HUNTINGTON, W.Va. — Officer Sean Brinegar arrived at the house first — “People are coming here and dying,” the 911 caller had said — and found a man and a woman panicking. Two people were dead inside, they told him.
Brinegar, 25, has been on the force in this Appalachian city for less than three years, but as heroin use has surged, he has seen more than his fair share of overdoses. So last Monday, he grabbed a double pack of naloxone from his gear bag and headed inside.
A man was on the dining room floor, his thin body bluish-purple and skin abscesses betraying a history of drug use. He was dead, Brinegar thought, so the officer turned his attention to the woman on a bed. He could see her chest rising but didn’t get a response when he dug his knuckle into her sternum.
Brinegar gave the woman a dose of injected naloxone, the antidote that can jumpstart the breathing of someone who has overdosed on opioids, and returned to the man. The man sat up in response to Brinegar’s knuckle in his sternum — he was alive after all — but started to pass out again. Brinegar gave him the second dose of naloxone.
Maybe on an average day, when this Ohio River city of about 50,000 people sees two or three overdoses, that would have been it. But on this day, the calls kept coming.
Two more heroin overdoses at that house, three people found in surrounding yards. Three overdoses at the nearby public housing complex, another two up the hill from the complex.
From about 3:30 p.m. to 7 p.m., 26 people overdosed in Huntington, half of them in and around the Marcum Terrace apartment complex. The barrage occupied all the ambulances in the city and more than a shift’s worth of police officers.
By the end of it, though, all 26 people were alive. Authorities attributed that success to the cooperation among local agencies and the sad reality that they are well-practiced at responding to overdoses. Many officials did not seem surprised by the concentrated spike.
“It was kind of like any other day, just more of it,” said Dr. Clay Young, an emergency medicine doctor at Cabell Huntington Hospital.
But tragic news was coming. Around 8 p.m., paramedics responded to a report of cardiac arrest. The man later died at the hospital, and only then were officials told he had overdosed. On Wednesday, authorities found a person dead of an overdose elsewhere in Cabell County and think the death could have happened Monday. They are investigating whether those overdoses are tied to the others, potentially making them Nos. 27 and 28.
It’s possible that the rash of overdoses was caused by a particularly powerful batch of heroin or that a dearth of the drug in the days beforehand weakened people’s tolerance.
But police suspect the heroin here was mixed with fentanyl, a synthetic opioid that is many times more potent than heroin. A wave of fatal overdoses signaled fentanyl’s arrival in Huntington in early 2015, and now some stashes aren’t heroin laced with fentanyl, but “fentanyl laced with heroin,” said Police Chief Joe Ciccarelli.
Another possibility is carfentanil, another synthetic opioid, this one used to sedate elephants. Police didn’t recover drugs from any of the overdoses, but toxicology tests from the deaths could provide answers.
A battle-scarred city
In some ways, what happened in Huntington was as unremarkable as the spurts in overdoses that have occurred in other cities. This year, fentanyl or carfentanil killed a dozen people in Sacramento, nine people in Florida, and 23 people in about a month in Akron, Ohio. The list of cities goes on: New Haven, Conn.; Columbus, Ohio; Barre, Vt.
But what happened in Huntington stands out in other ways. It underlines the potential of a mysterious substance to unleash wide-scale trauma and overwhelm a city’s emergency response. And it suggests that a community that is doing all the right things to combat a worsening scourge can still get knocked back by it.
“From a policy perspective, we’re throwing everything we know at the problem,” said Dr. James Becker, the vice dean for governmental affairs and health care policy at the medical school at Marshall University here. “And yet the problem is one of those that takes a long time to change, and probably isn’t going to change for quite a while.”
Surrounded by rolling hills packed with lush trees, Huntington is one of the many fronts in the fight against an opioid epidemic that is killing almost 30,000 Americans a year. But this city, state, and region are among the most battle-scarred.
West Virginia has the highest rate of fatal drug overdoses of any state and the highest rate of babies born dependent on opioids among the 28 states that report data. But even compared with other communities in West Virginia, Huntington sees above-average rates of heroin use, overdose deaths, and drug-dependent newborns. Local officials estimate up to 10 percent of residents use opioids improperly.
