Dead or in jail

I spent a good chunk of Monday talking with women who were recovering from opioid addiction. This was part of an ongoing effort to interview people whose lives were touched by the Affordable Care Act (ACA).

Two of those women were particularly memorable. Both were parents who regained control of their lives thanks to medically assisted treatment they were able to access due to the the decision by then WV Governor Earl Ray Tomblin to expand Medicaid under the ACA.

One spoke of loved ones lost to overdoses, including a fiance who was like a father to her son. Another told of her experience with jail and probation. Thanks to treatment, both had been clean for several months, were holding down a job, paying taxes, maintaining a home, and caring for their children. Both were proud of being made assistant managers at their jobs.

Both said that "nobody wakes up one morning and decides to become an addict." Both were glad to finally be drug free and in control, for the first time in their adult lives.

When I asked how their lives would be different without the treatment the ACA supports, the answers were pretty stark: "Dead or in jail."

Treatment for addiction at risk

This op-ed of mine on WV's opioid crisis and how killing the ACA would make it worse ran in today's Gazette-Mail.

There’s hardly a community in West Virginia that hasn’t been impacted by our opioid/addiction/overdose crisis. For that matter, there probably aren’t even that many families that haven’t felt the effects of it directly or indirectly.

I knew it was bad, but I had no idea of the sheer magnitude of addictive pills dropped like little bombs into the state by drug companies and wholesalers until I read Eric Eyre’s series on the issue in the Gazette-Mail. While this has damaged the lives of many individuals, it goes way beyond the level of a purely personal problem.

It reminds me of a basic insight by sociologist C. Wright Mills. In his classic “The Sociological Imagination,” he talked about the distinction and overlap between personal troubles and social issues.

Personal troubles “occur within the character of the individual and within the range of his immediate relations with others.” Potentially, these troubles can be understood and resolved at the individual level.

Social issues, on the other hand, “have to do with matters that transcend these local environments of the individual and the range of his inner life.” These include many institutions, organizations, and social forces that operate and interact in a given social and historical situation.

It’s a question of level of magnitude. Social issues can cause huge suffering to any number of individuals, but they involve larger forces and institutions at work that help cause the damage.

Mills uses unemployment as an example:

“When, in a city of 100,000, only one man is unemployed, that is his personal trouble, and for its relief we properly look to the character of the man, his skills, and his immediate opportunities. But when in a nation of 50 million employees, 15 million men are unemployed, that is an issue, and we may not hope to find its solution within the range of opportunities open to any one individual.”

In the same way, if a few individuals in a rural state fall victim to opioid addiction, this could be regarded as a personal trouble for those involved. But when, as Eyre has reported, a handful of drug wholesalers pumped 780 million hydrocodone and oxycodone pills into the state over six years — or 433 pills for every man, woman and child in the state — while more than 1,700 West Virginians died of drug overdoses, we’re talking about a huge social issue.

I’ve had a hard time getting a handle on what 780 million pills would even look like. For starters, I took a (pretty uninteresting) pill out of my medicine cabinet and measured it. It came out to 2.5 pills per inch. Then I reached for a calculator ...

You may want to double check this, but here’s what I came up with if you placed them end to end: at 2.5 pills per inch and 63,360 inches per mile, that comes to 4,924.24 miles of pills. That’s about the distance in air miles from New York City to Honolulu (4,909).

Which is to say, a lot.

Eyre’s research found that many of these were prescribed in economically depressed coalfield counties, which had high levels of fatal overdoses. Kermit, in Mingo County, for example, with a population of 392 received nearly 9 million hydrocodone pills at a single pharmacy in a two-year period.

There’s plenty of blame to go around on this, from aggressive marketing by drug manufacturers and wholesalers to doctors who ran “pill mills” to unscrupulous pharmacies cashing in on misery to lax oversight by public agencies.

There has been one bright spot in all this in some states, including West Virginia. Medicaid expansion under the Affordable Care Act has made treatment for addiction accessible to many people for the first time.

The Pew Charitable Trusts reported in 2015 that at least 2.5 million adults out of the estimated 18 million potentially eligible for expanded Medicaid coverage had substance abuse issues. Around 2.8 million people with slightly higher incomes would be eligible for subsidized substance abuse treatment through state health exchanges.

According to Pew, “In addition to increasing the number of people with health insurance, the ACA for the first time made coverage of addiction services and other behavioral health disorders mandatory for all insurers, including Medicaid.”

It’s hard to get a handle on exactly how many people are getting addiction treatment for the first time through the ACA. According to Kaiser Health News in December 2016, in Rhode Island, more than 3,600 people were treated for addiction. Between January 2015 and March 2016, more than 63,000 people in Massachusetts got help. Around 10,000 people in New Hampshire were able to get treatment in 2015.

Closer to home, The Columbus Dispatch reported in July: “Nearly 500,000 low-income Ohio adults, most of them uninsured, received mental health and addiction services under the state’s hard-fought Medicaid expansion.”

