CAUSE AND EFFECT: The New Heroin Epidemic

Ten years ago, prescription painkiller dependence swept rural America. As the government cracked down on doctors and drug companies, people went searching for a cheaper, more accessible high. Now, many areas are struggling with an unprecedented heroin crisis.

 By Olga Khazan - The Atlantic

In a beige conference room in Morgantown, West Virginia, Katie Chiasson-Downs, a slight, blond woman with a dimpled smile, read out the good news first. “Sarah is getting married next month, so I expect her to be a little stressed,” she said to the room. “Rebecca is moving along with her pregnancy. This is Betty’s last group with us.”

“Felicia is having difficulties with doctors following up with her care for what she thinks is MRSA,” Chiasson-Downs continued. “Charlie wasn’t here last time, he cancelled. Hank ...”

“Hank needs a sponsor, bad,” said Carl Sullivan, a middle-aged doctor with auburn hair and a deep drawl. “It kind of bothers me that he never gets one.”

“This was Tom’s first time back in the group, he seemed happy to be there,” Chiasson-Downs went on, reading from her list.

“He had to work all the way back up,” Sullivan added.

Chiasson-Downs and the other therapists with the Chestnut Ridge Center’s opiate-addiction program had gathered to update each other on the status of their patients before launching into the day’s psychotherapy sessions. Here in West Virginia, where prescription painkillers have long “flowed like water,” as Sullivan said, the team works to keep recovering addicts sober through a combination of therapy and buprenorphine, a drug used to treat painkiller and heroin addiction.

Chiasson-Downs’ patients are in the “advanced” group—so called because they’re well into their recoveries. She relayed a few success stories—a new baby here, a relapse averted there—but even years after they’ve found sobriety, her charges’ lives are still precariously balanced.

What Tom (not his real name) was attempting to work his way back up from was the weekly “beginner” group, where advanced patients are sent if they relapse and cannot stay clean. It happens fairly frequently, Sullivan, the director of the treatment program, said.

For patients in the less advanced groups, the therapists’ updates are gloomier.

“Trent called in crisis last week, and he didn’t come,” said Laura Lander, another therapist. An acquaintance who was supposed to give Trent a ride to the clinic instead stole his money and medication and then left him by the side of the road.

“He went without his meds,” Doug Harvey, the case manager, added.        

“He will have used this week,” Sullivan concluded.

“Jessica, she’s still living with her boyfriend, who is actively using.” Lander said.

“So she’s craving every day,” Sullivan noted.

“She’s financially dependent on him,” Lander said. “Three kids and nowhere to go. He’s a jerk to her.”

“She lives out in the middle of nowhere,” Sullivan added. “She talked about her neighborhood being full of people who use. Her family all uses. I’d be surprised if she’s clean today.”

The therapists’ stories go on, sketching a picture of a region that’s understaffed and under-resourced, and that found itself unprepared for an epidemic it has disproportionately been affected by. One woman has been skipping meetings and “doing weird things with her meds.” Another patient filled his prescription with a new doctor, raising the possibility he was “doctor-shopping,” or getting multiple prescriptions from different physicians simultaneously. A woman who lives more than two hours away wasn’t going to make it in—the Medicaid van that normally brings her fell through this week.

The meeting is brief and matter-of-fact. There’s some lighthearted banter between updates—one patient, apparently trying to curry favor with Lander, repeatedly called her “sweetie” over the phone. When the final chart is read, the group breaks, and the therapists head into their separate sessions.

In the newest front in the war on drugs, people from all walks of life are battling addictions to pills that are perfectly legal and distributed by medical professionals. Since prescription painkillers became cheap and plentiful in the mid-90s, drug overdose death rates in the U.S. have more than tripled. West Virginia was slammed especially severely, and for the past several years it’s had the highest drug overdose death rate in the nation.

More recently, heroin has taken root here after authorities cracked down on unscrupulous doctors who were overprescribing pain meds, sending addicts searching elsewhere for a similar high. In West Virginia, heroin-overdose deaths have tripled over the past five years, while prescription-painkiller deaths have dipped slightly. There were many contributing factors, not the least of which were personal decisions by the addicts themselves, but it’s clear that pharmaceutical companies, negligent doctors, and even the law-enforcement backlash have all played a role.

Now, the state’s few addiction treatment specialists—Sullivan is one—are drowning under their caseloads.

The goal at Chestnut Ridge, Sullivan explained, “is to treat effectively and treat as many we can. We’re exhausted and overwhelmed with how many opioid addicts there are in this area.”

(The Atlantic was granted access to Sullivan’s clinic, but some patients preferred to remain anonymous. In this article, these patients are identified by pseudonymous first names only.)

There’s a waiting list to get into the center’s program, and the only applicants prioritized are pregnant women. Sullivan isn’t above telling the sons of local tycoons to get in line. By the time they secure a spot, the average patient has been waiting for weeks or months.

Over the years, Sullivan has tried giving patients methadone, buprenorphine, and now naltrexone. He thinks buprenorphine—given out here in dissolving strips called Suboxone—is the best option, but he argues that the medicine isn’t the most important part. Here, all patients receive talk therapy as part of their treatment, and they can’t get their medication without attending psychoeducational group sessions. Those who are furthest into their recoveries attend once a month, but the others come weekly or biweekly. Moving from the weekly to the biweekly group takes 90 straight days of abstinence, a feat most patients can only accomplish within five or six months because of relapses. They’re also required to attend four 12-step Alcoholics Anonymous or Narcotics Anonymous meetings each week in their home communities. READ MORE

Image: Lauren Giordano/Atlantic