Reducing Opioid Deaths in West Virginia

Anderson: The National Institute on Drug Abuse reports that every day, more than 115 people in the United States die after overdosing on opioids. And for the last several years, the state of West Virginia has had the highest overdose death rate in the country. Hello, and welcome to "Comcast Newsmakers." I´m Tetiana Anderson. West Virginia has been on the front lines, battling high levels of addiction and overdose. And with me to discuss that battle and his efforts to combat the opioids epidemic is Dr. Rahul Gupta. He is the former West Virginia commissioner, and state health officer. Dr. Gupta is an honoree of Governing magazine´s 2018 Public Officials of the Year. Dr. Gupta, welcome to the program.

Gupta: Thanks for having me, Tetiana.

Anderson: So, you´ve moved on from West Virginia. You´re now helping to head up the March of Dimes. But you have said that the fight against the opioid crisis is a battle that you will never give up. What is it that you saw in West Virginia that sort of turned this into a personal crusade?

Gupta: What I saw in West Virginia during my experience is one of the most distinct and difficult experiences within public health that I´ve seen in my 25 years of clinical practice. This particular crisis is unweaving the very fabric of our society across the country. So, whether it´s a small town in West Virginia, or larger cities, what we´re seeing is the systematic breakdown of our communities. And part of that has to do with not just the health side of this, or the public-health side of this. This has to do with economics, the societal issues, and the socioeconomic issues that are associated with it. So, part by part, we are having to figure out how to address these problems in communities across the country like we have never done before.

Anderson: And, one of the problems you say is, of course, the lack of funding that hampers the fight seriously. But you say is, of course, the lack of funding that hampers the fight seriously. But you say that it´s more than that. You say stigma is also a problem. Explain that for us.

Gupta: Yeah, like we´ve seen in the past, when we have difficult diseases or conditions that are not easy to understand, and they have a societal component to them -- whether it´s HIV or others -- there´s a part of that that is because of stigma. So, whether we call that individual "an addict" or "a junkie," I think there is aspects of this particular crisis that we are attempting to, unknowingly sometimes, dehumanize those individuals. And I think it´s very important that first we start to address the stigma to understand that these are also human beings who also deserve to live, to be treated just like anyone else, because at the end of the day, addiction is a chronic brain condition. It´s not very different from heart disease or diabetes, where you might need lifelong treatment, or at least for several years. And you need comprehensive societal, as well as clinical, treatment along with it.

Anderson: So, part of the bad news here is that death rates from overdoses are expected to rise in 2018, but part of the good news is that that rate of rise is slowing. This is something you looked at in West Virginia. What is it that you and your colleagues did there that other states can look to and model?

Gupta: One of the things we saw-- and I really was concerned about it -- year after year, we´re seeing rises. So we wanted to understand better. And where better is it than go to the people who have actually died, and learn from them? So we conducted what we call the post-autopsy autopsy. We looked at individuals after death, not just their medical history, but their socioeconomic history, whether they were married or widowed. Did they have a job, what kind of education did they have, did they have insurance, did they get help, did they get what we call Nalaxone, which is, like, the antidote for overdosing? And we found some compelling things in there. We found that there were some opportunities to correct. These individuals are somebody who are coming in contact with the healthcare system, but we are failing them. So this type of social autopsy has become almost a cornerstone of how we need to understand what is happening, and develop those evidence-based, data-driven solutions, in terms of policy, rather than philosophical or ideological approach to this particular crisis.

Anderson: And you have a positive outlook about this. I mean, you say that West Virginia can overcome this. And you say, "It´s because of the people." What is it about them that leads you to believe that?

Gupta: I think the resilience is very cornerstone to any community attempting to address a crisis of the magnitude of this. Part of that, in West Virginia, that I found is people and communities are willing to come together in a time of crisis. They´re willing to learn, they´re willing to ask for help, and starting to really de-stigmatize the condition and talk about it. So one of the things I´ve found is now common individuals are able to talk about their suffering and what´s happened to them, and then work for a common cause. That´s very critical, to bring communities together and instill them with the scientific aspects of it. But at the end of the day, it´s going to have to happen community by community, across this country, in order for us to address this problem.

Anderson: Community by community, state by state.

Gupta: Yeah.

Anderson: Dr. Rahul Gupta, thank you.

Gupta: Thank you very much.

Anderson: And thank you for joining us as, well. For more great conversations with leaders in your own community and across the nation, visit comcastnewsmakers.com. I´m Tetiana Anderson.