The epidemic inside the pandemic: how COVID-19 affected the opioid crisis
Roanoke’s Drop-In Center on Williamson Road was one of the places to help lead Curren on the road to recovery.
ROANOKE, Va. (WDBJ) - WDBJ7 is taking a fresh look at Appalachia’s opioid crisis: the epidemic inside of the pandemic.
In our series on “Bridging the Great Health Divide” we examine the pandemic’s role in deepening the crisis, and the bridges people in our communities are building to bring hope to those who need it most.
“C’mere, Chance!” Mekaila Curren is calling for a white horse on the other side of the fence. “C’mon, Chance!”
It’s not the only chance staring her squarely in the face.
“You know, I got a car, I got a job. I got everything I could want,” Curren said. “I just gotta reach out and grab it.”
Today, Curren is clean. She’s a young woman in early recovery, abstaining from a life on the streets of Roanoke City for a chance at a fresh start.
“I feel like a lot stronger of a person. I’m happy I’m surrounded by my family again. I did miss them. I missed myself going through all of the stuff that I went through,” she said, chuckling. “But I’m back here now. One foot in front of the other.”
This family farm in Bedford is a haven away from a drug addiction that pulled her away several years ago.
“Bouncing from house to house, walking the streets. At all hours of the day,” she said. “Carrying our stuff with us.”
On the streets Curren saw the community’s opioid crisis up close, too close, especially as the pandemic settled in.
“And people that I knew, names that I was familiar with, started coming up a lot more in conversation. I was like, ‘Oh, my God, are you serious?’” she said. “I know people that I went to school with that overdosed and died.”
“It is everywhere,” said Lisa Via. “You know, everybody thinks it can’t happen. It is happening, it’s here. It’s not going away.”
In Roanoke City, Via is grasping at chances too.
Roanoke’s Drop-In Center on Williamson Road was one of the places to help lead Curren on the road to recovery.
Via heads up the Community Harm Reduction Program, which offers a clean needle exchange, testing, access to medical care and recovery. There are more than 115 participants already who are painting her a picture of what the pandemic has done to widen an already gaping chasm.
“We’re hearing from participants about friends that are dying,” she said. “So that really hits home when somebody comes to see you and say you know, ‘I just lost my friend yesterday.’ So it’s very disheartening, I feel like it’s a struggle that we are losing.”
In the Allegheny Highlands, Sheriff Kevin Hall has also seen the opioid crisis up close and remains worried for his community.
“And we’ve lost a lot, for a small area, these last probably 6-8 months, we’ve lost a lot of people to the overdose of opioids,” he said.
His son, Ryan, now three years clean, had been joining his father in dozens of classrooms, churches and civic groups, sharing their story in the hopes of saving a life.
“We were really helping a lot of people and then the pandemic hit,” he said. “Kind of really at a bad time because I think we were really gaining a lot of momentum here in Virginia on the opioid crisis.”
According to Sheriff Hall, Division 6 of the Virginia State Police, which spans from Sheriff Hall’s jurisdiction in Allegheny County to as far south as Martinsville, reported a 106-percent increase in heroin or opioid related overdoses last year compared with 2019.
Each overdose death in the Allegheny Highlands is a punch to the gut for a small, rural community.
“This crisis does affect everyone,” Hall said. “It doesn’t matter if it’s just small towns like what we have here. Even in the bigger areas this crisis can strike and it can strike at any economic level, race, creed, religion or whatever, it doesn’t discriminate.”
From law enforcement to public health, services stretched thin had to turn their attention to COVID, while the overdoses stacked up.
“But anecdotally we understand that we’re dealing with a bigger issue now than we did when the pandemic started,” said Nancy Bell.
Bell, Population Manager for the West Piedmont Health District, said pre-COVID, the local task forces had been making progress.
In some cases, they were working with data to identify specific neighborhoods with high overdose rates.
“And then of course, COVID hit and we had to focus our efforts elsewhere,” Bell said. “And probably the most damning thing that happened is we were no longer able to sit around a table and discuss at a granular level what was going on in the community.”
Appalachia has been among the hardest hit places since the opioid crisis began. In 2017, the Appalachian Regional Commission suggested a “markedly higher overdose death rate” for the region compared with the rest of the country.
A country that continues to struggle. In December, the CDC reported 81,000 drug overdose deaths nationwide from June 2019 through May 2020.
That, the CDC noted, is “the highest number of overdose deaths ever recorded in a 12 month period.”
And while overdose deaths were already on the rise, the CDC suggests the pandemic seemed to accelerate the number of deaths.
