On the Front Lines of Addressing America’s Opioid Crisis

on January 31 | in Featured | by

Hollins alumnae are not only witnessing the devastation of opioid addiction, they are also working with victims and families, writing about it, and changing laws.

By Beth JoJack ’98

Rampant abuse of prescription painkillers in Western Virginia has changed the way Angie Wooten M.A.L.S. ’11 navigates the Child Protective Services system as a family services specialist for the Roanoke County Department of Social Services.

When she first started working with abused and neglected children back in 1996, Wooten remembers, she would drive to initial home visits of families, where one or more adults in the home had been accused of abusing drugs, and think to herself, “Gosh, I wonder if they’re really using?”

Photo of Angie Wooten

Angie Wooten M.A.L.S. ’11 has seen increased opioid use in the households she visits as a family services specialist. [photo by Sharon Meador]

These days, Wooten admits that when she heads to that first home visit, her thoughts are different. “It’s wondering: ‘How much use? How frequently are they using?’” she says.

Wooten meets the family with a pretty good idea of what substances are being abused. “It’s usually opiates,” she says. “They might be using other things, but we usually see opiates on the [drug] screen.”

Although concrete data aren’t available yet for how many children have been removed from their homes due to caregivers struggling with drug addiction over the last two years—considered the height of the opioid epidemic—experts believe the number is high. Wooten sees that in her own caseload. “More and more grandparents, aunts, uncles, et cetera, are having to step up and raise these children,” she says.

The current opioid crisis, researchers believe, stems from an increase in doctors legally prescribing opioids, like Vicodin and OxyContin, for pain. Maybe that increase stems from pharmaceutical companies launching aggressive marketing campaigns. Maybe it’s the result of a ’90s push among doctors to do a better job of treating pain. Whatever the reason, the number of prescription opioids sold in the United States nearly quadrupled from 1999 to 2010, according to the Centers for Disease Control and Prevention. Some of those who became addicted to prescription opioids later switched to heroin or illegal fentanyl, which can be easier to obtain.

Each day, more than 90 Americans die from overdosing on opioids, according to the National Institute on Drug Abuse. In late October, President Trump declared the opioid epidemic a national public health emergency.

All over the country, Hollins alumnae are putting their liberal arts educations to work trying to address the crisis. While Wooten works on the front lines, caring for the youngest victims of the epidemic, Elizabeth Ropp ’99 fights to give mental health workers another tool to help opioid addicts in recovery, and New York Times-bestselling author Beth Macy M.A. ’93 puts the finishing touches on Dopesick, a book chronicling the opioid epidemic through the lens of three Virginia communities.

Elizabeth Ropp ’99

During an October talk show program, New Hampshire Public Radio reporter Paige Sutherland singled out Elizabeth Ropp ’99, crediting her efforts for the swift passage of a state law that permits specially trained substance abuse and mental health workers in New Hampshire to practice an ear acupuncture treatment designed to relieve withdrawal symptoms in opioid addicts.

“She really took it on herself,” Sutherland said of Ropp, who has worked as a licensed acupuncturist for over a decade. “She brought this bill to legislation and got it passed.”

Ropp, who majored in theatre and women’s studies at Hollins, learned about using ear acupuncture to help opioid addicts as a student at the now defunct Atlantic University of Chinese Medicine in Mars Hill, N.C. She didn’t become passionate about teaching recovery and mental health workers the technique, however, until after becoming heavily involved in the 2016 presidential campaign.

After moving to Manchester from Asheville, N.C., in 2010, Ropp quickly became immersed in progressive activism. She served on New Hampshire’s steering committee for Bernie Sanders and even hosted the first house party for the candidate in the state (so many supporters came to hear Sanders speak that some had to stand in the yard and listen through an open window).

While she “felt the Bern,” Ropp also made a practice of showing up at events hosting other presidential hopefuls. She listened as pundits described New Hampshire as ground zero for opioids. The state ranks number one among states for deaths related to fentanyl (a synthetic opioid) per capita and number two for opioid-related deaths proportionate to the population.

