CLARKSBURG, W.Va. — One of the nation’s leading physicians and opioid addiction researchers is not a fan of the initial seven-point action plan released by Republican gubernatorial candidate Bill Cole.
Dr. Andrew Kolodny, Executive Director of Physicians for Responsible Opioid Prescribing (PROP), Chief Medical Officer for the non-profit rehab and treatment organization Phoenix House, and senior scientist at the Heller School for Social Policy and Management at Brandeis University, doesn’t believe the candidate’s plan addresses what’s causing the opioid addiction epidemic.
“Based on this proposed plan, I don’t believe Cole has an accurate understanding of the problem,” Dr. Kolodny said in a phone interview Tuesday.
“The opioid problem that’s devastating West Virginia is an epidemic of addiction to opioids. The reason so many people in West Virginia are now suffering from opioid addiction is because they were overexposed to opioid pain medicine.”
When asked to respond to the comments by Dr. Kolodny, Senator Cole said he didn’t totally disagree with the assessment and that he wanted the “best and brightest” involved in helping solve the issue. But, Cole added, his tour of all 55 counties had helped him form his plan.
“With all due respect, [Dr. Kolodny] is in Massachussetts,” he said. “I’ve been to all 55 counties in West Virginia. I’ve seen first hand. I’ve heard first hand. Irregardless of how they got there, heroin is the huge issue right now.”
Dr. Kolodny said the primary focus needs to be on reducing access to prescription opioids that people can acquire legally.
“To prevent opioid addiction, you really have to take a look at prescribing practices,” he said. “We need doctors and dentists to prescribe more cautiously so that they stop addicting their patients and stop stocking their homes with a highly addictive drug.”
Dr. Nora D. Volkow of The National Institute on Drug Abuse, which is a component of the National Institute of Health, testified before the U.S. Senate in 2014 on the issue of over prescription. Between 1991 and 2013, the number of prescriptions written for opioids in the United States nearly tripled–increasing from 76 million to nearly 207 million.
Dr. Kolodny concurred that law enforcement may need to take a backseat to addressing the problem through the scope of public health–saying that prescribing practices of physicians needs to change. This is a position that Bill Ihlenfeld, U.S. Attorney for the Northern District, also previously expressed.
“The next governor of West Virginia, if they really want to tackle this problem, there is a role for law enforcement,” Dr. Kolodny said. “But the primary approach is a public health one.”
“Other state legislatures are looking at prescribing practices. They are passing laws to limit the number of pills a doctor can write on a first-time prescription. Those type of interventions will help prevent addiction. That’s one of the things we have to do.”
Dr. Chris Stansbury (R-Kanawha, 35), a member of the House of Delegates, said that West Virginia had already begun the process of cutting off supply.
“We’ve worked with DHHR to close loopholes–even just this past session–to make sure clinics are running responsibly,” he said. “People that need chronic pain medication can get it, but that we’re not necessarily abusing that system and providing excessive number of pills to them.”
West Virginia leads the nation in overdose deaths on an almost yearly basis. Between 2011-2013, West Virginia’s number of overdose deaths per 100,000 residents increased by 54 percent compared to 2007-2009.
“I want everybody’s input,” Cole said. “But I don’t want to just have meeting after meeting and not do anything. We need to get the best information we can get together and then attack the problem.”
Nationally, overdose deaths from opioids have quadrupled since 2000. West Virginia’s number of deaths per 100,000 residents is more than double the national average.
“The opioid addiction epidemic begins in 1996 with the launch of Oxycontin by Purdue Pharma,” Dr. Kolodny said. “When that drug hit the market, Purdue Pharma released a campaign to encourage the medical community to prescribe these medicines aggressively. That campaign included a lot of misinformation.”
The New England Journal of Medicine published a study in 2012 that found 76 percent of those seeking help for heroin addiction began by abusing pharmaceutical narcotics, primarily Oxycontin.
Over time, Dr. Kolodny said that over prescribing these pain killers had changed how different generations were dealing with addiction.
“The younger folks who got addicted to opioid pain medicine have been turning to heroin,” he said. “Older folks addicted to pain medicine are just overdosing on the pills that they can get pretty easily from doctors.”
“If we only curtail the over-prescribing and we don’t do something about expanding access to treatment, then heroin will keep flooding in to meet demand for it,” Dr. Kolodny said. “Cole’s approach looks like it’s almost entirely focused on law enforcement.”
“Focusing almost entirely on law enforcement and on a public announcement or education campaign for the public isn’t going to get us very far.”
Kent Gates, the Communications Director for the Cole campaign, said in an e-mail that the Cole plan had been developed after touring the state and talking with those who had been most impacted by opioids.
“The plan was developed after traveling to all 55 counties and seeing the devastation that drugs is leveling on every part of West Virginia. Certainly Bill’s tour of Recovery Point was critical in seeing how they connect the dots from treatment to jobs. And, the round table he held last week hearing from treatment providers, law enforcement officials and addicts was insightful. The plan was developed by Bill after a combination of meeting and tours of places that deal with this battle every day.”
Senator Cole said last week at a town hall forum in Clarksburg he believed that increasing economic opportunity and adding jobs to the economy would be a major part of helping solve West Virginia’s opioid epidemic.
“The problem is not about people not having jobs so they are deciding to use drugs all day long,” Dr. Kolodny said. “The problem is an epidemic of addiction caused by over exposing people to opioids.”
One of Cole’s seven action points addresses the need to re-purpose and retrain former addicts as addiction counselors, but Dr. Kolodny was skeptical over the impact it could have.
“There may be very good reasons to do that, but that’s not about the opioid addiction epidemic,” he said.
Dr. Stansbury disagreed with Dr. Kolodny’s assessment though–citing how few counselors there are in the state.
“It’s something that is desperately needed,” he said. “We need more counselors and more treatment in West Virginia. You are fulfilling a need as far as getting additional counselors into the system to help people with their recovery. I think that’s excellent.”
“Those people make the best counselors because they’ve been there. They understand what it’s like to deal with substance abuse. They understand what it’s like to deal with those struggles–those life-long struggles.”
When asked to comment, the Jim Justice campaign referred to Justice’s plan listed on his campaign website and released the following statement in response to Senator Cole’s plan.
“Bill Cole had two years to address this important issue and hasn’t done anything–except pass raw milk and cut the pay of construction workers. Now he wants to spend taxpayer money on another failed special session to promote himself. When I’m governor, I won’t wait two years to fix this terrible epidemic, and I won’t let us play politics with it.”
Gates fired back in an e-mail.
“Clearly Jim Justice has no plan to deal with West Virginia’s drug epidemic nor any understanding of the steps Bill Cole has taken. His cookie cutter attack ignores the fact that Bill Cole passed legislation to allow first responders to administer Narcan which was likely used to save the lives of the 26 people who overdosed in Cabell County on Monday.
Jim Justice obviously doesn’t understand that this issue isn’t about politics. It’s about restoring hope and West Virginia’s way of life that is being destroyed by drugs. Had he visited all 55 counties and actively campaigned he would understand this.”
Bill Cole also responded to the Justice campaign–citing the passage of the drug nalaxone and it’s life-saving potential.
“Ask the 26 overdoses in Huntington if passing the bill on nalaxone made a difference in their lives,” he said. “I bet you their families and, frankly, themselves would argue that it made a difference.”