The opioid epidemic has no economic, social, ethnic, racial, or geographic boundaries. The citizens of West Virginia know this better than anyone else. As the only state that’s completely within Appalachia – defined as a cultural region that straddles the Appalachian Mountains and stretches from New York to Georgia – the people of this rural, mountainous state have been hit hard by the opioid crisis.
We recently published an article on the opioid crisis in West Virginia, where we support individuals with opioid used disorder (OUD) in an inpatient treatment facility in the town of Williamson. To read that article, please navigate to the blog section of our website where you can find this in-depth look at how the state of West Virginia has responded to the opioid crisis:
This article follows up on that one. In this article, we’ll focus on a component of OUD treatment that’s both old and new: the critical role of peer support in addiction recovery. We say it’s old and new because the concept of peer support is inextricably intertwined with the traditional process of recovery from the disordered use of substances – which is now how we refer to addiction. The type of peer support we introduce in this article is different than the traditional concept of peer support.
Most people know about the traditional modes of peer support in recovery from alcohol use disorder (AUD) and substance use disorder (SUD): for alcohol, peer support – a.k.a. community support – most often happens in Alcoholics Anonymous (AA) meetings, and for substance use – including opioids – peer support most often happens in Narcotics Anonymous meetings (NA).
What we’ll discuss in this article is the role of Peer Recovery Coaches (PRCs) who support rural West Virginians through a program initiated in 2017 called West Virginia Peers Enhancing Education, Recovery, and Survival (WV PEERS).
The Need for Specialized Peer Support in West Virginia
Rural West Virginians with opioid use disorder (OUD) need help.
Here’s the latest information on drug overdose in West Virginia for 2019-2021:
- 2019: 870 overdose deaths
- That’s 52.8 deaths per 100,000 people
- 2020: 1330 people died of drug overdose in West Virginia
- That’s 81.4 deaths per 100,000 people
- 2021, 1,553 people died of drug overdose in West Virginia
- That’s 94.9 deaths per 100,000 people
Those rates are more than twice the national average, and data shows that between 75 and 85 percent of those overdose deaths involve opioids. Although there is a glimmer of hope. Preliminary reports indicate that the overdose death rate decreased between March 2021 and March 2022 for the first time since the beginning of the coronavirus pandemic.
We’ll talk about that in a moment.
Now, we’ll observe that the high rates in West Virginia beg a question: what makes the people of West Virginia so vulnerable to opioid use disorder (OUD) and opioid overdose?
The primary reason is geography.
Their location puts them at a significant disadvantage in getting help, compared to people in other parts of the country – even those in other rural areas. Access to services in the mountains creates unique challenges. Although the state is relatively small, it’s mountainous, and getting around isn’t simple. Roads don’t go as the crow flies, but rather, as the terrain dictates.
A treatment center 25 miles away might take two hours to access by car – if a car is available. This default fact creates significant barriers to accessing treatment for opioid use disorder (OUD). And in fact, it creates barriers to the awareness of availability of treatment. People in isolated communities typically stick to themselves, manage life independently, and are often reluctant to seek support from people they don’t know from their community.
That’s exactly why Peer Support Specialists can make an impact.
In rural isolated communities, familiarity and trust are often the most important factors that convince people to seek support when they may otherwise attempt to manage their challenges independently.
About the WV PEERS Program
First, let’s define who Peer Support Specialists (PRS) are and what they do.
The PRSs who form the core of the WV PEERS program participate in certification programs run by the West Virginia Certification Board for Addiction & Prevention Professionals (WVCBAPP). Certification as a PRS in West Virginia requires the following:
- 2 years continuous sobriety
- 500 hours of peer coaching experience
- 25 hours of direct supervision
- Demonstrated understanding of and familiarity with WVCBAPP policies and procedures
In order to validate the role of PRSs and WV PEERS and validate their role in OUD treatment and support, a study called Project MUSE tracked their work in local communities tracked the work of WV PEER PRSs between April and December of 2018.
First, let’s look at how PRCs in the WV PEERS program represent themselves:
“Who We Are: People in recovery connecting those in need to services.”
It’s important to point out that PRCs in this program are members of the communities they serve. As we mention above, familiarity, trust, and connection are essential parts of securing participation in support services for people who live in rural communities. Those things are important everywhere, of course, but in rural communities, personal connection can be the difference between a person accepting and pursuing support or not accepting and pursuing support.
Here’s how PRCs in the WV PEERS program describe what they do:
“We can help you with access to: Overdose prevention, Naloxone providers (naloxone is a fast-acting, lifesaving, opioid overdose reversing medication), Syringe exchange, Shelter, Food, Clothing, Medical care, Dental care, Detox services, Inpatient or Outpatient SUD/OUD/AUD treatment, and 12-step programs”
PRSs divided their work into six categories, which include the various service they offer in the list above:
- Substance use
- Harm reduction
- Infectious diseases
- Mental health
- Primary medical care
- Social services
During the Project MUSE study, PRSs made contact with 1,456 community members in need of connection to one or more of the support services available.
Let’s take a look at where those contacts originated, and what happened after the individuals met with a certified PRS.
