Quick hits: USDA plans fertilizer production in U.S.; farmers' 'stops' that aren't seasonal; curiosity builds community

Brooke Rollins

The Department of Agriculture plans to use tariff dollars and trade renegotiation resources to help fertilizer production in the United States. Agriculture Secretary Brooke Rollins said the "USDA is focused on helping move fertilizer supplies more quickly, but cautioned it will take time for crop nutrient prices to begin falling," reports Kim Chipman of AgriPulse. "Rollins said she hosted a meeting with executives of four top fertilizer companies and Commerce Secretary Howard Lutnick, U.S. Trade Representative Jamieson Greer and National Economic Council Director Kevin Hassett." The Trump administration hopes to roll out its full plan to move fertilizer production back to the U.S. sometime this week.

The University of Maine's Fort Kent campus will provide dorms,
 a lounge and a cafeteria for recovering teens. (UofM photo)

Just like some adults, preteens and adolescents can end up with severe drug and alcohol addictions that can end in an overdose or many failed recovery attempts. Recovery advocates in the tiny town of Fort Kent, Maine, will "use new funding to try a novel solution to the problem: a public boarding school for high schoolers in recovery," writes Lanan Cohen for The Hechinger Report. The new approach will "focus on abstinence and mental health to help students overcome their substance abuse problems." Educators hope the boarding school structure will allow students time to solidify new choices and coping strategies while remaining in school.

Graphic by A. Dixon, Offrange

It's not a farmers market. It's a farmers "stop," and it's open all year long. Farming advocates hope the concept continues to catch on. "The Argus Farm Stop model is built on a consignment basis with a 70/30 split: Farmers set their own prices and keep 70% of every sale, while Argus retains 30% to cover operating costs," reports Heidi Roth for Offrange. "A café inside each location accounts for roughly a third of sales but about half the profit, effectively subsidizing higher farmer payouts while creating a community hub where farmers can gather, and customers can meet producers." Not all farmer stops have the same elements, but all aim to support local farmers while fostering community spirit.

Musical talent from far-flung places often took center stage at the Big Ears festival in Knoxville, Tennessee. "The festival is rich with rural tradition, pulling in rural musicians from across the states and every continent except Antarctica (as far as I know)," reports Phillip Norman of The Daily Yonder. "I caught an ambient country jam by Setting in the backroom of Boyd’s Jig and Reel Scottish Pub, and hit the Knoxville Art Museum to witness the electric saxophone wizardry of Sam Gendel. . . . Big Ears is a festival for music nerds who are interested not only in how a concert sounds, but also how it reflects the lived experiences of the people making the music."

Beth Howard (Illustration by N. Nichols)

As an activist and community organizer for Appalachia and the broader South, Beth Howard hopes her memoir, Song for a Hard-Hit People: A Memoir of Anti-Racist Solidarity From a Coal Miner’s Daughter, helps readers see Southern differences through a lens of curiosity that they can apply to their daily interactions with other people, writes Nhatt Nichols of Rural Assembly. Howard said, "I think one of the biggest lessons for me when I was learning to organize is the importance of listening and asking really good, open-ended questions." Nichols adds, "Howard advocates for getting out into your community and finding other people who are doing organizing work that resonates with you, and offering to lend a hand, to learn more about your community without centering your own ideas."

Opinion: Rural kids need more than trade school training to lift themselves out of hopeless circumstances

Working-class rural kids need more than trade school training to help pull themselves out of unhealthy living situations, including abject poverty, writes Jessica Grose in her opinion for The New York Times.

Grose cites the new book by Beth Macy, Paper Girl: A Memoir of Home and Family in a Fractured America, as a source for insight and solutions on how the U.S. education system could help more rural youth recover from trauma and set their lives on a different track.

"Macy, a former newspaper reporter and the author of 'Dopesick,' the 2018 best seller about how the opioid crisis ravaged Appalachia, returned to her hometown, Urbana, Ohio, for the new book," Grose explains. "She is trying to figure out how a working-class girl like her got to college and the middle class from Urbana 40 years ago, while that journey is much more arduous for today’s rural working class."

"How do young people, especially those without supportive parents, make a future for themselves? . . . While learning a trade is excellent advice for many students, it is not the cure-all for inequality that our commerce secretary, Howard Lutnick, hopes it might be when he says he wants Harvard to build vocational schools,'" Grose explains.

Grose points out that "learning a trade" isn't easy and that trade work requires "the same kinds of executive functioning, people skills and intelligence that a college education requires, just applied differently."

Giving working-class youth the help they need through rural schools is one of the best solutions, according to Macy. "Rural schools need better access to wraparound services, providing students with necessities like food, but also health care in the form of school nurses and counselors on site," Grose adds.

But providing those types of services in rural areas is a tall order. Grose writes, "Most school systems run on economies of scale and a per-student funding model; it poses a great challenge to provide wraparound services to districts with fewer students who have a lot of needs and who are also spread out."

"My dark prediction is that kids with more stable families and better developed life skills will occupy the trade jobs that used to be a reliable route to the middle class," Grose asserts. "We need to support working-class kids before the 21st century abandons them completely."

Reporting on Addiction launches hub for journalists covering opioid addictions, deaths and settlement dollars

As opioid settlement money continues to be divvied out to state and local governments, reporters can help their communities understand where the money is coming from and discern who and how their regional governments are spending it.

Reporting on Addiction, a collaborative project of the Opioid Policy Institute and 100 Days in Appalachia, provides reporters with an "Opioid Settlement Resource Hub" filled with robust story ideas and insights to use when covering the history, dollar amounts, tools and impact of opioid settlement funds in local communities.

