When I read the powerful New York Times feature on McDowell County, West Virginia, my immediate reaction was, “That’s my community!” Although I’m not from McDowell, I grew up in Morgantown, West Virginia where I watched members of my own family fall victim to similar struggles with poverty and addiction.
As coal-mining jobs have declined, McDowell’s median household income has plunged to $22,000. Not surprisingly, many residents have turned to drug abuse and to the drug trade. While methamphetamine was long considered Appalachia’s biggest drug problem, it is clear that prescription opiates are now an even graver threat. The prescription drug scourge in counties like McDowell did not happen randomly. In the late 1990s, Purdue Pharma, the maker of OxyContin, aggressively marketed the pill to doctors in Appalachia, where injuries from hard-labor jobs often produce chronic pain. The use and abuse of OxyContin became so widespread that it eventually earned the nickname “hillbilly heroin.”
The consequences have been devastating. The rate of fatal overdose in McDowell is more than eight times the national average; McDowell’s incarceration rate is also one of the country’s highest. In 2011, nearly one out of every three babies born in the county’s hospital had been exposed to drugs. As McDowell’s sheriff put it, “Whole families have been wiped out in this county: mother, father, children.” Grandparents are raising children whose parents are in jail or caught in the throes of addiction. Adults are unable to provide for their families because they cannot pass the drug tests employers require.
This is a story I know all too well, and it is the story of countless families across Appalachia. Addiction is decimating rural America, yet we don’t hear about this tragedy nearly as often as we should. The news media has preferred instead to focus on the rising problem of prescription drug and heroin addiction in middle-class suburban communities. The people of McDowell, where shanties dot the secluded mountainous landscape, are largely forgotten.
I’m grateful to The Times for bringing attention to a region of the country that doesn’t often get a voice. However, it’s one thing to raise awareness, but unless we develop viable solutions in this area, the addiction scourge will continue to haunt the next generation. According to Deborah Taylor, R.N., regional director of Phoenix House Mid-Atlantic, rural America desperately needs “treatment on wheels.” In addition to lengthy waiting lists, a significant barrier to treatment access in rural areas is the long travel distance required to reach the nearest clinic or hospital. We cannot expect residents of these isolated areas to seek help unless we bring care directly to their doorsteps. For this reason, Taylor and other clinicians see great promise in mobile units that could provide medication-assisted treatment and management. These units should be part of a comprehensive program that would also include vocational training as well as financial incentives for those who successfully complete treatment.
Of course, we know that a program of this nature would be impossible to implement without increased funding for treatment. West Virginia continues to expand Medicaid for low-income residents, yet Medicaid funding alone won’t solve the state’s addiction epidemic. A federal demonstration project, on the other hand, would allow West Virginia to pilot a high-quality “treatment on wheels” program that could truly make a difference. Ideally, says Taylor, this project “would bring together the best minds in opioid treatment” to create a model of care that could then be replicated in rural settings across the country.
Now, I’m not naïve enough to believe that Appalachia’s drug crisis has a simple solution. However, when a situation becomes this dire, our nation has a responsibility to step in. “These are good people, good families,” McDowell’s sheriff said of his neighbors who have succumbed to addiction. His words ring true as I think of my own relatives. Above all, we must remember that these individuals are not society’s throwaways. It is up to us to ensure that their struggles are not ignored.
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