Opioid epidemic found ‘perfect storm’ of ingredients in West Virginia


BUCKHANNON — Though his work with individuals addicted to drugs spans 10 years, it was not until this year that an assistant professor at West Virginia Wesleyan College had a personal connection.

Travis Zimmerman, assistant professor of criminal justice, presented a faculty lecture series on opioid addiction earlier this month. He discussed the rise of opioid addiction, statistics and more.

But it was one person who Zimmerman shared a story about. Zimmerman began working as a substance abuse unit manager at Pruntytown Correctional Center in Grafton, co-developed and implemented the Marion County Adult Drug Court and ended field duty there as the drug court’s probation officer in 2015 but stayed on part-time to counsel those participants.

“This wasn’t necessarily a personal topic to me,” he said. “I didn’t know anyone who had died of an overdose until Dec. 4.

“I had a phone call that one of the clients I had in drug court, a young man 23 years old had passed away on Dec. 4 of an opioid overdose. For the first time, all this stuff became real to me.

“I knew him. He was bright. He graduated in the top fourth of his class; came from a decent family.

“I had listened to him talk about how excited he was to go to college. He had never gone to college. He was working towards that and was taking college prep classes in the evening.

“His grandfather died Dec. 1 and I am assuming that the depression of losing his grandfather caused this young man to relapse. His drug of choice was an opioid. When he relapsed, he relapsed with opioids.

“On the morning of Dec. 5, his grandmother went in to wake him up for breakfast.

His eyes were rolled back in his head. His lips and fingers were blue and he wasn’t breathing. When the paramedics arrived, they assumed he had been dead for about seven hours.”

“I tell you that story because there might be people in this room who have story just like that,” Zimmerman said. “There might be people out there who know the reality of what it means to lose someone to opioids.

“I invested in this kid. I worked hard to try to get him clean and sober, to try to get him to move forward in his life. He was making it. I felt good about it.

“To have your teeth kicked in by the announcement of his death and to get that phone call, it became very real to me. It really sort of illuminated and brought these statistics to life.

“I hope you never have to experience that, but just know that if you do, you’re not alone. Talk about it. Be open about those issues and be willing to share.”

Zimmerman ended his talk with symptoms of overdoses and resources such as naloxone, of which Narcan is one name brand.

“A Massachusetts city reported 95 percent success with opiate overdose anecdote Narcan,” he said.

“Overdose symptoms aren’t necessarily unique,” he said. “More often than not, they look like someone passing out drunk. You see a loss of consciousness, unresponsive, awake but unable to talk, slow shallow breathing. Once respiratory arrest has occurred, you might see bluing of the lips or fingertips. You will hear choking sounds or like the person is fighting for breath. “Sometimes they call it the death rattle,” he said. “In some cases, there is nausea and vomiting, a limp body, very pale, clammy skin and their heartbeat is slow, erratic or not there at all.”

“So, what do we do if we come across someone who has those symptoms of overdose?” Zimmerman asked. “The first thing we do is we call emergency responders.

“Those emergency responders were recently given permission to carry Narcan and most emergency responders in West Virginia now have a kit on their person or in their vehicle.”

Locally, CVS carries Narcan which can be purchased by the public.

“If you don’t have insurance, it will cost $109 but if you have insurance you can get it for remarkably less than that,” he said.

“If you came across one of those 36 out of 100,0000 people in the next year, wouldn’t it be nice to know that you had the means to possibly save their life?” he asked.  A statistic shared earlier in the program noted that 36 people out of every 100,000 people in the United States die from an overdose.

Nalaxone takes the opioid off the opioid receptor in the brain.

“Essentially it puts the overdosing individual immediately into detox and it is not a comfortable feeling for them,” he said.

West Virginia State Code made it legal for any lay person to administer it.

“As long as you call emergency services, you are covered under the Good Samaritan Law,” he said.

Nalaxone has no adverse effects if it is administered to someone who is not having an opioid overdose,” he said.

Talking about the problem is something Zimmerman said is needed to bring more awareness.

“Don’t be afraid to talk about overdoses; don’t be afraid to listen to people talk about overdoses,” he said. “It happens. It’s a reality we are all faced with.  Someone asked me tonight what is the purpose of your lecture. If nothing else, I hope people will be brought to a new level of awareness about just how bad this problem is and what they can do about it.”

Drugs are not discriminatory, he added.

“It’s not a problem you can buy your way out of, it’s not a problem you can educate your way out of and it’s not a problem that only picks on the poor or the lower educated or the blue collar worker,” he said. “Opioid addiction can strike anyone anywhere at any time. So, if you are not prepared and you don’t have any idea of how to handle it, then how can you possibly hope to take up the fight?”

Zimmerman will be teaching a drug courts class at Wesleyan in the spring semester and said drug courts were once thought of as a “crazy idea.”

“There are no bad ideas,” he said. “We need more tools; we need creative tools.”

