One West Virginia city's pioneering approach to opioid crisis

Huntington’s blend of law enforcement, data analysis, and compassionate care has become a model both in the state and elsewhere.

Within a minute of the siren sounding in Station 4, three firefighters are barreling through a red light.

Dispatch recaps the 911 call: A person walking by an apartment overheard someone say, “Pops, Pops, I told you not to take that. It’s too strong.”

When the truck pulls up to an apartment building, Huntington (W.Va.) Fire Chief Jan Rader is already there, jumping down from her tricked-out red Suburban. The firefighters climb the staircase two steps at a time. “Fire department,” they announce, their voices echoing in the fluorescent-lit hallway. An older man opens the door and says he’s fine.

“You sure?” asks Rader, who spots a telltale sign of opioid use. “Your pupils are pinpoint.” Just then a tattooed young man rolls up a small bag and walks to the bathroom. Rader and one of the firefighters exchange a look: This story isn’t adding up.

Two police officers arrive and find an empty can of naloxone, an overdose-reversing
drug. They search the purse of a younger woman in sweatpants. Used needles. Meth. A spoon, which is often used to cook heroin.

But then, as a police officer gives the woman a court date, Rader tells her about a city program to help drug users. There, she can meet a recovery coach.

The teamwork is emblematic of Huntington’s pioneering approach to America’s opioid epidemic, pairing law enforcement with compassionate outreach.

Rader and the rest of the Huntington team – the first of its kind in the state – are not waiting for the state or federal government to take action against opioid addiction. They can’t afford to: The Huntington Fire Department responds to at least five overdose calls per day. On one memorable August day, there were 26 – in just a few hours.

Statistics like those have made West Virginia ground zero in the fight against opioid addiction. But a budget crisis has left the state strapped for cash, pushing Huntington and other West Virginia cities to tap other resources. “We are resilient, we are proud, and we are hardworking,” says William Ihlenfeld, former US attorney for the Northern District of West Virginia. “If we ever climb out of this hole that we’re in ... it won’t be because of what D.C. does, or even the state government. It will be because of what the people are doing at the street level.”

Between 2000 and 2015, opioid overdoses killed more than half a million Americans – equivalent to the number of Americans killed by guns. Americans represent less than 5 percent of the world’s population, yet they consume 80 percent of the world’s opioids. Now, what began as a prescription painkiller crisis is becoming more lethal, as addicts turn to more-powerful substances such as heroin and carfentanil.

In West Virginia, one person died from drugs every 10 hours on average in 2016. That’s due to a number of factors, say experts: chronic pain from manual labor, the lowest education rate in the country, and an influx of pills from drug wholesalers.

Unemployment may be the largest factor. West Virginia has lost 35 percent of its coal jobs since 2011. Between 2015 and 2016, the number of coal miners dropped from about 16,000 to about 12,300, according to state labor figures. Experts have found a direct correlation between unemployment and drug use.

“We have a sense of hopelessness here,” says Chelsea Carter, a former drug addict from southern West Virginia who now counsels others through recovery. “They’ve lost everything they’ve worked for – houses, cars, everything – and you have this emptiness feeling. You’ll look for something else to make you feel better.”

The team: a policeman, fire chief, data guru

At first, Mayor Steve Williams hired more police officers to deal with the opioid crisis. But he came to believe that law enforcement couldn’t solve this problem alone, so in 2014 he established the Office of Drug Control Policy. He repurposed talent the city already had – bringing on retired Police Chief Jim Johnson to head the office, along with Rader and crime analyst Scott Lemley.

“They’re forward-thinking,” says Mr. Ihlenfeld, speaking of members of Huntington’s law enforcement, whose establishment of a dedicated office preceded any such move by the state. “We need somebody to work on this issue 24/7 and not just have it added to their list of other duties they have in state government. This needs to be the only thing they do.”

Huntington’s team is a diverse crew. Johnson, a Huntington police officer of 29 years who has already retired three times and “knows everybody,” has built a reputation for breaking down silos across the city. Mr. Lemley, a data guru from the police department, has turned his formidable number-crunching skills to the opioid problem. And Rader, the state’s first female fire chief, blends the care of a nurse – her former profession – with the street smarts of a first responder. Together, they take a comprehensive approach, coordinating the efforts of a diverse array of local stakeholders.

“I think we serve now as a model for every locality, whether it be a large city or small city, as to how a community can rise up to fight this,” says Mr. Williams, “because we started utilizing all the resources at our disposal: the county health department, the hospitals, the medical schools, the pharmacy schools, the universities, the business [community], the churches, the neighborhood groups.”

Currently there is no system in place to track overdose data in West Virginia – national statistics from the Centers for Disease Control and Prevention are two years old. So as with many other things, Huntington took data collection into its own hands.

All the information Lemley uses is readily available – it just requires someone pulling together a “master list” of overdose data from police departments, local hospitals, and 911 dispatch logs.

Based on graphs showing overdoses by location and time of day, Rader, Johnson, and Williams beefed up first-responder staff between 5 and 8 p.m. and located resource centers in specific overdose “hot spots.”

“The data allows us to do our job better,” says Lemley, “to better use the limited resources that we have.”

Data collected by Huntington’s Office of Drug Control Policy allowed Cabell County to be designated as a High Intensity Drug Trafficking Area, a classification that allows counties to access a federal grant program. “Data equals funding,” quips Lemley, who says several counties have approached the team about implementing similar initiatives.

