The State of West Virginia’s Battle Against Opioids


UPDATE ON THE STATE OF THE OPIOID CRISIS: 
West Virginia

Rising Rate of Deaths

The number of overdose deaths peaked at 733 deaths in 2016 with the majority of deaths attributed to synthetic opioids and heroin. Since 2010, deaths related to synthetic opioid deaths quadrupled from 102 to 435 deaths and deaths related to heroin rose from 28 to 235 deaths.

Opioid Pain Reliever Prescriptions

          In 2013, West Virginia providers wrote 110 opioid prescriptions per 100 persons (2.08 million prescriptions). In the same year, the average U.S. rate was 70 opioid prescriptions per 100 persons. Fentanyl was referred to as a nuclear device. They were designed to help those suffering from intractable pain. Then these powerful drugs, Hydrocodone, Oxycontin, Fentanyl became the drugs of choice and soon, when users could afford them no longer, they turned to heroin.

In America, a Baby is Born Dependent on Opioids Every 19 Minutes       

          It is called Neonatal Abstinence Syndrome (NAS), a fancy name for these innocent babies being brought into this world already horribly addicted to drugs. The immediate problems to the child involve lower birthweights, respiratory conditions, feeding difficulties, seizures, longer hospital stays, susceptibility to disease and physical defects.

          Imagine a helpless infant caught in the horror of being addicted to drugs with the very first breath taken in this life.  In a Reuters Investigative article “The Most Vulnerable Victims of America’s Opioid Epidemic, Helpless and Hooked", by  By Duff Wilson and John Shiffman, Dec. 7, 2015, entitled  "Newborns die after being sent home with mothers struggling to kick drug addictions", they say:  “In America, a baby is born dependent on opioids every 19 minutes.”   

          The Reuters’ story describes an infant boy going home with his addicted mother and dying within the first week when she rolled over in drugged sleep and asphyxiated him. Many babies die this way.  One stoned mother put her infant in the washing machine with the dirty laundry. The home environment of an addict is much like an insane asylum and is a death trap for these most vulnerable of our species.


Soaring Neonatal Abstinence Syndrome Rates

Between 2007 and 2013, NAS rates in West Virginia significantly increased from 7.7 to 33.4 cases per 1,000 live births per year (CDC MMWR, 2016). The average across the 28 states included in the 2013 analysis was 6.0 cases per 1,000 births.  Between 2014 and 2016 the rate of NAS in West Virginia rose further to 37 cases per 1,000 live births. In 2013, the southeastern region of the state had the highest NAS rate of 48.76 cases per 1,000 live births. National Institute of Drug Abuse (NIDA) Stabler ME et al, 2016

HIV: Prevalence and Diagnosis Attributed to Injection Drug Use

Abusers get a bigger rush by grinding up the pills and shooting them up.  As a matter of fact, on the package insert of OxyContin, it gave a warning not to do it for it is highly dangerous.  It was almost like a “how to” instruction. Many users did just that, causing the crisis in a big way, particularly in the Northeast including West Virginia. Appalachia seems to be the area most seriously affected.

Comparing West Virginia to US Incidence and Prevalence (National Institute for Drug Abuse)

  •  U.S. Incidence: In 2015, 9.1 percent (3,594) of the 39,513 new diagnoses of HIV in the United States were attributed to IDU (Injected Drug Use). Among new cases, 8.2 percent (2,614) of cases among men and 13.2 percent (980) of cases among women were transmitted via IDU (CDC).
  • State Incidence: Of the new HIV cases in 2015, 74 occurred in West Virginia, with 15.2 percent1 of new cases in males and 17.6 percent of new cases in females attributed to IDU (AIDSVu).
  • U.S. Prevalence: In 2014, 955,081 Americans were living with a diagnosed HIV infection—a rate of 299.5 per 100,000 persons. Of these, 18.1 percent (131,0561) of males and 22.6 percent (52,013) of females were living with HIV attributed to IDU (CDC).
  • State Prevalence: In 2014, an estimated 1,896 persons were living with a diagnosed HIV in West Virginia—a rate of 120 infections per 100,000 persons. Of these, 19.8 percent1 of males and 27.8 percent of females were living with HIV attributed to IDU (AIDSVu).

Hepatitis A and C Rocketing Out of Control

          Once, before the word Hepatitis became in use, it was called Yellow Jaundice. In French, jaune means yellow. Thus originated jaundice, meaning a yellowish or yellowing condition.

Hepatitis is inflammation of the liver cells due to any cause (bacteria, viruses, parasites, drugs, toxins, ischemia, etc) and this condition can create a yellowish cast to the skin and eyes. Jaundice is a clinical sign elicited when there is yellow discoloration of white of the eye (sclera) by excess deposition of bile pigments like bilirubin. Many hepatitis cases cause jaundice but all patients with jaundice do not have hepatitis.