There are precursors to addiction such as strain, stress, depression, low-employment rates and poverty.

“Get on those social issues and decide how we are going to do that better,” he said.

Zimmerman had titled his talk “White Lung: The Opioid Crisis in West Virginia” for a reason.

“Historically, coal miners in the state of West Virginia contracted a very common disease known as black lung,” he said. “It used to be one of the leading causes of death for coal miners in West Virginia. As of about 2006, the leading cause of death other than natural causes for West not a natural case of death.”

“A lot of people think that this current opioid crisis we are in is something new,” he said. “The reality is America had its first opioid crisis shortly after the Civil War. In the late 19th century, soldiers returning from the Civil War were hooked on morphine. It’s that addiction to morphine that led to the dispersal of opioid medications throughout the nation. The 19th century opioid crisis specifically involved an initial addiction to morphine. The invention of the hypodermic needle was one of the precursors to this addiction problem to morphine.”

Soldiers returned from the battlefields with what could be known as Post Traumatic Stress Disorder today and physical injuries that were treated with morphine.

“Morphine was essentially a cure-all at that time,” he said. “It was given for any sort of pain.

If a female had menstrual cramps or someone had depression, both were treated with morphine.

“Late in the 19th century, morphine and its cousin laudanum became cure-alls that were sold out of the backs of covered wagons across the frontier.”

“The Appalachian states particularly West Virginia is no stranger to opioid addiction and overdose,” he said.

West Virginia, Kentucky, North Carolina, Ohio, Tennessee, Pennsylvania and Virginia accounted for 22 percent of all opioid deaths nationally from 1999-2013. These states make up only 17 percent of the U.S. population.

“Something is obviously off if 17 percent of the population makes up for 22 percent of the deaths,” he said.

The current opioid crisis happened as a result of what Zimmerman calls the perfect storm.

“The first was a change in medical thinking,” he said. “Everyone has certain vital signs that indicate life and death. The medical field decided that pain was essentially what they called the fifth vital sign meaning that after you have established the other four, the fifth thing you need to treat is pain.

“They started to overprescribe more powerful opiates and we started to develop more powerful opiates,” he said.

“West Virginia is unique as well because we have a large number of labor jobs,” he said. “We have a lot of coal miners; we also have a lot of timber and we also have a lot of agriculture.

“Knowing that our economy is based on those heavy labor-intensive jobs, we also have to understand that those heavy labor-intensive jobs also create a lot of injuries,” he said.

This means that when these workers were injured, they were treated with stronger, more addictive opiates.

West Virginia also saw a higher rate of joblessness.

“We have lost 40,000 jobs in the last decade in the coal industry,” he said. “Now, along with that joblessness there was a lot of depression.”

“Anytime you see higher rates of mental instability or lower satisfaction with life, you see higher rates of recreational drug use simply as a method to curb some of that depression,” he said.

“Some people think the pharmacy is to blame,” he said. “Big pharma is pushing these opiates on our communities, big pharma is responsible for pushing these opiates out to our children, pushing these drugs out to sick people.

“They are taking advantage of sick people and it’s their fault that everyone in West Virginia is addicted to opioids.”

In some ways that is true, according to Zimmerman.

“West Virginia had the highest rate of pill mills in the country,” he said.

Look at Kermit, W.Va. which had a population of 239 in 2006.

There were 239 people who were prescribed 3.2 million doses of hydrocodone — that’s 13,389 doses per citizen.

“In other words, 37 doses of hydrocodone per day for every man, woman and child in Kermit, W.Va. in 2006,” he said. “That’s just astounding.”

West Virginia implemented a prescription monitoring program around 2008 that had been in the works since the mid-1990s.

There were crack downs on these pill mills and doctor education began to play a major role in West Virginia’s prescriptions.

However, the folks who were addicted to opioids began trying to get their fix from the street instead of the pharmacy. That led to heroin.

West Virginia is at the center hub of what are called Heroin Highways, referring to the interstates going north and south and east and west. 

“We have created this illicit market which is drawing in product from all the metro areas,” he said.

The ruralness of West Virginia is a problem in many aspects and one of those is it is hard to police the problem.

“We are not big enough, we are not technological enough, we don’t have the boots on the ground so to speak,” he said.

The rise of illicit heroine has led to increased potency of opioids.

“Fentanyl has been mixed with illicit heroin,” he said. “Fentanyl is the most common opioid mixed with heroin and it is responsible for a great number of deaths. It is 80 times the strength of morphine.”

In 2016, there were 26 overdoses in Huntington in less than four hours and it was later determined that the batch of heroin had been cut with fentanyl and came from Detroit.

Until Zimmerman began studying the issue further, he said he knew it was bad but he didn’t know how bad.

According to the CDC, approximately every 10 minutes someone in America dies of an opioid overdose.  Every 10 minutes during  Zimmerman’s presentation, he lit a candle and at the end of the evening, a moment of silence was held for the six people who died of an overdose during that 60-minute presentation.

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