Case study: Jackson County, W.Va.

Key Takeaways

NACo and National League of Cities, through the National City-County Task Force on the Opioid Epidemic, has explored how cities and counties collaborate to address the opioid epidemic and how local leaders can help to build upon these collaborations and scale them nationally. As an extension of this work, NACo has coordinated efforts with the Conrad N. Hilton Foundation and has expanded its scope to general youth substance abuse from what was once a focus on just the opioid epidemic. The goal of the current Hilton grant is to compile information learned from counties explaining the needs, gaps and opportunities they face regarding youth substance use and to illuminate any possible areas where significant gaps in knowledge or programming still exist through interviews, a broadly distributed questionnaire, focus groups, and roundtable discussions. The information collected will inform the development of a County Needs and Recommendation Report.

The following is an excerpt from a NACo led interview with Amy Haskins of Jackson County, W. Va.  Jackson County is a small county in W. Va. with a population of about 29,000. Twenty-two percent of their residents are under the age of 18 and 24.9% of children live in poverty. The unemployment rate is 5.6%, with a county per capita income of $21,800. Amy has served as the Administrator for the Jackson County Health Department for the past two years and has a background in health promotion and wellness management. She is also the Project Director of the Jackson County Anti-Drug Coalition.

Blaire Bryant, NACo: Tell us a little about your role in Jackson County and how you came to be a part of the Jackson County Anti-Drug Coalition.

Amy: I was originally hired as a public health educator and I have a background in health promotion and wellness management. From 2006 – 2008, we had 16 people die between the ages of 15 and 22, but there wasn’t any indication that it was a grouping of deaths. At the time, (coalition meetings were) just a lot of people sitting in the room pointing fingers, and there weren’t really any solutions coming out. Until we had some funding backing us to make some changes, nothing was ever going to really change. I offered to write a few grants and see what we could do as far as getting some education around prescription drugs and youth substance abuse in general.

We had reports of kids crushing pills, to snort them off of textbooks in the middle of class. We used Jackson County school systems PRIDE survey information, which indicated that most of the people who passed away during a two-year time period had substance abuse issues all the way through middle and high school. Their trends were off the charts, compared to everybody else. That was the very first thing that I saw. It started in middle school, where their tobacco use for that particular class was alarming. The school system is very good; they do the PRIDE survey every other year. So, I was able to follow that particular class of kids all the way through high school. And looking at their drug trends, it went from tobacco, to marijuana, to heavy underage drinking, and then at that point it was listed as illicit drugs.

The state office of vital statistics gave us a breakdown of the five (top five = most concentrated?) drugs in the body at the time of death for all 16 kids. It very overwhelming, but satisfying, to figure out that we had a hydrocodone, oxycodone, and a fentanyl problem. Almost all of the 16 kids who died showed those drugs in in their body at the time of death.

Now, we knew exactly what we were dealing with. The Coalition was awarded a Drug Free Communities Grant through SAMHSA. That funded education for everyone from preschool age to the seniors. West Virginia is overprescribed looking at meds per person, so there was a lot of medication that was probably sitting in homes, with uninsured and lower-income people tending to hold on to meds because they are not as eager to go to the doctor every time they get sick. We also had reports of mail theft and medication theft from people’s homes.

We added a drug takeback program before the DEA did. The very first thing turned in was 12 vials of liquid morphine. I said, how much would that cost on the street. He said, that would pay for your Christmas eight times over. And so, from that point on, we started doing take back days every quarter. We took back 90 pounds worth of medication, not including the packaging, every quarter. We’ve been doing that for almost 10 years. We’ve moved to doing permanent drop boxes.

Disposal is an issue, so I started looking at mobile incinerators, and DEA helped me pick out a mobile incinerator that met all required regulations, the state of WV regulations, and EPA regulations, and so then we were the first mobile incinerator in the state of WV.

Blaire: Some of the strategies that are antiquated have been looking at drug use as one issue, and not pinpointing what the issues are.

We have done education [programs] with kids. We have more than 120 kids involved in four youth coalitions and we also provide education for providers and for nursing staff. We taught teachers how to recognize if kids were using inhalants in the classroom. We showed teachers how to change their school supply list, so they didn’t have school supplies in their classroom that kids could get high off. Because adults are more aware in the community, and the kids are more aware.

Blaire: Can you talk about how you are prepping teachers to notice signs that indicate drug use among their students and how they’re intervening and possibly referring those students to treatment?

When you hit middle school, you have the option as a parent to enroll your kid into random drug testing. For any school sponsored activity, you’re required to sign that random drug testing form. Now if you are a child who’s enrolled into the random drug testing, and you fail the first drug test, you are automatically placed in the next round of drug testing. That child is also referred to a mandatory mental health evaluation within 48 hours to determine their risk upon failing their first drug test.

Blaire: Who participates in the Jackson County Anti-Drug Coalition?

Various law enforcement agencies, the school system, faith-based organizations, business leaders and civic organizations. We have our youth coalitions, and one of my most dedicated participants is a parent whose child was the last one to die out of those 16. The alcohol beverage control commission participates, our mental health provider participates, we’ve got another agency that works specifically with youth, our court system participates. We have any of the players that you need to have at the table to make change and that was all through relationship building. But it’s kind of hard not to forge those relationships quickly when you have 16 kids die.

We also have recovering addicts as part the group. They tend to come and go based on their schedules and what we’re doing throughout the year, but we’ve got healthcare providers, pharmacists.

Blaire: What have been some of your biggest successes in terms of minimizing this issue?

I think number 1 the biggest success is that we have been together as a core group for about 10 years. I think part of that is the solidarity with the health department. Because I think having our coalition be a part of the health department, we have access to more information and different types of statistics than just somebody who’s just a general nonprofit out in the community. Our biggest successes I think have been getting a synthetics law passed for the state of WV. Being the first to have a mobile incinerator for the state of WV, but then advocating to have 9 regional incinerators placed throughout the state. We kind of are a go to coalition for a lot of people.

It’s kind of funny because people ask me a lot how do we come up with the ideas that we have to do things, and how do we know what we need to do. My rule of thumb is that if I have thought of something or somebody in my group thinks of an idea, we’re not rocket scientists. Certainly, somebody else has done it. It’s just that for whatever reason we’re able to put it all together and make it really successful. I think it’s because we want to see change happen and we understand that the change is not going to happen quickly. But you know I look at ideas that I see other coalitions do across the country. I’m like ok I like part of this, and I like this, and I like part C of this, so let’s combine all of that and see what happens. As a coalition leader, I’m not scare of trying new things and failing. Because ultimately you grow out of that failure. Somebody is the expert somewhere, and if we’re not, we’ll find who it is, or who we think is the expert and bring them in to help us.

I’ve got data that shows that what we’re doing is working. Whatever that thing is that we’re doing, it’s the multitude of everybody in the community, but it’s working and we’re driving down those youth usage rates, to the point that for the most part they’re below national average. It’s kind of amazing. I’m always looking at the next hurdle that we have to cover. We don’t take a whole lot of time to celebrate because there’s always something else on the horizon that we need to battle with.

Blaire: With you all being so ahead of the curve, I think you did a great job in getting in front of how bad the opioid crisis could have been in your community. I definitely want to acknowledge that and the all the work you all have been doing. It’s amazing.

I did forget probably one of the biggest compliments that we’ve had. I was called in April to go testify in front of the House in Washington, DC on what we’ve done in our community. I don’t get nervous very often and I was quite nervous that day. That was pretty cool.