Valuable journalism has recently been published in the New Yorker on the opioid addiction crisis, with a focus in West Virginia.
There are plenty of idle people who want to be involved in productive work, and there’s a lot of that productive work that needs to be done. The economic system hasn’t been connecting the two anywhere near enough. The resultant despair among many is only becoming more apparent as time goes on.
At this stage of the American opioid epidemic, many addicts are collapsing in public—in gas stations, in restaurant bathrooms, in the aisles of big-box stores. Brian Costello, a former Army medic who is the director of the Berkeley County Emergency Medical Services, believes that more overdoses are occurring in this way because users figure that somebody will find them before they die. “To people who don’t have that addiction, that sounds crazy,” he said. “But, from a health-care provider’s standpoint, you say to yourself, ‘No, this is survival to them.’ They’re struggling with using but not wanting to die.”
We were driving away from Hedgesville when the third overdose call of the day came, for a twenty-nine-year-old male. Inside a nicely kept house in a modern subdivision, the man was lying unconscious on the bathroom floor, taking intermittent gasps. He was pale, though not yet the blue-tinged gray that people turn when they’ve been breathing poorly for a while. Opioid overdoses usually kill people by inhibiting respiration: breathing slows and starts to sound labored, then stops altogether. Barrett began preparing a Narcan dose. Generally, the goal was to get people breathing well again, not necessarily to wake them completely. A full dose of Narcan is two milligrams, and in Berkeley County the medics administer 0.4 milligrams at a time, so as not to snatch patients’ high away too abruptly: you didn’t want them to go into instant withdrawal, feel terribly sick, and become belligerent. Barrett crouched next to the man and started an I.V. A minute later, the man sat up, looking bewildered and resentful. He threw up. Barrett said, “Couple more minutes and you would have died, buddy.”
“Thank you,” the man said.
“You’re welcome—but now you need to go to the hospital.”
The man’s girlfriend was standing nearby, her hair in a loose bun. She responded calmly to questions: “Yeah, he does heroin”; “Yeah, he just ate.” The family dog was snuffling at the front door, and one of the sheriff’s deputies asked if he could let it outside. The girlfriend said, “Sure.” Brian Costello had told me that family members had grown oddly comfortable with E.M.T. visits: “That’s the scary part—that it’s becoming the norm.” The man stood up, and then, swaying in the doorway, vomited a second time.
“We’re gonna take him to the hospital,” Barrett told the girlfriend. “He could stop breathing again.”
As we drove away, Barrett predicted that the man would check himself out of the hospital as soon as he could; most O.D. patients refused further treatment. Even a brush with death was rarely a turning point for an addict. “It’s kind of hard to feel good about it,” Barrett said of the intervention. “Though he did say, ‘Thanks for waking me up.’ Well, that’s our job. But do you feel like you’re really making a difference? Ninety-nine per cent of the time, no.” The next week, Barrett’s crew was called back to the same house repeatedly. The man overdosed three times; his girlfriend, once.
Heroin is an alluringly cheap alternative to prescription pain medication. In 1996, Purdue Pharma introduced OxyContin, marketing it as a safer form of opiate—the class of painkillers derived from the poppy plant. (The term “opioids” encompasses synthetic versions of opiates as well.) Opiates such as morphine block pain but also produce a dreamy euphoria, and over time they cause physical cravings. OxyContin was sold in time-release capsules that levelled out the high and, supposedly, diminished the risk of addiction, but people soon discovered that the capsules could be crushed into powder and then injected or snorted. Between 2000 and 2014, the number of overdose deaths in the United States jumped by a hundred and thirty-seven per cent.
Some states became inundated with opiates. According to the Charleston Gazette-Mail, between 2007 and 2012 drug wholesalers shipped to West Virginia seven hundred and eighty million pills of hydrocodone (the generic name for Vicodin) and oxycodone (the generic name for OxyContin). That was enough to give each resident four hundred and thirty-three pills. The state has a disproportionate number of people who have jobs that cause physical pain, such as coal mining. It also has high levels of poverty and joblessness, which cause psychic pain. Mental-health services, meanwhile, are scant. Chess Yellott, a retired family practitioner in Martinsburg, told me that many West Virginians self-medicate to mute depression, anxiety, and post-traumatic stress from sexual assault or childhood abuse. “Those things are treatable, and upper-middle-class parents generally get their kids treated,” he said. “But, in families with a lot of chaos and money problems, kids don’t get help.”
In 2015, Berkeley County created a new position, recovery-services coördinator, to connect residents with rehab. Yet there is a chronic shortage of beds in the state for addicts who want help. Kevin Knowles, who was appointed to the job, told me, “If they have private insurance, I can hook them right up. If they’re on Medicaid—and ninety-five per cent of the people I work with are—it’s going to be a long wait for them. Weeks, months.” He said, “The number of beds would have to increase by a factor of three or four to make any impact.
This year, for the sixth straight year, West Virginia’s indigent burial fund, which helps families who can’t afford a funeral pay for one, ran out of money. Fred Kitchen, the president of the West Virginia Funeral Directors Association, told me that, in the funeral business, “we know the reason for that was the increase in overdose deaths.” He added, “Families take out second mortgages, cash in 401(k)s, and go broke to try and save a son or daughter, who then overdoses and dies.”
Michael Chalmers is the publisher of an Eastern Panhandle newspaper, the Observer. It is based in Shepherdstown, a picturesque college town near the Maryland border which has not succumbed to heroin. Chalmers, who is forty-two, grew up in Martinsburg, and in 2014 he lost his younger brother, Jason, to an overdose. I asked him why he thought that Martinsburg was struggling so much with drugs. “In my opinion, the desperation in the Panhandle, and places like it, is a social vacancy,” he said. “People don’t feel they have a purpose.” There was a “shame element in small-town culture.” Many drug addicts, he explained, are “trying to escape the reality that this place doesn’t give them anything.” He added, “That’s really hard to live with—when you look around and you see that seven out of ten of your friends from high school are still here, and nobody makes more than thirty-six thousand a year, and everybody’s just bitching about bills and watching these crazy shows on reality TV and not doing anything.”
Aldis touched briefly on what an overdose looks like, but acknowledged that the attendees probably already knew. (“Oh, Lord, yes,” a woman behind me said.) He demonstrated how to spray Narcan up a patient’s nose—take-home kits come in atomizer form—and announced that at the end of class he’d be writing prescriptions, which those in attendance could get filled at a pharmacy. If they had Medicaid or private insurance, the kit would cost only a few dollars; if they didn’t, it could cost anywhere from a hundred and twenty-five to three hundred dollars. At the first meeting I attended, in November, a few women began to cry when they heard that. At the second, in January, Aldis had some good news: the state had agreed to provide a hundred and eighty free kits.
“Yes!” Melissa said. “Aiden’s pre-K teacher told me forty per cent of the kids in her class are being raised by somebody other than a parent.”
“That means forty per cent have been found out,” Christine said. “Who knows what’s going on with the other parents?”