Kanawha County Sheriff’s Lt. Scott Elkins gets ready for his 12-hour shift by checking his patrol car and equipment, then contacting the dispatcher to discuss the team of deputies with whom he will patrol 900 square miles until dawn.
Lastly, Elkins inspects his supply of Narcan, the trade name for naloxone, an opiate antidote. In a county with record opioid-related deaths, Elkins must be prepared to treat a drug abuser overdosing on prescription or illicit opioids.
“If you respond to a call where someone is overdosing before the medics arrive, you spray it into their nose,” said Elkins, 44. “It doesn’t save their life, but it starts them breathing again. It buys them some time to go for treatment. I used it on a guy who was in full overdose when I got there.”
Law enforcement agencies around the country are adding antidotes such as Narcan to their arsenals as prescription and illicit opioid overdose deaths have skyrocketed. Police officers at such scenes are performing lifesaving techniques as well as law enforcement duties, officials said.
The current “wave of addiction is devastating communities of all sizes and demographics,” said Richard Beary, past president of the International Association of Chiefs of Police, based in Alexandria, Virginia.
In an email, Beary said law enforcement officials are working with other agencies because policing alone will not resolve the problem. “While Naloxone is not the answer to this epidemic, it is another tool law enforcement officers have to save lives while serving their communities.”
Kanawha County, in southwestern West Virginia, is the front line for officers fighting a surge in deadly opioid abuse. Although the death in April of Prince from an overdose of the opioid fentanyl brought wide attention to the crisis, it is here that the burden is heaviest on police, court, public health, rehabilitation, social work and medical resources.
“The majority of what we do now is based on the opioid and heroin epidemic,” said Kanawha County Sheriff’s Chief Deputy Mike Rutherford. “It has impacted everything.”
More than 150 miles away, along West Virginia’s Eastern Panhandle, opioid prosecutions now make up “80 to 85 percent” of the cases handled by the Hampshire County police and prosecutor’s offices, said prosecuting attorney Dan James.
Nationally, 47,055 people died of an accidental overdose in 2014, the last year for which the Centers for Disease Control issued numbers. Sixty-one percent of those deaths – 28,647 – involved opioids, which include heroin, as well as painkillers such as OxyContin, Percocet and hydrocodone. And the death toll has been rising in the past decade. The 2014 statistics show a stark increase over the 13,756 opioid overdose deaths reported in 2004.
The deaths are occurring in small towns and large cities. In West Virginia, which has the highest death rate in the nation, 628 people died of overdoses in 2014 – 35.5 per 100,000 people. That rate was more than twice the national average of 14.7 deaths per 100,000, CDC data shows. New Mexico tallied the second highest rate at 27.3 deaths per 100,000.
The highest number of deaths in the state in 2015 – 112 – occurred in Kanawha County, where 85 people had died in 2014. In Cabell County, home of Marshall University and its NCAA Division I Thundering Herd football team, 92 people died in 2015, up from 71 in 2014 – the second highest number of deaths in the state, statistics show.
Deputies respond to one or two overdoses per 12-hour shift in a jurisdiction with only 23,000 residents, said Chief Deputy Nathan Sions of the Hampshire County Sheriff’s Department. Ten people fatally overdosed in 2015. “It really takes a toll on our families. It affects all different classes of people, not just the lower class.”
The abuse is also driving up the crime rate in the Mountain State, police said. Thefts are up as users steal to buy the drugs. Violence has increased because of drug turf confrontations. Assaults, domestic violence complaints and reports of child neglect have also increased.
Joshua James Garrison, of tiny Augusta, in Hampshire County, is accused of choking and beating octogenarian Betty Crouse so severely with a hammer and skillet in the wee hours of Aug. 22, 2015 that he broke the handle off the pan. Garrison, 27, allegedly told authorities that he went to Crouse’s home on remote Starbright Drive to steal prescription medications. He was found in possession of medications belonging to Crouse, officials said.
“The suspect thought he was getting an opioid drug, but what he got was high blood pressure medicine and vitamins,” Sions said.
President Obama visited West Virginia last October to promote federal training for prescribers. In his 2017 budget request, Obama asked Congress for $1.1 billion to address opioid abuse.
In March, the Department of Health and Human Services awarded $94 million in Affordable Care Act funds for health centers to expand “medication-assisted treatment” programs for opioid abusers, according to a statement. The funds were given to 271 health centers in 45 states, the District of Columbia and Puerto Rico and are expected to assist in the treatment of 124,000 new patients and the hiring of 800 additional personnel. West Virginia received $1.77 million for five treatment centers.
For those who wage the drug war every day, however, that promise of federal help is remote.
Elkins was surprised to get through his rainy 12-hour shift on a recent night without being called to one overdose scene. A man who was found lifeless lying on a bench downtown apparently died of natural causes. That was the only corpse Elkins saw that day.
He also watched as his deputies arrested a 66-year-old man who admitted using opioids before driving to a local convenience store and falling into a snoring slumber inside his pickup. His wife sawed logs by his side. The man was arrested for driving under the influence. He was checked and drug-tested at a local hospital, then escorted to the Kanawha County Sheriff’s Office for booking.
