As drug overdose deaths have decimated West Virginians and their families, state lawmakers have consistently said they’re focused on curtailing the problem. Despite that, the overdose death rate has more than doubled since 2015, and continues to be higher in West Virginia than any other state.
This year, state senators and delegates are once again eyeing changes to laws that affect people with substance use disorder. The bills they’ve introduced so far are wide-ranging, from decriminalizing self-use drug testing kits to stark increases on punishment for making and distributing certain illegal drugs.
And Senate President Craig Blair, R-Berkeley, said he wants even more punitive consequences for dealing and making fentanyl, the dangerous opiate that is involved in most West Virginia fatal overdoses; he plans to be a sponsor on a bill that would bring back the death penalty for people found guilty of either crime.
“When you’re doing that, you’re making it a clear message to our youth and everyone else that we’re serious about getting the drug crisis under control in the state of West Virginia,” Blair said at a press conference earlier this month about his 2024 legislative priorities. He did not respond to emailed questions for this story.
While there’s almost no evidence that suggests bringing back the death penalty will prevent drug dealing or overdoses, there are state policy changes that many public health researchers say would protect more West Virginians from dying. Namely, lawmakers could make it easier to access buprenorphine and methadone, two effective medications used to treat opioid addiction.
Robin Pollini, an infectious disease epidemiologist at West Virginia University, said research shows increasing access to these treatments would accomplish what lawmakers say they’ve been trying to do: reverse the state’s overdose trajectory.
But she said that throughout her seven years studying the state’s overdose crisis, lawmakers have been less focused on these types of public health initiatives and more on ideas like Blair’s.
“The question you have to ask is ‘are we really committed to solving this problem?’” Pollini said.
Putting restrictions on life-saving medication
Throughout the U.S., methadone and buprenorphine are used by people to decrease the agony of heroin, fentanyl and prescription pain pill withdrawal. Study after study has found these medications to be a safe and effective way to treat opioid use disorders, and new research from WVU suggests that people treated with buprenorphine may also have some protection from dying of a fentanyl overdose.
But in West Virginia, state laws create obstacles for people seeking either treatment. In 2007, concerned by the rising rate in methadone-related overdoses, lawmakers passed a bill that banned any new methadone clinics to treat addiction. And although at the time the federal government had said the rise in methadone overdoses was due to providers prescribing the drug as a painkiller, the law was still enacted.
Because federal law says these clinics are the only places where health care workers can prescribe methadone to treat addiction, West Virginians’ access to the medication has been limited to nine state locations for the past 15 years.
“We need as many tools in our tool belt as we possibly can to help folks,” said A. Toni Young, the Appalachian health nonprofit Community Education Group’s Executive Director. “And we don’t have all our tools.”
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Suboxone, by contrast, was designed to be prescribed by most physicians, including family doctors. The drug combines buprenorphine with the overdose-reversing drug naloxone; but in West Virginia, a rule authorized by a bill lawmakers passed in 2016 requires patients to undergo regular counseling and drug testing services in order to get suboxone from a doctor’s office.
This goes against what both experts and the federal government recommend. Multiple agencies have said that while counseling and other services are useful and important for treating opioid addiction, suboxone prevents overdoses with or without additional services. And in a place like West Virginia where counseling can be scarce, these requirements can prevent people from getting critical treatment.
Dr. Zachary Hansen, an addiction sciences professor at Marshall University’s Joan C. Edwards School of Medicine, said that to his knowledge, the state doesn’t strictly enforce the counseling requirements. But Dr. Joanna Bailey, a family physician in Pineville, said the counseling and drug testing requirements discourage West Virginia primary care doctors, including herself, from prescribing suboxone.
“Primary care is stretched so thin, if there’s a reason not to add something to your plate, you’ll take it,” she said. “If those regulations weren’t there, then somebody wouldn’t have an excuse for it.”
Even as West Virginia keeps these methadone and suboxone restrictions, the federal government has tried to make the medication easier to access. In 2022, the Substance Abuse and Mental Health Services Administration proposed a change to permanently allow patients on methadone to take home more medication, decreasing how frequently they need to physically go to clinics. In 2023, Congress passed a bill to allow all authorized providers, not just ones with a special waiver, to prescribe suboxone to their patients.
Despite these changes, Pollini said the effects won’t be fully realized in West Virginia as long as the state maintains its current laws and rules.
“If what we care about is reducing overdose deaths, then what we really need to be doing is, full stop, getting people on to methadone and buprenorphine,” she said.
Some changes possible, others unlikely
There’s some indication that lawmakers may change one of its medication restrictions this legislative session; a bill is moving through the House that would let new methadone clinics open if they were affiliated with academic medical centers like West Virginia and Marshall Universities.
The bill has a powerful sponsor in House Health and Human Resources Chair Amy Summers, R-Taylor. But Summers said she doesn’t expect her committee to make any changes to the state’s suboxone restriction this year.
“Not enough time this session to look at that, think that through and draft something,” she said.
Her Senate counterpart, Mike Maroney, R-Marshall, did not respond to emailed questions for this story. Minority House Health Chair Mike Pushkin, D-Kanawha, said he supports removing the methadone moratorium but views the suboxone restrictions as necessary to ensure patients dependent on opioids are adequately treated.
“I see it as a way of trying to ensure the types of clinics people are going to maintain a certain set of standards,” Pushkin said. “I don’t think it’s too much to ask that people get counseling when they’re receiving this medication.”
David Herzberg, a professor at the University at Buffalo who studies the history of drugs and drug policies, said there’s good reason for policymakers to be cautious of medication touted by pharmaceutical supply chain companies. After all, it’s the same industry responsible for flooding small West Virginia towns with millions of pain pills and the addiction that followed.
But, in his opinion, those feelings and the desire for protection from pharmaceutical companies should be directed to that industry, not restricting effective medication from the people who’ve been victimized by the catastrophe. The state could track suboxone sales to local pharmacies to make sure it’s only going to the people seeking treatment or invest in community education on proper drug storage.
“The people using the drugs aren’t the source of the danger,” Herzberg said.