In the U.S. 'overdose capital,' questions linger over Trump's emergency opioid declaration

Fog rolls in thick from the Ohio River to the foothills of the Appalachian Mountains, where West Virginians in the epicentre of the opioid crisis want clarity about U.S. President Donald Trump's plan to lift a community battling deadly drug abuse.

"We can be the generation that ends the opioid epidemic," Trump proclaimed in a speech Thursday, formally declaring the opioid crisis a "national public health emergency," which although it doesn't free up any new funding, should speed up state access to public health funding by cutting red tape and expand telemedicine services for rural areas.

Cynical residents of Huntington, W.Va., will believe it when they see it. The town of 50,000 is known as the "overdose capital of America" for having the highest rates of deaths in what the Centers for Disease Control and Prevention deemed the worst-hit state for overdose fatalities (35.5 deaths per 100,000).

Huntington is well acquainted with the despair of addiction. Though it welcomes any help it can get, the community isn't waiting for a federal saviour. It can't afford to, with local estimates of the overdose rate at 10 times the national average. In August 2016, a staggering 26 people overdosed in the span of just four hours.

'A step in the right direction'

As Trump took to cable news on Thursday to declare the crisis a public health emergency — a designation that applies for 90 days and can be renewed but offers no new cash with which to fight the crisis — most of the staff at Lily's Place, a local neonatal care facility, missed the whole speech. They were busy cuddling and soothing drug-affected babies born with the tremors and prone to fits of vomiting associated with drug withdrawal.

Olivia Meade, the facility's director of development, did watch the address online with the centre's administrative assistant and an intern in a front office.

What Meade had been hoping the declaration would clarify is whether she'll finally be able to accept newborns exposed to drugs in the womb from mothers who live in neighbouring Ohio or Kentucky. Meade's non-profit rehab centre for newborns is the first of its kind in the nation, and Meade said she often receives calls from out-of-state parents in this tri-state area who are looking for care.

She said after Trump's announcement she's still unclear whether she'll be able to help them but that the declaration will at least build greater national awareness about the opioid epidemic.

"It's a step in the right direction," she said.

'You got to have a plan'

A few blocks away and across the railroad tracks, Teddy Johnson, who lost his 23-year-old son Adam to a heroin overdose 10 years ago, switched off live news coverage of Trump's address and headed out the door to bring fresh flowers to lay at Adam's grave.

He thinks Trump is serious about tackling the opioid epidemic but has doubts about whether his talk of solving "the worst drug crisis in American history" goes beyond just words.

"You got to have a plan," he said, picking grass from the edges of Adam's gravestone. "You can't just say you're going to stop this, you're going to stop that. It's easy to say.

"It's all going to probably come down to funding," he said. "We definitely need three times the recovery places."

'Good luck'

That, too, could prove a challenge. Trump's announcement didn't allocate any new federal funding to the problem, and the existing Public Health Emergency Fund that can be tapped into for treatment or prevention, whose reserves haven't been replenished by Congress for years, has a balance of only $57,000 US, a negligible amount considering drug overdoses killed a record 64,000 people last year. 

Downtown at the First Steps drop-in centre on Thursday, Thomas Ward, a 27-year-old recovering heroin addict, lounged in the back watching Predator on TV, then headed outside for a cigarette, rubbing his tattooed arms. The president's speech had just ended.

In the speech, Trump vowed to ramp up the effort to choke off the supply of illegal fentanyl coming into the U.S. from China, but Ward scoffed at the suggestion that fentanyl could be eradicated.

"Good luck. That's what I say, good luck."

He's been clean six months, he said. "Just wasn't the way I wanted to live no more."

Earlier in his speech, Trump had also singled out a "truly evil" drug that he said would "be taken off the market immediately." He didn't name the drug, but ABC News later reported that a White House spokesperson said he was referring to a painkiller called Opana ER that had been pulled from the U.S. market in July.

Changes little

So it goes for Huntington, a once-prosperous coal town longing to reverse its fate. Today, ambulances scream through the streets with alarming regularity. Deaths in West Virginia, mostly attributed to drug overdoses, have nearly bankrupted the state's burial program for the destitute and homeless for five consecutive years.

Without any extra spending and with Trump's apparent focus on a "just say no"-style anti-drugs campaign, Dr. Michael Kilkenny, the physician director at the Cabell-Huntington Health Department, mused about the substance in Trump's announcement.

"The question is: Did he make a declaration that carries more authority than my declaration? I can make a declaration in Cabell County. It brings with it no resources; it suspends no rules; it changes nothing but the awareness."

'Definitely a start'

But for some, the declaration carries symbolic value, even if it doesn't bring extra money.

"It's definitely a start. I'm thankful he's kept his promise to declare or make an emergency declaration," said Matt Boggs, the executive director of Recovery Point, a nonprofit long-term residential recovery program with a lengthy waiting list.

He hopes the administration will support expanding needle exchanges to curb the use of shared syringes that can spread hepatitis C and HIV.

He also hopes the president's reference to providing "life-saving overdose medications" means the wider distribution and cheaper availability of naloxone, an antidote that often comes in the form of a nasal spray and can reverse the effects of an opioid overdose. Boggs and many others who work with addicts carry an emergency supply on them.

One welcome move is the president's promise to waive restrictions on drug-addiction treatment facilities with more than 16 beds and allow them to be funded by Medicaid, the federal health insurance program for seniors, low income families and some other Americans. Drug users are often seen to be at risk of relapsing or fatally overdosing when they're placed on long waiting lists for long-term treatment.

'Before Jessie Died'

The lack of nearby available options for Dave and Kate Grubb, whose daughter, Jessie, became addicted to heroin after a sexual assault in college, meant her family had to drive her six hours to Michigan for treatment.

In their home near Charleston, about an hour east of Huntington in Cabell County, Kate showed a photo of herself receiving a hug from former U.S. president Barack Obama when he came to speak about the opioid crisis in 2015.

"That was B.J.D.," she said. "Before Jessie died."

Jessie was 30 when she overdosed fatally on oxycodone last year. The pills were prescribed by a doctor who somehow missed her addiction history after she had routine hip surgery.

New legislation, dubbed Jessie's Law, is winding its way through Congress and would ensure any addiction histories are provided clearly to medical professionals prescribing medication. It has the backing of Trump's opioid commission in a draft report.

"What always goes through the back of my head is how Jessie would love this — that she could be helping and making a difference," Kate Grubb said. "But unfortunately, it's because she's not here that she's making a difference."