According to WFPL public radio, in Kentucky, a new report “shows a 740 percent increase in substance abuse services for Medicaid expansion beneficiaries. The number of Kentuckians with traditional Medicaid who received treatment for substance was four times higher between 2014 and 2016, according to the report.”

I haven’t been able to find exact figures for how many West Virginians have received or are now receiving treatment for addiction under Medicaid expansion, but if we extrapolate Pew’s estimate that around 14 percent of the Medicaid expansion population nationwide has addiction issues, that would amount to around 24,500 people here who would be eligible for it, not counting those who gained coverage through the exchange.

That’s enough to take a big bite out of the problem. And we know this is something people want and need.

That’s the good news. Unfortunately, the new president and the Republican majority in the U.S. House and Senate plan to repeal the Affordable Care Act. Unless it is replaced by something comparable, this would pull the rug out from under many individuals, families and communities now on the road to recovery.

It remains to be seen if West Virginia’s delegation will let that happen.

To treat or to trash

So it's no secret that opioid addiction is destroying many lives and families in West Virginia and many other parts of the country. It's a sad fact that repeal of the Affordable Care Act, which seems to be on the agenda, will yank the rug out from under many who need treatment for mental health and addiction issues. According to a recent Harvard study, ACA repeal would threaten a 45 percent of funds available in WV for medically assisted treatment for those battling with addiction.

The game of chicken continues, but the casualties will be real.

780 million opioids?

A bit of a downer before the holidays: the latest Front Porch features Gazette-Mail reporter Eric Eyre on his series about WV's opioid epidemic. It's hard to get my head around this but over a few year's time, 780 MILLION opioids were dumped into WV, mostly to depressed areas in the southern coalfields.

I actually did the math, based on measuring one of my own (not very interesting) medicines: at 2.5 pills per inch w 63,360 inches per mile, 158,400 pills per mile divided into 780M=4,924.24 miles of pills. It's about the distance in air miles from New York City to Honolulu.

Damn.

An act of war

In case you missed it, please take a look at this great reporting from Gazette-Mail journalist Eric Eyre about WV's opioid epidemic. It's really hard to get your head around. Or my head, anyway.

Teaser: a handful of drug companies poured 780 MILLION pain pills into WV over a few years, even while our overdose rate increased. They specifically targeted a handful of rural communities in the coalfields.

It reminds me of Great Britain's shameful behavior towards China (or is that Jina?) during the opium wars, when that empire forced addictive drugs on the Chinese people.

If another country did this to us, we'd go to war. Unless it was Russia, which apparently gets a pass from the president elect.

Some good news. No, really

These days I've been trying whenever possible to highlight any good news when it shows up. On bit of that comes from the Census Bureau, which recently released it's data on poverty and health coverage. Turns out that thanks largely to Medicaid expansion, WV is a national leader in health care coverage.

The percentage of uninsured decreased from 14 to 6 percent and the numbers dropped from 255,000 to 108,000. Not universal yet but moving in the right direction. As I've said before Medicaid expansion in WV has been the biggest victory for social justice on my watch and it's one worth going all out to protect.

Then there's this: according to the WV Division of Corrections, Medicaid expansion is saving money while also providing needed care. By providing help with substance abuse and addiction, it could even reduce recidivism. Here's a snippet from the article:

“One of the drivers behind a criminal history, directly or indirectly, is a substance abuse problem,” Jim Rubenstein, commissioner of the state Division of Corrections told the Gazette-Mail in 2014. “[Medicaid coverage] could make a critical difference, by having some kind of coverage that would gain these individuals access to needed treatment or counseling. And while we know that substance abuse is a big issue, to have coverage for basic medical care could also make a difference in their lives as well.” 

Taken all together this is a pretty big deal.

From the horse's mouth

The city of Huntington is ground zero in WV's opioid crisis. When 26 people there overdosed in a few hours, the story made headlines nationwide. It was nice to see this editorial in that city's Herald-Dispatch about how to respond. Here's bit:

If locking up users and dealers were the "silver bullet," we would have won the war on drugs years ago. Largely because of tougher penalties for drugs, the American prison population rose from 400,000 in the 1970s to record levels of 2.3 million in recent years....

Local, state and federal government has spent billions fighting drugs for the past 50 years. A reasonable investment in prevention, treatment and recovery is long overdue.

The rest is here.

This is a much more productive approach than more mandatory minimums as proposed by Republican candidate for governor Bill Cole.

Houston, we've got a problem

It's no secret that West Virginia, and my own county of Cabell, is ground zero for the opioid plague. As of 2015, Huntington had the highest drug overdose rate in the nation, with West Virginia "leading" the pack among states.

