Thirteen people out of every 100,000 in the United States died from overdose of an opioid in 2016.
In West Virginia, the numbers are much higher. And these numbers don’t account for those living with an addiction that rewires their brain to want one thing: more of the drug.
There’s so much about opioid addiction and treatment that we don’t understand. But we have help. The six researchers you’re about to meet are only a few of the people at West Virginia University working to understand what’s going wrong and how to fix it.
Marc Haut, Addiction Treatment
There’s more to recovering from opioid addiction than introducing yourself to a roomful
of strangers and having them tell you "Hello." Although Narcotics Anonymous meetings
may be included in a plan of care, they likely don’t constitute all of it. In fact,
plans of care can be as diverse as the individuals engaged in them. They can include
group and one-on-one therapy sessions, prescription medications that alleviate
the desire to use drugs, or mindfulness practices to help people withstand drug
cravings. In the future, they may even incorporate neuromodulation — the practice
of using electrical currents or magnetic pulses to stimulate specific areas of
a patient’s brain.
As the director of the WVU School of Medicine’s Department of Behavioral Medicine,
Marc Haut oversees research into these and other methods for helping patients who
have substance use disorders. He also leads the comprehensive addiction treatment
program tailored to WVU Medicine patients who use opioids inappropriately.
"We have so many people suffering from the disease of addiction, and we don’t have
enough treatment opportunities," Haut says. "We have to maximize the outcome for
those who are involved in treatment. There’s a belief that some people have to
fail a certain number of treatments before they really succeed. We don’t want people
to go through that. If we can get people to succeed the first time, that’s fine
His focus on providing more avenues to success, rather than punishing patients for
being stranded in addiction, is echoed across WVU. It’s in the ways healthcare
providers screen, counsel and listen to their patients. It’s in the ways researchers
reach out to, advise and strive to understand particular communities. And it’s
in the ways researchers and clinicians alike view people who misuse opioids as
individuals with addictions, not as addicts.
Cassie Leonard, Moms and Babies
Ask someone flat-out if they abuse drugs and there’s a good chance they’ll say no
even if they do. Ask them if they used to, their parents do or their partner does,
and they might be more forthcoming. These are some of the screening questions pregnant
women answer at obstetrics visits in West Virginia. Based on a patient’s responses,
her doctor can intervene to lessen the baby’s exposure, inform the patient of available
social services and collect data on the patient’s status as someone who uses drugs.
The data wasn’t always so accurate. "The way the CDC gets data on a state’s substance
abuse and pregnancy is from vital records, which is basically birth certificates,”
says Cassie Leonard, an OB/GYN at WVU Cheat Lake Physicians. But when a baby is
born, the doctor who fills out the birth certificate may not know the mother uses
drugs. "Clinically," she said, "we felt like we were seeing more substance exposure
and pregnancy than what was reported, especially in NICUs in the southern part
of the state."
Data collection started to improve in 2009 when the West Virginia Perinatal Partnership
(with which Leonard collaborates) screened babies born at eight hospitals across
the state for drugs and alcohol. They found that 15 percent had alcohol or drugs
in their systems. Leonard suspects that, since then, the prevalence has probably
increased. She adds, "Even though we’re seeing really big numbers, we think our
state is doing better than most in addressing these issues."
She cites better screening of pregnant women for substance abuse as the No. 1 improvement.
In addition, the state established a universal definition for neonatal abstinence
syndrome. Nurses have been trained to diagnose it, too.
Leonard leads the Drug-Free Moms and Babies Project, sponsored by the West Virginia
Perinatal Partnership and Claude Worthington Benedum Foundation. Through the project,
patients learn about the Women, Infants and Children Program and Medicaid eligibility,
get help with transportation to doctor’s appointments and receive support from
a recovery coach who has been through addiction herself, has had a child with an
addiction and is now in recovery.
The recovery coach holds her own meetings with pregnant women. "If you walk into
a Narcotics Anonymous meeting with this big belly, there’s a stigma there," says
Leonard. Reducing that stigma may make pregnant women feel comfortable coming to
treatment and participating in group meetings, which are vital to recovery.
"We have tried to provide a healthy environment where they don’t feel so much stigma
— more to congratulate them,” Leonard said. "'You’re pregnant! Good job addressing
the substance abuse disorder. You’re doing a great job by trying to get treatment.'"
Laura Lander, Moms and Babies
When someone is labeled a “drug user” their identity as an abuse survivor
— or as a caring spouse or well-intentioned parent — can be overlooked. That’s
particularly true for pregnant women, who “have a lot of guilt and shame on top
of the insecurity of being a new mom,” says Laura Lander, an addiction therapist
at J.W. Ruby Memorial Hospital’s Chestnut Ridge Center and an assistant professor
in WVU’s Department of Behavioral Medicine and Psychiatry.
Through a recovery program focused on pregnant women, Lander and her clinical
team teach patients recovery strategies and parenting skills, give them contraceptive
information and referral to care and simply listen to them with compassion and
not judgment. The integrated program encompasses clinical staff and faculty from
WVU Medicine’s pediatrics and OB/GYN departments.