“People were just swamped with folks who were relapsing,” said Beth Macy.
Macy, whose bestselling book Dopesick highlighted the toll of the opioid crisis in southwest Virginia, says experts in the field have reported devastating setbacks.
“Some people who had many years of recovery were relapsing from the stress of the pandemic,” Macy said. “Job losses, isolation. People were overdosing alone with no one to Narcan them.”
“The numbers aren’t getting any better.”
That’s what Roanoke County Chief Howard Hall told WDBJ7 in May of last year, when the number of deadly overdoses in just 5 months were already double the number for all of 2019.
In January, Virginia’s Chief Medical Examiner noted the Commonwealth recorded “an enormous increase in fatal overdoses” at the start of the pandemic.
And while fewer Virginians went to emergency rooms in 2020, more people overdosing did.
In a chart of the top three causes for unnatural deaths in Virginians, fatal drug overdoses take the lead - by a lot.
Preliminary data for 2020 suggest more than 2,200 drug overdose deaths statewide. That’s hundreds more cases - hundreds more lives - than were claimed than the year before.
While 2020 data are preliminary, it led the Chief Medical Examiner to conclude in their report, “2020 will be the worst year on record by far for fatal overdoses in Virginia.”
MeKaila Curren has a theory.
She points to locking state lines at the beginning of the pandemic, restricting access to heroin supplies in particular.
“And because it was harder to get more of it, because the state lines locked, they would start cutting it with fentanyl, and that’s what caused a lot of the overdoses in the very beginning because people didn’t know,” she claimed. “They weren’t being told, hey, you know - this is cut with this - so don’t do this much. People would just sell it so they could get the money.”
It’s a theory supported by the DEA’s 2020 Drug Threat Assessment.
The agency says the ”availability and use of cheap and highly potent fentanyl” has increased.
Noting that by combining “just a small amount of fentanyl into heroin allows dealers to maximize profit by extending heroin supplies.”
“We have never had a foe as formidable as fentanyl, and so that’s what’s driving the biggest increase for us right now and it’s really scary,” Macy said. “So you can say it’s wrong to give people needles or whatever, but in the era of fentanyl - this idea where we don’t extend help, it’s just deadly. You could say I’m all about tough love, I think we should let them hit rock bottom. Well in the era of fentanyl, rock bottom too often is death.”
But Curren and others believe fentanyl is not the only reason for the spike.
“People would start spending their unemployment money. When people get $700 or more a week and that’s $700 they’re gonna go drop on drugs,” Curren said. “Every week.”
Add in isolation, depression and anxiety. Lisa Via says those are deadly combinations.
“You know, you’re used to getting out, you’re used to being with your friends,” Via said. “When you’re stuck by yourself, you’re depressed and you’re already at a low point. And throw a pandemic on it, I would say depression and being isolated is a huge part of it.”
Sheriff Hall worries, too, about the people teetering on the edge of an addiction.
“And things like this, the emotional trauma of the pandemic, and not being able to hang out with the people, not being able to go to movies or sporting events or other different things that they end up going back to that drug and getting their self further down the road in that addiction.”
And once people are embedded in their addition, Via said, getting them the help they need is still a struggle.
“The frustrating part is there are not enough resources,” she said. “...Mental health-wise, recovery, treatment, to get the folks that are so ready to get to that, you know that style. And there are not enough resources. Phone call after phone call and we can spend hours trying to get these folks, and that frustration is, it’s just not there.”
Via and Curren say even if you can find a spot cost can be prohibitive.
“They should have more things that are more available for free... I’m not really a political person,” Curren said. “I don’t know a lot about it or the law or views of it but if you know you can’t get Medicaid then you can’t get anything. Especially when it comes to a place for recovery.”
But, Macy notes, some problems for those suffering from substance abuse disorder can’t be paid for with money.
“I still would say if people ask me what the number one problem was I would still say it was stigma,” she said. “Because everything comes under stigma.”
In Covington, Sheriff Hall believes they were making progress, with the drug court and the Community Services Board working directly with inmates.
Factoring in the COVID disruption, he’d like to see more funding for these community services. Funding that could be coming soon.
“You know the truth is, this is a crisis that has its origins in our medicine cabinets and it goes right back to the boardrooms and marketing officers of the pharmaceutical companies,” Virginia’s Attorney General Mark Herring told WDBJ7.
He said the Commonwealth has scored some wins lately in settlements with drug manufacturers and marketing companies.
One recent settlement will bring nearly $13 million to the Commonwealth.
But work continues.
