A look at how rural America, already devastated by opioids, is about to get hammered by COVID-19.
Years ago former Defense Secretary Donald Rumsfeld argued that the solution to an intractable problem was to create a bigger problem. He suggested that this would subsume the other problem and thus somehow make a solution possible.
Certainly the coronavirus pandemic we face is as big a problem as it gets. Yet rather than helping to solve lesser problems, it is exacerbating many of them. One of them is the opioid crisis and the continued hollowing out of rural America.
In this week’s WhoWhatWhy podcast we talk with Eric Eyre, Pulitzer Prize–winning West Virginia journalist and the author of Death in Mud Lick, about how rural America, already devastated by the opioid crisis, is about to be rocked by COVID-19.
Rural America, Eyre tells us, has no trust in the medical or pharmaceutical industry, is lacking in hope for its economic future, and has already experienced high numbers of deaths from opioids. It’s a place where 25 percent of the people have no access to broadband, and where the loneliness of social distancing feeds into the original causes of opioid addiction. These are communities with limited healthcare facilities, and people made more vulnerable to COVID-19 by the physical damage wrought by opioids.
As if that weren’t bad enough, Eyre reports on efforts by the pharmaceutical distributors to use the pandemic to escape from existing opioid lawsuits.
It’s a grim reminder that all the pain is not just in the big cities.
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|Jeff Schechtman:||Welcome to the WhoWhatWhy podcast. I’m your host Jeff Schechtman.
Suddenly the nation turns its lonely eyes on the pharmaceutical industry as if it might be the ones to save us from the ravages of COVID-19. And maybe they will, and maybe it will be from some of the profits that came from an industry that distributed tens of millions of opioids that devastated much of small-town America. The problems of America that existed before March 1st are not going away. In fact, some of them, like the opioid crisis itself might even be exacerbated by it. After all, the loneliness and sadness that drove so many to opioids will only be magnified by social distancing. Because we’re so focused on one thing now, it does not mean we need to abandon all the problems that existed before patient zero. One thing is for sure, like disease itself, the problems will be back and more virulent than ever.
|Jeff Schechtman:||Joining me to talk about the opioid crisis and perhaps it’s nexus with today’s pandemic, I am joined by Pulitzer Prize winning reporter, Eric Eyre. Eric has been a reporter for the Charleston Gazette-Mail since 1998. A couple of years ago, his investigation into the massive shipments of opioids to West Virginia’s coal fields was awarded the Pulitzer Prize. He’s the author of Death in Mud Lick, and it is my pleasure to welcome Eric Eyre here to the WhoWhatWhy podcast. Eric, thanks so much for joining us.|
|Eric Eyre:||Well, thanks for having me on, and you’re spot on in your analysis. We’re really fighting a war on two fronts here. We’ve got the battle of West Virginia’s opioid crisis in the shadow of coronavirus.|
|Jeff Schechtman:||And to what extent, and we’ll talk about the depths of it in a moment, but to what extent is the opioid crisis still going on? To what extent are the pills still readily available, and the use still taking place at alarming rates?|
|Eric Eyre:||Well, still our overdose rates are high as they’ve ever been. There was a little dip last year. I expect that that dip is going to turn into a surge as this coronavirus continues. We’ve got a lot of people in treatment, and we’ve got thousands of people in substance abuse treatment for opioid use disorder. And a lot of the success of that treatment is having people in groups, group therapy, where you have 10 to 15 people in a room, and you talk about what you’re going through, and you share stories. Well, that’s all gone now in this era of coronavirus. I guess you can do it a little bit over the phone. Most of these people, you’d think maybe you could do it on Zoom, or something like that. But 25% of our population doesn’t even have broadband, so getting access to broadband is difficult.|
|Eric Eyre:||You also got these requirements that people come every day to get their medications, Suboxone, which reduces cravings for opioids. And they have to line up in crowds. So it’s hard to separate people and keep them from crowding. And I think you can get a little bit away from that with some telemedicine initiatives. Yeah, and also the impact on the grandparents. Our population, we have the highest percentage of older adults in the country. So I’m really concerned about their safety. And these grandparents are raising their kids, whose parents are suffering from opioid use disorder. So it’s again, like I said, it’s definitely a war on two fronts, and we have a hollowed out infrastructure already. Trying to deal with coronavirus is an incredible challenge.|