As Cpl. Josh Lester, 35, completed the paperwork for the arrest, the suspect dozed intermittently, leaned sharply over in his chair – “the nod,” it is called. Lester occasionally checked the man’s vital signs.
“You voting for Hillary Clinton?” the man asked the deputy at one point, his eyes rolling and his speech fuzzy. “She’ll probably do as well as anybody else,” he slurred after getting no answer, and nodded again.
In their effort to address the overdoses, law enforcement officials are clamping down on prescribers and operators of pill mills, where dangerous medications are illegally dispensed, said Dr. Rahul Gupta, West Virginia’s Commissioner of Public Health.
Statements from the U.S. Attorney’s Office and the Drug Enforcement Administration (DEA) detail some of the arrests.
*Tressie Montene Duffy, 45, a physician from Martinsburg, was convicted in December 2015 of illegally distributing painkillers at her West Virginia Weight and Wellness Inc., clinic.
*Kofi Ohene Agyekum, 37, owner of A+ Care Pharmacy in Barboursville, was sentenced in August 2015 to five years in federal prison and forfeited $2.3 million. The judge said the funds came from the sale of oxycodone, including some to people with no prescriptions.
*Edita Milan, 76, a physician from Fairmont, was sentenced to 60 months in May 2015 for illegally distributing prescription painkillers. One man died after using pills that she distributed.
Gupta praised recent CDC guidelines for prescribing opioids and the agency’s recommendation that physicians consider alternatives to addictive painkillers.
“Four out of five heroin addicts started as opioid medication users,” said Andrea Smith, an assistant U.S. Attorney for the Eastern District of Maryland in Baltimore and regional director of the Mid-Atlantic Organized Drug Crimes Task Force. Baltimore is a major source for opioids for West Virginia residents.
“You get a tooth pulled and the doctor gives you a 30-day supply,” Smith said. “We’ve created a nation of addicts.”
Police complained that a drug even more deadly than prescription drugs and heroin has risen precipitously – fentanyl, a synthetic opiate that can be 100 times more potent than morphine.
Legally, fentanyl is manufactured for use as an anesthetic for surgical and cancer patients. Heroin dealers are using fentanyl in clandestine labs to cut and spike the potency of heroin.
On April 14, Sergio Mendoza Bohon, of Tijuana, Mexico, was arraigned in federal court in San Diego for allegedly attempting to smuggle 1,183 fentanyl tablets labeled as oxycodone into the U.S. at San Diego’s Otay Mesa Port of Entry. Authorities heralded the February seizure of the pills and 5.4 grams of powdered fentanyl in Bohon’s underwear as the first such interception at the California-Mexico border.
“We are very concerned that these counterfeit pills could cause serious harm to users,” Laura E. Duffy, U.S. Attorney for the Southern District of California, said in a statement.
Fentanyl is gaining ground because it is cheap and easy to manufacture, DEA spokesman Rusty Payne said.
Some Mexican and Columbian drug cartels now prefer it to heroin as a profit maker and its potency is driving up deaths, he said.
Del. Chris Stansbury (R), a first-term member of the West Virginia House of Delegates and an optometrist in Kanawha County, said the stigma associated with drug abuse and the paucity of programs to help people overcome addiction are contributing to the problem.
Stansbury has proposed several bills related to opioids. These included a measure to allow pregnant women to get priority for drug treatment programs and another that increased access to naloxone.
Finishing up his shift back in Kanawha County, Elkins, a Charleston native who has been with the sheriff’s office for 19 years, described the sad toll opioid abuse has taken on his state and explained how police have adjusted to the crisis.
Once, drug abuse was seen as a crime, Elkins said. Now it’s treated as a public health concern.
Residents can drop off unused prescription opioids at the sheriff’s office. Deputies in Kanawha County now respond to overdose scenes before emergency medical personnel because many abusers wake up “fighting” after they are revived with naloxone, Rutherford, the chief deputy, said.
Deputies are now also tasked with picking up and transporting abusers who are court-ordered to undergo evaluations at mental health facilities.
People who encounter police at overdose scenes likely will not be arrested. Victims never are, officials said.
During a ride through Charleston, Elkins recalled the incident where he saved a young man by administering Narcan.
The call came in just after 3:30 p.m., four days before Christmas 2015, directing him to a trailer in an economically-depressed area of South Charleston. A young man lay on the bathroom floor “suffering decreased consciousness and labored breathing” and making gurgling sounds, Elkins wrote in an incident report. Opening his “overdose treatment kit,” Elkins “dispensed” a half dose of naloxone into the man’s right nostril, then the second half into the left nostril. The man started to regain consciousness as paramedics arrived.
“He claimed to have taken several Ambien CR’s, a sleep aid,” Elkins wrote. The man agreed to be transported to a hospital for treatment.
Elkins is the first person in the Kanawha County Sheriff’s Office to save a life using naloxone, Rutherford said.
Elkins said he believes that even in a cash-strapped state such as West Virginia, expenditures to rescue overdose victims is money well spent.
“It’s a life you’re saving,” Elkins said. “Everybody deserves to have their life saved.”