To get a sense of just how bad things are, consider this: yesterday between 3:30 and 9:00 pm fully 26 overdoses were reported in Huntington. It's almost miraculous, but so far nobody has died. While there's no such thing as a good batch of heroin, this one was particularly powerful. Some patients required more than one dose of naloxone to come out of it.

This year's overdose rate for the city is about the same as last year, but there is a bit of good news: the rate of overdose deaths is down by about 25 percent, from 35 last year to 26 this year.

The epidemic has got to be exhausting to the emergency medical service workers. According to this MetroNews report, some individual first responders helped save as many as eight overdose patience in one day.

This clearly shows the need for more investment in drug abuse prevention, treatment and recovery. And don't count on "the market" to provide it.

Why warehousing people doesn't work

We've been trying to chip away at mass incarceration in WV for a while now, both for adults and for kids in the juvenile justice system. This NY Times op-ed provides a good summary of why it just doesn't make sense.

One thing that does make sense is substance abuse treatment. WV just launched its first residential treatment program for regional jail inmates. That's kind of a big deal since many inmates aren't eligible for parole without treatment.

Off topic, I really hope the WV legislature doesn't revisit the bogus "religious freedom" license to discriminate bill in the future. Here's what an editor at the Gazette-Mail had to say about that.

Urgent owlet update...and other stuff

Photo credit: Sister in law Unit.

A while back I posted a picture of a baby great horned owl that was born on our hill. I'm pleased to say that he survived and has now taken to venturing forth. This isn't quite the same as fledging, according to the Spousal Unit. Apparently that is like moving out. Instead, the little critter is branching, which entails a return to the nest. You can see both in the picture above, with the nest in the upper left and the owlet in the lower right.

YOU REALLY CAN'T. I've often mentioned here my campaign to update state motto of West Virginia from "Mountaineers Are Always Free" to "You Can't Make This **** Up." This column by statehouse reporter Phil Kabler has a priceless example in it.

COAL-LAPSE. There's been a lot of coverage about the decline of coal. This AP article suggests it's happening faster than anticipated. Note that the article attributes most of this to market conditions rather than a certain Muslim socialist of questionable American birth.

SPEAKING OF SUBSTANCE ABUSE. I knew things were bad, but I didn't know things had gone this far.

Good news, bad news, repeat

To start on a positive note, the Affordable Care Act and Medicaid expansion in particular is shaping up to be a success story in WV. Aside from the fact that around 170,000 West Virginians are covered by Medicaid expansion and another 33,000 have gained coverage via the exchange, now hospitals are reporting huge savings. The Charleston Gazette recently reported that 25 hospitals have reported a $265 million drop in uncompensated care.

On a negative note, changes to food stamp aka SNAP benefits could result in thousands of West Virginians losing them.

On a positive note, my beloved Cabell County Schools is expanding free meals for students. On the other hand, Cabell is also ground zero for substance abuse, with over 900 overdoses reported last year.

Half empty or half full?

Must see TV

I have to give props again to Stephen Colbert for this hilarious "report" on an Appalachian small town in eastern Kentucky which is, so far, the smallest to adopt a Fairness ordinance banning discrimination on the basis of sexual orientation. Vicco has a population of around 334...and an openly gay mayor.

Props to the people of Vicco, too!

WHERE YOU LIVE may affect how long you live. And WV doesn't come off too good from this look.

PATRIOT COAL. Union miners are voting today on a proposed agreement with Patriot Coal (search Patriot Coal in upper left corner for more information). I'm not sure how the vote will go but if I was a gambling man I'd say it will pass. The big news is that the UMWA leadership got a better deal for its members than a federal bankruptcy judge after the judge's ruling.

MEDICAID, PRISONS, DRUG ABUSE. An audit from Oregon suggests that the former will help reduce problems with the other two. And save millions.

GOAT ROPE ADVISORY LEVEL: ELEVATED

Myth-using a good word

I always kind of cringe when I hear the word myth used to signify commonly held but wrong belief, as in, for example, the myth of welfare dependency. I think of myths as stories that provide meaning to life. The word itself means something like plot in Greek. The more I think about it, though, wrongly held beliefs often do function as a kind of myth that does tell a story and provide meaning, even if it isn't accurate.

Today a friend of mine produced a well done blog post titled The "Welfare Dependency" Myth in West Virginia. It does a good job of pointing out that widespread dependency on such kinds of aid for families has in fact dramatically declined..

Still, the delusion of widespread welfare dependency does function as a dark myth that gives meaning to mean-spirited people who like to bash the poor, most of whom are seen as unworthy. This kind of myth justifies cutting such programs, sometimes even by claiming that this would really help poor people in the long run.

Since myths are something we apparently can't live without, the only viable course seems to be to come up with a better one.

I'VE BEEN THINKING THIS TOO. From the same source, here's another post about how Medicaid expansion can help deal with substance abuse, a major factor in prison overcrowding.

GOAT ROPE ADVISORY LEVEL: ELEVATED