For journalists looking to explain the history of opioids in the U.S. and the background of the settlements, the hub provides story angles and questions for reporters to consider, as well as examples from reliable news sources for context.

Once an audience knows more about how opioid addictions and overdose deaths negatively impacted their community and how settlement spending plans aim to spur recovery, journalists can create community-specific settlement tracking tools that serve as a valuable public resource. The hub provides links for numerous ways to investigate and report on settlement spending.

Is it working? Journalists can help their audiences measure if opioid settlement plans and spending are slowing the opioid crisis within their communities. Stories that evaluate the results and how plans evolve will become increasingly crucial as programs are implemented and more data becomes available.

A virtual chat on Sept. 17 will explain how journalists can track and report on opioid settlement fund spending

As part of its mission to help journalists cover opioid lawsuit settlement fund spending in their communities, Reporting on Addiction will host a virtual chat with Mississippi Today’s Allen Siegler and Kate Royals on Sept. 17 at 1 p.m. EST. 

Interested journalists can register here.

During the 30-minute session, Siegler and Royals will discuss:

• How to explain settlement spending with audiences that need specific and clear details on why opioid spending is vitally important to the future health of their communities.
• Outline how they work together -- as reporter and editor -- to shape stories that include complex public health and financial information that readers understand and find engaging.
• Tips on how to pitch accountability stories that get approved.

Siegler is Mississippi Today’s mental health reporter. He has reported on public health for nonprofit newsrooms such as Mountain State Spotlight, an investigative outlet in West Virginia, and Healthbeat, a startup with bureaus in Atlanta and New York City. He holds a master of public health degree.

Royals became Mississippi Today’s managing editor in June. She previously served as the newsroom’s community health editor. Under her leadership, the health team won the 2023 Bill Minor Prize for Investigative Reporting for its series “Shaky Science, Fractured Families,” which she co-reported.

Reporting on Addiction is a collaborative movement staffed by media professionals working to decrease addiction stigmas by sharing leading practices for covering all types of addiction.

W.Va. local governments get 24.5% of opioid settlement funds, but the oversight and how the funds are spent varies

Graph by Hannah Heiskell, data from West Virginia First Memorandum of Understanding 

In 2021, West Virginia lost more than one thousand residents due to opioid overdose deaths. Between 2021 and 2024, the state ramped up its prevention and treatment efforts, some of which now benefit from opioid settlement dollars. As investigative student reporters from West Virginia University’s Reed School of Media discovered, how those funds are spent varies widely throughout the state.

"West Virginia will receive about $980 million from the settlement, split into payments over 18 years," reports Hannah Heiskell for Mountain State Spotlight. "The West Virginia First Foundation – a nonprofit created by the state Legislature – will control the spending of 72.5% of the funds, local governments 24.5%, and the West Virginia Attorney General’s Office 3%."

How local governments spend their chunk of settlement funds is limited by state guidance, but includes "increasing access to treatment or prevention-education programs."

With those constraints in mind, WVU student reporters looked at "how local governments oversee that money, including the process through which they take applications, make awards and account for spending," Heiskell explains. Since each local government can make its own decisions, "oversight and accountability built into local spending can be markedly inconsistent from county to county – with some doing very little to collect the advice and opinions of addiction experts or people with lived experience."

Local funding is often decided by county commissioners, who are not subject to the oversight by the West Virginia First Foundation. "While county commissioners are not required to have expertise in substance use disorders or follow a specific application, review, or awarding process, Laura Lander, addiction therapist and associate professor at West Virginia University’s Rockefeller Neuroscience Institute, said this thinking confused her," Heiskell reports.

"Without input from external sources and stakeholders, Lander said funding awards are subject to a commissioner’s individual bias," Heiskell writes. Lander told her, "Clearly, in other counties, based on what I’ve seen, the money used for law enforcement has the county commissioner’s ear, and we see lots of money going towards police vehicles."

Kanawha County Commission has opted to share some details by "posting all applications to their website for the public and other organizations to review," Haskell writes. "In contrast to many counties in the state, the Preston County Commission has taken a more deliberate approach to its spending. . . . It's one settlement and 55 systems."

Proposed $7 billion Purdue settlement advances; leaves Sacklers exposed

Adobe Stock photo

Since last July when the U.S. Supreme Court rejected the Purdue Pharma opioid bankruptcy agreement, negotiation has continued. The latest offer from the Sackler family may have enough support from stakeholders to stick.

"OxyContin maker Purdue Pharma’s latest plan to settle thousands of lawsuits over the toll of opioids could soon move forward after every U.S. state involved agreed to it," reports Geoff Mulvihill of The Associated Press. U.S. Bankruptcy Court Judge Sean Lane "is being asked to clear the way for local governments and individual victims to vote on it next."

If Lane moves the agreement forward, impacted parties have until Sept. 30 to vote "on whether to accept the deal, which calls for members of the Sackler family who own the company to pay up to $7 billion over 15 years," Mulvihill explains. Roughly $6.5 billion of the settlement will be taken from the Sackler's wealth, and "potentially more than $850 million would go directly to individual victims."

The biggest change the reworked plan offers is that it does not guard Sackler family members from civil liability suits related to the opioid crisis. Groups that reject this settlement can continue litigation against Sackler family members. Mulvihill adds, "Under the plan, the Sackler family members would give up ownership of Purdue."

