Jeremy Samples, senior advisor for the Legislature’s Joint Committee on Health, testified Monday that West Virginia’s substance use disorder (SUD) crisis has had devastating effect on policies, communities, and families.
Mr. Samples said West Virginia has led the nation since 2010 in fatal overdose deaths.
“I won’t bury the lead,” Mr. Samples said. “We have not made enough progress. We’re nowhere near where we need to be.”
West Virginia is 151% higher than the best state and 85% higher than the national average in overdose deaths. He added that all strategies and expenditures must be reassessed.
Mr. Samples noted that despite billions of dollars and involvement of several federal agencies, the national overdose death has quadrupled, and the impact has been greatest in West Virginia.
Citing data, Mr. Samples told the committee that the drug crisis has been estimated to cost West Virginia $11.3 billion annually. In 2022 there were 1,335 known overdose deaths, and the state has recorded a 1,680% increase in overdose deaths since 1999.
Medicaid is the largest substance-abuse payer in the state through the Substance Use Disorder (SUD) waiver that waives federal authority and allows the state to go to outside parameters. The SUD waiver program spent $12 million in 2019 and $129 million in 2023. The expenditure is projected to be $161 million in 2027.
Noting that recovery homes and other resources are starting to make progress, Mr. Samples said, “There’s a lot of promising things happening,” but he added the disclaimer, “We’ve not had a lot of success. We’ve had failures.”
Trends around the country from 2023 to 2024 show that West Virginia is not keeping pace with decreases that other states are seeing. That affects overall life expectancy, and West Virginia has the highest death rate in the country for the working-age population. Mr. Samples added that drugs are directly linked to West Virginia’s child-welfare crisis. West Virginia has led the nation in children in foster-care entry rates since 2010.
West Virginia also leads the nation in neonatal abstinence syndrome (NAS), defined as a baby being fully addicted at birth. Mr. Samples described 2,500 babies who are exposed annually to drugs in the womb as “a demographic tsunami.”
After presenting the effects of substance use disorder, Mr. Samples provided some solutions. He said the passage of Senate Bill 820 was critical and drives quality performance measures. He stressed that the state has to measure what matters and that it is most important to measure every aspect of policies and expenditures.
Mr. Samples presented 10 core societal metrics and then specific societal measures. He included 10 critical outcomes for individuals and proposed policy solutions. The top three of the policy recommendations were:
· Mandatory treatment (Casey’s Law)
· SUD Transparency Act: SUD Outcome and Expenditure Dashboard
· Improve CPS Management of Cases with Drug Addiction
In his concluding remarks, Mr. Samples said that evidence-based and best practices are good guideposts but haven’t translated into success in West Virginia. He advised the committee to look at what works.
“If it works, I’m all about it. It has to work, and it has to be measured,” he said. “We can’t sustain 2,500 babies being exposed to substances in the womb.”
He added that he’s leaving this legislative position next month but will always be available.
The next presenter was Jonathan Board, Executive Director of the First Foundation, which was created to receive and disburse anti-opioid funding.
“We must get this right the first time,” Board said.
National litigation regarding the opioid crisis began 10 years ago. In 2023, Senate Bill 674 created the First Foundation, and its first meeting was in November 2023. He said the new nonprofit has had a workshop, developed policies, formed committees, and set protections for the fund.
Core strategies focus on reverse medications, neonatal abstinence syndrome, and prevention programs. Approved uses of funds are in place. They include treatment, recovery, and support for people involved in criminal justice programs.
West Virginia received the highest per-capita settlement in the country. The funds are contained in three “buckets”:
· Counties and Municipalities: 24.5%
· The Foundation: 72.5%
· State Attorney General: 3%
The Foundation structure includes a Board of Directors made up of six regions with an elected director and five gubernatorial appointees. Its mission statement is, “Empowering
West Virginians to prevent substance use disorder, support recovery, and save lives.”
The Foundation has a public access policy and, in answer to a question from Delegate Mike Pushkin of Kanawha County, follows open meetings law.
Mr. Board said the next steps include finalizing staff, opening offices, and establishing the application process, among several other tasks.
The final presenter was Dr. Steven Lloyd, who was in his first day on the job as the new Executive Director of the Office of Drug Control Policy. He told the committee that he has been to many communities and has started looking at outcomes.
“We have to have the courage to move money from things that aren’t working to things that are,” Dr. Lloyd said.
Revealing that he has been in recovery for 20 years, Dr. Lloyd offered a bathtub analogy. A person can leave the bathtub and recover, flop back and forth, or die.
“If we allocate all the money to reversal drugs, we will save some lives, but we haven’t changed anything. We have done nothing to address shrinking the number of people in the bathtub,” Dr. Lloyd said.
He pointed out that addiction has changed because long-term use was the main cause of death in the past, but now one use can kill because of fentanyl in drugs. Describing his own addiction, he said people confronted his addiction 20 years ago.
“I stepped into a system of care with a high success rate,” he said. “We have to talk about strategies that work,”
Dr. Lloyd said predictive analytics and data modeling will reveal other measurable things.
“West Virginia is ground zero for the opioid crisis,” he said. “We can show the rest of the country how to get out of this.” |