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Finding the helpers: Locals offer addiction support

Charlottesville resident Jordan McNeish knows the perils of opioid addiction first-hand.

Three years ago, he was on an East Coast road trip with his ex-girlfriend, and the plan was to end up in Maine. But their first stop was Baltimore, to buy heroin. McNeish, 29, says he had gone from using heroin once or twice a year to “more than I would like.”

He bought 10 bags of “Scramble,” “basically a mixture of fentanyl and low-grade heroin cut with god-knows-what,” and shot up in a Burger King parking lot. The next thing he remembers is waking up covered in the orange drinks his ex had spilled while trying to resuscitate him. An EMT had revived him using two doses of naloxone, a drug designed to rapidly reverse an opioid overdose.   

“The paramedic that revived me said she thought I was done,” he says.

Naloxone saved his life. Now, he wants to make sure others have the same chance.

Charlottesville has been largely shielded from the opioid crisis, with only six overdose deaths from prescription opioids reported from 2011-2017 (compared to roughly 500 a year, statewide). But the epidemic has still touched local lives, especially as it shifts from prescription opioid abuse to heroin and fentanyl (a synthetic opioid that is often mixed with or sold as heroin, but is 50 times more powerful).

In Virginia, overdose deaths from heroin and/or fentanyl have increased from 153 in 2011 to 938 in 2017, mirroring a nationwide trend.

Charlottesville reported zero heroin deaths in 2011 and 2012, but experienced 13 over the following four years, including four in both 2016 and 2017.   

Twenty-five-year-old Betsy Gilbertson was among those who died in 2016. Loved ones said the free-spirited music-lover had been clean for months before her fatal overdose.

McNeish had been friends with Gilbertson when they were teenagers, but had fallen out of touch with her. He found out about her death when he read her obituary in the Daily Progress.

Still, he continued to use. “It is hard to learn a lesson vicariously when it comes to addiction,” he says. “You always have to learn for yourself.”

Eventually McNeish, who had shot heroin the day after his overdose in Baltimore, got serious about quitting.   

“I started getting really angry about drug use,” he says. “Started being a fascist about being around drugs, and I would get mad when they were around me.”

He made it a week, a month, two months, and then just kept going. “The longer it had been, the easier it was to continue not using,” McNeish says. He’s now been clean for over a year. 

“Some people will hit rock bottom and they’ll just turn around and never use drugs again,” he says. “It just took me three or four tries.”   

McNeish funneled his energy during withdrawal into looking for ways to help others who were addicted. He was inspired by the non-judgmental stance of places like Youth on Fire, a drop-in center in Cambridge, Massachusetts, and the New England Users Union, a harm reduction group in which current and recovering substance abusers work to keep each other safe–even if they’re not yet ready to quit.

Along with his girlfriend, Morgan Freegan, McNeish started his own group here in Charlottesville, Jefferson Area Harm Reduction. They distribute naloxone to users who need it, many of whom they know personally. But they are limited by what they can get for free from the Health Department, and by their work schedules and daily lives.

When a public health emergency was declared in response to the epidemic in 2017, the Virginia Department of Health made naloxone available for free to the public. (It can be bought over-the-counter, but even a generic costs $20 to $40 per dose).

“The fact that anybody can get it, that means it’s out in the communities,” says Dr. Denise Bonds, health director for the Thomas Jefferson Health District. She oversees the distribution of naloxone at the Virginia Department of Health in Charlottesville, and says EMTs in the district have been using it for a few years now.

Those interested in acquiring naloxone must attend a one-hour training session, held on the first Wednesday of the month. They can then pick up two doses per week at the Health Department. But McNeish argues that the treatment should be more available and anonymous. “Someone that’s using and still driving around with drugs in their pocket is going to have a hard time going to the Health Department, sitting through a one-hour training, and even doing paperwork,” he says. In December, he asked City Council to consider starting a group similar to his to help distribute naloxone.   

In addition, McNeish wants the city to look into a needle exchange program to fight the spread of Hepatitis C and HIV that is prevalent in those using intravenous drugs.