The $7 billion the Sacklers have put on the table pales in comparison to their exposure. Mulvihill reports, "The settlement is a way to avoid trials with claims from states alone that total more than $2 trillion in damages. Thousands of local governments and other groups have also sued Purdue."

While the settlement is an attempt to hold the Sackler family accountable for its part in the prescription drug crisis, the family will remain exceptionally wealthy and will continue to run its global pharmaceutical company, Mundipharma, which operates in the United Kingdom, Canada, Germany and Singapore. 

Reporting on addiction resources helps journalists approach alcohol use disorder with more accuracy and empathy

Reporting on Addiction offers an audio "Tip Sheet" for journalists who want to understand what alcohol use disorder is, address alcohol use stigma or enhance your community's understanding of the diagnoses.

Throughout April, which is designated Alcohol Awareness Month, journalists can access Reporting on Addiction's resources and learn the different parts of alcohol use, including prevention, harm reduction, treatment and recovery. 

The tip sheet helps reporters approach alcohol issues with more accuracy and empathy. According to Reporting on Addiction, when journalists engage in informed reporting, they benefit their communities by helping to:

• Reduce the stigma associated with alcohol use disorder.
• Make the public more aware of available help and support services.
• Foster more productive community discussions and effective policies regarding alcohol.
• Ultimately improve overall community health and well-being.

Reporting on Addiction is on a mission to improve how the media discusses and depicts addiction in the news. The collaborative service offers education for professional and student newsrooms that uses addiction science experts, research-based reporting resources, an expert database, and a network of media professionals passionate about decreasing stigma and improving the media’s portrayal of addiction and recovery. Access their materials here.

Class-action suit against The Salvation Army could help addiction sufferers access the two most effective medical treatment drugs

The Salvation Army is best known for
its holiday bell ringers. (Adobe photo)

Managing up to 25,000 Christmas bell ringers isn't the only thing The Salvation Army does. The charity also runs addiction treatment facilities whose care is at the "center of a legal fight that could set a precedent for all Americans seeking treatment for opioid addiction using two common and effective medications, methadone and buprenorphine," reports Lev Facher of STAT News.

The Salvation Army addiction facilities prohibit participants from using methadone and buprenorphine, despite the fact the "two medications are widely used to treat addiction and are vastly safer than the drugs they are meant to replace, like heroin or fentanyl," Facher explains. The class-action suit alleges its plaintiffs were "denied access to addiction treatment services because of their use of the medications."

The two drugs form the only medical treatment shown to effectively help addiction sufferers stop using opioids. The drugs also prevent severe fentanyl withdrawal, which can be physically and mentally excruciating.

Methadone and buprenorphine are often viewed by many Americans as "little better than street drugs," Facher reports. "As STAT found in the investigative series "The War on Recovery," many recovery-focused groups — including The Salvation Army and other rehabilitation centers, as well as 12-step recovery organizations like Narcotics Anonymous — remain opposed to the medications’ use despite the overwhelming evidence of their medical benefit."

Officials with The Salvation Army did not respond to requests for comments, according to Facher. 

Janet Herold, an attorney with the nonprofit Justice Catalyst Law, which sued The Salvation Army, told Facher, “The case has the potential to quite dramatically change the access situation for people with opioid use disorder." Facher adds, "The ongoing lawsuit, Herold said, could set a precedent that leads more treatment providers to offer the medications regardless of their ideological objections."

According to Facher's report, the "judge's ruling relies in part on the Rehabilitation Act of 1973, legislation that bars any group receiving federal financial assistance from discriminating against an individual solely on the basis of their disability."

A little-known pharmaceutical company that made billions selling opioids 'escapes' billions in fines and IRS payments

Endo began in 1920 as "Intravenous Products of America." Its website does not mention opioids;
instead it highlights the company's "past successes and history of expertise." (Endo photo)

A lesser-known pharmaceutical company named Endo made billions of dollars during the U.S. prescription opioid crisis by marketing its flagship opioid, Opana ER, as safe and non-addictive.

Despite whistleblower suits from Endo employees, the U.S. Department of Justice failed to pursue Endo, even as it vigorously prosecuted Purdue Pharma for its part in the opioid crisis, report Bob Fernandez of ProPublica and Craig R. McCoy of The Philadelphia Inquirer. The DOJ's investigative delay and the company's clever bankruptcy exit strategy allowed Endo to "escape $1.5 billion in fines and forfeitures" it owed and billions more "officials said it owed the U.S. government."

When the DOJ finally moved to prosecute Endo for its part in the opioid crisis, the company was bankrupt. "In what amounted to a liability fire sale by the Justice Department, the company’s woes with the federal government would all be resolved by a $200 million payment," Fernandez and McCoy explain. "In sentencing Endo in federal court Judge Linda Parker wondered how the amount paid to the U.S. could be so low. Parker said, 'I just don’t understand how it went from $1 billion to $200 million.' Federal prosecutor Benjamin Cornfeld explained: Endo was broke."

While Endo's 2024 financial troubles were real, a deeper look at the DOJ's delay after winning a criminal case against Endo in 2014, revealed how in those intervening years allowed Endo "vastly expanded its narcotic-pill empire before executing a corporate escape plan," Fernandez and McCoy write. "The plan allowed Endo to restructure its debt to retain control of the company and hand out $95 million in executive bonuses before seeking protection in bankruptcy."