The heroin problem emerged about five years ago when authorities around the country cracked down on “pill mills” that sent pain medications into communities; officials here specifically point to a 2011 Florida law that arrested the flow of pills into the Huntington area.
As the pills became harder to obtain and harder to abuse, people turned to heroin. It has devoured many communities in Appalachia and beyond.
In Huntington, law enforcement initially took the lead, with police arresting hundreds of people. They seized thousands of grams of heroin. But it wasn’t making a dent. So in November 2014, local leaders established an office of drug control policy.
“As far as numbers of arrests and seizures, we were ahead of the game, but our problem was getting worse,” said Jim Johnson, director of the office and a former Huntington police officer. “It became very obvious that if we did not work on the demand side just as hard as the supply side, we were never going to see any success.”
The office brought together law enforcement, health officials, community and faith leaders, and experts from Marshall to try to tackle the problem together.
Changes in state law have opened naloxone dissemination to the public and protected people who report overdoses. But the city and its partners have gone further, rolling out programs through the municipal court system to encourage people to seek treatment. One program is designed to help women who work as prostitutes to feed their addiction. Huntington has eight of the state’s 28 medically assisted detox beds, and they’re always full.
Also, in 2014, a center called Lily’s Place opened in Huntington to wean babies from drugs. Last year, the local health department launched this conservative state’s first syringe exchange. The county, health officials know, is at risk for outbreaks of HIV and hepatitis C because of shared needles, so they are trying to get ahead of crises seen in other communities afflicted by addiction.
“Huntington just happens to have taken ownership of the problem, and very courageously started some programs … that have been models for the rest of the state,” said Kenneth Burner, the West Virginia coordinator for the Appalachia High Intensity Drug Trafficking Areas program.
‘A revolving door’
While paramedics in the area have carried naloxone for years, it was this spring that Huntington police officers were equipped with it. Just a few officers have administered it, but Monday was Brinegar’s third time reviving overdose victims with naloxone.
Paramedics, who first try reviving victims by pumping air with a bag through a mask, had to administer another 10 doses of naloxone Monday. Three doses went to one person, said Gordon Merry, the director of Cabell County Emergency Services. During the response, ambulances from stations outside Huntington were called into the city to assist the eight or so response teams already deployed.
Merry was clearly proud of the response, but also frustrated. He was tired, he said, of people whom emergency crews revived going back to drugs. Because of the power of their disease, saving their lives didn’t get at the root of their addiction.
“It’s a revolving door. We’re not solving the problem past reviving them,” he said. “We gave 26 people another chance on life, and hopefully one of those 26 will seek help.”
In the part of town where half the overdoses happened, some homes are well-kept, with gardens, bird feeders, and American flags billowing. “Home Sweet Home,” read an engraved piece of wood above one front door; in another front yard, a wooden sculpture presented a bear holding a fish with “WELCOME” written across its body.
But many structures are decrepit and have their windows blacked out with cardboard and sheets. At one boarded-up house, the metal slats that once made up an overhang for the front porch split apart and warped as they collapsed, like gnarled teeth. On the plywood that covered a window frame was a message spelled out in green dots: GIRL SCOUTS RULE.
In and around the public housing complex, which is made up of squat two-story brick buildings sloping up a hill, people either said they did not know what had happened Monday, or that “lowlifes” in another part of the complex sparked the problem. Even as paramedics were responding to the overdoses, police started raiding residences as part of their investigation, including apartments at the complex, the chief said.
Just up the hill, a man named Bill was sitting on a recliner on his front porch with his cat. He said he saw the police out in the area Monday, but doesn’t pay much attention to overdoses anymore. They are so frequent.
Bill, who is retired, asked to be identified only by his first name because he said he has a son in law enforcement. He has lived in that house for five decades and started locking his door only in recent years. His neighbors’ house had been broken into, and he had seen people using drugs in cars across the street from his house. He called the police sometimes, he said, but the users were always gone by the time the police arrived.