Article from Scientific American

“Here in West Virginia, which has the nation's highest rates of overdose deaths and new hepatitis C and hepatitis B infections, public-health officials are attempting to identify as many new hepatitis carriers as possible — and are girding for decades of repercussions."

"If we don't cure a significant number of the people who are injecting, in 20 years from now, the hospitals in this part of the world will be flooded with these people with end-stage liver disease, which has no cure," said Judith Feinberg, a professor of behavioral medicine and psychiatry at the West Virginia University School of Medicine. "I can see it coming at me like the headlights of a train. Just coming, coming, coming, and I'm thinking, 'Doesn't anybody want to jump out of the way?"

"The number of new confirmed hepatitis C cases nationwide rose from 853 in 2010 to 2,436 in 2015, according to the Centers for Disease Control — a 15-year high. But tens of thousands more are believed to have contracted the disease without knowing it.”

Hepatitis C (HCV) Prevalence and HCV Diagnoses Attributed to Injection Drug Use in West Virginia

Comparing West Virginia to US Incidence and Prelevance (National Institute for Drug Abuse)

  • U.S. Incidence: In 2015, there were 181,871 reported cases of chronic HCV and 33,900 estimated cases of acute HCV (CDC). Where data were available, 64.2 percent of acute cases reported IDU (CDC).
  • State Incidence: In 2015, West Virginia reported 6,347 cases of chronic HCV and 63 cases of acute HCV at rates of 344.2 cases per 100,000 persons and 3.4 cases per 100,000 persons, respectively. Among acute cases, nearly 40 percent were attributed to IDU (WV.gov).
  • U.S. Prevalence: An estimated 3.5 million Americans are living with HCV, including approximately 2.7 million living with chronic infections (CDC).
  • State Prevalence: Current state prevalence data are not available. As of 2010, an estimated 24,400 persons (1,660 cases per 100,000 persons) were living with HCV in West Virginia (HepVu).

Out of Nowhere 

          A tsunami of deaths, HIV and Hepatitis A and C cases have inundated West Virginia. Here are some quotes from Scientific American about it:  “About 80 percent of those known to be infected in the outbreak say they use illicit drugs, according to state records. Although health officials do not know exactly which substances are involved, self-reported data from hepatitis A patients indicate about 58 percent inject illicit drugs and 42 percent use non-injected ones; some report using both. A number of the patients specifically mention heroin, according to the West Virginia Department of Health and Human Resources (DHHR).

How is it Transmitted?

          The virus, which attacks the liver, is easily transmitted via sexual or oral exposure to even microscopic quantities of infected feces; it can be as simple as touching a contaminated surface like a subway pole or bathroom door and then eating lunch without first washing one’s hands. The disease can be highly contagious up to two weeks before an infected individual shows any symptoms, which include nausea, fever and sometimes yellowing of the eyes or skin. In patients with underlying liver disease it can cause liver failure, potentially leading to death.

Hepatitis A cases in the U.S. have often been linked to contaminated food. The disease is also associated with poor hygiene among those struggling with homelessness or inadequate housing conditions, which can sometimes accompany addiction; the illness can be transmitted by unwittingly ingesting traces of fecal matter or by being exposed to them during sexual contact. (Scientific American: Dina Fine Maron, Auguste 276, 2018, West Virginia Roiled by Side Effect of Opioid Crisis – a Major Hepatitis A Outbreak.)


Judith Feinberg Speaks

Judith Feinberg has a joint appointment in the West Virginia University School of Medicine as a professor of Behavioral Medicine & Psychiatry and Medicine/Infectious Diseases. She is the Vice Chair of the HIV Medicine Association and a nationally-recognized expert on the opioid epidemic in West Virginia, Appalachia and rural America.

She was asked about the relationship between Opioids and the Hepatitis C escalation of cases. “The epidemics are inextricably intertwined. Hepatitis C is extremely contagious when you are sharing infected injection equipment, so the opioid epidemic has certainly had an effect on the spread of Hepatitis C. Sadly, the opioid epidemic has not peaked yet, and individuals are going to continue to be at risk for Hepatitis C, along with Hepatitis B and HIV, because of injection drug use.”

“In Appalachia, there are many factors influencing the spread of Hepatitis B and C. Many people who live in Appalachia engage in physically demanding work that can lead to injuries and turn to prescription opioids to control pain. When prescribing opioids became more common in the 1990s, there was an enormous number of people receiving opioids for chronic pain. When we realized that over-prescribing was leading to a massive increase in addiction, there was a clampdown in prescriptions, which in turn led to pills becoming scarcer and people turning to the street market for heroin and fentanyl.”

Doctors in my generation were taught to fear opioids and only prescribe them when the pain was extreme, but in the 1990s opioids were marketed to doctors and hospitals as not being addictive and this was exacerbated by making pain the “fifth vital sign.” This drove many patients to expect painkillers for every complaint and drove doctors to embrace the use of opioids and prescribe them frequently. Now, here we are.

