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West Virginia Delegate Don Purdue, Chair, Health and Human Resources Committee, spent much of the 2007 legislative session focusing on the issue of medication-assisted treatment for opiate addiction.
Could you talk about substance abuse in West Virginia and how you became interested in the topic?
About two years ago, four teenagers were murdered in Huntington, W. Va., the largest city close to my home. The perpetrators were never found, but it was assumed and later proven that the murders were drug-related. Because those murders struck the community—and me—very hard, I began to look at the issue of substance abuse from a different perspective. We know about enforcement. We know what it does and what it attempts to do. We also know that it is extremely difficult to achieve results with enforcement alone. We also know that treatment programs, such as methadone programs, are important to the process, but they aren't successful by themselves. Dealing with substance abuse is an incremental process.
The one missing element was long-term substance abuse recovery. We have only 264 long-term beds in West Virginia., so we need to distinguish between treatment and recovery. Anyone who is in recovery for substance abuse will be in recovery for his or her entire life.
Government has not engaged the recovery community as much as it should. Those folks can move their peers in a way that even professionals can't. We can supply professional help—psychiatrists, psychologists, social workers—but they won’t be as effective as someone in the recovery community.
With only 264 long-term substance abuse beds in West Virginia, long-term care will not be available to treat the Charleston street walkers who are addicted to crack. If we’re going to have meaningful programs to deal with this problem, every available resource must be engaged, every possible avenue must be explored—law enforcement, treatment, recovery. If we engage only one or two of those resources, we won't be successful—they all must be engaged.
How do you see the legislature being involved in 2008?
In the West Virginia legislature, I’m pressing to arrive at a funding offer for the facility we’re building in Huntington—I’m not sure how exactly much money it will take—to use it as a pilot program for several other sites in the state. I’ve discussed this with the governor’s office and, interestingly enough, our share of the oxycontin settlement was $44 million. Because of how the opinion was written, however, the entire settlement had to be directed to law enforcement. Our governor set aside $3 million of that $44 million for what he referred to as replication efforts in his State of the State address. I think it was his nod to what we’re trying to do. I anticipate the legislature this year will approve financing to continue the pilot project in Huntington and, hopefully, will expand it to Charleston.
Can you talk about West Virginia's problem with methadone deaths?
It's a terrible problem. It’s easy to suggest that it is caused by the growth of methadone clinics. Somewhere between 4,000 and 5,000 people per day, seven days a week, visit West Virginia methadone clinics, and the state population is only 1.8 million. Many come from other states where they have no access to such programs. It’s too easy lay the blame for all those deaths on the clinics. That may be part of the problem, but methadone was prescribed inappropriately by physicians and used inappropriately by the people who took it.
When we began to discuss this in the legislature last year, we had committees that met on methadone treatment. Someone who lives near me in Wayne County, W.V. called to tell me, "Well, my daughter has so much trouble sleeping at night, I give her some of my Xanex." Of course, that could be lethal. When I explained that to him, he was shocked.
The educational coefficient has been lacking. Because the number of methadone clinics was growing so rapidly, it became difficult to educate the public about the problems. In 2007, we put a moratorium on the development of new clinics until rules are provided that are acceptable to the legislature. That moratorium is still in effect, and I don’t expect it to be lifted this year. We still consider it an ongoing project to determine how it fits within the tapestry of drugs and substance abuse treatment.
Is the state considering any alternatives to methadone?
Absolutely. We actually wrote into the rules two years ago that each person who comes to a methadone clinic is to be given information about suboxone. That was a small step. More than one initiative has started this year to encourage more physicians to become educated about and licensed to provide buprenorphine.
Research and development are ongoing to develop even more alternative [medications to treat addiction]. I see the value in this because I know that some people cannot recover through abstinence. On the other hand, I don’t think enough opportunities have been offered to those people.
How involved is Medicaid in substance abuse treatment?
Medicaid in West Virginia does not pay for many of the substance abuse initiatives we would like to see used. A plan amendment is required to create different codes. A major problem for Medicaid patients who need mental health services is that our mental health facilities are overwhelmed by substance abusers. This overcrowding has caused us to consider building a forensic hospital to separate substance abusers from people who need mental health services that are not related to substance abuse. Our Medicaid commissioner is attempting to devise a plan to accommodate both behavioral health patients and substance abuse patients.
You mentioned border areas. Are many people from other states in your facilities?
Yes, although an adversarial relationship has developed in many cases between the methadone clinics and the people who own them. Of the eight clinics in West Virginia, seven are owned by one company. This relationship has bred such a lack of trust that those who own the methadone clinics make it difficult to obtain the information we need.
Federal law also presents difficulties. We want to know who these methadone patients are to ensure that they aren't shopping from clinic to clinic and, if they are to intervene in some way. Federal regulations don't allow to do that, however. This area is protected even more deeply and strongly than through HIPPA. That put us in an odd juxtaposition. We would like to be able to regulate clinic use more effectively, but in many cases our hands are tied. If we suspect there are issues with our methadone clinics, it is difficult to define them. People like me think that's unfortunate, and sometimes it makes people angry. I think a state should be able to protect the health of its citizens, and I’m not so sure anyone is protecting the interests of those who go to methadone clinics.
