A city wrestled down an addiction crisis. Then came COVID-19

HUNTINGTON, W. Va. (AP) — Larrecsa Cox steered past the used tire shop, where a young man had collapsed a few days before, the syringe he’d used to shoot heroin still clenched in his fist.

She wound toward his house in the hills outside of town. The man had been revived by paramedics, and Cox leads a team with a mission of finding every overdose survivor to save them from the next one.

The road narrowed, and the man’s mother stood in pink slippers in the rain to meet her. People have been dying all around her. Her nephew. Her neighbors. Then, almost, her son.

“People I’ve known all my life since I was born, it takes both hands to count them,” she said. “In the last six months, they’re gone.”

As the COVID-19 pandemic killed more than a half-million Americans, it also quietly inflamed what was before it one of the country’s greatest public health crises: addiction. The Centers for Disease Control and Prevention estimates that more than 88,000 people died of drug overdoses in the 12 months ending in August 2020 — the latest figures available. That is the highest number of overdose deaths ever recorded in a year.

The devastation is an indictment of the public health infrastructure, which failed to fight the dueling crises of COVID-19 and addiction, said Dr. Michael Kilkenny, who runs the health department in Cabell County, including Huntington.

The pandemic drove those already in the shadows further into isolation, economic fragility and fear while at the same time upending the treatment and support systems that might save them. Simultaneously, Kilkenny said, disruptions in health care exacerbated the collateral consequences of injection drug use — HIV, hepatitis C, deadly bacterial infections that chew flesh to the bone and cause people in their 20s to have amputations and open-heart surgeries. There were 38 HIV infections tied to injection drug use last year in this county of fewer than 100,000 people — more than in 2019 in New York City.

Huntington was once ground zero for the addiction epidemic, and several years ago they formed the Quick Response Team Cox leads. “Facing addiction? We can help,” reads the decal plastered on the side of the Ford Explorer they use to crisscross all over the county.

It was a hard-fought battle, but it worked. The county’s overdose rate plummeted. They wrestled down an HIV cluster. They finally felt hope.

Then the pandemic arrived and it undid much of their effort.

On this day, five overdose reports had arrived on Cox’s desk — a daily tally similar to the height of their crisis. The one she held detailed how 33-year-old Steven Ash slumped among the piles of used tires behind the shop his family has owned for generations. His mother, pleading, crying, had thrown water on him because she couldn’t think of anything else to do.

Ash was 19 when he took his first OxyContin pill and his life unraveled after that, cycling through jails, he said.

The last year has been particularly brutal. His cousin died from an overdose in somebody’s backyard. He has a friend in the hospital in her 20s scheduled for open-heart surgery from shooting drugs with dirty needles, and the doctors aren’t sure she’ll make it. He had three agonizing surgeries himself from drug-related infections. He took more drugs to numb the pain, but it made things worse — a vicious cycle, he said.

He knows he’s putting his mother through hell.

“I fight with myself every day. It’s like I’ve got two devils on one shoulder and an angel on the other,” he said. “Who is going to win today?”

Larrecsa Cox has a file cabinet back in her office, and the top three drawers are filled with thousands of reports on her neighbors trapped in this fight. She can recite what treatments they’ve tried, their stints in jail, the life story that led them here; their parents’ names, their kids’ names, their dogs’ names.

The cabinet’s bottom drawer is labeled “dead.”

It’s filling up fast.

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The Quick Response Team was born amid a horrific crescendo of America’s addiction epidemic: On the afternoon of August 15, 2016, 28 people overdosed in four hours in Huntington. Connie Priddy, a nurse with the county’s Emergency Medical Services, describes that afternoon as a citywide rock bottom. “Our day of reckoning,” she calls it.

Almost everyone who overdosed that afternoon was saved, but no one was offered help navigating the bewildering treatment system. One of them, a 21-year-old woman, overdosed again 41 days later. That time she died.

The crisis was raging not just in Huntington but across America, killing by the tens of thousands a year. Life expectancy began tumbling, year after year, for the first time in a century —…