Taking up the fight

It has been described as a scourge on our society, a national emergency and the deadliest drug crisis in American history. The facts are frightening. Every day, 116 people die from opioid-related drug overdoses in the United States. That equates to more than 42,000 lives lost every year to commonly prescribed pain killers or heroin. Appalachia has been particularly hard hit, and today it is nearly impossible to find someone whose life hasn’t been directly impacted by the crisis. Solutions to this public health emergency have not come easy, but that has not deterred Marshall University from taking up the fight to end this national nightmare.

In October 2016, the university announced the formation of a substance use recovery coalition. Marshall President Jerome Gilbert said the effort is university-wide, with at least 10 academic departments and programs working together in various ways. What’s more, the school is working with partners in the region to join the fight.

While speaking at a meeting on the Huntington campus in January, President Gilbert drew a line in the sand and pledged to continue using the university’s vast resources to end the opioid crisis: “I think we are going to make a huge difference,” Gilbert said. “We are better positioned than any other university in the country to make a huge impact on solving the addiction problem. It won’t be done overnight. But we have dedicated people who sincerely believe that this is a disease and a social condition that we need to fight. We have the determination and the ability to conduct that fight, and I’m very proud that Marshall is a major contributor in the fight against addiction.”

From doctors at the School of Medicine to students in behavioral science, from researchers at the School of Pharmacy to faculty in wellness and prevention, from counselors and social workers to alumni working on the cutting edge of addiction sciences, Marshall is waging war on the opioid crisis.

Wellness and Prevention

The first wave in the university’s war on the drug crisis is education. Knowledge is power and officials at Marshall understand the importance of preventing their students, and area residents, from falling into the trap of opioid addiction.

Amy Saunders is the director of the Marshall Wellness Center and a co-chair of the university’s Substance Use Recovery Coalition. She is also the principal investigator for a nearly $1 million grant Marshall received from the Substance Abuse and Mental Health Services Administration to provide evidence based prevention and early intervention training to health care students and faculty, along with community members to identify substance misuse. The three-year grant was awarded in 2015 and has enabled Marshall to provide Screening, Brief Intervention and Referral to Treatment (SBIRT) training to more than 3,500 health care students and providers.

“Our first step was to train faculty so they could train our emerging, future health care students and members of the community,” Saunders said. “Not all, but about half of individuals who have a substance use disorder also have a mental health diagnosis, and many have a history of trauma. It is important for health care providers to understand this connection and the connection to underlying trauma that many of these individuals have experienced in order to treat individuals.”

Those taking the training learn how to provide screening, brief intervention and referral to treatment for individuals who are at risk of developing, or who have already developed, a substance use disorder or mental health issue.

The effort is a collective one with Marshall University’s Joan C. Edwards School of Medicine, School of Pharmacy and School of Physical Therapy, nursing, public health, psychology, social work and counseling programs; and the Wellness Center.

“The program has been a huge success,” Saunders said. “SBIRT at Marshall has not only trained students and community members on this important model, but it has also encouraged more collaboration between departments and interdisciplinary research.”

Saunders believes Marshall faculty members, and especially the program’s clinical coordinator, Lyn O’Connell, have been working diligently to ensure their training efforts will continue beyond the life cycle of the grant.

“Lyn has gone above and beyond, traveling all around the state to train case managers, nurses, school counselors and other health care providers,” Saunders said. “Faculty members have infused the training into their curriculum, ensuring that SBIRT will be sustained beyond 2018. Also, we could not have trained so many individuals without the help of our graduate students.”

SBIRT is one of several projects in which the university is working with the City of Huntington’s Office of Drug Control Policy and other community organizations to address the substance use issue at each stage.

“While socioeconomics are a risk factor, we have seen the drug epidemic does not discriminate,” Saunders said. “Marshall is committed to sharing our innovative and evidence-based solutions to the opioid crisis with our community, state and federal partners. Marshall will work to address the health disparities associated with the issue. SBIRT is only one of the education and workforce initiatives we hope to provide to the community and state.”

Cedric Gathings, the vice president for student affairs at Marshall, said the university is making a concerted effort to support students with education and prevention programs.

“We’re maintaining an open and transparent dialogue with both students and parents,” Gathings said. “That dialogue begins early. At freshman orientation, we have a panel discussion about the support services available to students including the counseling center, the women’s center and disability services.”

Gathings said a counseling center staff member is on call 24/7.

“The biggest thing we try to do is make sure the students know we’re here to support them. Regardless of who you are, where you’re from or what you’re dealing with, we want to help.”

A Seeds of Hope grant will provide funding, technical assistance and mentorship as Marshall works to increase its collegiate recovery efforts. University officials are determined to help all students, and this grant will aid those who need help with both their recovery and academics.

