HUNTINGTON, W.Va. — When a group of Clark County residents set out last week for Huntington, West Virginia, they were seeking solutions to bring home from a community that's been hit hard by the opioid epidemic.
The group, led by grassroots community organization Clark County CARES, included judges, police, fire and medical professionals, representatives with social organizations and other residents committed to helping fight the drug issues in Southern Indiana — an area in good company with communities across the U.S.
The daylong trip was packed with conversational meetings with Huntington city officials, organization leaders and department heads across the board. Their goal? To learn about how that area has responded to the crisis, and figure out which approaches could work in Southern Indiana.
What they found was a city that worked together, that had buy-in from the community and its leaders to find a way to treat the crisis.
“I think it's always important to see what someone else does,” Brad Jacobs, Clark County Circuit No. 2 judge, said.
“We know what's going on and we have ideas, but to see how somebody else is attacking it is a better plan — maybe you've overlooked something. Maybe something you've overlooked as [having] no chance of success turns out it works just fine. Maybe a roadblock you've had, someone else has solved it.”
PATH TO AN EPIDEMIC
From 2007 to 2012, Cabell County, West Virginia's overdose numbers hovered between around 110 and 160. But then something started to change. The 272 cases reported in 2014 were more than 100 more than previous years. By 2015, that would jump to 944 and in 2016, the county experienced 1,476 opioid overdoses, an increase of 443 percent over 2014.
But these numbers, ones that only show those who were transported to one of the area's two hospitals after a 911 call, are around 20 percent less than the real numbers, Huntington Fire Chief Jan Rader said.
Also in 2016, Huntington experienced a three-hour window with 25 cases. While all of those people survived the overdose, none got into treatment. At the same time, hepatitis B cases rose to more than 10 per 1,000 residents in 2014, and hepatitis C to 3.4 — both above the national average of less than one person per 1,000.
ALL FOR ONE
In the summer of 2014, officers with the Huntington Police Department began working with Mayor Steve Williams, taking him on raids to show the magnitude of the issue in their city.
“He watched our police officers go into harm's way and he saw the carnage of people suffering from substance abuse disorder,” Jan Rader, Huntington Fire Chief said. The mayor led a day of prayer for the city, which went viral on YouTube.
“People started [asking] 'what can I do?'”
Bob Hansen, director of Addiction Services at Marshall University, said getting everyone together at the same table was a necessary part of healing Huntington.
"We just work it out," he said. "The issue is we have to look at the bigger picture. The bigger picture is we are a community that's hurting."
In 2017, the Mayor's Office of Drug Control Policy was rolled out, a two-year strategic plan to address the opioid crisis in Huntington, Cabell and Wayne counties. The document outlines strategies for prevention, treatment and recovery expansion and law enforcement — not only with reducing the amount of drugs coming into the area but also creating diversion programs for people with certain drug offenses.
The city, in collaboration with Huntington's Marshall University, made a commitment to help. Meanwhile, people in the community started working together in new ways, to approach the issues that were affecting them all.
“We started figuring out how we were going to tackle this problem,” Rader said. This included getting a handle on real-time data — information such as locations of the overdoses and how many were missed by using only logs of ambulance runs.
And before any big changes were made, they needed to bring everyone together.
“There were good people in the community doing good things,” Rader said. “They just didn't know about each other. And we needed to educate the leaders in the community on how broad the problem was, and things we could do to combat it.”
Rader said the initial task force spent about six months on a near daily basis meeting with small groups of people, presenting the evidence and seeking support.
Jacobs, the Clark Country judge, along with others who visited Huntington, said the collaboration stood out as a major strength in how the West Virginia area is handling their epidemic.
“We know buy-in from the community was important,” he said. Everybody was invested, for their own reasons. Everybody is affected by the opioid epidemic and everybody is affected in their own unique ways.”
He said he was also impressed at how everyone they met with last week just added another piece to the puzzle of treating the opioid crisis.
“You didn't see anybody that said 'My program is the best,'” he said. “And I was surprised at how much everybody worked together, because you don't see large groups of people working together very often. That doesn't mean we can't do it.”
TREATING THE COMMUNITY
Like other communities across the U.S., treating the opioid crisis is a game of learning and working together to evolve and improve.
This means that when Dr. Michael Kilkenny, physician-director with the Cabell-Huntington Health Department projected that the syringe exchange program opened in 2015 would see 150 new clients in the first year and 450 total, they had to revise plans when those numbers were much larger.
In the first three months, the program had served 600 people with clean injection supplies and harm-reduction methods such as resources for treatment, virus testing and immunizations. In 2016, the program served 2,000 new clients and another 1,900 in 2017.