“I hate to say this, but you know, I’d let them die,” Bill said. “If they knew that no one was going to revive them, maybe they wouldn’t overdose.”
Even here, where addiction had touched so many lives, it’s not an uncommon sentiment. Addiction is still viewed by some as a bad personal choice made by bad people.
“Some folks in the community just didn’t care” that 26 of their fellow residents almost died, said Matt Boggs, the executive director of Recovery Point.
Recovery Point is a long-term recovery program that teaches “clients” to live a life without drugs or alcohol. Boggs himself is a graduate of the program, funded by the state and donations and grants.
The clients live in bunk rooms at the facility for an average of more than seven months before graduating. The program says that about two-thirds of graduates stay sober in the first year after graduation, and about 85 percent of those people are sober after two years.
Local officials praise Recovery Point, but like many other recovery programs, it is limited in what it can do. It has 100 beds for men at its location in Huntington, and is expanding at other sites in the state, but Boggs said there’s a waiting list of a couple hundred people.
Mike Thomas, 30, graduated from the main part of the program a month ago and is working as a peer mentor there as he transitions out of the facility. Thomas has been clean since Oct. 15, 2015, but has dreams about getting high or catches himself thinking he could spare $100 from his bank account for drugs.
Thomas hopes to find a full-time job helping addicts. His own recovery will be a lifelong process, one that can be torn apart by a single bad decision, he said. He will always be in recovery, never recovered.
“I’m not cured,” he said.
A killer that doesn’t discriminate
As heroin has bled into communities across the country, it has spread beyond the regular drug hotbeds in cities. On a 2004 map of drug use in Huntington — back then, mostly crack cocaine — a few blocks of the city glow red. Almost the entire city glows in yellows and reds on the 2014 map.
In 2015, there were more than 700 drug overdose calls in Huntington, ranging from kids in their early teens to seniors in their late 70s. In 2014, it was 272 calls; in 2012, 146. One bright spot: fatal overdoses, which stood at 58 in 2015, have ticked down so far this year.
“I used to be able to say, ‘We need to focus here,’” said Scott Lemley, a criminal intelligence analyst at the police department. “I can’t do that anymore.”
Heroin hasn’t just dismantled geographic barriers. It has infiltrated every demographic.
“It doesn’t discriminate. Prominent businessmen, their child. Police officers, their child. Doctors, their child,” Merry said. “The businessman and police officer do not have their child anymore.”
The businessman is Teddy Johnson. His son, Adam, died in 2007 when he was 22, one of a dozen people who died in a five-month period because of an influx of black-tar heroin. The drug hadn’t made its full resurgence into the region yet, but now, Johnson sees the drug that killed his son everywhere.
He runs a plumbing, heating, and kitchen fixture and remodeling business. From his storefront, he has witnessed deals across the street.
Adam, who was a student at Marshall, was a musician and artist who hosted radio shows. He was the life of any party, his dad said.
Johnson was describing Adam as he sat at the marble countertop of a model kitchen in his business last week. With the photos of his kids on the counter, it felt like a family’s home. Johnson explained how he still kept Adam’s bed made, how he kept his son’s room the same, and then he began to cry.
“The biggest star in the sky we say is Adam’s star,” he said. “When we’re in the car — and it can’t be this way — but it always seems to be in front of us, guiding us.”
Adam’s grave is at the top of a hill near the memorial to the 75 people — Marshall football players, staff, and fans — who died in a 1970 plane crash. It’s a beautiful spot that Johnson visits a few times each week, bringing flowers and cutting the grass around his son’s grave himself. Recently a note was left there from a couple Johnson knows who just lost their son to an overdose; they were asking Adam to look out for their son in heaven.
But even here, at what should be a respite, Johnson can’t escape what took his son. He said he has seen deals happen in the cemetery, and he recently found a burnt spoon not more than 20 feet from his son’s grave.
“I’ve just seen too much of it,” he said.
If Huntington doesn’t have a handle on heroin, at least the initiatives are helping officials understand the scale of the problem. More than 1,700 people have come through the syringe exchange since it opened, where they receive a medical assessment and learn about recovery options. The exchange is open one day a week, and in less than a year, it has distributed 150,000 clean syringes and received 125,000 used syringes.
