By CHARLIE BOOTHE
Bluefield Daily Telegraph
BLUEFIELD, W.Va. — Eight West Virginia counties, including Mercer and McDowell, have been targeted for a new program that will try to prevent the spread of infectious disease related to opioid abuse.
With money provided by four federal grants, West Virginia University will head the program, which combines research, health services and community involvement in harm reduction strategies.
Dr. Judith Feinberg, a physician with the WVU School of Medicine and co-leader of the project, said the state has the highest drug overdose fatality and hepatitis rates in the nation and infectious diseases often follow drug abuse epidemics.
“We have not seen an HIV outbreak yet,” she said. “But it’s a ticking time bomb for us, especially in rural areas where the local health system’s ability to detect and mitigate an HIV outbreak may not be well developed.”
Those diseases are spread by use of “dirty needles,” she said, and that includes injecting heroin or prescription drugs that have been crushed and dissolved into a solution.
Armed with the $1 million grant, Feinberg and co-leader Dr. Gordon Smith, professor at the WVU School of Public Health, will develop an integrated prevention, harm reduction and treatment team across the region in partnership with local communities to identify and mitigate the diseases associated with abuse.
“The success of this approach will be driven by input from local communities and public health agencies,” Feinberg said. “We will work with them to coordinate and improve screening, prevention and treatment for hepatitis C, HIV and other infections associated with injection drug use.”
Feinberg said the reasons the eight counties were chosen is the high incidence of overdoses.
McDowell County has the second highest per capital overdose death rate in the United States. Mingo County ranks seventh, Wyoming County 16th, Raleigh County 18th, Logan County 20th, Boone County 22nd, Mercer County 147th and Kanawha County 209th.
“The threat of an HIV outbreak here is among the highest in the U.S.,” Smith said. “Based on the CDC’s analysis of a 2014-15 outbreak of HIV and hepatitis C in rural Indiana, and the high rates of poverty, overdose deaths, and hepatitis B and C infections we see in this region, it would not take long for a small number of HIV cases to set off a serious health crisis.”
“We are losing a whole generation of young people here,” Feinberg said. “Victims are in their teens to the early 40s.”
In McDowell County, about 40 percent of children are raised by grandparents, she said, often due to the drug epidemic, and many babies are born addicted.
“The purpose of harm reduction is to keep them (addicts) alive and healthy enough to make the decision to go into recovery,” she said. If they get a disease, their health can spiral down quickly, so it’s crucial to understand where any outbreaks are.
Another dangerous disease associated with abuse is endocarditis, when the heart is infected from bacteria associated with injections.
“You can see a growing number of young people in hospitals with heart infections from using dirty equipment,” she said. “They inject bacteria right into their blood and it sticks to the lining of the heart.”
It’s “very serious,” she said, and can take up to two months of intravenous antibiotics to treat and may severely damage the heart.
This project is long-term and entails considerable research.
The first phase is a two-year effort to develop an evidence-based road map, which requires working in the communities and gathering information.
“We will assess services available and what communities want,” Feinberg said. “We will start in the local health departments. We will see how people feel about harm reductions, like needle exchange programs.”
Those programs provide clean needles, preventing the use of dirty ones.
“We have to do a good job collecting data in the first two years and get the other funding later,” she said, adding that the funding for implementation will be much greater.
“It also involves developing a novel strategy to rapidly identify the emergence of HIV and other complications of injection drug use in isolated rural communities and use it to target communities at highest risk,” Smith said. “If this first planning phase is successful, increased funding for a further three years will enable … implementation of a comprehensive program to prevent the devastating effects of injection drug use in these hard-hit communities.”
“There is a lot of unnecessary suffering and death that we can help alleviate,” Feinberg said.
These drugs “highjack” the brain, she said, and people are taken over by the drug.
Feinberg said they are “excited” about getting started on the project, which will begin in mid-September with a meeting in Washington, D.C., and she hopes communities will share that excitement.
“It’s not going to be easy,” she said of fighting the epidemic and associated problems. “But if we don’t try, shame on us.”
The project is officially called Rural West Virginia Responds to Opioid Injection Epidemics: From Data to Action, and is supported by the grant for two years from the National Institute of Drug Abuse, a part of the National Institutes of Health, the Centers for Disease Control and Prevention, and the Appalachian Regional Commission.
It is also supported by the Substance Abuse and Mental Health Services Administration and the West Virginia Clinical and Translational Science Institute.
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