WASHINGTON, D.C. — Dr. Clay Marsh, the Vice President for Health Sciences at West Virginia University, will speak on Tuesday’s Congressional Academic Medicine Caucus panel about opioid abuse disorder, joining physicians from the University of Cincinnati and Yale.
The chief focus of the panel is to inform Congressional leaders about treating patients in under served communities and stemming the tide of overdoses in those hard-hit areas, which is particularly relevant to the Mountain State’s battle with opioids.
“Certainly, the challenge we’re facing in West Virginia, there are a number of things that are urgently in need of being addressed because people are dying of opioid overdoses,” Marsh said in a phone call with WAJR-AM Monday.
Marsh said there are two facets to the opioid epidemic that apply to West Virginia, the state that consistently leads in data that tracks opioid overdose deaths throughout the nation, and the nation as a whole. The first facet is treating what he calls the “above-the-ground” issues. First, he advocates for increased access to life-saving reversal agents like narcan or naloxone. Second, he said the medical community needs to take different approaches to treating chronic pain that includes control programs to avoid the over-prescribing of opioids. Third, he said education of best practices needs to reach every medical school in America. Finally, Marsh suggests experts in the field need to continue developing a means to predict what makes up the most vulnerable communities.
“Those are all sort of, if you pull out a weed, the things that you see above the ground,” he said. “All those things need to be addressed, and we are addressing many of them here.”
“But then there’s the root. And in order to eventually get rid of the weeds, you have to pull it up by the root.”
The ‘root’ is far more complicated though, according to Marsh. The root of the problem isn’t tied to any single factor, but many that have contributed to weakening formerly strong communities and already at-risk communities alike.
“The root is the breakdown in our communities, the breakdown of purpose and hope, and the feeling that things are going to get better in the future,” he said. “Social isolation and loss of your position in life, also called a loss of social capital, and a breakdown in communities we think is the really long term cause. And it’s something else we’re trying to work on.”
Socioeconomic status, he said, isn’t the only indicator for opioid abuse. Marsh said a lot of the data indicates it’s the rare epidemic that is impacting communities across a wide spectrum of wealth, or lack thereof. Some of the predictors Marsh did cite as potentially hopeful are already being used in limited cases, including a survey done by the Kaiser Family Foundation that often can predict the increased chances of illness, injury, quality of life, and life expectancy. Often, West Virginia scores poorly on surveys like this, and Marsh said that’s something the state must confront.
“We are approaching this in a multi-dimensional way and a multi-pronged way to deal with the acute needs, but also with the long-term prevention opportunities for our state,” he said. “And to use our state as a model to try to help other places in the United States and beyond have a satisfactory outcome.”
The Kaiser Family Foundation survey is only ten questions, but even one ‘yes’ answer can be indicative of future risk. As an example, Marsh said answering yes to any four of the 10 questions correlates with an increased chance of contracting emphysema by 1,200 times for the individual answering. The basic crux: more ‘yes’ answers leads to more factors that indicate a lower quality of life. In McDowell County, Marsh said he’s corresponded with local officials who believe the student average on the survey would include eight yes answers — a clear indicator of shorter life expectancy.
“West Virginia has, we believe, a high level of childhood traumas,” he said. “And based, at least, on the Gallup well-being survey has the least confidence that things will be better — that they see their lives as good — for any state for eight years in a row.”
But if socioeconomic status isn’t the fault line that opioid abuse sits on, then what is? Marsh believes it comes down to social capital — the basic belief that life either will or won’t improve in a given community. In essence, Marsh said one of the major battles in the opioid epidemic is figuring out how to stop someone from walking down the road of opioid abuse in the first place. Once that occurs — and addiction takes over — it becomes a medical condition. While it is difficult to treat, Marsh said it’s still a medical condition that has guidelines and best practices. But those medical best practices don’t address the issues facing at-risk communities, which is why he wants to see the medical field seize on predictive measures.
“Look at opportunities for us to start to predict the people that might have the problems, particularly children that are vulnerable, children with a lot of trauma, children who may not live with their biological parent that would be at risk for having problems,” Marsh said.
If not, he said, the consequences will continue to include the destruction of lives and communities alike.
The panel, “Care in the Face of the Opioid Epidemic: How Medical Schools and teaching Hospitals are Reaching Underserved Communities,” begins at noon Tuesday.