Working with patients who have substance abuse disorders was not what Lander
thought she wanted to do when she undertook her master’s in social work at Columbia
University, but an internship at a day treatment program for mothers with substance
abuse disorders changed her outlook.
"I ended up loving it," she said, "and finding the women incredibly strong and
persevering, having overcome very difficult odds." She’s even had women continue
long-term treatment after delivering their babies.
"One in particular really struggled, and she relapsed during her pregnancy, so
Child Protective Services got involved, and her baby was initially taken away,"
Lander said. "Six months later, she’s gotten the baby back, and she’s doing really
well, and it’s just wonderful to see that progress and to begin to see the person
take ownership of the things they’ve done wrong, not use that to beat themselves
up with but to use that as a way of moving forward."
John Deskins, Economics
Of all adults in West Virginia, only 53 percent are working or looking for
work, says John Deskins, who directs WVU’s Bureau of Business and Economic Research.
This puts the state several points below the national average.
"That is a major, major impediment to economic development in this state." According
to him, three factors drive down that participation rate: poor health, poor education
and a high rate of drug abuse.
Deskins is trying to change that. Originally from southwest Virginia, he taught at
Creighton University in Nebraska before taking on his associate professorship at
the WVU College of Business and Economics. Now he’s trying to improve the state’s
prosperity by examining why relatively few West Virginians participate in the labor
In a recent study, Deskins examined the expenses associated with opioid-related healthcare,
criminal justice, lost productivity and deaths. His conclusion: the opioid epidemic
has cost the state economy nearly $1 billion.
"I want West Virginia to achieve average economic prosperity compared to the rest
of nation — if not above average — but there’s no way we can do that unless we
get a normal share of our population in the workforce," he says.
"You might have people who would like to work, in a perfect world, but if they have
diabetes or cancer, they don’t even bother looking for work. The same thing goes
for people who have managed to get caught up in this cycle of drug abuse."
Suzanne Bell, Forensic and Investigative Science
Synthetic opiates have become so dangerous that Suzanne Bell won’t let them
in her lab.
The director of WVU’s Department of Forensic and Investigative Science, Bell focuses
her research on the pyrolytic products of drug abuse — that is, how burning a drug
to smoke it changes its chemical composition — and she advises law enforcement
officers and healthcare providers on synthetic opioids’ toxicity.
"It’s so dangerous that people in the forensic labs will have NARCAN in their lab
coat when they are analyzing it," she said. "Sometimes they have to work in full
Getting a handle on synthetic opioids’ toxicity is especially difficult because illicit
manufacturers are constantly changing their formulations. As soon as one is identified,
another slightly different one appears. "We see new substances every seven to 10
days," says Bell, "but it takes months and months to synthesize an analytical standard
that we can work with."
West Virginia has seen one of the largest increases of synthetic-opioid-related deaths
in the nation. When Bell joined the WVU faculty in 2003, methamphetamine — not
opioids — was the primary drug the state was grappling with. When people did use
opioids, they were typically diverted prescriptions ingested in many "creative"
ways. For example, users would scoop the gel out of time-release opioid patches
and smoke it.
"It’s a whole other world," says Bell. "You have no idea." Before coming to WVU,
she taught at Eastern Washington University, worked with Los Alamos National Laboratory,
and — at the start of her career — analyzed drugs and investigated crime scenes
for the New Mexico State Police Crime Laboratory.
Bell hopes her current research will bring about more detailed knowledge of synthetic
opioids’ toxic effects so that the medical community, law enforcement and drug
users themselves can be better informed. "We want to get that out to the users,"
she said, and help emergency room doctors understand what they're seeing so they
can help these folks."
Robin Pollini, Needle Exchange
Robin Pollini has never injected drugs, but she says she’s always felt a "kinship" with people who do. "There but for the grace of God go I," she says. "They deserve to be treated like human beings and have access to the services that will make them healthier." As an associate professor in the WVU Injury Control Research Center, she is devoting her research to the cause.
Pollini began researching injection drug use during graduate school at Johns Hopkins University. She went on to study injection drug use in Tijuana, Mexico, while doing a postdoc at the University of California, San Diego. Her research took her to prisons, shooting galleries and a harm reduction van from which she distributed condoms and sterile syringes.
"It had a dancing condom on the side and a loudspeaker on the top, and at the back it had a big-screen TV so people could watch educational videos. You’d go around, yelling, ‘¡Condones! ¡Cuetes!’—a slang word for syringes."
Now her work includes studying factors that influence whether patients with endocarditis — a heart infection prevalent among injection drug users — complete in-hospital treatment. She is also helping West Virginia health departments and communities with their own harm-reduction efforts.
"Working here, I feel like there’s a real commitment to the people of West Virginia. Here, you really know who your beneficiaries are. It’s the people of West Virginia. And that, I think, helps me to keep very focused. I get jazzed about that."