“There’s virtually no place to get clean needles,” says McNeish, who contracted Hep C himself but has since been cured. “I’ve seen people use dirty or broken syringes because they don’t have a clean one.”

Currently, the state has only authorized needle exchange programs in the districts with the highest rates of Hepatitis C and HIV, so our district can’t legally distribute syringes. But Bonds says the community is “fairly well-resourced” when it comes to addiction treatment.

Addiction Recovery Systems, Region Ten, and a handful of other facilities now offer medication-assisted treatment, a proven approach that uses drugs like methadone and buprenorphine to relieve addicts’ withdrawal symptoms and cravings. Region Ten also recently opened the Women’s Center at Moores Creek, which has 12 inpatient suites and offers the opportunity for women to keep their young children (under age 5) with them while they receive treatment.

These options allow substance abusers to regain stability in their lives, advocates say.    

It’s support that may be increasingly needed. “It has gotten worse here in the inner circles that I’ve been in,” McNeish says of heroin users. “One out of 10 might die in the next couple of years in that using community.”

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Inside the opioid epidemic: Author Beth Macy tells the story of a crisis 

When the opioid crisis began to unfold, Virginia journalist Beth Macy was at its epicenter. As a beat reporter for the Roanoke Times, southwest Virginia’s largest newspaper, Macy focused on social and economic trends and how they affect ordinary people. The paper covered the stories of the addicted and their families, the corrupt doctors that both over-prescribed opioids and dealt with the aftermath, and the cops, judges, and first-responders caught up in the encroaching epidemic.

Now, more than two decades and two books later, Macy has returned to those experiences for her latest bestseller. 

In Dopesick: Dealers, Doctors, and The Drug Company That Addicted America, Macy traces how the profit-driven Purdue Pharma, a drug company, began aggressively marketing OxyContin for pain, and how the cycle ultimately led to the abuse of heroin when prescription opioids became harder and harder to come by.

I spoke with Macy about the book, and what it was like to be among the first reporting on—and paying attention to—the opioid epidemic. The interview has been edited for clarity and length.

The title of the book, Dopesick, refers to the nightmarish and extremely painful symptoms a heavy drug-user experiences during withdrawal. Addicted users eventually don’t use drugs to get “high,” but to help ease the debilitating sickness that comes from quitting cold-turkey. Would you describe some of the symptoms you’ve witnessed of someone being dopesick?

Beth Macy: Sure. Almost to a person, everyone I’ve interviewed said it’s like the worst flu times a hundred. Night sweats, diarrhea, vomiting, fever, restless legs; it’s a physical pain that everyone I spoke with would spend [their whole days] avoiding feeling.

I know [Dopesick] is an in-your-face title. If people could just understand that number one, a lot of people weren’t [using] to get high, but because they’d been addicted to this drug, some of them initially through no fault of their own, maybe that would go a long way towards the public understanding and reducing the stigma that prevents some of these people from getting life-saving treatment.

Do you remember your first assignment for the Roanoke Times 20, 30 years ago?

I worked [at the Roanoke Times] for 25 years. I was the family beat reporter. My last big series I did was in 2012, a three-part series about heroin. I was following the travails of these two families whose lives had been upended by heroin. One was a 19-year-old kid who had died of overdose. And the other, the same age, his former classmate [Spencer], was about to go to prison for his role of handing him the heroin that led to his death, and of course he was an addicted user himself.

Not excusing what he did, but they were all at an apartment partying and that happened and Spencer got the blame for it. I was following him around trying to figure out what was happening, because everyone was like “what, wealthy white kids are doing heroin in the suburbs?” Nobody had any idea, myself included.

In some way this was my first experience writing about this. I had read when OxyContin first broke out in the coalfields in central Appalachia in the late ’90s, [but] I didn’t quite put together the connection between all the stories until after the series on heroin. And most people in the country didn’t…The pills are chemical cousins, when the pills get hard to get—if there’s no treatment available for people—they go out to the black market and switch to heroin. That was an important thing to get across.