More from Judith Feinberg

“You can’t imagine what life in these communities is like due to the opioid epidemic. You drive through little towns in West Virginia, and half of the storefronts are boarded up. You can see that the bottom of the economy has fallen out of these places due to the loss of jobs in extraction industries like mining, and there are very few resources. A middle school principal in Wyoming County, WV was telling us how few kids in her school live in a home with two biological parents. We’re talking about communities where over 40 percent of the children are in foster care or are being raised by grandparents. There is no aspect of life that is untouched by the opioid epidemic. We’ve got to do better than this, or we’re going to lose way too many human beings as a result.”

Now, Let's Look at the Real Horror

It is difficult to imagine being born into and then having to live in an environment with a parent addicted on opioids. What if both were addicted, and possibly other family members. That is an unthinkable hell.

We covered the grim statistics of children born with addiction, now lets see an even more unimaginable fall-out.  What happens?  Obviously drugged people cannot responsibly attend to business, particularly the exacting duties attendant to raising infants and young children, which is difficult even for stable adults. All of your attention units must be on alert at all times. It is no time to selfishly try to continue living as a single person. Many times children are injured, even negligently killed, or just neglected.

Here Social Services enter and take charge. Many of the children are moved to foster homes. In West Virginia, the state most virulently affected by the opioid epidemic, had 5,481 children removed to foster homes in 2016, of which 16% were infants. In 47% of these placements, parental substance use was a factor.

Lifetime Impact

 Children dealing with traumatic experiences can face social, emotional, physical, and mental health challenges that last into adulthood. Left unaddressed, early childhood adversity can lead to school failure, risky behaviors like alcohol and drug use, and increased chance of health conditions like obesity and heart disease.


HIV, AIDS and Hepatitis C in Drug Addicted Mothers

            So let’s heap a bit more of a problem on these little innocents.  One of the horrors, if being born with addiction is not enough, is to come forth onto this earth laden with disease. How is this explained? It has been clinically shown that women are more susceptible to these diseases. This is a classic scenario of what occurs when the female is very stoned or high on drugs.  She may be careless in assuring that her lover has a condom for one thing, or may not make sure it is fitted properly, therefore enhancing her chance of being infected.  And when stoned, and using community needles, it is commonplace to transmit such as Hepatitis to a friend using the same needle.

How Does It Happen?

              “HIV transmission from mother to child can occur in utero, during labor or from breastfeeding. If left untreated, approximately 25 percent of newborns exposed to the virus from their infected mothers will become infected themselves and potentially develop AIDS. Fortunately, antiretroviral drug combinations, which typically include AZT, a nucleoside reverse transcriptase inhibitor, have reduced the rate of transmission from mother to child to less than 2 percent in infants who are not breast fed.Science Daily

One Evil Man

         Did you know one particular man, and his family, were the evil seeds that set off an epidemic of horror and death and walked away with impunity, wealthy beyond imagination, and totally without conscience or any consideration of having done anything wrong.

State and Federal Efforts at Control

             Authorities are working overtime at trying to get a handle on this runaway train on both the state and Federal Level.  There will have to be a joint federal and state effort at formulating and effecting the proper plan.  What is the answer? The train is gaining speed, and it is estimated that in the next year or so the costs could be over a trillion dollars to America and Americans. It is war on the level of control.


Ultimate Answer

            Healthcare providers must take responsibility for this crisis, for it was by their agency that started it:  Prescriptions were written by doctors, and when it began, the only way to get it was by prescription.  Of course, they had ample help from one man who manufactured and sold a dangerous, highly addictive drug that he advertised that had little or no addictive side effects. He was a doctor himself, trained in psychiatry, and knew doctors believed other doctors. Capitalizing on this he convinced the profession that his drug, OxyContin, was not addictive, and so there was a flurry of prescribing it without reservation for any and every complaint. Thus, the medical establishment must stop what it began, even though it was deceived.


Now Let’s Fix What We Broke: Integrated Healthcare

It’s our responsibility as doctors to fix what we broke, and we have the seminal product that will bring the wildfire crisis under control.

         The collaborative healthcare of doctors of different disciplines working together in clinics to find the real problem and then repair it without the use of addictive drugs or useless invasive surgery is the answer. The only need for such drugs is when there is intractable pain. The Integrated clinic will only prescribe pain drugs if there is no other answer. With thousands of these clinics in America, one within driving distance of every citizen, then America can have premier healthcare, and only be given treatment that is proper and needed. It will end the medication driven, disease maintenance “care” of today’s “healthcare.

The Future of Perfect Healthcare is Here

It is visualized that with health maintenance programs of the integrated clinics, there will be little real illness to handle. Integrated clinics provide a healthy, vigorous, productive America and American requiring no drugs or needless invasive surgery.  This is the healthcare provider of the future; healers who really heal, and who go to the basis of the problem and refuse just to handle symptoms and make people truly well.  We are building an army of men and women who are healers in the true sense of the word.