Project MUSE: The Results
First, let’s look at where the referrals to PRSs originated.
Source of Referral:
- First Responders – EMS or Police:
- Juvenile or Adult Drug Courts:
- Social Services:
- Harm Reduction/Syringe Service Programs:
- Community Members:
Next, let’s look at the outcome of those contacts between community members in need of support services and PRSs. We’ll discuss the relative size of the numbers by referral source below.
Result of Referral:
First Responders – EMS or Police:
- Engaged in SUD or mental health treatment: 27
- Engaged in SUD or mental health treatment for over 6 months: n/a
- Completed SUD or mental health treatment program referred to: 20
Juvenile or Adult Drug Courts:
- Engaged in SUD or mental health treatment: 8
- Engaged in SUD or mental health treatment for over 6 months: 5
- Completed SUD or mental health treatment program referred to: 3
- Engaged in SUD or mental health treatment: 10
- Engaged in SUD or mental health treatment for over 6 months: 7
- Completed SUD or mental health treatment program referred to: 4
- Engaged in SUD or mental health treatment: 121
- Engaged in SUD or mental health treatment for over 6 months: 64
- Completed SUD or mental health treatment program referred to: 76
Harm Reduction/Syringe Service Programs:
- Engaged in SUD or mental health treatment: 388
- Engaged in SUD or mental health treatment for over 6 months: 96
- Completed SUD or mental health treatment program referred to: 184
- Engaged in SUD or mental health treatment: 202
- Engaged in SUD or mental health treatment for over 6 months: 45
- Completed SUD or mental health treatment program referred to: 78
- Engaged in SUD or mental health treatment: 175
- Engaged in SUD or mental health treatment for over 6 months: 66
- Completed SUD or mental health treatment program referred to: 122
Inside these numbers is a wealth of information that’s of immense value to anyone interested in learning about what types of programs – including referral sources – have the most positive impact. In our article on the opioid crisis in West Virginia we link to above, we quoted Steve Williams, the Mayor of Huntington, WV.
We offer that quote again here – because his observation is confirmed by the data we just shared:
“I realized we couldn’t arrest our way out of this. If we were going to do this, we were going to have to take a more inclusive, more holistic approach that involves prevention, intervention, treatment — as well as law enforcement. The only way we were going to overcome this was if everybody in the community realized they had an assignment. Every one of us has to take responsibility…We realized we just had to start saving people’s lives”
We’ll explain why this quote from 2016 was, in a word, prescient.
Participation in SUD or Mental Health Treatment in West Virginia
The first thing we notice is the radical disparity between the number of people who accessed services through law enforcement or EMS referral, as compared to referral from a harm reduction service, a social service, a community member, or self-referral.
Here’s what we mean:
- 388 people referred by harm reduction services to PRSs engaged in SUD or mental health treatment, compared to 27 referred by law enforcement/EMS, and compared to 8 referred by drug courts
- 278 people referred by schools, social services, harm reduction programs, community members, or self-referrals engaged in SUD or mental health treatment for over 6 months, as compared to the 5 known cases referred either by the court system, law enforcement, or EMS
- 464 people referred by schools, social services, harm reduction programs, community members, or self-referrals completed SUD or mental health treatment programs, compared to 23 referred either by the court system, law enforcement, or EMS
Please don’t misunderstand us: this is not a knock on the role law enforcement or EMS services play in our efforts to mitigate the harm caused by the opioid epidemic in West Virginia. Those valuable community members are the everyday heroes. We’ll say it again to drive the point home, they’re everyday heroes that keep us safe and help us every day of the year.
We highlight those numbers to point out the wisdom of Mayor Williams.
We can’t arrest our way out of the opioid crisis.
Not long ago, the prevailing opinion was that substance misuse and overdose was a law problem. People that got addicted and died of overdose were lawbreakers, and therefore, increased enforcement of laws must be the answer.
We now know that’s only one part of the answer, and one component of the solution. We now know what people need most is simple: a helping hand.
Peer Support and Community Engagement Helps Everyone
Buried in the beginning of this article is a statistic that tells the story as well as the numbers we just dissected. Here it is again: between March 2021 and March 2022, for the first time since the beginning of the coronavirus pandemic, the rate of fatal drug overdose and fatal opioid overdose declined in West Virginia.
The numbers in West Virginia rose dramatically between 2014 and 2017, plateaued in 2018-2019, then increased again – dramatically – in 2020 and 2021. Now, in 2022, after the implementation of an all of the above approach to addressing the opioid/overdose crisis, the Director of the West Virginia State Office of Drug Control Policy, Dr. Matthew Christiansen, makes the following observation:
“West Virginia is starting to plateau and likely seeing a slight downward trend [in fatal opioid overdose]. We are encouraged by [the] CDC’s data and will continue our efforts to end West Virginia’s substance use epidemic.”
We’ll add that a significant part of the all of the above strategy adopted by West Virginia was an expansion of peer support services in rural areas. It makes sense: sometimes, what people need is a familiar face, a helping hand, and the kind support of friends in the community to encourage them to get the lifechanging, lifesaving help they need.