Also on the prevention front, faculty and students in Marshall’s schools of pharmacy and nursing have visited middle schools and high schools throughout the region as part of ongoing efforts to educate the next generation about the dangers of opioids.

Mothers and Newborns

Sadly, adults are not the only victims of the opioid crisis. In 2012, a drug-exposed baby was born every 25 minutes in America. Since then the numbers have skyrocketed. On a positive note, Huntington is nationally recognized as a leader in care for infants born with neonatal abstinence syndrome.

Babies who are born to mothers with a substance use disorder at Cabell Huntington Hospital have an incredibly detailed care network, including prenatal care services for the mothers and inpatient care units for babies before and just after they are born to combat negative symptoms and consequences of the exposure. The network represents a significant investment by Cabell Huntington Hospital and Marshall University to care for these children.

A portion of the babies discharged meet the criteria to move on to Lily’s Place, the first Neonatal Abstinence Syndrome (NAS) Center in the United States. Assistant Professor of Pediatrics, Sean Loudin, M.D., serves as medical director for Lily’s Place, which provides medical care to infants suffering from NAS and offers non-judgmental support, education and counseling services to families and caregivers.

One of the leaders in the care for mothers is Dr. David Chaffin, an obstetrician-gynecologist specializing in maternal-fetal medicine at Marshall Health and professor at the School of Medicine. Chaffin founded the Maternal Addiction Recovery Center (MARC) program, where he provides medication-assisted treatment to pregnant women who have an opioid addiction.

“There is a significant coalition of individuals from the School of Medicine, School of Pharmacy, campus departments and the community at large who help women find their way out of the streets and provide medical care to them throughout their pregnancy,” explains Dr. Kevin Yingling, inaugural dean of the Marshall University School of Pharmacy and co-chair of the Substance Use Recovery Coalition.

Collaboration is a key component. Robert Hansen, the director of addiction services at Marshall Health, came out of retirement to join the fight and has vast experience working with nonprofits by building networks and finding resources. He’s been busy putting all those skills to use after assuming his position in January 2017.

“Even though everyone talks about the opioid crisis, finding dollars to do something unique and creative is a challenge,” Hansen explained.

It’s happening, though, and Hansen has his hands in a host of initiatives. One of the first is named Healthy Connections, and its goal is to fill the void that exists after newborn care for babies and their mothers is completed.

“The big question for us has been what happens when a baby leaves Lily’s Place or the hospital. What does the mom do? What happens to the babies?” said Hansen, who retired from Prestera Center in 2012 and headed up Harmony House and Recovery Point before joining Marshall Health. “We started meeting with a few agencies and it just morphed into 15 to 20 agencies wanting to help. We designed a program that includes wrap-around services for moms who are in recovery and their young children.”

Several departments at Marshall, along with River Valley Child Development Services, which offers an available daycare facility, are among those involved.

In addition, Hansen said he is working on a grant for Healthy Connections that will help mothers develop soft skills.

“We need to help these mothers build up self-esteem and self-confidence. Sometimes you have to develop self-worth before you can go out and get your GED or enroll at Marshall,” Hansen said.

Quality Insights, a multi-agency nonprofit based out of Charleston, recently committed $1 million to the Healthy Connections initiative.

“I’m very optimistic because the amount of work we can accomplish going forward is going to be amplified,” Hansen said.

The next initiative is called Project Hope. With the help of a $2.8 million Ryan Brown grant from the West Virginia Bureau for Behavioral Health and Health Facilities, Marshall Health will open a women and children’s treatment center.

“This project is very unique, one of the few in the entire state, where mothers and children will have a protected environment to live, recover and rehabilitate for six months,” Yingling said. “It’s designed to keep families united, help children develop and give them the tools so that they can grow up to be healthy adults.”

Success Breeds Success

Leaders in the fight against the opioid crisis say there is much to be learned from the success Huntington and Marshall have had treating mothers and their newborns. They’re hoping that success breeds success.

“The next step is for the city and the university to be nationally recognized for its solutions to addiction. For that to happen, we need broad-based, wrap-around care and integration of services in the community,” said Yingling. “We will be addressing addiction across all ages, all demographics and all genders.”

Marshall Health, along with the experienced faculty, professionals and dedicated students at the schools of medicine and pharmacy, will play vital roles in many of the efforts to make sure Huntington’s citizens have no shortage of pathways and support on their way to recovery.

One such project currently in the works is named PROACT, an outpatient wrap-around service for men and women.

“PROACT is going to be a separate facility in Huntington for the purpose of integrating all care aspects for individuals in substance use disorders,” Yingling said. “That would include social workers, psychologists, psychiatrists, mental health, group therapy, career and job rehabilitation, long-term recovery and medication-assisted therapy.”

Yingling explained that medication-assisted therapy, commonly referred to as MAT, is the supervised use of medication to stop dangerous behaviors, stabilize lives and reduce drug cravings and relapses. The ultimate goal is to be drug free.