DOJ's settlement with Endo concluded some of the company's financial troubles and "also mostly erased claims of another $1.5 billion for false health care billing and Medicare costs generated by the opioid crisis." In addition, "Endo paid a tiny fraction — three pennies on the dollar — of the $7 billion that officials said it owed the U.S. government, including $4 billion in taxes," Fernandez and McCoy explain. "Hundreds of lawyers, paralegals and financial advisers litigated Endo’s bankruptcy, billing more than $350 million. . . . Individual opioid victims didn’t fare as well. They got just $40 million from Endo — a sum that works out to about $1,000 per victim."

States promised opioid settlement spending transparency, but many have already strayed from commitment

When states and local governments anticipated billions in opioid settlement dollars, 12 states committed to 100% spending transparency, "promising annual reports 'specifying the activities and amounts,' they have funded," reports Aneri Pattani of KFF Health News. "But many of those reports remain difficult, if not impossible, for the average person to decipher."

Idaho settlement dollars are an example. The attorney general’s website hosts "more than 90 standardized spending reports from state and local entities. Sounds great. But in reality, it reads like this: 'In fiscal 2023, the city of Chubbuck spent about $39,000 on Section G, Subsection 9.' Cracking that code requires a separate document," Pattani explains. "The Idaho attorney general’s office, which oversees the state’s opioid settlement reports, did not respond to requests for comment."

New Hampshire has a different transparency problem. "The state government controls 85% of the state’s settlement funds and posts reports from grant recipients on its opioid abatement website," Pattani reports. "The reports explain the projects and populations served but lack a key detail: how much money each organization received."

Accessing dollars and cents details means searching through "the opioid abatement advisory commission’s meeting minutes, which date back several years" or other state government meetings and notes.

Graph by Aneri Pattani and Lydia Zuraw, KFF Health News and Christine Minhee, OpioidSettlementTracker.com

Idaho and New Hampshire aren't the only states falling short of their commitment. Other states have zero reporting, even though many residents are asking for the information. Pattani writes, "One of the loudest and most frequent questions from the public has been: Where are the dollars going? Victims of the crisis, along with their advocates and public policy experts, have repeatedly called on governments to transparently report how they’re using these funds, which many consider 'blood money.'"

Of the 12 states that promised spending accountability, seven have "reported 100% of their expenditures in a way that is easy for the public to find and understand," Pattani reports. "There are also states such as Indiana that didn’t originally promise 100% transparency but are now publishing detailed accounts of their expenditures."

Sharing settlement spending information not only helps the public hold state and local officials accountable for their spending choices, but it can also foster hope. Norman Litchfield, the director of addiction medicine at St. Luke’s Health System in Idaho, told Pattani, "A lot of people simply are just not aware that these funds exist and that these funds are currently being utilized in ways that are helping."

Expert, best practices resources for journalists from Reporting on Addiction are available and free

Reporting on Addiction is a collaborative movement staffed by media professionals working to decrease addiction stigmas by sharing leading practices for covering all types of addiction.

Photos can help readers connect and
remember. (ROA photo)

 

One of the project's best offerings is its website's visual guide, which allows journalists to access photo portrayals that illustrate addiction experiences from multiple real-life angles. This addiction-sensitive photography helps journalists report on substance use while sticking to a principle of "do no harm."

The photos also help readers develop a more memorable and connected understanding of how illegal drugs harm individuals and communities. Access their one-page visual style guide here.

Applying for Reporting on Addiction's expert database
takes less than five minutes. (ROA photo)

The project also gives options for newsrooms of various sizes, including professional and student newsroom training, research-based reporting resources, and an active expert database for question-and-answer sessions.

For journalists covering the opioid settlement's terms, disbursements and news, the site has a series of recorded "Fireside Chats" and a Slack channel to help reporters inform readers about where, when and how opioid litigation money will be handled in their community.

As added support, Reporting on Addiction offers downloadable, free resources that include:

• Language style guide
• Digital Security Toolkit
• Trauma-Informed and Empathetic Reporting Toolkit

They also offer one-to-one and group training for individual journalists or their newsrooms.

U.S. Surgeon General outlines ways to address disparities among smokers, including many who are rural Americans

Secondhand smoke harms people who don't smoke.
 (Adobe Stock photo)

Over the past decade, the rate of U.S. adults and teens who smoke has hit its lowest level since 1965, but "disparities remain among the 36 million adults and 760,000 kids who smoke," reports Ken Alltucker of USA Today. U.S. Surgeon General Vivek Murthy released a report that outlined identifiers for those who continue to smoke, which are often the same descriptors used to depict American rural populations: Poorer, less educated, Native American, and lacking access to medical care.

Native Americans, specifically those in Alaska, often live in some of the most remote pockets of the country, where medical access isn't readily available and many residents live in poverty. Alltucker writes, "Smoking is more common among American Indian and Alaska Native people than other racial and ethnic groups. . . . People living in poverty are more than twice as likely to smoke than those who earn non-poverty wages."

Rural populations tend to be heavier smokers than their urban counterparts, and the more rural residents smoke, the unhealthier their broader community becomes. Alltucker explains, "Because cigarette smoking and secondhand smoke kill nearly half a million people each year nationwide, Murthy said an accelerated effort is needed to limit disparities in smoking rates and reduce secondhand smoke."

The report also calls for "limiting the nicotine in cigarettes and other tobacco products to 'minimally addictive or nonaddictive levels,'" Alltucker reports. "Such a move could prevent more than 33 million people from starting to smoke. . ." This change could have a positive effect in rural populations where "kids are also more likely to start smoking at a much younger age and smoke daily, making addiction more severe and smoking harder to quit," the American Lung Association reports.