|Jeff Schechtman:||You mentioned the grandparents taking care of children all the more difficult with schools closed.|
|Eric Eyre:||Oh, absolutely. And kids want to get together in groups. We’re under a stay-at-home order here in West Virginia, I think you guys are there in California. And you do see these kids gathering in groups and stuff like that, because they really don’t want to stay inside. So, yeah. You’ve got some real challenges for the grandparents keeping these young children home and safe.|
|Jeff Schechtman:||Talk a little bit about how the community in these small towns, places like the towns you’ve written about in West Virginia, how they view the pharmaceutical industry and the way opioids were just poured into these communities.|
|Eric Eyre:||They feel they’ve been targeted, they feel they’ve been poisoned. As I mentioned in my book, you have towns like Kermit, West Virginia, which is population 382, and we uncovered that they had nearly nine million prescription opioid pills poured into the town, and into one single pharmacy in two years. You’ve got cases like that all over the state, and all over Appalachia, Eastern Kentucky, where you have these towns of a few thousand people with millions upon millions of opioid pills. So there’s a real anger about that, and there’s a real anger at the drug companies, and there are a lot of lawsuits pending right now against the companies. But people feel that, again, they were targeted for this, and they want to see that the drug companies be held accountable.|
|Jeff Schechtman:||Given that attitude going in, how are they looking at this current crisis? Given the lack of trust that exists among people in these communities, lack of trust towards government officials, towards the healthcare industry, the pharmaceutical industry, what do you see is that impact with respect to dealing with the current crisis?|
|Eric Eyre:||Well, yeah. I mean, there’s certainly a lack of trust of the medical community as well, because a lot of these pills were distributed by pain pill clinics, where they had some shady doctors, and these pharmacies that were part and parcel with these illegal pain clinics. So there is a real distrust. And I’ve seen stories lately now where some of the same companies that I wrote about, there was a really interesting article about how they were talking with investment bankers a week ago about how they could leverage the coronavirus outbreak to duck and dodge responsibility for the opioid crisis. Because there’s upwards of 3,000 lawsuits pending across the country, trying to hold the drug companies accountable. But those lawsuits now will be delayed, there’ll be further delays. I mean, they’ve been delayed for upwards of … they started about two or three years ago, three years ago.|
|Eric Eyre:||But now the companies that I wrote about are trying to spin, in this age of coronavirus, that they’re delivering the goods, they’re the good actors. They were up on that recent press conference with President Trump, they were up talking about how they were there to help save the day, they were getting needed medical supplies to hospitals and that sort of thing. So again, there’s this real story about how they’re trying to use the opioid crisis to dodge and duck responsibility, how they’re trying to use the coronavirus to duck accountability for the opioid crisis.|
|Jeff Schechtman:||Does anybody believe them, and is it your sense that because this larger problem has come along, perhaps they’ll be successful in ducking that, and there’ll never be a day of reckoning for these companies and what they’ve done?|
|Eric Eyre:||It’s a good question, because they make the case that without people to deliver drugs, how are people going to get drugs? And they’re really good at shipping drugs, they’re very efficient at shipping millions and millions of pills, millions and millions of drugs. And not just opioids, blood pressure medications, just the whole gamut. So I think their argument in court will be, “Hey, there’s Purdue Pharma. Okay, maybe they’re bankrupt. You can put them out of business because they were marketing opioids and telling lies about their addictive qualities. But look at us, the distributors, the ones that ship the drugs to the pharmacies. We’re a vital part of America, and putting us out of business would be devastating to America, especially amid a crisis like coronavirus.”|