About two years ago, four teenagers were murdered in Huntington, W. Va., the largest city close to my home. The perpetrators were never found, but it was assumed and later proven that the murders were drug-related. Because those murders struck the community—and me—very hard, I began to look at the issue of substance abuse from a different perspective. We know about enforcement. We know what it does and what it attempts to do. We also know that it is extremely difficult to achieve results with enforcement alone. We also know that treatment programs, such as methadone programs, are important to the process, but they aren't successful by themselves. Dealing with substance abuse is an incremental process.
The one missing element was long-term substance abuse recovery. We have only 264 long-term beds in West Virginia., so we need to distinguish between treatment and recovery. Anyone who is in recovery for substance abuse will be in recovery for his or her entire life.
Government has not engaged the recovery community as much as it should. Those folks can move their peers in a way that even professionals can't. We can supply professional help—psychiatrists, psychologists, social workers—but they won’t be as effective as someone in the recovery community.
With only 264 long-term substance abuse beds in West Virginia, long-term care will not be available to treat the Charleston street walkers who are addicted to crack. If we’re going to have meaningful programs to deal with this problem, every available resource must be engaged, every possible avenue must be explored—law enforcement, treatment, recovery. If we engage only one or two of those resources, we won't be successful—they all must be engaged.
How do you see the legislature being involved in 2008?
In the West Virginia legislature, I’m pressing to arrive at a funding offer for the facility we’re building in Huntington—I’m not sure how exactly much money it will take—to use it as a pilot program for several other sites in the state. I’ve discussed this with the governor’s office and, interestingly enough, our share of the oxycontin settlement was $44 million. Because of how the opinion was written, however, the entire settlement had to be directed to law enforcement. Our governor set aside $3 million of that $44 million for what he referred to as replication efforts in his State of the State address. I think it was his nod to what we’re trying to do. I anticipate the legislature this year will approve financing to continue the pilot project in Huntington and, hopefully, will expand it to Charleston.
Can you talk about West Virginia's problem with methadone deaths?
It's a terrible problem. It’s easy to suggest that it is caused by the growth of methadone clinics. Somewhere between 4,000 and 5,000 people per day, seven days a week, visit West Virginia methadone clinics, and the state population is only 1.8 million. Many come from other states where they have no access to such programs. It’s too easy lay the blame for all those deaths on the clinics. That may be part of the problem, but methadone was prescribed inappropriately by physicians and used inappropriately by the people who took it.
When we began to discuss this in the legislature last year, we had committees that met on methadone treatment. Someone who lives near me in Wayne County, W.V. called to tell me, "Well, my daughter has so much trouble sleeping at night, I give her some of my Xanex." Of course, that could be lethal. When I explained that to him, he was shocked.
The educational coefficient has been lacking. Because the number of methadone clinics was growing so rapidly, it became difficult to educate the public about the problems. In 2007, we put a moratorium on the development of new clinics until rules are provided that are acceptable to the legislature. That moratorium is still in effect, and I don’t expect it to be lifted this year. We still consider it an ongoing project to determine how it fits within the tapestry of drugs and substance abuse treatment.
Is the state considering any alternatives to methadone?
Absolutely. We actually wrote into the rules two years ago that each person who comes to a methadone clinic is to be given information about suboxone. That was a small step. More than one initiative has started this year to encourage more physicians to become educated about and licensed to provide buprenorphine.
Research and development are ongoing to develop even more alternative [medications to treat addiction]. I see the value in this because I know that some people cannot recover through abstinence. On the other hand, I don’t think enough opportunities have been offered to those people.
How involved is Medicaid in substance abuse treatment?
Medicaid in West Virginia does not pay for many of the substance abuse initiatives we would like to see used. A plan amendment is required to create different codes. A major problem for Medicaid patients who need mental health services is that our mental health facilities are overwhelmed by substance abusers. This overcrowding has caused us to consider building a forensic hospital to separate substance abusers from people who need mental health services that are not related to substance abuse. Our Medicaid commissioner is attempting to devise a plan to accommodate both behavioral health patients and substance abuse patients.
You mentioned border areas. Are many people from other states in your facilities?
Yes, although an adversarial relationship has developed in many cases between the methadone clinics and the people who own them. Of the eight clinics in West Virginia, seven are owned by one company. This relationship has bred such a lack of trust that those who own the methadone clinics make it difficult to obtain the information we need.
Federal law also presents difficulties. We want to know who these methadone patients are to ensure that they aren't shopping from clinic to clinic and, if they are to intervene in some way. Federal regulations don't allow to do that, however. This area is protected even more deeply and strongly than through HIPPA. That put us in an odd juxtaposition. We would like to be able to regulate clinic use more effectively, but in many cases our hands are tied. If we suspect there are issues with our methadone clinics, it is difficult to define them. People like me think that's unfortunate, and sometimes it makes people angry. I think a state should be able to protect the health of its citizens, and I’m not so sure anyone is protecting the interests of those who go to methadone clinics.
(Editor’s note: Central registries exist to ensure that clients do not enroll in multiple programs to obtain additional methadone. By having clients sign a consent form giving them permission to check these registries, programs can check clients without violating HIPPA.)
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