The Surgeon General's report "cited 2023 research that projected a nationwide ban on the sale and marketing of menthol cigarettes would prevent up to 654,000 deaths in the next four decades," Alltucker reports. But controlling the flow of cigarettes isn't going to happen overnight, and in the meantime, rural access to medical education and smoking cessation programs is needed.

Murthy told USA Today, "What's at stake are the lives of our kids and adults across America. Tobacco is the leading cause of preventable death in the country − 490,000 lives we lose every year to tobacco-related disease. Despite all the progress we've made, that remains the truth today."

Cherokee Nation's mobile drug unit delivers life-saving care to some of its most remote-living members

A tribal member unloads the Cherokee Nation harm-reduction
van. (Photo by Shane Brown, Native News Online via The Guardian.)

A new program in Oklahoma is using a mobile drug unit to distribute harm reduction and drug safety supplies to rural Cherokee Nation members struggling with addiction, reports Elyse Wild of The Guardian. The traveling service is part of the tribe's overall "Native people taking care of Native people" effort to address the severe risks and lack of access facing Native Americans with substance-use disorders.

The drug unit van can be the first point of contact for an addicted tribal member to receive life-saving supplies and education. Coleman Cox, who drives the unit, stops along drug "hot spots" in remote northern Oklahoma and sets up tables "with black bins of naloxone, a drug to reverse opioid overdoses, along with testing strips, clean syringes and wound-care supplies," Wild writes. "The mobile unit typically sees 16 regulars from the community, he says. Some days, no one comes. It all depends on the patterns of drug use and the current drug supply."

The Cherokee Nation "is the largest of the tribes, with more than 450,000 citizens worldwide and 141,000 people living within its sovereign boundaries," Wild explains. "Mobile harm reduction is uniquely suitable for tribal nations. . . where culture and connection are measures of health, harm reduction mitigates the isolation of active addiction." Cox told Wild, "Native people heal as a community.”

With the mobile unit, the Cherokee Nation can reach more remote members who need physical and cultural help coping with addiction. "The effect of culture on addiction health in Native communities is not purely anecdotal," Wild adds. "A doctoral research project conducted by the University of Arizona in 1992 with the Shuswap First Nation community in Alkali Lake, British Columbia, found that employing substance abuse treatment with cultural practices such as sweat lodges, pipe ceremonies, drumming, singing and powwows were instrumental in reducing the tribe’s rate of drug and alcohol abuse by 95% from 1970 to 1985."

A simpler assessment tool for newborns exposed to opioids means more mom time and fewer medications

Cailyn Morreale continued using buprenorphine during her pregnancy. Once her baby was born, the two were never separated. (Photo by Taylor Sisk, KFF Health News)

A new approach is helping mothers recovering from opioid addiction and newborns with opioid exposure stay together after birth. Historically, babies born with opioid exposure have been separated from their mothers and received heavy medications in neuro-intensive units, but "research has since indicated that in many, if not most, cases, those extreme measures are unnecessary," reports Taylor Sisk of KFF Health News. "A newer, simpler approach that prioritizes keeping babies with their families called Eat, Sleep, Console is being increasingly embraced."

Over the past decade, how pregnancy pairs with addiction treatment has changed, meaning most women can continue to take addiction-recovery medication throughout pregnancy. For Cailyn Morreale, a West Virginian from rural Mars Hill, the new methods helped her continue her recovery medicine, buprenorphine, and her care team assured her "that her baby would be assessed and monitored using the Eat, Sleep, Console approach," Sisk explains. "Morreale was never separated from her son. She was able to begin breastfeeding immediately. She was told, the trace of buprenorphine in her breast milk would help her son withdraw from it."

The Eat, Sleep, Console method is slowly replacing the older Finnegan Neonatal Abstinence Scoring System, which involved 21 evaluative questions. Sisk writes, "David Baltierra, former director of West Virginia University’s Rural Family Medicine Residency Program, chair of WVU’s Department of Family Medicine, suggests this protocol could simply be called 'parenting.' Baltierra and his colleagues have been training residents to use an Eat, Sleep, Console approach for a decade. . . .The results are persuading more health professionals to adopt the method."

A 2023 study found "babies treated this way were discharged from the hospital in nearly half the time and less likely to receive medication than those receiving Finnegan-based care," Sisk reports. "Matthew Grossman, an associate professor of pediatrics at the Yale School of Medicine, found a non-pharmacological-first approach works best. He said the Finnegan tool is useful but often too rigid. Under its scoring, one sneeze too many could send a baby to the NICU for weeks."

Research by Leila Elder and Madison Humerick, who each did their residency in WVU’s rural program, "found that median stays for newborns in withdrawal dropped from 13 days in 2016 to three in 2020," Sisk adds. "The simpler treatment also means more babies born in rural communities can receive care closer to home and has reduced the likelihood a mother will be released before her baby is cleared to go home."

A young farmer and former addict offers hope for recovery: 'The only thing you’re not coming back from is death.'

Nathan Caburn, a successful Mississippi Delta farmer
and past opioid addict. (Photo by C. Bennett, Farm Journal)

Nathan Casburn could be a poster child for a drug-addicted prodigal son, who threw away his farm and family for oxycontin and heroin highs.

Casburn's story is a tale that resonates with opioid-ravaged families and reflects what the love of a father and the support of a rural community can do for addicts who want to go home and begin again, writes Chris Bennett of Farm Journal. "Casburn is a most unlikely survivor. He tells a hellish tale of loss and triumph on the farm — without a shred of blame cast beyond his own shadow."

