West Virginia addicts have long wait to get needed help
May 29, 2016 12:00 AM
Anthony Davis/The Herald-Dispatch
Scott Lemley, a criminal intelligence analyst for city police in Huntington, W.Va, speaks to guests this month at a workshop, “Understanding the Impact of Addiction & Supporting Recovery: Strategies & Tools for Clergy & Congregational Leaders,” at a church in Huntington.
By Adam Smeltz / Pittsburgh Post-Gazette
At the largest opioid addiction clinic in overdose-ravaged West Virginia, just getting in the door can take more than a year.
That won’t be fast enough for some addicts on the waiting list, which topped 530 names this spring.
“Most of them will never get into treatment here. Some of them, I guarantee you, will die of an overdose before they ever get into treatment,” said Carl R. Sullivan, who oversees the Comprehensive Opioid Addiction Treatment Clinic at WVU Medicine in Morgantown. “We wouldn’t put up with this with any other disease.”
The national epidemic of narcotic overuse struck early and hard in West Virginia, helped by a dire economy, geographic isolation and chronic ailments among the blue-collar workforce. By the early 2000s, up to 90 percent of opioid addicts there were getting hooked through excessive prescriptions written by clinicians, Dr. Sullivan estimated.
But even as doctors cut back on the painkillers, he projected about a quarter of the state’s narcotic problem still arises from bloated prescriptions, a figure disputed by physician associations. Disciplinary boards in West Virginia punished at least two dozen doctors from 2011 to 2015 for misprescribing narcotics, a Pittsburgh Post-Gazette analysis found.
Those sanctions reached nearly five of every 1,000 doctors practicing in the state, the third-highest rate of discipline among seven states in the newspaper’s six-month opioid investigation. Pennsylvania ranked seventh, with fewer than two in 1,000 doctors sanctioned for overprescribing.
“I wouldn’t put the blame squarely on the doctors, but there are people who started out just with a back injury who became addicted to pills. When those dried up, they moved to heroin,” said Scott Lemley, a criminal intelligence analyst for city police in Huntington, W.Va.
He said the community of about 49,000 counted 58 drug overdose deaths last year, the vast majority connected to opioids. That’s nearly nine times the national average of 13 overdose deaths per 100,000 people.
West Virginia overall saw more than double the national average in 2014, notching the highest overdose death rate in the United States, according to the Centers for Disease Control and Prevention. At least 610 people statewide died from opioid-related overdoses last year, including 196 that involved heroin.
That’s up from 412 in 2007, including 22 linked to heroin, state data show.
“Everybody knows somebody who has died or is suffering from addiction,” Mr. Lemley said. “Twenty years ago, when you’d say someone is a drug addict, you had a picture in your mind of what that person looked like. Today it’s everyone.”
A prescription dip
While heroin keeps increasing the death rates, state health officials see hope in falling prescription numbers.
As recently as 2012, West Virginia medical providers wrote about 138 opioid pain-reliever prescriptions for every 100 people, the third-highest rate nationwide, according to IMS Health. The figure tumbled to around 110 prescriptions last year, marking one of the sharpest declines in the country, said state health commissioner Rahul Gupta.
“There’s a relearning of the system. It’s a paradigm shift,” Dr. Gupta said.
In particular, he said, West Virginia has begun requiring doctors to undergo routine training on opioids. A toughened prescription-drug monitoring program demands often that physicians check on a patient’s prescription history before offering a narcotic. A state advisory panel alerts investigators to doctors linked to multiple overdose deaths.
Another factor: Expanded availability of naloxone, the emergency overdose treatment, has pushed physicians to think more about responsible prescribing in the first place, Dr. Gupta said. State health authorities also are telling the most frequent opioid prescribers about their high ranking.
“A lot of doctors are writing more prescriptions, but they’re writing them for just a week’s supply. Instead of giving [patients] 120 pills, they’re giving them 30,” said Mike Goff, who runs the West Virginia prescription monitoring program.
