Big Solutions Start Small: Policy Responses to the Opioid Crisis in West Virginia
BY WILL LINDSEY
The opioid epidemic will likely go down as one of the largest public health crises of our lifetime. While opioids don’t command daily headlines, the crisis still kills approximately 72,000 in the United States a year, surpassing annual automobile deaths. In my home state of North Carolina, the Center for Disease Control reported that 1,600 people overdosed from opioids in 2017, the largest overdose rate in history. Expert projections indicate the overdose rate will continue to surpass records.
Recently, a heart-wrenching obituary went viral, detailing the struggle of a Vermont woman addicted to opioids, unable to break free from this devastating disease. The human cost of this epidemic continues to grip our nation.
Last May, a group of Harvard Kennedy School students, including myself, traveled through the Dubin Field Leadership Experience to West Virginia to grapple with the realities of the opioid epidemic. Over a five-day span, we visited Huntington, Charleston and Morgantown to meet with leaders from responding to the crisis from all levels: state government, local government, treatment centers, rehab centers and Universities. Though West Virginia has often been dubbed the epicenter of the opioid epidemic, it has also been at the forefront of the opioid response.
Our trip to West Virginia illuminated the stages in opioid response and helped crystallize what I believe may be a comprehensive solution to the crisis. I consider the opioid epidemic in four primary parts: (i.) immediate response occurring at the local level, (ii.) intermediate recovery support, (iii.) long-term workforce training, and (iv.) long-term preventive education.
1) The opioid response has been tackled most effectively at the local level. We had the opportunity to meet with Mayor Steve Williams of Huntington, Fire Chief Jan Raider (2018 “Time 100” honoree), and Police Chief Frank Dial. The coordination and resources coming from local government in West Virginia model a response that all states addressing the crisis should replicate. Mayor Williams made the opioid response a local priority, holding regular meetings with Raider and Dial to ensure cross-department coordination. The fire and police departments made the distribution of Narcan (the life-saving drug that reverses overdoses) a major policy priority. These departments have prioritized day-to-day response, which involves regular monitoring of communities and at-risk users of opioids. Engagement at the local level allows intervention before individuals overdose and ensures that those going through overdose episodes are treated quickly. Prioritization of local response prevents overdoses and combats the crisis on the front line.
While local governments are critical, they need legislative support and resources from the state level. State governments must let local government take the lead, providing resources where they are needed.
2) In-patient treatment center investment with medically assisted treatment. In-patient centers remove those in recovery from the culture of opioid use in their communities and put them on a path towards long-term recovery. Getting individuals into centers is a critical step to stop the cycle of overdose and addiction. Some of the most effective treatment programs . It is important that those-in-recovery have access to these resources for comprehensive treatment coverage.
3) Pairing those-in-recovery with workforce development programs. Relapse is almost inevitable if individuals are not paired with employment or workforce development programs. In many instances, the networks of those in recovery encourage relapse. Workforce development provides a structure outside of those existing communities and creates a sustainable life and income for those-in-recovery. Further, employers have had a difficult time filling jobs in this low employment environment. Pairing those-in-recovery with workforce training and jobs can help both those-in-recovery achieve long-term success and help employers fill these jobs.
4) Preventative education as early as middle school. While the first three prongs address the response to the crisis after addiction, it is perhaps most important to head off the crisis before it ever begins. Children in middle school are sometimes caught in a cycle of addiction due to family and community pressures. In many cases, opioid use is cultural and passed down through family systems. If children are not informed of the dangers of opioid use early in life, family structures can take over, resulting in high schoolers addicted early in life. One institution making an impact on this prong is the West Virginia Department of Education Steering Committee, which implemented programs to educate students early about the need for mental health treatment and the dangers of opioids. State government health systems should consider similar programs to ensure we are protecting our students early.
A potential solution: Public-private partnerships and a model for positive change
While in Charleston, we were hosted by Dave Wallace, a local philanthropist and businessperson invested in addressing the opioid epidemic and helping the Charleston community. Wallace and his board are fundraising for a treatment center, the T-Center, that would provide in-patient beds for those struggling with addiction issues and partner with local Kanawa County schools to provide integrated education programs for students.
The T-Center and similar projects address two of the key prongs noted above: preventative education and in-patient recovery. The T-Center can provide the funding and resources to help implement education programs in public schools, while programs like the West Virginia Department of Education Steering Committee can coordinate execution of such programs. Institutions like the T-Center can supplement the need for desperately needed in-patient recovery services. Ultimately, if local governments can coordinate day-to-day response efforts, centers like the T-Center can address education and recovery efforts in partnership with state and local governments while workforce programs facilitate long-term employment. This may be the working model for what success in the opioid crisis looks like.
Our trip to West Virginia revealed a state fighting to push back against an epidemic that grips the country. State funding will need to flow to the local level in order to implement key initiatives: local coordination, in-patient recovery, workforce development and preventative education. As we look to a long-term solution to the opioid epidemic, local and state governments must work together with the private sector in order to implement comprehensive measures for targeted success.
Will Lindsey is a joint-degree student at Harvard’s Kennedy School and Harvard Law School. A native of Durham, NC, he graduated from the University of North Carolina at Chapel Hill in 2014
Edited by Jaylia Yan
Photo by Find Rehab Centers on Flickr