Photo of woman administering acupuncture

Ropp was instrumental in getting a law passed in New Hampshire that allows trained practitioners to use acupuncture to treat recovering opioid addicts. [photo by Paige Sutherland, New Hampshire Public Radio]

Living near downtown Manchester, Ropp had seen plenty of evidence of the opioid crisis. Walking to her job at the Manchester Acupuncture Studio, Ropp frequently spotted needles in snow banks and on sidewalks. It was all the talk about the epidemic during the primary, however, that made her realize the seriousness of the problem and propelled her into taking action.

Ropp, who describes herself as an “acu-punk,” began talking to other advocates about treating opioid addiction with a specific type of ear acupuncture, also referred to as acudetox or the NADA protocol, a treatment that involves applying up to five needles just under the skin at designated points in each ear. Clients and clinicians report the treatment, which has been practiced in the United States since the 1970s, leaves many individuals who are addicted to opioids feeling more positive about recovery, as well as experiencing reduced cravings, anxiety, and sleep disturbances, according to the National Acupuncture Detoxification Association (NADA).

While attending a conference of the People’s Organization of Community Acupuncture in Tennessee in 2016, Ropp heard from acupuncturists in Rhode Island who were working to get a law on the books that would allow trained substance abuse workers to practice the NADA protocol on people in drug treatment. Ropp became determined to follow their lead. “I decided that was going to be my next project,” she says.

At the New Hampshire AFL-CIO Labor Day breakfast that year, Ropp approached state legislator Bob Backus. “I said, ‘If we want to do something about the opiate crisis, this is what we could do,’” Ropp recalls.

A few days later, Ropp says, she saw Backus at the Unitarian Universalist church they both attend, and he agreed to sponsor a bill.

Now Ropp had to get the legislation to the governor’s desk.

Through her work with the Sanders campaign, Ropp had become acquainted with lobbyist Huck Montgomery. When she told him about her work on HB 575, the bill that would allow specially trained recovery and mental health workers to use the NADA protocol, he gave her an hour and a half of free advice. “He basically laid out everything I needed to do,” she says.

In particular, Montgomery recommended that Ropp think carefully about whom she wanted to provide testimony on the issue to the House’s Executive Departments and Administration Committee. So Ropp spent about 30 hours a week last winter recruiting recovering addicts, family members of addicts, doctors, recovery and mental health workers, and acupuncturists from other states to testify. “I would have just had lots of patients calling the committee, but it wouldn’t have been very pragmatic or systematic,” Ropp says. “[Montgomery] got me to focus on how to get all different kinds of testimony, and so that way everyone had a different perspective of why we needed this.”

Support for HB 575 came from both sides of the aisle. “Passage of this bill will bring another source of aid to the substance abuse victims,” state Rep. Peter Hansen, a Republican, told the New Hampshire Union Leader.

Opposition stemmed mostly from the members of the New Hampshire Board of Acupuncture Licensing. Minutes from the licensing board’s March meeting stated that members found the bill’s “rule-making section is not adequate and it does not give specific enough authority for qualification, ethical standards, training and scope of practice.”

In reality, Ropp believes, the board members’ opposition, as well as the resistance the bill received from some acupuncturists in the state, stems more from concern about protecting turf and bank accounts. Ropp points out that most people struggling with addiction can’t afford traditional acupuncture offices. And anyway, she adds, there aren’t enough licensed acupuncturists in New Hampshire to meet the demands of the masses suffering from opiate addictions.

As she worked to get the bill passed, Ropp also began volunteering once a week to individuals struggling with addiction. For a while, Ropp administered the NADA protocol at a respite care facility, where addicts went while waiting to get into intensive treatment programs. “They were basically coming in off the street and getting clean cold turkey because there was nothing to offer them,” Ropp says. “They were uncomfortable. They had headaches. They were nauseous. They had body aches. …A lot of people walk out of respite care because they can’t handle the withdrawal symptoms.”

There, Ropp saw firsthand that the ear acupuncture could reduce cravings, help with the symptoms of withdrawal, and ease the anxiety that leads some addicts to try opioids in the first place.

