at this from all sides and said, ‘Ok, what are the actions this community could take,’” said Dr. Carlin Rafie. The assistant professor in Virginia Tech’s Department of Human Nutrition, Foods and Exercise was put in charge of the project, based on her previous experience working with the research methods used. 

Working with local police, educators, medical groups, nonprofits and community members, the team came up with a plan. They grouped community members together based on like experiences: Group one included people in recovery and family members of people who use drugs. Law enforcement and emergency room personnel made up group two, while the third included other interested members of the community. All three groups worked with the Engaging Martinsville team, asking questions and coming up with potential solutions.  

“They would ask things like how many resources do we have in the community? How many people are seeking treatment,” said Dawn Moser, Engaging Martinsville’s project coordinator. “Then the research team went out and got the answers.” 

By the end, the groups came up with a list of 63 things they wanted to see addressed in Martinsville. 

“We dwindled it down to four, because there were some very big actions,” Moser said. “Some of them the [Virginia state] General Assembly would have to do.” Those included things like legalizing marijuana to reduce incarceration rates.

The four tasks the group settled on were more manageable, but also a realistic place to start.

Two Major Shifts

The Engaging Martinsville team placed at the top of their list the launch of a drug court. That one decision could drastically alter access to care for people with substance use disorders.

“Currently if someone gets arrested for substance use, they go to jail,” Rafie said. “Drug court instead offers them opportunities to attend classes or counseling, so they can change their behaviors. If they comply, they don’t have to go to jail.” 

The project provides access to critical care, while also cutting down on repeat offenders. Data from the National Institute of Justice shows recidivism, or repeat arrest, rates fall between 17 to 28 percent in areas with a drug court. 

But as Rafie and Moser point out, it’s just like any other judicial agreement. If the person doesn’t follow the rules, if they don’t go to classes or counseling sessions, the judge can send them to jail. 

The application was approved by the state and as of now, Martinsville’s regional drug court will start in January 2022. 

Next, the group wanted to focus on how cases are handled in the emergency room. 

“Before, you’d be given some resources or be told, ‘Here are numbers you can call,’” said Bonnie Favero. Although officially retired, she still works with Piedmont Community Services, a behavioral health operation in Martinsville. “Now, we have peer support specialists that go to the hospital. Now there’s a person who has been there before in some way, a [person in recovery]. They have lived experience.” 

This way, Favero said, you’re also providing treatment for the larger disease. This program came together over the past year, with two local hospital systems getting on board. Martinsville’s Sovah Health, a 220 bed acute care hospital, and Carilion Clinic in neighboring Franklin County are both working with Piedmont Community Services to hire people for those positions. 

Pointing The Way

The final two changes may seem pretty simple to the average person, but solving them could drastically shift access to care in Martinsville. Both center on education.

“The number one thing you’ll hear [in Martinsville] is we don’t have any [recovery] services,” Moser said. “Well, it’s quite the contrary. People just don’t know these options exist.” 

Martinsville has long-term housing, counseling and other resources. Through video and social media, as well as local news, the group has been trying to get the word out, to educate their community about what resources are at their fingertips. 

Six people have also been trained to work with Henry County Schools to educate kids about substance use disorders. That program stalled a bit last spring, thanks to COVID-19, but now it’s starting up again. 

Overall, Rafie doesn’t believe her group did anything revolutionary. They simply brought people together to find solutions for a community. 

“It wasn’t that we identified a new thing,” Rafie said. “People wanted to do something. Organizations had ideas. The process itself just got the right people to the table and established the motivation to make it happen.” 

Brian Carlton is a 20-year veteran of digital and print media, with work published in the Associated Press and BBC Travel. A nine-time Virginia Press Association award winner, Brian has been recognized for investigative reporting, column writing and public safety material while running newspapers in Waynesboro and Martinsville, Virginia.

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This article was originally published by 100 Days in Appalachia, a nonprofit, collaborative newsroom telling the complex stories of the region that deserve to be heard. Sign up for their weekly newsletter here.