Not only is it somewhat of a surprise that we see the abuse of these drugs in the middle and upper-middle class, but also how… the opioid epidemic began in a rural environment, here in Appalachia.

Right, so for that reason it was easy for it to happen in “politically unimportant” places. Regional media like the Roanoke Times stopped covering the rural hinterland. Newspapers were dying, and politicians stopped giving a crap about poor people from the mountains, as one of my sources Dr. Van Zee said. He was the first doctor in the country, from rural St. Charles, Virginia, in the heart of central Appalachia, to pick up the phone and call Purdue and say, “This drug has got to be addictive. I’ve got kids I immunized as babies showing up in the ER with overdose.” [This was] in the late ’90s. People he had treated for years, farmers and coal miners, most of them in their 70s, losing everything they had built their lives around because of OxyContin.

Your closeness with your sources, who shared their most private feelings during the darkest times in their lives, is remarkable. Why do you think you were welcomed in such a way?

The last third of the book follows the travails of Tess Henry, this beautiful former honor roll student and basketball star and poet. By the time I met [Tess] it was November 2015, she was three years into her addiction. Her dad is a surgeon, her mom is a hospital nurse, a very educated family. She grew up with a second home. I mean just not what you would expect. Not the kind of person that falls through the cracks typically in our society, and yet over and over and over, [clinic after clinic] denied her treatment. They were so worn out with it.

Unlike a lot of other people who may have said “no we don’t care to be interviewed,” [the Henrys] were like “no, come in, see us all,” and I was just so grateful to them. And similarly with some of the first responders I interviewed, drug court judges, recovery coaches, they had seen these cases for so many years, they were like, “Please. We need somebody to speak for us, we’re too worn out to speak for us.”

Dr. Van Zee, who I talked about in the book, he still works 14-hour days and I think he’s 71 now. Sister Beth Davies is 86. She’s the activist nun that also fought Purdue in the early years, she works 12-hour days. She’s a drug counselor. I mean these are incredible people, and they’re so worn out.

I saw a drug-court judge’s hair turn from salt and pepper to white in the course of about 18 months. I was shocked by the last time I interviewed him how much his hair had changed…People were coming up to him at the grocery, in tiny Lebanon, Virginia, begging him to put their children, their adult children, in drug court—people who don’t even have charges. I think I showed up at the time when they were so worn out they didn’t care about the stigma at this point. I mean, some people still do, but a lot of people are just willing to let me in.

I’m sure you were aware there was a good chance that some of the people you were speaking with weren’t going to make it. Did you prepare for that possibility, that these stories may not necessarily have a good ending?

I did. I spoke with one of my good friends, Roland Lazenby, who has written a lot of sports books, a really excellent writer. He’s been writing books a lot longer than I have.

He said you should focus on the heroes because that’s what the readers will come to identify with and those are the people who are going to help get us out of this crisis. He quoted Mr. Rogers—“find the helpers”—and that really became my lodestar, because I knew I could live in the material a bit better if I focused on the families and the first responders that were fighting back.

You know at no point in the book do I hang out with active users in the middle of their using. I hang out with active users but…I’m not necessarily living in their homeless world or watching them inject heroin into their veins. At no point do I watch anybody use or describe anybody using. That was partly to protect myself. And also so many people in America have no idea how bad this epidemic is. I wanted to write something that would illuminate it and make them care and make them really understand how hard these families and first responders are working to keep their loved ones alive.

At the end, did I know that I was eventually going to get a call that one of my main sources in the book had died? I had [seen] the data. It takes the average user eight years of fortified treatment to get one year of sobriety, I knew [with] fentanyl [emerging], people didn’t have eight years.

Tess Henry had only six. And I knew eventually I would get the call from her mother but didn’t know when and then the day after Christmas. [But] it wasn’t the call that we thought.

[Tess] was dead but she was murdered. She was left to fend for herself in this faraway city where she had relapsed and been kicked out of abstinence-only treatment. It’s another huge telltale sign of how important treatment is, that we allow the narrative that abstinence-only works, and that hurts people with opioid abuse disorder. People continue to fall through the cracks unless they are given easy access to medication-assisted treatment.

