The Heroin Epidemic

In a state that has become synonymous with the heroin epidemic, figuring out what has caused the problem–and what continues it–has proven difficult. As national attention grows, are we doing what’s necessary to bring resolution to the quiet, widespread crisis?

John sits in one of those collapsible chairs–like you might find supporting a father at his daughter’s soccer game–at the very back of the room. He’s tall and lanky, late 50’s-early 60s, with grey hair. For a long time, John’s been a fixture at meetings like the Jefferson County GOP’s monthly get-together. He’s a principled conservative, a true believer, who’s privy to Sean Hannity’s talk show and fringy-Breitbartesque sites. He’s hardcore, but just about the nicest person you will ever meet.

At the WVGOP headquarters in Jefferson County, John is one of the most well-liked volunteers. Like clockwork, he is in every day after he flies his model airplane in the field a little ways down Route 9. He’s willing to do anything except make calls (he doesn’t like getting yelled at). Most days he will hand-write addresses and in exchange one of the staffers will buy him a sandwich. Next to a tablet pumping out Fox News radio, he will contently do work for three straight hours every day–more than any other volunteer.

One day, John was noticeably late. When he finally arrived, he seemed none the worse for ware. His demeanor was not different, nor was his level of excitement. He slinked in through the door the way he typically did and walked passed the offices of staffers busy at work.

“Sorry I’m late,” he said flatly, almost annoyed, “there was body on the side of the road.”

John lives in an area known as the Mountain. Situated directly on the West Virginia side of the border with Virginia, the Mountain was home to Jefferson County’s greatest income disparity and most conservative voters. The area is a mosaic of sprawling, upper-middle income developments, as well as unpaved, heavily wooded neighborhoods of what can only be described as shacks. Many on the Mountain live comfortably, while just as many live in almost unreachable, tin-roof homes without basic amenities such as running water.

While driving down from the Mountain to the field where he flies his model airplane, John spotted a body on the side of the road. The woman he found was unresponsive and John used his Motorola flip phone to call emergency services. On the Mountain, an ambulance can take longer than is desirable to reach an emergency, and the dispatcher instructed John to try to unblock the woman’s airways.

Eventually the ambulance arrived with a police escort. The woman had overdosed and was taken to the hospital for treatment. John wasn’t sure if she survived. The woman’s shoes were found in a nearby house owned by a friend of hers, who said–somewhat suspiciously–that the woman had not been with her that day. John noted it appeared that the woman had been dragged by her friend to the side of the road to avoid an unwanted visit by the cops.

The story was shocking, but what was perhaps even more shocking was that this was not the first time John discovered someone who had overdosed on the side of the road while on the Mountain. But for John, and many other West Virginians, life goes on.

What are the Causes and What are the Problems?

In some areas of West Virginia, overdoses have become such a common occurrence that the state has begun handing out injections of Narcan–the brand name for naloxone, a drug that reverses the effects of a heroin overdose–for average citizens to carry with them as they go about their lives. Just as you might have an Epipen available in case of a bee sting or a peanut allergy, many West Virginians carry in their purses and backpacks an injection of Narcan.

Last summer, over the course of four hours, 27 people in Huntington–one of the largest cities in the western part of the state, just before the Ohio state line–overdosed on heroin. That same summer, the Family and Child Tracking System reported that 50 percent of babies in Harrison County, West Virginia, were born to mothers who used drugs. And the Center for Disease Control reports that West Virginia maintains the highest drug overdose death rate in the country, with 41.5 people dying from overdoses per 100,000 between 2014-2015.

The terrifying statistics are endless, but some or more telling of the causes, rather than the problem, itself.

Take, for instance, that West Virginia has the third-largest rate of opioid pain reliever prescriptions in the country–trailing only Alabama and Tennessee.

perscription-chart

The state also ranks in the top ten states for prescriptions for high-dose and extended-release opioids, a favorite of abusers. And the state’s unusual amount of manual laborers–largely due to the coal and natural gas industries–results in more individuals who require pain relief than other states typically have.

This goes along with the predominant theory many outside observers have in regards to West Virginia’s heroin problem. Manual laborers require pain relief. Liberal prescribing standards have been on the rise since the 1990s and affect West Virginia disproportionately because of the nature of the state’s economy and economic drivers. Laborers are given opioids, sometimes in vast quantities and at high doses, and sent on their way. Over time, the pain returns because the prescriptions are not strong enough–and the cost of those prescriptions weigh on the wallets of low-wage laborers–resulting in those laborers to seek other means of pain relief: heroin.

What About Everyone Else?

Typically, the above is the theory you will find in reports from CNN and the Washington Post in regards to interpreting the data and investigating this “new” problem. This writer argues, however, that there are other important factors affecting West Virginia’s battle with opioids. The drug is gender-blind, color-blind, and certainly occupation-blind. And for the casual audience of West Virginia’s strife–a state most often associated with coal and only coal–this is the theory that makes sense. But not everyone in West Virginia is a coal miner, or even a high-intensity manual laborer, so how do we explain why this problem is cutting across multiple groups and thousands of individuals? Let me try to explain a few. 

