The Doctor And The Epidemic: Three Years At Ground Zero Of The Opioid Crisis

Oct 15, 2018

When Dr. Rahul Gupta started work as West Virginia’s chief health officer his state was already ground zero for the opioid epidemic, with some of the nation’s highest rates of addiction and overdose fatalities.

That was 2015, and 735 state residents died from overdoses that year.  

Preliminary data for 2017 show there were 1,011 overdose deaths last year, a record high for the state.

“Not a day goes by that I’m not constantly thinking about it,” Gupta said. “We’re losing three, three-and-a-half West Virginians per day. So, the clock’s always ticking in my head.”

The epidemic takes an emotional toll on Gupta not only because the loss of life, but because he sees how it has impacted the loved ones of people with opioid use disorders.

“When I hear about parents that say ‘I’d rather have my child arrested and put in prison because that way I know that person will be alive.’ That’s the most heart wrenching part of this,” Gupta said.

After three years on the front lines of the crisis as commissioner of the Bureau for Public Health, Gupta is leaving West Virginia next month to become Senior Vice President of the March of Dimes organization.

 

Reflecting on the fight against the opioid crisis during his time in West Virginia, Gupta is hopeful that he is leaving behind tools that will allow the state to overcome the epidemic. And he says his experience has strengthened his resolve to continue advocating for solutions in his new position.

The Stigma Barrier

Like other health officials, Gupta has struggled with a lack of resources to address addiction treatment needs in rural communities. But he says the stigma surrounding opioid use disorder is perhaps the biggest barrier for public health workers.

 

Dr. Rahul Gupta signing an order expanding availability of the overdose-reversal drug naloxone.
Credit Courtesy WV DHHR

“This particular epidemic has taken really extreme toll in terms of dividing the country,” Gupta said. “Half of the country literally feels that it’s a disease of choice. Whereas, if you think about the science and the changes that happen to change the chemistry in the brain, you’re not the same person anymore.”

Research shows the words we use or the false ideas we hold about addiction can prevent us from implementing scientifically-back strategies to approaching the epidemic, such as medically assisted treatment or needle exchange programs.

“We all have an opportunity to behave differently, to empathize,” Gupta said. “But also help propagate that stigma, whether it’s the terminology we use or the actions we take.”

Gupta’s inward reflection on the way he addressed the epidemic made him believe eliminating stigma is the most important step toward progress.

 

Data Lessons

While the data surrounding the crisis are grim, the numbers are not entirely negative.

Preliminary data predict overdose fatalities for the state will rise again this year. But the rate at which they are increasing is slowing down. That means some steps the bureau has taken are working, such as expanding access to the overdose-reversal drug naloxone and supporting overdose follow-up teams.  

Another strategy Gupta says he is proud of is the creation of a data profile based on the 830 residents who fatally overdosed in 2016.

“We found some really interesting characteristics,” Gupta said. “We found that majority of these individuals, eight out of 10, were actually coming in contact with the healthcare system prior to their deaths, prior to the overdose.”

 

Credit Alexandra Kanik | Ohio Valley ReSource

Gupta called this a “social autopsy” and local health departments call it one of the most important developments the health bureau made during Gupta’s tenure.

It helps identify who to look for and how to connect people to resources they need.

“It’s a lot easier if you can see a person or the representation of a person. Dr. Gupta allowed locals and the state to do that,” Kanawha Charleston Health DepartmentPublic Information Officer John Law said.

 

The Water Crisis

Of course the opioid epidemic was not the only challenge Gupta faced as a public health official in West Virginia. He served as executive director of the Kanawha Charleston Health Department from 2009 until he became the bureau’s commissioner.

There he dealt with another high-profile crisis when the coal-cleaning chemical MCHM leaked from Freedom Industries into the Elk River in Charleston, leaving 300,000 people in nine counties without usable water.

“Doctor Gupta was probably the acknowledged expert at the time in how to address the water crisis when he was here at the Kanawha Charleston Health Department,” Law said.

One of the first actions Gupta took after MCHM was discovered in the water supply was to shut down the area’s restaurants as a precaution.

“He, in a really innovative way, started making plans for reopening the restraunts a couple of days later,” Law said. “They had to submit a plan about how they would use water that didn’t come through the system. But we got those places back open.”

He then continued to spearhead the discussions about the water crisis, including a meeting in Washington D.C. at Sen. Joe Manchin’s office with the Centers for Disease Control and Prevention.

Law said whether it was the water crisis, the opioid epidemic, or the recent surge of Hepatitis A, it was Gupta’s clear vision for public health that made him an asset to the people of West Virginia.

“I think Dr. Gupta will take his public health vision and his knowledge of public health policy on a national level and be successful wherever he goes,” he said.

Marching On

Gupta hopes to keep working to combat the opioid epidemic in the Ohio Valley in his new role at the March of Dimes. He plans to help the organization focus on mothers with opioid use disorder and their babies born affected by the drugs in the mother’s body, a condition known as neonatal abstinence syndrome.

Data from last year show nearly 51 babies out of every thousand live births in West Virginia were found to be affected by drugs, the highest rate in the Ohio Valley and among the highest rates in the nation.

“Every baby may cost up to a million dollars to the state in terms of all the care that has to be provided in the first few years of life,” Gupta said. “And we don’t even know the long-term impact as of yet.”

 

First Lady Melania Trump with an infant in Huntington, WV, born affected by opioids.
Credit Courtesy White House, Office of the First Lady

West Virginia has been Gupta’s home for nearly a decade. He worked alongside his neighbors to tackle some of the states most challenging health problems.

And what he learned about the people leads him to believe they will one day overcome the addiction crisis.  

“People who are the most resilient, that spring back and fight for the right reasons, and, at the end of the day, are able to find solutions when we feel that there aren’t any,” Gupta said.

Gupta’s last day with the Bureau of Public Health is November 4.

The state Department of Health and Human Resources has announced a nationwide search to find his replacement.