Can you elaborate a bit on medication- assisted treatment and why this form of treatment is a big point of a contention between recovery centers, law enforcement, addicts and their families, and the medical community?

Maintenance drugs are basically weak opioids that block the receptors [in the brain that allow you to get high]. Buprenorphine and suboxone…if you’re taking them like you’re supposed to, and then you shoot up heroin, you won’t feel the effects.

Study after study shows, people who take these drugs correctly with counseling are less likely to [commit] crime, less likely to relapse, and less likely to die. They are 50 to 60 percent [less likely to die], compared to abstinence-only models that show only a 6 to 10 percent (success rate). Fifty to 60 percent is pretty good, but that’s still 40 to 50 percent that it doesn’t work for all of the time, and a lot of people have to go through numerous attempts.

There is also a lot of diversion and abuse, which is why law enforcement is against it. But still, if you say your goal is to prevent overdose, there is no question that it is the number one way to do that. It’s the low-hanging fruit.

Is it accurate to say the opioid epidemic has the signs of getting worse before it gets better?

It’s completely accurate. The latest statistics from the Centers for Disease Control show that we lost 72,000 [people to drug overdose] last year, which is up 10 percent from the year before, which are largely due to opioids.

The few states that have MAT widely available, emergency room to MAT programs as a standard, and also have syringe exchanges, and harm-reduction programs in place—there’s three New England states, Massachusetts, Rhode Island, and Vermont—we’re starting to see a slight decline. But overall, epidemiologists and public health experts have shown it’s going to plateau sometime after 2020. That’s unnerving, “sometime after 2020.” These [three New England states] were early passers of Medicaid expansion. In Virginia, we just passed it. It is the number-one way to get people that don’t have insurance into treatment.

This interview was originally published by 100 Days in Appalachia, a digital news publication incubated at the West Virginia University Reed College of Media in collaboration with West Virginia Public Broadcasting and the Daily Yonder.

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Would UVA allow guns on campus?

Capitalizing on fears from high-profile school shootings, a national grassroots organization has formed at universities and colleges that advocates for the right to carry concealed weapons on campus. According to their website, Students for Concealed Carry on Campus (SCCC), citing events at Columbine and Virginia Tech, contend "the only way to stop mass murders…is to have responsible citizens in the classroom and on campuses…carry their licensed handguns." Sixty schools have active chapters of the SCCC, including four Virginia institutions: George Mason University, James Madison University, Christopher Newport University and Northern Virginia Community College.

So what about UVA? The University prohibits students or employees from bringing or carrying firearms on any University-owned or -operated property, without express written permission by the University Police Department. So far, no one has stepped up to spearhead an SCCC chapter.

Andrew Ferring, an undergraduate student in the School of Nursing and president of the Virginia Rifle and Pistol Club at UVA, says his organization has no official view on the campus gun ban at this time. He can only offer his personal view: "I think that concealed weapons on campus is a definite possibility, there are two sides to every argument. But I think you would have to look at how it is done."

"I think a lot of people see concealed carry [weapons] as a deterrent. If you don’t know [if] somebody is armed, maybe that will deter people," Ferring says. "You look at a college campus, how different is that from any place else? What draws the line between college campuses and malls…where concealed carry permits are allowed?"

Lieutenant Melissa Fielding of the UVA Police Department feels that introducing concealed weapons on Grounds would complicate her job and create dangerous situations. "Concerns with concealed weapons on campus would arise when officers arrive on a scene with an active shooter and are faced with determining the good guy from the bad guy," says Fielding.
 
Last year, the National Rifle Association supported a failed legislative effort in Virginia that would have permitted students with concealed weapons licenses to carry their firearms on campus, though the organization has toned down its talk since the tragedy in Blacksburg.

SCCC stresses the fact that they support only licensed concealed weapon holders to carry handguns on campus. The group encourages its members to become locally active with elected officials and media outlets to "overturn University ‘gun-free’ campuses" and lobby for licensed persons to carry their concealed firearms on campuses.—

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