Report: 'Deaths of despair' decrease across the country, but Appalachia still sees the highest mortality rates

Opioids are one of the biggest drivers of deaths of despair
in Appalachia. (Photo by S. Pollio, Unsplash) 

The U.S. mortality rate from "deaths of despair" has declined by 5%, according to a report by researchers at the University of Chicago and East Tennessee State University. The decrease means such deaths, which are commonly linked to drug overdoses, alcohol and suicide, are hovering near pre-pandemic levels, reports Liz Carey of The Daily Yonder. 

Despite the encouraging news, deaths of despair remain disproportionately high in Appalachia, where drug overdoses are considered the "primary factor driving the difference."

Michael Meit, the director of the Center for Rural Health and Research at ETSU and a co-author of the report, believes the reasons for the higher rate of deaths of despair in Appalachia aren't fully known. He told Carey, "I think there are a lot of complexities to it, and I don’t know if we know all of the answers."

The new report is the "latest update to research started in 2017," Carey explains. "At that time, Appalachian mortality from overdose, alcohol, and suicide was 44% higher than it was in the rest of the country." Despite a decreasing mortality rate since 2017, the number of Appalachian deaths of despair remains stubbornly higher than the rest of the U.S.

The decrease in the number of deaths by despair isn't happening evenly across all age groups. Millennials are a generation that has lost thousands of lives to deaths of despair. Carey reports, "According to a report by Trust for America’s Health, the largest number of deaths from overdoses, alcohol, and suicide in the 25- to 44-year-old demographic has steadily increased since 2017." 

The report singled out opioid addictions and overdoses as the biggest driver of Millennial deaths of despair. As a result of those findings, the Appalachian Regional Commission awarded "nearly $11.5 million in 2023 to nearly 40 projects across the region to address the impact of substance use disorder," Carey writes.

But regional progress is slow. Meit told the Yonder, "You don’t necessarily see a region-wide impact, but you see really strong community-based efforts that impact those communities. And as you reduce numbers in any given community, that has a broader impact across the region.”

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.

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.”

Opinion: Understanding how fentanyl 'saturated the U.S. drug supply' could help address the addiction crisis

Naloxone can prevent overdose deaths, but it's expensive.
(Adobe Stock photo)

The current U.S. opioid crisis started with painkiller prescriptions in the early 2000s, but once medical providers started nixing those medicines, heroin's popularity surged, and then fentanyl and its "tsunami" of death entered the market, reports Maia Szalavitz of The New York Times. "Understanding how fentanyl saturated the drug supply, moving from the East Coast of the U.S. to the West, is critical to ending the worst drug crisis in American history."

Drug cartels' greed drove the creation and use of fentanyl. "By 2013, cartels had realized that they could slash their labor, manufacturing and transit costs by replacing heroin derived from farm-grown opium with a powder made in a lab — fentanyl," Szalavitz writes. "Before 2018, 80% of all deaths associated with fentanyl occurred east of the Mississippi. . . . Since 2021, at least two-thirds of America’s 100,000 annual overdose deaths involved a synthetic opioid like fentanyl."

While heroin was considered a more urban drug, "increased opioid prescriptions — followed by sharp reductions — resulted in new heroin users in rural areas," Szalavitz explains. "Illegally manufactured fentanyl began appearing in both urban and rural drug markets. . . . Rural West Virginia and other Appalachian regions were the center of the earliest prescription opioid wave of the crisis, which led to the establishment of new heroin markets in places facing job loss."

Combating opioid addiction and overdose deaths liked to fentanyl is tough because the drug's supply chain and use is now deeply embedded across the country. The drug is cheap to make and buy, and provides an exceedingly potent high for the user. "So, what can be done? The answer is to focus on the drivers of demand, not supply. This means addressing the roots of addiction and treating it compassionately," Szalavitz writes. "We have a great generic opioid overdose antidote, naloxone. . . . And two medications — methadone and buprenorphine — have proved to cut the risk of death among people with opioid addictions by 50% or more when used long-term."