I. Veterans

West Virginia has the second-highest rate of veterans per capita in the country. Maine, Alaska, Virginia, and Montana each have veterans comprising 10 percent of their population, while West Virginia is a close second, with 9 percent.

Nine percent of the population of a state like West Virginia only accounts for about 170,000 individuals (assuming this number accounts for those that have left the state in the past few years). This group of individuals, however, is an extremely troubled and subsidized group.

According to the National Institute of Health:

  • 31 Percent of Vietnam veterans suffer from Post Traumatic Stress Disorder (PTSD)
  • 10 Percent of Gulf War veterans suffer from PTSD
  • 11 Percent of veterans of the war in Afghanistan suffer from PTSD
  • 20 Percent of Iraqi war veterans suffer from PTSD

With a large amount of veterans comes disproportionately high rates of Post Traumatic Stress Disorder and Traumatic Brain Injury. Not only does PTSD increase veterans’ likelihood of substance abuse, but the chronic pain associated with the disorder increases the likelihood of this group asking for and having access to opioids. Just as the typical laborer who uses opioids to manage pain eventually seeks out cheaper and stronger means of pain relief, so too do veterans.

Additionally, higher rates of PTSD lead to higher rates of unemployment. The relatively low cost of living in West Virginia, combined with the financial benefits individuals receive from being a veteran, being unemployed, and other attributes through which additional benefits can be obtained, results in a surplus of personal income that can sometimes be used to obtain illicit drugs.

II. More Time, More Money, More Problems

In the same way veterans receive benefits that may subsidize their ability to fund an addiction, so too are many West Virginians who live beneath the poverty line (20.8 percent, fourth highest in the country), are unemployed (5.8 percent, sixth highest in the country), are disabled  (29.8 percent, fifth highest in the country), or some combination of the three.

Lawmakers in the state have linked joblessness and lack of economic opportunity with the heroin epidemic, saying that jobs are needed not only to rejuvenate the economy, but also to take up people’s time. This goes along with the belief that people who work don’t have the time or the want for drug addictions. But those who are unemployed, but still receive benefits that allow them to purchase drugs due to a cost of living that does not use up available personal income, will theoretical have a higher chance of using.

Whether or not this theory holds is still to be determined, but West Virginia’s joblessness has yet to see improvement over the last decade or more.

III. The Heroin Culture in West Virginia

Finally, on a more abstract level, there is a culture in West Virginia that continues to push people toward opioid abuse. To help you understand what that means, I liken it to marijuana use. In Colorado, for example, the accessibility and widespread usage of marijuana is likely to engender a greater amount of users than somewhere with more restrictions on the substance.

The only difference between Colorado’s use of marijuana and West Virginia’s use of heroin is that the former is legal while the latter is not.

I am not saying that people openly use heroin like they might use marijuana where it is legal. No one is outside in broad daylight on their patio tying a tourniquet around their arm. But, if you are a West Virginian, the likelihood that you know someone who is a user or you know where to find it–a greater level of accessibility and acceptability–is significantly higher than most places. Societally, West Virginia allows for more users, and this especially affects younger people growing up in that environment.

Are Outsiders Helping?

On a final note, this article covers only a fraction of what is going on, and to encapsulate every aspect of the heroin problem on one page is impossible. But including this final section is important for audiences out of state.

Recently, there has been a lot of attention on the heroin “epidemic” in places like West Virginia, Ohio, Kentucky, New Hampshire and Maryland. Specials on news channels and shocking images of addicts overdosed in cars while their children remain strapped-in in the backseat have flooded the airwaves and the internet. This type of exposure is both beneficial and detrimental for states like West Virginia.

It’s beneficial because of the support and education of the issue that it can bring to what is ultimately a very serious problem affecting thousands of Americans. It helps shed light on the issue and hopefully brings about changes in government, business, and society at large.

However, their appears to be both an misunderstanding  of the problem and a stigmatization of states like West Virginia when it comes to the heroin issue. The following clip from Donald Trump’s recent address to the joint session of congress seems to capture this:

Did you catch it? The focus from many observers outside of the problem area seems to be on the influence of others–those who are not those affected–and their role in the country’s drug problem.

In the case of heroin, this makes no sense. The causes of the heroin issue are largely our own problems; our own institutions, our own standards, and our own drugs. Persecuting “cartels” flooding our country with drugs may stop the influx of cocaine or illegal marijuana, but opioids, heroin and the problem, itself, tends to be made in the U.S.A.

On top of this, by casting states like West Virginia in the shadow of an ominous “Heroin Epidemic” we are effectively scaring away laborers, businesses, and opportunity from a place that desperately needs it. We shouldn’t ignore the problem, but framing West Virginia as the Heroin Capital of the World does little to bring about changes for the better.

There are few right answers to this problem, but we can work to at least change the tone and our view of it. West Virginia is gifted with some of the most beautiful scenery and best people in the country, ignoring what is good only helps what is bad. Do your part.

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