Working at the respite care center showed Ropp that the law needed to be as flexible as possible because people working on the front lines with addicts are often peer coaches, individuals who have struggled with addiction themselves, not licensed mental health providers.

When the licensing board tried to get the bill amended to require that a licensed acupuncturist be on hand whenever a trained recovery worker practiced the NADA protocol, Ropp fought hard. “This would totally make it unaffordable,” Ropp told the New Hampshire Union Leader in June. “The whole way this works is to allow recovery workers to give this treatment without the administrative overhead.”

On July 20, 2017, Governor Christopher Sununu signed the bill—a version that lacked the amendment the licensing board wanted tacked on.

When Ropp saw Bernie Sanders at this year’s AFL-CIO Labor Day breakfast, she gave him a birthday card that had a copy of HB 575 inside. “He hugged me and it was really beautiful,” she says. Ropp’s experience left her passionate about New Hampshire politics: “I saw the best come out of a lot of people around this bill.”

She continues to provide ear acupuncture once a week at a recovery center in Manchester. Once the rules for the legislation are ironed out, Ropp expects she will help with organizing trainings for mental health workers who want to provide the NADA protocol.

Ropp doesn’t rule out eventually running for a state office herself. “A lot of people are asking me to,” she says, pointing out that New Hampshire has a mammoth state house with 400 members. “I feel like everybody at some point runs for the state house [in New Hampshire], so I am sure that at some point I will run.”

Beth Macy M.A. ’93

Macy’s third book is about opioid addiction in Southwest Virginia.

Acclaimed author Beth Macy M.A. ’93 gravitates toward stories of unlikely heroes. Her first book, 2014’s Factory Man, profiles John Bassett III, a brash Galax, Virginia, furniture maker who fought back against low-cost Chinese furniture imports, saving hundreds of U.S. jobs. With her 2016 follow-up, Truevine, Macy turns the spotlight on Harriet Muse, an illiterate African American maid in the Jim Crow South. The book pushes modern readers to understand the remarkable courage Muse demonstrated, especially during a time when lynchings still occurred, by speaking out for justice for her two sons. When they were just boys, the Muse brothers were abducted by or sold to a circus promoter and forced to work at a sideshow because their albinism qualified them as “freaks.”

When Macy decided to focus on the opioid epidemic for her third book, she gave careful thought to how to tackle a subject so engulfed by misery. “I chose to write about the helpers and the people fighting back,” she says. “It just seemed a little bit more hopeful and less scary to me.”

Part of the book—tentatively titled Dopesick, and slated for release in August 2018—is set in Virginia’s coalfields. Macy features the work of an octogenarian nun who tirelessly helps addicts and a country doctor who, in the 1990s was among the first to argue that the prescription opioid OxyContin was addictive, even as pharmaceutical sales reps repeated that “the risk of addiction was less than one percent” over and over again like some kind of mantra. “He’s still kind of on the front lines,” Macy says of the doctor. “[In the book] you see him back then and you see him now.”

Macy also takes readers to Roanoke, where she has lived for nearly three decades and where she covered the opioid epidemic in 2012 for a series in The Roanoke Times, the newspaper where she worked for the bulk of her career. Macy focuses on suburban Roanoke County, where she depicts a community slow to realize the scope of its drug problem.

“It was easier to hide in the wealthy suburbs because people had money,” Macy explains. “So not only were the kids having an easier time hiding it, they weren’t getting busted like the people in the coalfields were for breaking into houses and driving stolen lawn mowers down the street. …Their parents would have money to send them off to treatment and keep it quiet.”

In Roanoke, Macy profiles mothers who watched their own kids struggling with opioids. These mothers are now working with the Roanoke Valley HOPE Initiative through the Bradley Free Clinic, a program that connects addicts with treatment and works to keep them out of jail.

Dopesick also portrays a small town in the Shenandoah Valley of Virginia where a drug dealer moved following a prison sentence to work at a chicken plant. He later began importing heroin. “One reason that’s a good story is because you can see in this one small town…the progression of the epidemic,” Macy explains. “Overnight almost, this town goes from having a handful of known heroin users to hundreds. The heroes in that locality are the cops and an ATF agent who sort of banded together and said, ‘Not in our town.’”