Szalavitz adds that people often start doing drugs because their lives feel hopeless. "Addiction is most often an attempt to escape despair. The condition itself is defined by compulsive drug use despite negative consequences, which is why threats of punishment or even death rarely yield recovery. . . . It’s not coincidental that the exponential rise in overdose deaths has occurred in tandem with a profound increase in income inequality."

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."

Appalachian program helps people in recovery find a new life in construction work

Lindsey King works on a new home.
(Photo by J. Glendenning, IRJ)

Lindsey King is rebuilding her life by building homes in Kentucky. Her new career is a testament to a successful trifecta of efforts from the Hazard-based Housing Development Alliance's Hope Building Program, the Perry County Drug Recovery Court, and King's determination, reports Jenni Glendenning of the Institute for Rural Journalism. King will celebrate four years of recovery on Aug. 18.

Like many people in recovery circles, King experienced a "moment of clarity" when she "was only able to see her children once during her six-month stay," Glendenning writes. "She praised Perry Circuit Judge Alison Wells, who sent her to treatment after her arrest. King told Glendenning, “She seen things in me far before I’ve seen them in myself, and she pushed me to get there.”

King attributes part of her ongoing successful recovery to community support. She told Glendenning, "There’s no stigma over recovery anymore around here." Glendenning writes, "When King entered the Hope Building Program as a trainee, she and her children, now 8 and 7, lived in a one-bedroom apartment with one twin bed and a small closet. She moved up to a two-bedroom apartment and now owns her own home, where they all have a bedroom, and the kids have a place to play outside."

King likened recovery to building a home, which starts with a solid foundation and goes up from there. "She knew she wanted to be a carpenter after about a month of being involved in the Hope Building Program, even though she had never done construction," Glendenning explains. "King said that she has not been treated differently on the job because she was a woman. . . . Her advice for women looking to enter the trade is, 'Even if it’s something you think you can’t do, do it, go for it!'"

To become a carpenter, King attended Hazard Community and Technical College and "is the first person in her immediate family to attend college," Glendenning reports. "After King completed the program, the HDA hired her as a temporary assistant trainer for a year. Now she is a full-time assistant to lead trainer Josh Boyd; they work with a crew of four in the program."

King with her children, Waylon and Iris
(Photo by J. Glendenning, IRJ)

The Hope Building Program is primarily funded by the Appalachian Regional Commission’s Just Transition Fund for coal counties. "It aims to increase the long-term success rates of people in recovery while also rebuilding the local housing market," Glendenning writes. Shannon Gabbard, who runs the Hope Building Program, told Glendenning, “Ultimately, our goal is to help them transition into the workforce full-time. They must consistently pass random drug screenings, and the feedback we can provide helps to ease the minds of employers who may otherwise hesitate to hire employees who are in recovery.”

A criminal record can make it hard for people in recovery to find employers willing to give them a chance. Glendenning explains, "The Hope Building program does a background check, but Gabbard tells trainees, 'I don’t want them to stress about it because we haven’t seen anything yet that we haven’t been able to work through.' This offers a sense of relief, but once they are hired, 'they cannot have any new criminal charges after they begin the program.'"

Mindy Miller, HDA’s director of development and communications, whose own family has seen hardship from the drug epidemic, told Glendenning, “It's stories like Lindsey’s that give people hope. Her story is a lighthouse, a beacon shining in the night for every addict and for every person out there who loves an addict." Glendenning adds, "King considers the folks at the HDA her family and loves knowing that through her work she is giving back to her community by building something that is going to be someone’s home."

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."

'On the Front Porch' is hosting an expert-led discussion on July 8 about the opioid crisis in rural America

Tony Pipa and Brent Orrell are back "On the Front Porch" hosting rural-focused conversations starting on Monday, July 8, from 12:45 to 1:45 p.m. E.T.

Their July 8 event will include insights from Keith Humphreys, a professor at Stanford University, and Sally Satel, senior fellow at the American Enterprise Institute, both of whom are experts on opioid use disorder and its impact on rural communities. Their discussion will look at the causes of and potential solutions to the nation’s drug epidemic, especially as that challenge presents in nonmetropolitan areas.