“So we had served 4,000 people in a program I projected would serve 450 people,” Kilkenny said.
Restrictions over the past year has improved that. Around 30 percent of the clients were coming from outside Cabell County. While they still can come now for the other resources, injection supplies are limited to residents.
In December, a Quick Response Team was formed through partnerships with Marshall University, Cabell County EMS, the Huntington police and fire departments, the Huntington Comprehensive Treatment Center, the Cabell-Huntington Health Department, the Prestera Center and Recovery Point, a peer-supported recovery facility.
The goal was to reduce the number of overdoses while increasing the number of those in treatment by following up and offering support. Within 72 hours of an overdose, a team consisting of an emergency staff member, law enforcement and behavioral health staff make contact with the individual, offering help to get treatment if they choose. The team can arrange for a stay in a facility and provide transportation.
The point is to help them get well.
“We'll tell them that you're not out there by yourself,” Larrecsa Cox, a paramedic at Cabell County EMA and a quick response team member said. “You have a support network. If you want help, we'll be here.”
But that doesn't mean the team tries to force recovery on anyone.
“We try to meet them where they're at,” Amber Wilfong, a treatment center counselor who serves on the team said. “We try not to be pushy but if they're being receptive and want to look into treatment resources, we kind of lay it out there, tell them what's available and let them make their own choices.”
Since its inception, the program has shown about a 35 percent success rate. In 2017, there were 105 referrals, a team made contact with 52 people and 19 entered treatment. In January 2018, there were 71 referrals, 35 contacts and 14 entering treatment. February had 67 referrals, 41 contacts and 12 entering treatment.
Connie Priddy, QRT coordinator, said taking the proactive approach can help reach more people.
“As a community, we sort of sat back and waited for people to come get help,” she said. “And we realized we need to go where they are instead of waiting for them to come where we are. It's been eye-opening all around.”
At Recovery Point West Virginia, a 117-bed men's recovery facility, residents go through a multi-phase process on their path to healing. It starts with a five- to seven-day detox, followed by a month or more of getting adjusted before the next phase, nine to 12 months of working on themselves before they graduate to the next phase and can have a job. They have rules and chores, and they hold themselves and each other accountable.
"It's the best opportunity you can give — the opportunity to take the time and work on yourself," Ray McWilliams, program director said.
The program, modeled off of The Healing Place in Louisville, is one of four facilities in the Cabell area under this umbrella.
Like McWilliams, Brian Holley is in recovery. After graduating from Recovery Point, he now works as its phase 1 coordinator. He said it's the most rewarding job he's ever had.
"Getting to watch these guys go through and get their lives back together the same way it worked for me is hard to put into words," he said. "It also helps them to see people who have gone through recovery applying it to their daily lives, so they can see it is possible."
Other organizations have formed to provide support for children affected by opioid use, such as Lily's Place, a center for babies exposed to the drugs in utero to adjust in a safe and therapeutic environment.
AHEAD OF THE PROBLEM
Dr. Eric Yazel, Clark County Health officer and member of Clark County CARES, said one of his biggest takeaways from the trip was how similar the stories are between what's happening in another state three hours away, and what's happening in Clark County.
“All the challenges are the same,” he said. “When they talk about some of the things they deal with, some of the barriers, it's verbatim the things we deal with here.”
Numbers for overdoses in Clark County have dropped over the last year and a half — a third fewer overdoses were record in 2017 than in 2016. Yazel said numbers are on pace for about a drop of another third this year.
Deaths from overdose, around 35 to 40 per year, are closer to pre-epidemic numbers than they have been in several years. But part of that is due to higher rates of methamphetamine use, an equally dangerous drug that affects the whole community, but that doesn't have the same risk for acute overdose deaths as opioids. Yazel said that doesn't mean the crisis is over, it just means the situation is changing, and he said the community needs to be prepared.
“We want to prepare for the worst,” he said. “And if it can happen to a town of their size, those numbers could reach locally. So we want to model ourselves after them.”
Jacobs said that the group is still digesting the information gleaned from their new partners in Huntington, and through upcoming meetings, Clark County CARES group members will be comparing notes, looking at what might work best for this area.
But before they can dig in deep, Jacobs said there needs to be a desire and a commitment from all the players — law enforcement, health and government leaders, social service providers and residents of the community.
First, they will likely meet with top city and town administrators in the area, to “take the temperature of the room,” he said, and see who would be on board with sharing some of their resources to help mimic the plans Huntington has in place.
While he doesn't expect big changes overnight, he's hopeful for the long run.
“I think we can get everybody working together,” he said.