But to grow and sustain its programs, Huntington needs money, officials say. The community has received federal grants, and state officials know they have a problem. But economic losses and the collapse of the coal industry that fueled the drug epidemic have also depleted state coffers.
“We have programs ready to launch, and we have no resources to launch them with,” said Dr. Michael Kilkenny, the physician director of the Cabell-Huntington Health Department. “We’re launching them without resources, because our people are dying, and we can’t tolerate that.”
In some ways, Huntington is fortunate. It has a university with medical and pharmacy schools enlisted to help, and a mayor’s office and police department collaborating with public health officials. But what does that herald then for other communities?
“If I feel anxious about what happens in Huntington and in Cabell County, I cannot imagine what it must be like to live in one of these other at-risk counties in the United States, where they don’t have all those resources, they don’t have people thinking about it,” said Dr. Kevin Yingling, the dean of the Marshall University School of Pharmacy.
Yingling, Kilkenny, and others were gathered on Friday afternoon to talk about the situation in Huntington, including the rash of overdoses. But by then, there was already a different incident to discuss.
A car had crashed into a tree earlier that afternoon in Huntington. A man in the driver seat and a woman in the passenger seat had both overdosed and needed naloxone to be revived. A preschool-age girl was in the back seat.
Make it all legal……….. No one wants to be an addict, most of these addicts were made that way, ON PURPOSE by the manufacturers of the “”non addictive”” ROFL (sic) heroin called OxyContin, that they prescribed to anyone merrily who needed pain relief, even sell this stuff to kids now……………… so the Sackler family, who made the fortunes on the blood of their addicts, now don’t want to know? Still trying to pretend their form of heroin, isn’t heroin? You make addicts the way the Sacklers did, only say they can have the pills every 12 hours, when the drug only actually worked for 6-8, and instead of spreading the dose, they told the doctors, to INCREASE the dose, but ONLY give every 12 hours. So addicts they made, so it was legal for the pharma company to pretend it wasn’t addictive heroin, and they get away with this mess? You create terror in addicts, and I mean the poor innocent mothers, kids, grannies, who got prescribed this crap, when they have to go cold turkey? Let them get what they need, let the sackler family pay for the damn stuff, they made the mess, and let the people taper, as they are able to. Why the hell switch them from one drug to another?
How deep does the rabbit hole go? Could it be that the Sacklers were in collusion with cartels from Mexico the whole time? When the “crackdown” on pain pills came, was that basically a signal for the cartels in Mexico to ramp up heroin production? And now the cartels are cutting their heroin with fentanyl… Are they getting their fentanyl from the Sacklers?
And who stands to gain from all this? What if this is a deliberate attempt of the oligarchy to incapacitate middle class America, now that America is in terminal economic decline, to pre-empt any attempt at an uprising? And what if America learnt of this from Britain’s own opium wars with China in the 19th century?
What if this was all a plan, first executed over 20 years ago? Who stands to gain?
How deep does the rabbit hole go?
SY,…GOD BLESS.ILL BE PRAYEN FOR YOU ALL. MOOMAW
Great TED talk about successful drug therapy in Portugal.Judging by every metric, decriminalization in Portugal has been a resounding success,” says Glenn Greenwald, an attorney, author and fluent Portuguese speaker, who conducted the research. “It has enabled the Portuguese government to manage and control the drug problem far better than virtually every other Western country does.”
Wonderful we have NALOXONE, now can we make sure that it is readily available to those in need and who are able to administer properly. Then the follow up with competent treatment………… to a lifetime of recovery. Yes!!!!
While the Sackler family continue to flog their addictive heroin? opps fentanyl, and create more of a problem? They flog it to damn kids now too! Pharma rep quote “”get a child on drugs, you got a customer for life”” seems they not living long on that OxyContin, though?