|Jeff Schechtman:||Talk a little bit about the loneliness that drove a lot of people to opioids in the first place, and how that may be exacerbated by the current situation.|
|Eric Eyre:||Yeah. I mean, that’s a really good point there. There is a feeling of isolation here. We have hollows and mountains, and with the downturn in the coal industry, there’s a lack of hope for many people. There’s little to do on weekends, so people were driven first to prescription opioids, hydrocodone and oxycodone, or oxycodone. Then heroin, then heroin mixed with fentanyl. And now meth oftentimes mixed with fentanyl. All those are a deadly combination, they can kill you when you take too much. So yeah, there’s this despair. And you’re right, I worry that as people are more isolated now, not coming together, I fear that the, as you said at the very beginning, that the opioid crisis will in fact be exacerbated.|
|Jeff Schechtman:||There’s also the economic impact of all this. Things were bleak on the economic front in a lot of these small towns, some of the towns that you’ve written about. Given where we are now, it’s very possible that they will be even bleaker economically for a long time to come as a result of this.|
|Eric Eyre:||Absolutely. A lot of people, Jeff, that are in recovery, work in like the restaurant industry, at bars and that type of thing, all the things that are now closed. But having a job gave them a sense of pride. We have entire restaurants here that exclusively employ people in drug recovery, and those restaurants are now closed. So where are the people to go? What are they to do? How are they to make money? I mean, one possibility is they get these strips of the medication Suboxone, that also can be diverted and abused. And if you’re down on your luck, and you’re not getting any money, you might start going to the doctor, getting your medication-assisted treatment, but then selling it to buy food, put food on the table. So I just think that there’s a chance that there’s going to be a much more potential for diversion as people lose their jobs and become more desperate.|
|Jeff Schechtman:||Talk a little bit about how the community views the work that you do. And by that, I mean the local journalism, the local focus on this, and really bringing national attention, in your case, to these problems. Do they want the spotlight on this, or do they really want to hide in the shadows?|
|Eric Eyre:||Well, that’s a really good question. They did want the spotlight on it back in 2017, but we had so many out-of-state, and actually international film crews that were coming here and filming the scenes with people passed out on the ground with needles in their arms. There were so many documentaries, I can’t count the number of documentarians that were here. So many television programs from Germany, from Italy, Denmark, Sweden. They would come here, the UK, and do these stories about the tragedy here. And they were very accommodating at first, the local city officials, the first responders. But then they got so worn out, I mean, not just from the media attention, but just so worn out from having to revive so many people who had overdosed.|
|Eric Eyre:||And so I guess about a year ago, they said, “Enough is enough. This is painting, shedding a bad light on the state. Nobody’s going to want to come to a place that’s struggling with so many of these problems, where people are dying left and right of drug overdoses.” So they’ve been a lot more resistant to that in the national and international attention.|
|Jeff Schechtman:||Tell us a little bit about the political leadership in these small communities.|
|Eric Eyre:||A lot of them act now that they didn’t know what was going on back then, and that’s pretty hard to believe. You’ve got a real mix. I mean, you’ve got some people that are really out in the forefront with really good intentions. Just giving an example, there was talk of this settlement with this lawsuit, with all these lawsuits as they’d settle for upwards of $50 billion. And of course, many of us would like to see that money go towards opioid use disorder treatment, some residential facilities, some bricks and mortar, increased treatment programs, and the like. But the way they had this settlement structured, is that the cities and counties could do whatever, and towns could do whatever they wanted to do with the money that they got from the settlements. So if they wanted to buy a trash truck, or make a new basketball court, or build a new basketball court in town, they could use the money for that instead of using the money from where it really should be put.|
|Jeff Schechtman:||You mentioned to me before we started, was that the coal mines right now are still open, there is people still working in them. Talk about that.|