“Anyone can call or walk into this facility and be immediately triaged and be integrated into recovery,” Yingling said. “It is awesome.”

PROACT will be operated with financial support from Cabell Huntington Hospital, St. Mary’s Medical Center and Marshall Health.

“We will have physicians and pharmacists, social science faculty, behavioral science faculty and students all working at the facility,” Yingling said. “The goal is to move those seeking treatment toward long-term recovery, and all the services they will ever need would be provided there.”

An effort led by Hansen that was launched last December is Huntington’s Quick Response Team (QRT). QRT workers spend 40 hours per week following up with people who have overdosed. Coordinator Connie Priddy of Cabell County EMS reviews who overdosed the previous day, and then the team heads out to talk with them.

“We follow up with people multiple times because it may be the fifth time we see them that they decide to ask for help,” Hansen said. “We have a policeman, a full-time EMS worker and a clinician or recovery coach. They rotate. We’re trying to bring multiple people together to access as many resources as possible.”

Hansen read about a similar program that had been successful in the Cincinnati area and invited the key players to Huntington to share their expertise. The city collaboratively applied for and was awarded two grants to fund a Huntington version of the program.

In yet another initiative, Hansen has been working with Cabell Huntington Hospital and St. Mary’s Medical Center on Project Engage. Established with the help of a consultant — Dr. Terry Horton from Christiana Healthcare System in Wilmington, Delaware — the program aims to identify and help people admitted to the hospital, usually for other health reasons, who have a substance use disorder. It could be someone who tried to use drugs illegally in the hospital or someone going through withdrawal in the hospital. Once they are identified at the hospital, they can enter recovery programs.

“Part of this model is that eventually, there will be peer recovery coaches in both hospitals who will meet with patients, build a relationship and then help them into an outpatient program,” Hansen said.

An effort that has seen great success is the Cabell-Huntington Health Department’s Harm Reduction Program, which involves a clean needle exchange program. It is utilized by hundreds of patients each week. The program not only prevents outbreaks of infectious diseases such as HIV and hepatitis, but it also puts drug users in contact with a peer recovery coach who encourages them to begin the recovery process.

Hansen chairs the West Virginia Harm Reduction Coalition, which now covers 53 of the state’s 55 counties with harm reduction efforts.

Marshall’s schools of medicine and pharmacy are involved in another part of the Harm Reduction program, which is educating the public about Naloxone for treatment of an overdose and distributing it to those interested in having some on hand. That program goes by the acronym SAFE, for Stop Addiction Fatality Epidemic.

Yingling expects Huntington will be at the leading edge of recovery efforts regionally when the PROACT center is open and Healthy Connections is in full swing. Marshall University, with its many areas of expertise, is a crucial component to finding the solution to substance use disorders.

“I commend President Gilbert for taking on the initiative to establish the coalition and to focus the energies of the university in a significant way,” Yingling said. “We would not be where we are today in providing a sound, broad-based solution if it were not for President Gilbert’s leadership at the university.”

Planning for the Future

As part of the university’s comprehensive plan to address the opioid crisis, officials are not only offering a plethora of services and programs today, but preparing their graduates to continue the fight in the future.

Dr. Lori Ellison is the director for Marshall’s Counseling Program which offers a Master of Arts in Counseling. Whether they become professional counselors or school counselors, it’s inevitable the program’s graduates will find themselves faced with helping people who have been caught up in the opioid epidemic. Accordingly, she said it’s imperative students in the program be involved in the SBIRT training to identify individuals who need treatment.

“The effects of opioids are widespread and insidious,” Ellison said. “The addictive properties of opioids are so strong that it seems many are blindsided by their effects.”

Another key role of substance abuse counselors is to work with the families of patients as the user moves through treatment.

Jo Dee Gottlieb serves as director for the Bachelor of Social Work program within the College of Health Professions at Marshall. She said most of the region’s social workers see the effects of substance abuse daily in their practice, with it reaching up to almost 90 percent of their caseload. As such, Marshall has reached out to other campuses, including West Virginia State and Concord universities, enlisting them in the effort.

Gottlieb noted beginning this academic year, Marshall has established a multidisciplinary minor in addiction studies that “brings together disciplines dedicated to understanding addiction.”

“Unlike other Addiction Studies programs at other schools, this minor encompasses much more than just the aspect of treatment,” Gottlieb said. “It includes history, psychology, social work, public health, sociology, anthropology, criminal justice and kinesiology. The idea of the program is to create innovative thinkers who can take their interdisciplinary knowledge of addiction into the world in order to contribute toward tackling the problem.”