As a teenager, Casburn obsessively played video games. He told Bennett, "I played every waking moment I could, to the point of fixation. I knew I was different from the other kids and not in a good way; I was geared toward escapes. In my case, an obsession with video games was a symptom of my unhealthy mindset.”

From video game escapes, Casburn went on to alcohol. Bennett writes, "In 2004, on backroad gravel, Casburn, a high school junior, broke two vertebrates in an alcohol-related car crash. The subsequent pain management became a party, legitimized by medical approval in the age of OxyContin. Casburn was in love. Welcome to the wonder world of opioids."

Casner wanted nothing to do with his family's Mississippi Delta farm in Tallahatchie County. He was all about the highs. "Next stop, 75 miles west to Ole Miss and Oxford, and a chain of descent in a college town: DUI’s, car wrecks, arrests, hospitalization, overdoses, academic probation, and legal woes," Bennett explains. "By 2014, with no job, no degree, and no prospects. . . . OxyContin and other legal pharmaceuticals were out of his price range. He responded with the most hellish economic decision of his life. Go home to the farm and tap the vein. Heroin."

"Rain or shine, addiction woke Casburn at dawn every day, demanding a morning fix," Bennett writes. "In 2017, at 29, Casburn’s body gave out. After two weeks in intensive care due to a heart valve infection derived from heroin use, he returned home, and checked into rehab. . . . Three weeks after rehab, Casburn was back on the needle."

Then death came knocking. Casburn told Bennett: "I had an out-of-body experience with no drugs involved. I saw everyone going on with life, and me stuck right there dying as an addict. Right then, in the library, I dropped to my knees and threw up a prayer in desperation, but I meant every word. I called out to God for mercy and forgiveness. I told Him that if He would help me, then I’d do everything He asked. That prayer was answered.”

He told Bennett, “All the people around me in our farming community came to help me in one way or another." Bennett adds, "Seven years after crashing to his knees, Casburn has earned a stellar reputation and built a thriving farm life. . . . In March 2024, he and his wife Caitlin were blessed with a baby girl — Nora." He is grateful for a "particularly stalwart source of support — his father, Rea."

Casburn wants people who are addicted to know there is always hope. He told Bennett, "Never, never believe that you can’t get out of drugs. You’re never too far gone. The only thing you’re not coming back from is death.”

Quick hits: Trucks for farmers; guide for emergency alerts; Native Americans enter elections; PORKtober is here!

AGwagon kits make trucks tough enough for farming.
(Photo by Matthew J. Grassi, Farm Journal)

Farmers who want a truck built for the rigors of farming can now make one with "AGwagon," aftermarket kits, reports Matthew J. Grassi of Farm Journal. "There has never been a pickup truck 100% purposely built for farmers and ranchers. . . . The kits convert off-the-factory-line trucks into rugged and tough, back 40 devouring, farm equipment hauling beasts. . . . The AGwagon kits were built off feedback from a panel of 14 farmers and ranchers."

Signing up for emergency alerts may sound simple, but often it's not. This group made an emergency alert guide that can be a model for other communities, reports Natasha Uzcátegui-Liggett of CalMatters. "If you’re interested in publishing a comprehensive emergency alert guide for your state, you can start with our article on CalMatters (it’s free to republish if you credit us clearly, and the majority of it applies to all states), and then swap out the section titled 'How to sign up for your county’s alerts' with your reporting for your state. . . "

Humans and other animals have more than one 'prong' of defense against germs.
(Knowable graphic)

Immune systems are part of living creatures' defenses against bacteria and viruses, but they aren't the only type of protection. "Some scientists think we should devote more attention to a second prong of defense: one that allows our bodies to more harmlessly live with pathogens until they’re cleared from our systems," reports Liam Drew of Knowable. "There is a substantial body of research showing various ways in which animals can tolerate, and so survive, maladies such as malaria, sepsis and dysentery."

Dr. Stephen Loyd

He was a physician, then an opioid addict, and now he's West Virginia's "drug czar," reports Leah Willingham of The Associated Press. "Dr. Stephen Loyd, who has been treating patients with substance use disorder since he got sober two decades ago, says combating opioid addiction in the state with the highest rate of overdose deaths isn’t just his job. It’s an integral part of his healing. . . . Loyd says he is ready to help advise the state's foundation on how to distribute the nearly $1 billion in settlement money saying the state has a 'moral and ethical responsibility' to spend it wisely."

Amid election year tensions and negativity, there are some bright spots. This November, "a record-breaking number of Native Americans are running for state and local office," reports Daniel C. Volk of Route Fifty. "Advance Native Political Leadership, a group that works to increase Native American representation at those levels of government, says there are 230 Native candidates running across the country this year, up from 100 when it first started counting in 2016. About 80% of this year’s candidates are women."

Deanne Frieders

It's PORKtober, and "This Farm Girl Cooks" web writer Deanne Frieders can help you decide "what's for dinner," even if you're delivering supper to a field of workers, reports Jennifer Shike of Farm Journal. "As a cook, she loves how versatile pork is to cook with as it can take on so many flavor profiles from Italian to Tex-Mex to Asian." To explore Frieders' website full of farmer-friendly meals, click here.

PFAS, also known as "forever chemicals," can cause devastating health issues for humans, partially because they build up in the body over time. Much of the concern over PFAS has been their "everlasting" presence in U.S. water supplies, but this town has succeeded in removing them, reports Pien Huang of NPR. "Yorba Linda is a small, sunny city southeast of Los Angeles. It’s home to the nation’s largest per- and polyfluoroalkyl (PFAS) water treatment plant of its kind." The plant can serve as a model for other communities.