Register here. If you have missed previous On the Front Porch conversations, you can find them here.

In other rural news, the second season of Pipa's Reimagine Rural podcast continues with new episodes every three weeks this summer. The most recent episode explores Licking County, OH, the future home of Intel’s two new semiconductor factories, which is the largest private sector investment in Ohio’s history. Pipa speaks with elected leaders of nearby jurisdictions about the inevitable changes they face and the collective planning process they developed to protect the integrity of their towns after being left out of the siting decision. You can listen to that episode here or on your favorite podcast platform.

Past episodes, including all of season 1 and the first three episodes of season 2, can be found here.

A simple tool can help identify and treat addiction while creating data for future programs and policies

Using evidence-based addiction screening tools can help
current and future patients. (Adobe Stock photo)

Treating opioid addiction requires practitioners to use multifaceted approaches, and adding process for regularly screening for Opioid Use Disorder is a small tool that can make big difference in patient intervention and data-driven policy, reports Kaitlyn Levinso of Route Fifty. "An under-utilized 'starting point for evaluating care is measuring what portion of the population is diagnosed with OUD. Knowing this information will help policymakers understand how well treatment systems identify people with OUD, which is the first step in getting them needed care,' said Alexandra Duncan, project director of Pew Charitable Trust's substance use prevention and treatment initiative."

Only two states are measuring for OUD as a part of their regular assessment tools for Medicaid patients. "Indiana and West Virginia have leveraged the Screening, Brief Intervention and Referral to Treatment, or SBIRT, model, an evidence-based approach for talking with patients about the use and misuse of drugs and alcohol," Levinso writes. "It helps health care providers flag concerning substance use behaviors in Medicaid patients and intervene with necessary resources and services to aid patient prevention or treatment and recovery of SUDs."

The Indiana SBIRT program provides practitioners with alcohol and drug abuse screening tools, Levinso reports. They also use "the CRAFFT tool, which helps identify substance use and associated behaviors in youth and adolescents, among others. The SBIRT model has been expanded for use at community health centers, federally qualified health centers and rural health centers in Indiana."

As states receive opioid settlement funds distributions, it could be an opportune time to focus on screening as a relatively inexpensive way to combat OUD. Duncan told Levinso: "These data will provide states with crucial information on allocating scarce resources more effectively, whether through increasing SUD screening or other data-driven treatment system improvements."

The number of children who have lost a parent to drug overdose or firearms climbs; overdose loss is up 345%

Nearly 100,000 children lost parents to a drug overdose
or gun violence in 2020. (Adobe Stock photo)

Over the past 20 years, the number of U.S. children who have faced a parent's death from drug overdose or firearms has increased at an alarming pace. These children are left to grapple with a loss that impacts how they thrive or don't thrive throughout their developmental years and into adulthood.

"Nearly 100,000 children lost parents to a drug overdose or gun violence in 2020 alone – almost three times more than in 1999," reports Deidre McPhillips of CNN. "Overall, more than 1 million children have lost a parent to a fatal drug overdose or gun violence over the past two decades, according to the study published in the Journal of the American Medical Association.

The increase in the number of parent-age deaths from drug overdose is staggering. McPhillips writes, "About 72,800 children lost a parent to a drug overdose in 2020, up 345% from the 16,000 children affected in 1999, according to the study."

The percentage increase in gun-related deaths is not as high as that for drug overdoses, but it's still startling. "There was a 39% increase in children who lost a parent to gun violence – from 18,000 in 1999 to 25,000 in 2020," McPhillips reports. By comparison, the number of children who lost parents due to other causes increased 24% between 1999 and 2020.

"Other research has shown that losing a parent can have negative effects on a child's health, education and livelihood – in both the short and long term," McPhillips adds.

Deaths due to drugs, guns or crime are not as acceptable for children and adults to discuss. Robin Gurwitch, a psychologist and professor at the Duke University School of Medicine, told McPhillips: "When it can't be talked about openly and freely, it makes it harder for children to get the support they need. For children who hold those things inside, the risk of it leaking out into everything from severe behavior challenges to bereavement disorders to other types of mental health challenges – anxiety, depression or their own substance abuse – goes way up."