In an email to followers who sign up on her author website, Macy describes Dopesick as a sort of sequel to Factory Man. “It’s the story of what happened in the forgotten parts of America when a flood of opioids descended at the same time the factories and mines were shutting down, and how that flood became a heroin epidemic now plaguing most of America’s cities, towns, and suburbs,” she writes.

Macy, whose father was an alcoholic, calls the book the hardest thing she’s written. “People who are really impaired make me scared and nervous,” she says.

Carole Tarrant, who was the editor of The Roanoke Times when Macy wrote the series on the opioid epidemic, has read drafts of Dopesick and thinks it showcases the best reporting Macy has ever done. “It has a wide sweep—looking broadly at the history of opioids and then zooming in with the kind of authentic details that make Beth’s reporting feel rock solid,” Tarrant wrote in an email. “You know the people she’s reporting about—they are real and not stick figures.”

Macy received some pushback when she reported about opioid abuse in 2012, according to Tarrant, now coordinator of development at Virginia Western Community College. “Some key leaders in the Roanoke Valley didn’t want to acknowledge what was happening and treated it like this was a random blip of a few troublesome rich kids,” she explains.

The series was widely read, Tarrant writes, but she wishes it had spurred more action in the community. “I know we’re both deeply saddened today by the fact that we thought the series would have made more of an impact,” she writes. “Maybe it did open a few eyes—maybe some folks emptied their medicine cabinets. But five years later, all you have to do is read the obits carefully and you see so many more young people in Roanoke are dying.”

While Macy puts the finishing edits on Dopesick, her first two books continue to gather steam. Paramount Pictures purchased the rights to Truevine, according to Macy, with Leonardo DiCaprio envisioned as playing Candy Shelton, the man who, for many years, pocketed the fortunes the brothers made on the circus circuit. Meanwhile, according to the Los Angeles Times, playwright and screenwriter John Patrick Shanley, who won an Academy Award for Moonstruck, is penning the miniseries based on Factory Man for HBO and Tom Hanks’ production company, Playtone.

When Dopesick gets released thisyear, Tarrant hopes the book “will finally make everyone see this as the crisis that it is.” The opioid epidemic has received an onslaught of media attention in recent months. So much, Macy had to stop looking at her Google alerts because she was being inundated with articles. “Everybody in the world is writing about this, so it’s pretty intimidating,” she says.

But at the end of the day, Macy says, all she can do is tell the story she knows how to tell. “I think what we have is a fresh contribution,” she says. “I hope it will help with the battle against the shame and the stigma.”

Beth JoJack is a Roanoke writer and frequent contributor to Hollins magazine.



Pulitzer Prize for “Courageous Reporting”

Follow the pills and you’ll find the overdose deaths.

The trail of painkillers leads to West Virginia’s southern coalfields, to places like Kermit, population 392. There, out-of-state drug companies shipped nearly 9 million highly addictive—and potentially lethal—hydrocodone pills over two years to a single pharmacy in the Mingo County town.…

In six years, drug wholesalers showered the state with 780 million hydrocodone and oxycodone pills, while 1,728 West Virginians fatally overdosed on those two painkillers, a Sunday Gazette-Mail investigation found.

So began the Pulitzer Prize-winning series of stories in the Charleston Gazette-Mail about the crisis that’s killing so many West Virginians. Reporter Eric Eyre wrote the series, which received the 2017 prize for investigative reporting. The Pulitzer committee wrote that Eyre “performed in the face of powerful opposition, to expose the flood of opioids flowing into depressed West Virginia counties with the highest overdose death rates in the country.”

In her Washington Post article about the newspaper’s award, Margaret Sullivan wrote that “what motivated [the reporting and editorial staff] was the West Virginia paper’s unofficial motto: ‘Sustained outrage.’”

The newspaper’s publisher, Susan Chilton Shumate ’90, praised staff members for their dedication to “changing the world for the better.” The Gazette-Mail has been in Shumate’s family for more than 100 years. Her mother, Elizabeth “Betty” Easley Chilton ’50, still serves on the newspaper’s board.

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