Rural jail offers newly released prisoners with addiction disorders a long-lasting drug to prevent relapse

Cost is a major barrier to using Sublocade as an
addiction treatment for prisoners. (Adobe Stock photo)

In rural Maine, a county jail began giving a long-lasting form of buprenorphine to inmates with drug addictions before they left incarceration. The medicine, which curbs opioid cravings for 28 days, helps past inmates avoid "withdrawal, relapse and overdose — dangers that newly released prisoners confront nationwide," reports Jan Hoffman of The New York Times.

Once out of jail, addiction sufferers can face several obstacles to staying in recovery while re-entering their communities. Maine's Somerset County sheriff, Dale P. Lancaster, was discouraged by the number of inmates who would leave prison and die from overdoses. Lancaster pushed for the extended-release medical treatment. Hoffman writes, "According to a recent analysis in Health and Justice, the switch had a remarkable effect. The long-acting injection afforded newly released prisoners a crucial buffer period after they were discharged, with more time to set up continuing addiction treatment and stabilize their lives."

People suffering from drug addictions are more likely to end up on the wrong end of the judicial system. "Of the more than 1.2 million prisoners in the United States, up to 65 percent of prisoners have active substance use disorders, according to some studies," Hoffman explains. And while those institutions have an opportunity to treat the addicted, few have the resources or staffing. In the case of extended-release shots of buprenorphine, known as Sublocade, the treatment's cost remains a big barrier, with the list price for a monthly injection about $2,000, while a month's supply of pills ranges from $90 to $360.

But the success of Maine's program may help turn the tide. "After being released, the Somerset County prisoners who got the shot were three times as likely to continue treatment as those at another rural Maine jail who received the daily pills" [which are discontinued upon release], Hoffman adds. "Between September 2022 and September 2023, three prisoners from the jail where the pills were dispensed died from overdoses within three months of being released; a fourth died by suicide. None of the former Somerset prisoners who had received the injections died."

Dr. Alane O’Connor, co-chair of Maine's Opioid Response Clinical Advisory Committee, said that "as word of the Somerset program spreads, she is getting inquiries from other county sheriffs about how to bring the shots on board," Hoffman reports. "She is also hearing from former prisoners." O'Connor told Hoffman, "Many wanted to stay on the shots, so they would come back to the jail asking our help in finding a provider."

Some U.S. lawmakers want to change methadone treatment availability, but their plan's success seems unlikely

When it comes to substance abuse disorder, perhaps
there is 'no cure.' (Adobe Stock photo)

Solving the U.S. fentanyl overdose crisis has led to political discussions about decreasing methadone treatment restrictions. A recent proposal by a bipartisan group of U.S. senators seeks to save lives by "allowing addiction specialists to prescribe [methadone] outside of the clinics now permitted to dispense it," reports Carmen Paun of Politico. But the bill faces opposition from methadone clinic directors who maintain "that allowing prescribing outside of clinics is risky without their strict safeguards. Methadone is an addictive opioid that’s deadly if abused."

If passed, the bill "would reshape not only how methadone is prescribed but also dispensed — patients could pick up their prescription at the pharmacy," Paun explains. "Now, most have to go in person every day to a clinic to receive their dose under supervision." The additional time and expense of daily travel to and from treatment clinics can make recovery more difficult.

Conflicts over methadone are like a catch-22: "Proponents of making methadone easier to get say that [fentanly's death] toll is ample reason to rethink treatment rules that are now decades old," Paun reports. "The clinics fear it’s a bad idea that could make the overdose problem worse. Thus far, they’re winning the debate in the only forum that matters: Congress."

As the legislation stands now, it is not likely to become law, but the opioid problem remains. "The clinics have succeeded in convincing enough Republicans that expanded access comes with significant risks," Paun writes. "Advocates of broader prescribing say the clinics are more interested in protecting their turf than in saving lives. . . "

Even if methadone could be dispensed through the pharmacy model, the drug isn't a panacea. "Many of those who start methadone treatment drop out within the first year," Paun reports. "Only 34% of a sample of 39,000 patients at BayMark Health Services, one of the nation’s largest methadone treatment providers, were still in treatment one year after they started . . .The reality of opioid use disorder is that, for many, there is no cure, experts in the condition say. Rather, it’s a chronic condition needing lifelong medication and management."

Drug-use stigma among addiction treatment providers is a barrier to care; state policymakers can help create change

Many substance abuse disorder providers have stigmas
about drug use. (Photo by V.  Hryshchenko, Unsplash)

Even though many addiction treatment centers encourage participants to talk openly about their opioid or substance-use disorder, many patients encounter medical providers with drug-use stigmas, which present an obstacle to care, reports Kaitlyn Levinson of Route Fifty. Some state governments can use policy changes to help remove social stigmas as a barrier to addiction treatment.

Noa Krawczyk, an assistant professor at New York University, told Levinson, "At the individual level of a person choosing not to use those treatments because of negative perceptions around them, to the policies that regulate these treatments [and] to the protocols that exist in treatment programs for how these medications are delivered. . . .[Stigma is] ingrained in every single aspect of these treatments and plays a huge role as in terms of a barrier to care.”