West Virginia needs to arrest everyone that is connected to the drug use in Huntington, just like they did during the Crack problem, years ago. The only difference is that most of your Heroin users are White, with many coming from middle class families and prison is too good for those people. When it was a Black Crack problem, the user and the dealer were treated the same, with both getting locked up. Now with White Heroin users, they are not being classified as criminals but as addicts “suffering from the illness” of addiction. They need rehab, love and care, not prison. They need to be cured through treatment not serving years behind bars and ending up with a felony record. As a Black person, living in WV, it is utterly fascinating to see the terminology, portrayal and treatment of drug addicts based on the drug they use and the color of their skin. Can you imagine a free Crack pipe giveaway or exchange, to protect those users from old pipes that might break and injure the user? I can’t and yet we have a needle in exchange for dirty syringes. I love it how Whites always accuse Blacks of “playing the race card” but who invented the game in the first place?
A free needle exchange isn’t the same as standing in line at a candy store to get a “freebie.” If crack pipes were responsible for the spread of HIV, Hepatitis, and other blood borne diseases…then perhaps a “free crackpipe program” would have been in order. Your comments about race in regards to heroin addiction…is a ridiculous statement with no fact base. Heroin addiction is non-discriminatory…even when people like you try to turn it into a race issue.
I agree Sackler family straight to jail, for murder. OOOPs they own the pharma company.
SSShhhh don’t tell anyone they lied when they said OxyContin isn’t addictive, shhhh! Apparently pharma heroin, isn’t addictive, only the non prescription version was. Except they never told anyone it was heroin.
Difficult problem, I lost a nephew to drugs. Good article, two journalistic thumbs up!
OR perhaps, all these overdoses were actually prescribed, and as we all know fentanyl, ie OxyContin, aka Sackler family (pharma) is THE MOST addictive substance in the world, innocents, addicted to this stuff, put on for pain post caecarian, or post knee surgery, the innocents, end up so addicted, and they don’t overdose, the fentanyl (prescribed) kills em, just like it killed Prince.
For Huntington, and all other cities with a drug problem in the US, it could be salutary to learn from the example of Zurich, Switzerland: http://www.pri.org/stories/2016-02-12/us-can-learn-lot-zurich-about-how-fight-its-heroin-crisis
I agree with you! Looking to other nations that have had success is the most logical thing to do.
“It became very obvious that if we did not work on the demand side just as hard as the supply side, we were never going to see any success.”
Yes. They’re right about that.
Here’s a quote by one of my favorite people of all time.
“Prohibition… goes beyond the bounds of reason in that it attempts to control a man’s appetite by legislation and makes a crime out of things that are not crimes… A prohibition law strikes a blow at the very principles upon which our government was founded”
~ President Abraham Lincoln
The things is… we can’t change the appetite of a person’s soul. Addictions runs deep. Deeper than any physical or emotional pain you could imagine.
But, we can teach people to make different choices. We can give them jobs that allow them to be more than J.ust O.over B.roke so depression and despair don’t seep in and create a yearning for escape. We CAN give people access to a better life, to hope, and to such things that don’t put them at risk for self medicating.
Imho, it’s time to end Drug Prohibition! The trillions of dollars spent since Nixon declared war on drugs (more like war on (sick) people) has NOT yielded ANY positive results. Drug abuse continues to rise. Violence is more common in our communities… and so forth.
Time to spend trillions on educational programs for adolescents and teens. Programs that treat the aching soul of the addict. JMHO.
Sorry, I can’t help myself. I swear, I checked my grammar and for typos but apparently when I comment at 3am I make awful mistakes. Double plurals? Yikes! LOL!
You are overlooking the fact, in reality, most of these addicts are taking prescription doses, they still overdose, don’t mean to. If you got a script, you still an addict. Pharma did this, the Sackler family, flogging heroin, dressed up as a pain pill, purposely creating addicts. No money for pharma in cures, they like addicts……….. ie drugs that maintain, don’t cure.
I am happy to see that Huntington, West Virginia has a needle exchange program and a long term recovery program as well. I feel every state in our country should do the same, and there should be several in each state so people will have the option and beds would be more available.
They don’t inject fentanyl, it is a prescription form of heroin.
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