He said the trend means patients must visit pharmacies more often, leaving fewer pills to sit unused in home medicine cabinets. That translates to fewer opportunities for drug diversion and other abuse — and fewer chances for prescription overdoses, Mr. Goff said.
“I admit there have been some physicians who have used these medications over a period of time in a non-judicious way,” said Ahmed Faheem, an addiction psychiatrist who leads the West Virginia Board of Medicine. He said opioids “became a very lucrative business” amid the ragged economy in the state.
At the same time, Dr. Faheem warned against assigning doctors sole blame for the epidemic. He said the pharmaceutical industry played a key role by making pain medication abundantly available, and widespread treatment standards for years listed opioids as a first response to pain.
Patient satisfaction surveys, too, grew to emphasize the effectiveness of pain treatment. Dr. Faheem said hometown dealers and major highways crisscrossing West Virginia helped push illegal opioids into the state, as well.
Now health groups from the CDC to the American Medical Association are urging clinicians to throttle back. The CDC in March released a dozen new recommendations on narcotics, pressing doctors to consider safer options before they offer the addictive drugs for common pain.
“I think the vast majority of physicians want to do what’s best for their patients. For a patient presenting with pain, they want to help that patient,” said Brian Foy, executive director at the West Virginia State Medical Association.
He estimated that overprescribing by physicians likely accounts for less than 5 percent of the state’s opioid problem, “but it seems higher because that’s what’s reported in the press.”
“Treatment is the answer,” Mr. Foy said.
Prescription pills to heroin
M. Corbin, an obstetrician-gynecologist in Mason County, said he was offering just that — buprenorphine treatments for addicts — when the state medical board slapped him down. An opioid itself, buprenorphine can help ease addiction and dependence on stronger narcotics.
But Dr. Corbin’s cash-only addiction clinic in Point Pleasant operated out of a two-bedroom apartment and failed to pay business and occupation taxes, according to a consent order that he signed in August 2011. The operation also failed to carry state and local business registrations, the board found, banning him from running buprenorphine clinics anywhere in the state.
“I should have investigated more and known I was supposed to pay. I should have had a second business license,” said Dr. Corbin, whose clinic for women’s care remains in Point Pleasant.
His backing from at least 30 supporters didn’t appear to sway the board, he said. He doesn’t “totally buy” the idea that doctors started the narcotics epidemic.
“What’s happening now is that they’re not allowing pain medication. It hasn’t changed the situation. It’s made it worse,” Dr. Corbin said, pointing to the rise in heroin deaths.
The street drug is a relative bargain compared to the inflated street prices for prescription pain medication, which can run around $80 to $100 per pill. In Huntington, that’s about double to triple the price of heroin, said Mr. Lemley, the intelligence analyst.
He said the street prices for pain pills spiked in 2011 when illicit supplies began getting tighter. He credited, in part, a government crackdown on overprescribing clinics known as “pill mills,” including those in Florida. Many of West Virginia’s illegal narcotics originated there.
“We did such a good job blowing down pill mills, but we still had an addicted population. We didn’t do anything for them,” Mr. Lemley said. ”Of course they’re going to move on to whatever the next drug is, to keep them going.”
Dr. Sullivan sees the change at his addiction clinic in Morgantown, where about 75 percent of newcomers are addicted to heroin, he said. That marks a steady change since 2008, when most new patients were addicted to prescription narcotics.
Still, Dr. Sullivan said many heroin addicts started with prescription drugs. He said broad distribution of the street drug is driving the opioid crisis now, although doctors “really fueled the epidemic” in the beginning.
“I don’t think many of these doctors really wanted to hook their patients and turn them into addicts,” he said. ”They just didn’t know what they were doing and didn’t practice very safe medicine.”
Adam Smeltz: email@example.com, 412-263-2625 or on Twitter @asmeltz.
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