Even when opioid treatment is available and affordable, facing a biased medical community can mean a substance disorder patient opts out of recovery treatment. "A recent analysis from The Pew Charitable Trusts suggests normalizing methadone treatment could help expand its accessibility," Levinson writes. "Some states are moving to align their methadone-related regulations to mirror the federal government’s efforts, including California where policymakers are considering a bill that would allow doctors — not just methadone clinics — to prescribe take-home doses of the medicine."

Making treatment more accepted and widely available may address some stigmas, but changing policy goals and language can also help shift attitudes.

Massachusetts policymakers are working to remove drug-use stigma dynamics when a newborn tests positive for drug dependency. "Under current law, hospital workers are required to notify state officials about babies whose blood tests indicate substance use from their parent," Levinson reports. "The new policy would only mandate such reporting if the infant was at imminent risk of abuse or neglect, WBUR reported. The bill also directs health officials to establish a plan for new parents managing their substance use disorder."

Addiction workers need to thoroughly understand addiction as a medical problem or many treatment facilities will fail to help patients. Frances McGaffey, associate manager of Pew’s substance use prevention and treatment initiative, told Levinson, "[Otherwise] there is a mismatch between the community the provider aims to serve and the population actually getting care."

Friday quick hits: Rural top-flick picks; dairy funds; heat can kill; racial voting division; bread debate; hop on a new train

Eita Okuno, Anna Sawai, and Hiromoto Ida in 'Shōgun.' (FX /IMDb image via The Daily Yonder)

On steamy days when the pool is too crowded and you can't handle any more of Mother Nature's energy-sucking heat, it might be time to chill indoors and take in a rural flick. From the "Mad Max Saga" to wrestling's fierce Von Erich family drama to the stunning "craftsmanship and costuming" in "Shōgun," Adam B. Giorgi of The Daily Yonder has some fine movie picks that will make relaxing in the AC much more fun.

In states with the highest number of drug overdose deaths, patients in treatment for mental illness often live with an opioid use disorder that mental health clinics are unable to treat, a study showed. "Despite high rates of opioid use disorder among people with mental health disorders, only a third of community outpatient mental health treatment facilities in 20 high-burden states offered medications for OUD," reports Shannon Firth of MedPage Today. "Among the 450 community outpatient mental health treatment facilities surveyed, weighted estimates showed that 34% offered medications for OUD, reported study co-author Jonathan Cantor, PhD. JAMA Network Open published the study in June.

Jersey Scoops capitalized on the USDA's new small
dairy initiative. (Jersey Scoops photo)

What's better than locally made ice cream or homestead cheeses? More of both. At least that's what the Department of Agriculture seems to think. The USDA is funding a new initiative that "aims to transform and diversify the dairy industry, one small producer at a time," reports Naoki Nitta of Civil Eats. "At 'Jersey Scoops' in Loleta, a small, unincorporated community in Northern California’s Humboldt County, the ice cream is as fresh as it gets. From pasture to parlor, its organic, butterfat-rich milk travels less than 10 miles, produced by a herd of Jerseys pasture-raised on the misty coast. . . . But Jersey Scoops didn’t get here on their own; they leveraged a $60,000 grant from the Pacific Coast Coalition’s Dairy Business Innovation Initiative to secure both the space and equipment." Learn about how local cheese ventures are leveraging this funding here.

As global temperatures continue to spike, awareness of heat-related illnesses is especially vital for outdoor workers and their employers. Heat can make workers sick, but it can also be deadly, reports Seth Borenstein of The Associated Press. "With much of the United States, Mexico, India and the Middle East suffering through blistering heat waves. . . several doctors, physiologists and other experts explained what happens to the human body in such heat." To find out how heat kills, click here.

Handmade bread is much different than mass produced
loaves. (Bluegrass Baking Company photo)

Bread is considered a U.S. family staple for affordable nutrition, but the processing that creates a uniform and stay-fresh loaf has landed "packaged bread in the middle of a fraught debate over 'ultra-processed food,'" reports Jesse Newman for The Wall Street Journal. "Less-processed foods tend to be more expensive and quicker to spoil. . . . For bakers like Jim Betts, owner of Bluegrass Baking Company in Lexington, Ky., most packaged bread is a far cry from the food that has been sustaining humanity for at least 10,000 years." To read why homemade bread is so dramatically different and more pricey than store-bought loaves, click here.

The U.S. rural-urban voter divide primarily exists among whites, a new study published in Politics, Groups, and Identities found. Kate Blackwood for PHYS.org reports, "When it comes to politics, Black and Latino residents of rural America differ far less, if at all, from their urban counterparts than do non-Hispanic white residents, the researchers report." One of the study's authors, Suzanne Mettler, told Blackwood, "Rural and urban Americans began moving apart politically in the late 1990s, and the division has widened and deepened since then. . .We wanted to know whether all Americans, regardless of race and ethnicity, are swept up in this growing cleavage.

A Borealis Amtrak train rounds the corner
surrounded by Midwestern fall colors. (Amtrak photo)

Midwestern states have been busy working to add more train services to their transportation portfolios. The new Amtrak Borealis service between Chicago and St. Paul opened last month after 12 years of planning, reports Daniel C. Volk of Route Fifty. "The new service was also a breakthrough. It is the first new passenger route launched in Minnesota since 1975, and the first in Wisconsin in more than two decades. . . . Officials in both states — like dozens of others across the country — are now planning for even more new passenger routes, because of incentives in President Joe Biden’s 2021 infrastructure law." Borealis trains include wide reclining seats, ample legroom, free Wi-Fi and views of the Mississippi River between St. Paul and La Crosse, Wisc., in daylight in both directions across Wisconsin.