Huntington has also established a Harm Reduction Program, which includes naloxone training, recovery assistance, and syringe-exchange programs. Participants are also educated on the dangers of drug use and introduced to a recovery coach. While advocates say that giving drug users clean needles cuts down on infectious diseases and provides an opportunity for them to engage with professionals who can help them, many in this largely conservative, Christian city did not welcome the idea of a syringe-exchange program, at least at first.

But some, including Johnson, have come to support the program. “As Jim [Johnson] puts it: Enabling is not saying something to a friend who has an addiction problem, or to a family member ... and then burying them,” says Lemley. “Jim had to do that.”

Lawsuits against the ‘big three’

The opioid crisis surpasses other drug epidemics in the United States’ recent history, with opioids killing five times as many people per capita as crack cocaine, for example. It began with a surge in prescription painkillers in the 1990s, when medical attitudes toward pain treatment shifted and the use of opiate painkillers – marketed by pharmaceutical companies as largely nonaddictive – became far more prevalent.

In West Virginia’s Wyoming County, the No. 1 county nationwide for fatal prescription-drug overdoses, virtually everyone is affected. Dee, a Speedway attendant in Oceana, knows five people addicted to opioids – on one side of her family.

Lawyers have argued that drug wholesalers disproportionately targeted vulnerable populations in West Virginia. In December, the Charleston Gazette-Mail’s Eric Eyre reported previously withheld data showing that drug wholesalers distributed more than 780 million hydrocodone and oxycodone pills to West Virginia between 2007 and 2012. In just two of those years, 9 million hydrocodone pills went to a pharmacy in Kermit, W.Va., a town with fewer than 400 people.

“Profits came before people. They didn’t care about the overdose rate,” says Justin Marcum, a lawyer and Democratic state representative from the district in which Kermit is located. “These corporations had no respect for the people of West Virginia.”

Mr. Marcum is leading a suit against the “big three” – Cardinal Health, McKesson, and AmerisourceBergen – on behalf of Logan County. He and other lawyers argue that drug distributors have a duty to monitor themselves. Cardinal Health denies wrongdoing, telling the Monitor that “the facts and the law are on our side.” McKesson and AmerisourceBergen did not respond to repeated requests for comment.

Cardinal Health and AmerisourceBergen paid West Virginia $36 million in January, settling a lawsuit filed in 2012 by Darrell McGraw, then West Virginia attorney general. However, some consider the settlement mere pocket change. Huntington alone spent roughly $100 million last year dealing with the health consequences of intravenous drug use, Rader says.

Attorney General Patrick Morrisey inherited the state lawsuit when he was elected in 2012. But after a West Virginia bar investigation found that Mr. Morrisey had earned $250,000 for pharmaceutical lobbying and had received $8,000 in campaign contributions from Cardinal Health, he voluntarily recused himself. Last year, Morrisey also recused himself from state cases involving AmerisourceBergen and McKesson.

Chief Deputy Attorney General Anthony Martin denies any wrongdoing on the part of the attorney general, arguing that Morrisey can still effectively fight drug addiction in West Virginia without participating in lawsuits against the big three.

In the interim, cash-strapped West Virginia communities have taken matters into their own hands.

Rusty Webb, a medical malpractice lawyer and former state legislator, is suing drug distributors on behalf of the city of Huntington.

“Our lawsuits are alleging public nuisance claims. The damages are the costs to alleviate, abate, or remedy the nuisance,” says Mr. Webb. “And there’s no limit to the damages.... It’s the sky.”

In April, the West Virginia Legislature passed the West Virginia Drug Overdose Monitoring Act with bipartisan support: The state Senate approved the act unanimously and the state House passed it 96 to 4.

The act, which would create a statewide Office of Drug Control Policy similar to Huntington’s, is awaiting a final signature by Democratic Gov. Jim Justice.

Even though the state Legislature is very diverse, says Marcum, “when it comes to this issue we are very united.”

But as states like West Virginia cracked down on pharmacies and doctors prescribing excessive amounts of painkillers starting in 2010, patients who had already become hooked turned to cheaper and more dangerous drugs: heroin, fentanyl, and carfentanil. A less-than-$5,000 investment in fentanyl – which is 50 to 100 times as strong as heroin – can reap $1.3 million on the street.

“On Monday we shut the pill mill down, put the guy in jail,” says Johnson, speaking metaphorically. “But Tuesday morning, there were 100 people lined up at that doctor’s office. What did we do with them? Where did we send them?”

‘I never give up on people’

Ms. Carter, who got hooked on painkillers in her teens and later turned to stealing to support her drug habit, says she still remembers the sound the jail door made when it slammed behind her.

“That’s a noise you never forget,” says Carter, who was charged with 17 felonies and convicted of two. “I hit my knees and I prayed. I said, ‘Lord, if you ever bring me out of this, I’ll never touch a drug again.’ ”

And she hasn’t.

But she says treatment is essential and it’s important to tailor it to each person. Her medication-assisted treatment center is criticized for employing drugs to treat drug addiction, but she has seen lives turned around.

“I’ve had people come to this program who live in tents,” she says. “And in six months they have their very first apartment. And you’re telling me it can’t work?”

Back in Huntington, Rocky Meadows runs another sort of recovery initiative – a sober-living program with seven homes, called LifeHouse. Unlike many sober-living programs, it does not turn away repeat customers. 

“The reason I never give up on people is because God never gave up on me,” says Mr. Meadows, who was arrested more than 37 times and spent cumulatively 10 years in prison; he says he eventually got sober through his Christian faith. “You fall down? I don’t care, I’ll pick you up. Let’s go again.”

Staff writer Christa Case Bryant contributed reporting.