|Eric Eyre:||Yeah, they listed that as an essential business along with supermarkets, and of course gun stores are listed as essential. I mean, I worry about that, but I did talk to a friend the other day, that he thought that most of the mining companies were taking this seriously, and they weren’t going to put coal miners in harm’s way, especially the ones working underground. Now, there’s other methods of mining, mountaintop removal and the like. So there’ll be less of a chance that the disease would spread. I mean, we’re very fortunate right now. We have just two deaths to coronavirus in the entire state. Of course, like everywhere, we’ve had a lack of adequate testing. We’ve identified over, I think about 200 coronavirus cases now. But I do worry that we tend to be at the back end of a lot of things that go on in the country.|
|Eric Eyre:||So I worry that over time, while the curve starts decreasing in places like California and New York, that we’ll have an increase. And again, as I said, our infrastructure for handling that, our rural hospitals have been closing. I worry that we’re going to be hit with this for a long time moving forward.|
|Jeff Schechtman:||What is the altitude as people hear about all the deaths from coronavirus and the possibility of death coming to West Virginia, given the deaths that everybody has suffered as a result of the opioid crisis? Does it have a different perspective?|
|Eric Eyre:||There was a feeling that certain people got themselves into this, that addicts shouldn’t have the same rights as everybody else. I mean, this is coronavirus, it’s hitting everybody, rich and poor, old, but also some young. But yeah, I don’t think there’s any kind of different attitude. I just think it’s like you’re running a marathon, you’re getting near the finish line. We were finally turning a corner on the opioid crisis, and moving in a positive direction. And then all of a sudden, you’re hit by this new wave, this new tsunami coming in, fearful that we’re going to be right back to where we were, and that’s losing upwards of 1,000 people every year in a small state of 1.8 million to opioids.|
|Jeff Schechtman:||Is it as easy for the population to get opioids there today?|
|Eric Eyre:||No, there’s much more restrictions, prescriptions have been tightened up. You can’t get your 90-day supply of oxycodone anymore. There’s new reporting requirements for the drug distributors. All the attention from the story that we’ve done and others have done, have really put the spotlight on them, and I think it’s a lot harder. We don’t have these pill mills popping up everywhere, where they were just churning out prescriptions for opioids by the thousands every day, where people lined up around the block to get their oxycodone. So it has gotten better in that respect.|
|Jeff Schechtman:||One of the other aspects is that we have seen that the COVID-19 has had a tougher impact on those with preexisting health conditions. Is there concern that some of those that have been suffering the after- effects of opioid addiction become more vulnerable?|
|Eric Eyre:||Well, that’s really a good question. I mean, that’s a really good point. We have the highest rate of disability in the country. We have the highest rate of disease in the country of these underlying conditions in our population already. We have lower life expectancy already. So when you compound, throwing coronavirus on that, we’re in an extremely vulnerable position. And again, the people who are in treatment, I worry about them because they’re not going to have the same access that they currently have, and if they’re more isolated, that’s not a good recipe for recovery.|
|Jeff Schechtman:||Is there a high level of fear at the moment?|
|Eric Eyre:||I think we all have fear, right? I mean yeah, there’s the fear of the unknown. It’s going to be difficult times, and on the good side, West Virginians, they’ve been through a lot. We’ve been through floods, we’ve been through mine disasters, and we seem to pull through. So I think we’re a tough, hardworking people. So I think we will be able to pull through in the end.|
|Jeff Schechtman:||Eric Eyre, his book is Death in Mud Lick. Eric, I thank you so much for spending time with us here on the WhoWhatWhy podcast.|
|Eric Eyre:||Well, thank you for having me on. I really appreciate it.|
|Jeff Schechtman:||Thank you. And thank you for listening and for joining us here on Radio WhoWhatWhy. I hope you join us next week for another Radio WhoWhatWhy podcast. I’m Jeff Schechtman.|
|Jeff Schechtman:||If you like this podcast, please feel free to share and help others find it by rating and reviewing it on iTunes. You can also support this podcast and all the work we do by going to WhoWhatWhy.org/donate.|
Related front page panorama photo credit: Adapted by WhoWhatWhy from CBO.