On a wet, hot evening, addicts sit in a circle with their family members in a church recreation room and relay their histories with opioids and heroin and the steps they have taken to recover, in many cases with Medicaid.
The government-funded healthcare programme for low-income Americans was expanded under Barack Obama’s Affordable Care Act. Whether it will continue to fund their treatment is now in question.
A healthcare bill put forward by Senate Republicans this week allocates a whopping $45bn to tackle the opioid crisis ravaging rust belt states but could also deal a devastating blow by rolling back Medicaid, on which many addicts rely for treatment.
For one Berkley Springs woman in her early 20s, Medicaid contributed to the cost of the monthly naltrexone injection that helped her kick a heroin addiction of many years, says her mother Melody, a hospital administrator. Medicaid has given others a free bed in one of the state’s detox centres or helped them enter rehabilitation programmes.
According to the Kaiser Family Foundation, more than 560,000 West Virginians, or 30 per cent of the population, are covered by Medicaid. Of those, about a third have received coverage thanks only to the programme’s expansion under the Affordable Care Act. Medicaid pays for more than 40 per cent of the state’s buprenorphine, a drug used to treat addiction.
“We are a state that is very dependent on federal help on Medicaid,” says Barbara Evans Fleischauer, a Democratic member of the West Virginia House of Delegates. “Two-thirds of our spending for Medicaid is for seniors and nursing homes. A lot of our spending is on children who get healthcare. If there is this deal with the [opioid treatment funding] which we’re desperate for, it means these other areas will get cut.”
Ms Fleischauer accuses Republican Senate leaders of “dangling” the opioid money in front of Republican senators whose states have been ravaged by the epidemic. “I have an aunt [who is addicted]. I have a cousin who had a job injury and got hooked [on painkillers]. This stuff changes your brain and it makes you desperate.”
Several Republican senators have voiced opposition to the new version of the healthcare bill, which would keep largely in place the deep cuts to Medicaid proposed in the earlier iteration. At least two Republican senators — Susan Collins of Maine and Rand Paul of Kentucky — say they are against the new bill while others, including Rob Portman of Ohio and Shelley Moore Capito of West Virginia, say they need more time to review it.
On Thursday, Ms Capito said she would object to any bill that “cut traditional Medicaid too deeply, and harmed rural healthcare providers”.
A Philadelphia Police officer shows a package of the overdose reversal agent Naloxone Hydrochloride, or Narcan, while on patrol near a heroin encampment in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017. In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia’s opioid epidemic. Several officers in the department have had to deploy the drug since they started carrying it on patrol. The tracks and the surrounding property are owned and operated by the Consolidated Rail Corporation, a joint subsidiary of Norfolk Southern and CSX. Last month, Philadelphia Mayor Jim Kenney announced citations against the Consolidated Rail Corporation for what the mayor, in a release, said was Conrail’s failure to clean and secure their own property." Visitors and homeless residents of the gulch say the trash isn’t their fault, and that they are only there because they have nowhere else to go. According to the city Health Commission, Philadelphia is on track to see 33 percent more drug overdose deaths in 2017 over last year. / AFP PHOTO / DOMINICK REUTER (Photo credit should read DOMINICK REUTER/AFP/Getty Images) © AFP
“We’ve got a real problem,” she says, referring to the opioid crisis. “[It] is exceedingly important to me that that population have access either through expanded Medicaid or sufficient ways for them to be supported [by] private insurance.”
With its expansion under the Affordable Care Act, Medicaid and addiction treatment in the state are now “closely tied together”. Medicaid funds offer “significant access to treatment to a devastating problem that these affected have never had”, she says.
In Cabbel county, in the western corner of West Virginia, 10 per cent of people are estimated to be fighting some sort of addiction, says Steve Williams, mayor of Huntington, which lies in the county.
“It’s readily acknowledged that it is the single most existential public health threat that we have in the country. But then when it comes to something as critical as how we pay for healthcare in the country then the opiate epidemic becomes a minor player,” Mr Williams says. The $45bn the Republicans are offering to fight the crisis overshadows the $2bn in the original legislation but even this would not be enough, Mr Williams says. “This is going to cost hundreds of billions of dollars.”
“One thing that I’ve learned is if you don’t deal with the crisis at hand, if you just put a Band-Aid on it, you don’t learn how to deal with the crisis down the road.”
While the western corner of West Virginia has been among areas hardest hit, the epidemic snakes across the state to the eastern panhandle, just two hours from Washington DC.
In Morgantown, near Berkley Springs, four women have taken it upon themselves to help addicts find places at detox and rehab centres, founding the non-profit Hope Dealer Project. Tina Stride, whose son has spent years battling painkiller and then a heroin addiction, drives them to the facilities, the closest of which is two and a half hours away. Sometimes she will drive them as far as six hours.
The number of detox centres in the state has increased gradually but many struggle to keep up with demand, turning addicts away because no beds are free.
On a recent afternoon, Ms Stride and Lisa Melcher, her friend, who helps run the project, watched their granddaughters, aged seven and eight, at play. Ms Melcher’s daughter Christina died a few weeks earlier after an overdose, leaving the young girl and her older brother. Christina’s husband had died of an overdose 18 months earlier, the week before Christmas.
“When it happens that close to you, it’s like you’re in a bad movie. You can’t believe that this is really happening,” Ms Melcher says. “There are mornings I wake up and I am ready to conquer the world. And there are mornings I wake up and it’s all I can do to get past the bed.” She wonders how the new bill will affect her grandchildren.
Growing up, Ms Stride recalls, everyone looked down on the junkies on the street. Now, she says, the addicts look just like them, are people they know.
“It’s not the junkie down the street. It’s my son. It’s her daughter. It’s their parents,” she says, gesturing at the two girls. She sighs. “We’re going to lose a whole generation between age of 20 and 40.”