“The Purdue Case that we brought in southwest Virginia has been put on hold because they filed bankruptcy and so now we are in that bankruptcy court trying to really advocate on behalf of people who have really been hit hardest,” Herring said.
While Herring’s team fights in court, he says he wants to make sure the money that comes in goes out to the right places.
This past session, he worked to craft legislation creating an Opioid Abatement Authority: a team of people who would funnel those dollars to the communities that need it most.
“So that money received from these court cases, whether it’s by a verdict or whether it’s by a settlement, will come into the abatement fund,” he said, “and then be distributed at various levels, local, state, regional in order to abate this crisis for more treatment, for more services and instead of just going into the general fund and being spent on other priorities.”
Macy believes while that could be a start, programs on the ground need to consider science in the structure of recovery.
“We know abstinence only works in a very small minority for people with opioid use disorder compared with medication-assisted treatment, which works with 50 to 60 percent or more to prevent overdose death,” Macy said. “So I think we’ve got a lot of work to do with our structures.”
While Herring waits for the Governor’s signature, community groups remain committed to tackling the problem at the ground level.
“I’m Nancy Bell, I’m with the Healthy Patrick County Coalition,” said Bell during a March 4 Zoom call.
Since Patrick County’s hospital closed nearly three years ago, leaders there have been working toward improving health outcomes for the area. And they are putting particular emphasis on the opioid crisis.
Early March, they consulted virtually via Zoom with a team from Virginia Tech that has been doing work with community members in Martinsville and Henry County.
“We would like to present what we have done to you all and talk a little bit about the process we used to get that done,” said project leader Carlin Rafie.
The Engaging Martinsville Henry County team has been working for two years to find solutions and bring education programs to local classrooms. This month, they submitted an application to the Supreme Court to establish a drug court in the 21st circuit.
If approved, they aim to implement it as soon as October.
Piedmont Community Services also installed a staff member at the emergency department at SOVAH Health in Martinsville this month. The staffer can offer people counseling and medication-assisted therapy. In the first three weeks, they’ve connected with 15 people at the hospital, with 7 of them following up for care.
It’s modeled off of the Bridge Program at Carilion Clinic, which has reported success and a better understanding of the disorder, in the two years since initiated.
Bell says, “Don’t lose hope. We haven’t forgotten about the opioid epidemic and we are starting to see some new money coming in from the drug manufacturers and everyone’s looking at it through a new lens of helping instead of ignoring, so I feel very hopeful and I’m hoping the community will continue to have the conversation with us and to work together to try to support those who need us most right now.”
There are hurdles to be sure. COVID persists.
People disagree on the best methods for recovery.
And lack of access to services, including the internet, can thwart the best intentions.
But bridges, even if small and unsteady are being built every single day.
“Oh, pretty amazing,” Hall said of his son, Ryan. “Still get teared up about some of it when I start thinking about it. Where he was to where he’s at now is just an amazing story….. it just gives you an example of how low you can go but then where you can rise to - able to keep that it’s just amazing that he was able to do that and that’s what we’re hoping to try to save other people and bring them back to that level…. Hopefully we can put this pandemic behind us and we can get back out there and put this opioid crisis to rest.”
In the meantime, Macy is working on a second opioid book, focused on solutions to this devastating crisis.
And production on the Hulu series based on Dopesick is in full swing.
“I think it’ll bring more people to the issue, just because of it being television,” she said. “And I think it will so in a quicker way what I attempted to do with the book, which was to show Americans that a lot of these folks got into trouble, initially, through no fault of their own.”
Macy says she’s also pleased to see money from President Biden’s relief package earmarked for addiction recovery services.
The kinds of services the Engaging Martinsville team says are working hard to fight the epidemic inside of a pandemic.
“But these communities have resiliency,” Rafie said, “they have answers in the community they just need to lock arms and work united to solve their problems.”
In the meantime, Curren is working on putting one foot in front of the other, for herself and for her son.
“I’m working hard to get him back because if it wasn’t for him, I wouldn’t be here. He is my world. He’s the reason I’m alive... I look back on my band teacher now and he said don’t ever say you can’t. Until you try and try and try and fail and fail and fail, don’t ever say you can’t. You can, as long as you set your mind to it.”
The chance of a lifetime.
A chance Via says, everyone deserves.
“Just because they use drugs, they’re still a part of our community, Via said. “They still deserve our respect.”
To learn more about resources in the area:
- RVA Collective Response
- The Hope Initiative
- Engaging Martinsville-Henry County
- Healthy Patrick County
- The Drop-In Center
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