The university is even recruiting new generals in the fight against opioid addiction. In December, Daniel Langleben, M.D., a highly regarded addiction psychiatry specialist and a federally funded researcher with the University of Pennsylvania Perelman School of Medicine, was named the inaugural Maier Professor and Director of Addiction Sciences at the School of Medicine. He will begin work at Marshall in August.

The professorship, the result of a $1.25 million gift from the Maier Foundation, will support the university’s efforts to address the opioid addiction crisis across the region and country. In addition, the position helps build a foundation for future expansion of the medical school’s offerings in graduate medical education. Gilbert said the addition of Langleben to Marshall’s faculty is pivotal in the university’s efforts.

“Dr. Langleben brings a breadth and depth of experience that will propel our university forward in the fight against all addictions,” Gilbert said.

Dr. Joseph Shapiro, dean of the School of Medicine, said Langleben will help the school expand its existing clinical experience with cutting-edge molecular research.

“We will press forward in the quest to find answers to some of the most devastating illnesses, like addiction, plaguing our generation.”

Garnering National Attention

On Feb. 20, Dr. Walter J. Koroshetz, director of the National Institutes of Health’s National Institute of Neurological Disorders and Stroke, and three other officials from the NIH, visited the School of Medicine to learn more about the university’s research and clinical outreach in regard to the nation’s addiction crisis. Koroshetz and his team met with researchers, clinicians and students during the visit, which included a roundtable discussion.

“I’m very proud of the work we are doing here at our medical school related to pain and to opioid addiction,” said President Gilbert. “I am hopeful that the NIH will look favorably upon the institutions like Marshall — of our size —­ that are in the trenches, doing innovative work in these areas. I feel like we forged some wonderful relationships during the visit and look forward to working with NIH in the future.”

In April, a team of experts from Marshall traveled to Atlanta to present at the The National Rx Drug Abuse & Heroin Summit — the nation’s largest annual conference focused on the opioid crisis. In their session “Using What We Know: Helping Teachers, Families and Communities Respond Systematically to Children Affected by Familial Substance Use Disorder,” team members discussed the effects on children when substance use disorders are present in families, as well as effective school, community and family-based interventions. They explained how failing to intervene to support the family structure contributes to cognitive, emotional and behavior problems in children before and after they start school.

The panel of Marshall presenters included Amy Saunders, director of the Marshall University Wellness Center; Marianna Footo-Linz, chairman of the Psychology Department; Conrae Lucas-Adkins, assistant professor of school psychology; Lyn O’Connell, clinical coordinator of Marshall’s Screening, Brief Intervention and Referral to Treatment (SBIRT) program; and Todd Davies, Ph.D., associate director of research in the Division of Addiction Sciences at Marshall’s Joan C. Edwards School of Medicine.

The Marshall speakers joined a number of national figures on the agenda, including U.S. Surgeon General Jerome M. Adams, and the heads of the National Institutes of Health (NIH), the Office of National Drug Control Policy, and the Centers for Disease Control and Prevention (CDC).

President Gilbert said he is pleased to see Marshall’s leadership in recovery efforts recognized.

“In Huntington, we are at the center of the solution to this epidemic impacting communities across the country,” he noted. “Because our community was affected early, we are now ahead of the curve and the rest of the country in creating recovery initiatives. Recent data show that Huntington may have turned a corner in this fight in the last few months and the lessons Marshall’s health care and social services providers have learned will be helpful to the rest of the country.”

President John F. Kennedy once said, “When written in Chinese, the word ‘crisis’ is composed of two characters. One represents danger and the other represents opportunity.”

Today, Marshall University is rising to meet the challenge of America’s opioid crisis. It has turned to its faculty, staff and students, as well as partners throughout the community, to educate the public about the dangers of opiates. What’s more, the university is leading the way to seize every opportunity available in its vast network of resources to help solve the riddle of addiction. The crisis may not be over, but because so many talented, dedicated and caring people have chosen to join the fight, there is finally a light at the end of the tunnel. 

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Jack Houvouras is the publisher of Marshall Magazine.

James E. Casto is the retired associate editor of The Herald-Dispatch and the author of a number of books on local and regional history.

Jean Hardiman is university relations specialist at Marshall.

Kasey Madden is the managing editor of Marshall Magazine.

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Dr. Lori Ellison is the program director for Marshall’s Counseling Program, which offers a Master of Arts in Counseling.

Jo Dee Gottlieb, MSW, LCSW, serves as the director for the Bachelor of Social Work program within the College of Health Professions’ department of social work. A licensed social worker for over 30 years, she is also the social work chair for Healthy Connections.

St. Mary’s Medical Center, along with Cabell Huntington Hospital and Marshall Health, is offering financial support to PROACT, a facility that will integrate all aspects of care for those who suffer from substance abuse. Social workers, psychologists, psychiatrists, mental health, group therapy, career and job rehabilitation, long-term recovery and medication-assisted therapy are all part of the comprehensive list of services PROACT will provide.