Fighting Opioids

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 with us."

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 market.

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."  

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 protective gear." 

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 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."