Some opioid settlement money is used to raise salaries and replace other funding; victims' families say that's wrong

Addiction recovery advocates say redirecting funds isn't
in the 'spirit of the settlement.' (Adobe stock photo)

As opioid settlement funds hit state, county and city coffers, some have been diverted for staff salary increases and already-established budgets. Victims' families and addiction treatment advocates argue the practice, formally known as known as supplantation, is not what the money was intended to do, reports Aneri Pattani of KFF Health News. "Local officials say they're trying to stretch tight budgets, especially in rural areas. But critics say it's a lost opportunity to bolster responses to an ongoing addiction crisis and save lives."

Commenting on what many see as misguided spending, Robert Kent, former general counsel for the Office of National Drug Control Policy, told Pattani, "To think that replacing what you're already spending with settlement funds is going to make things better — it's not. Certainly, the spirit of the settlements wasn't to keep doing what you're doing. It was to do more."

Opioid disbursements in Scott County, Indiana, are an example of how the money and disagreements on how to spend it are playing out. "In 2022, the county received more than $570,000 in opioid settlement funds," Pattani writes. "According to reports it filed with the state, it spent about 45 percent of that on salaries for its health director and emergency medical services staff. The money usually budgeted for those salaries was freed to buy an ambulance and create a rainy-day fund for the health department."

On balance, throughout the national waves of intense addiction trials -- from prescription to heroin to fentanyl -- many cities and counties redirected thousands of dollars to respond to the crisis. Now that settlement funds are coming in, "They want to recoup some of those expenses," Pattani reports. Some states have "restricted substituting opioid settlement funds for existing government spending, according to state guides created by OpioidSettlementTracker.com and the public health organization Vital Strategies."

While community spending can be complex, there are tools to help citizens identify the amount of opioid dollars their community has received to date. Pattani adds, "Use our searchable database to find out. Then, ask elected officials how they're spending those dollars. In many places, dedicated citizens are the only watchdogs for this money."

California prosecutors charge fentanyl suppliers with murder. The legally unsettled approach is catching on.

Prosecutors in California are forging a path to make fentanyl dealers accountable for their part in overdose deaths by filing homicide charges against them. In Riverside County, California, county district attorney Mike Hestrin "has charged 34 suspected fentanyl suppliers with murder and is said to be the first prosecutor in California to achieve a guilty verdict from a jury in a fentanyl-related homicide trial," reports Michael Corkery of The New York Times. Some critics fault the prosecution of street dealers "as a misguided return to the aggressive approaches of the 1990s, which failed to curb drug use and swelled state prison populations."

But even in boldly liberal parts of the state, murder investigations of fentanyl overdoses are being used to discourage fentanyl sales and provide some level of justice for families. Corkery writes, "Some other counties — like San Diego and Placer, near Sacramento — that have also brought murder charges against fentanyl suppliers have sizable numbers of conservative-minded voters who tend to favor more punitive approaches to crime." Even in San Francisco, the district attorney's office is planning to prosecute fentanyl dealers for overdose deaths.

While prosecutors pursue murder charges against fentanyl dealers, their cases are on murky legal ground. "Prosecutors have been working around the fact that California does not have a law that specifically allows fentanyl deaths to be charged as murders," Corkery explains. 

Defense attorneys have responded to the prosecutions as "overbroad and unconstitutional," Corkery reports. But their complaints are being drowned out. "Parents whose children died from fentanyl are a driving force behind new laws and stepped-up prosecutions just as the parents of drunken-driving victims swayed the nation to crack down on alcohol-fueled traffic deaths decades ago."

To read more on how California prosecutors are using the Watson murder rule to prosecute fentanyl suppliers, click here. 

Drug Enforcement Administration statistics draw a startling picture of fentanyl's lethal power: It is the leading cause of death for Americans ages 18 to 45, and it's responsible for nearly 70 percent of the United States' 107,000+ drug overdose deaths in the past year. A educational warning video is shared below.