January 2020

Executive Summary

 Cabell County is uniquely positioned to study, address, and share information related to the

crisis. It is the ideal laboratory in the nation’s continuing search for reproducible solutions

to the opioid epidemic.

 The national opioid crisis has hit Cabell County especially hard.

 The immediate impact of the crisis upon our community has been devastating.

 County leaders have rallied together with resources and strategies to respond to the crisis.

 Innovative solutions are starting to make an impact.

 Our community’s collaborative efforts have gained national (and even international)

recognition as a model for other suffering communities.

 There is much more that needs to be done to address the long-term impact of the crisis.

 Cabell County is uniquely positioned to address the crisis going forward based on our

collaborative framework.

 Cabell County has extensive assets in place to support developing solutions to the multitude

of problems directly resulting from the opioid crisis.

 These assets include, but are not limited to, a well-established and successful health care

system, a Division 1 Public University with and R2 research designation, and supportive

political leadership at all levels.

 The centerpiece of our plan is the development of an Addiction Sciences Institute which will

house state-of-the-art research facilities, a center for education, foster researchers, and

offices for representatives of all community stakeholders.

 The Institute and identified “Areas of Focus” will provide the foundation for developing

immediate, short-term strategies as well as long-term solutions that foster sustainable

recovery in the community.

 The Institute will be a place of shared concerns and ideas for all agencies, programs, and

individuals in the County involved in responding to the opioid crisis and will serve as a

conduit for funding the activities of the plan.

 Our plan outlines the main short-term and long-term goals of this collaborative effort.

 The plan will remain flexible and organic, and ever responsive to the changing nature and

understanding of the active crisis and its long-term effects.

 A recommendation regarding governance and accountability is included.

 The results of dedicated efforts of Cabell County will be shared nationally and

internationally to reduce hardship of other communities suffering the effects of the opioid

crisis.

 
 
 
 
Table of Contents 
Acknowledgements ....................................................................................................1 
Introduction ...............................................................................................................2 
Areas of Focus ............................................................................................................4 
Where We Started ......................................................................................................5 
Where We Are Now ....................................................................................................8 
Local Landscape ........................................................................................................ 10 
Framework and Organizational Structure ................................................................. 13 
Addiction Science Institute ....................................................................................................... 13 
Short-Term Approaches ............................................................................................................ 15 
Long-Term Approaches ............................................................................................................. 22 
Governance Structure ............................................................................................... 28 
For the County, the Region, and the Nation .............................................................. 29 
 
 
 

Acknowledgements

This document is the product of many contributors from throughout Cabell County who have been

willing to share their expertise and experience in a common effort to share and build upon the

solutions that have been developed to address the devastating impact of the opioid crisis in our

community. The preparation of this brief was coordinated through the Division of Addiction Science

in the Department of Family and Community Health at the Marshall University Joan C. Edwards

School of Medicine. The following is a list of the organizations and community leaders who donated

their time in support of the development of this important plan.

Contributing Organizations

Cabell County Commission

Marshall University Joan C. Edwards School of Medicine

Cabell County EMS

Marshall University Research Corporation

Cabell-Huntington Health Department

Marshall University School of Pharmacy

Cabell Huntington Hospital

Mountain Health Network

Cabell-Huntington-Wayne Continuum of Care

Prestera Center

City of Huntington

Prevention Empowerment Partnership

FaithHealth Appalachia

PROACT

Huntington Regional Chamber of Commerce

St. Mary’s Medical Center

Lily’s Place

Valley Health Systems, Inc.

Marshall Health

United Way of the River Cities

Marshall University

West Virginia DHHR Office of Drug Control Policy

Contributors

Elizabeth Adkins

Deeidra Gravely

Sean Loudin

Kelly Schneider

Jessica Auffant

Zach Hansen

Jodi Maiolo

Ashley Shaw

CK Babcock

Krishawna Harless

Gordon Merry

Jana Stoner

Carol Bailey

Tim Hazelett

Taucha Miller

Brett Wellman

Bill Bissett

Michael Kilkenny

Lyn O’Connell

Steve Williams

Amanda Coleman

Deb Koester

Stephen Petrany

David Wolfe

Todd Davies

Grace Linz

Connie Priddy

Karen Yost

Brian Gallagher

Marianna Linz

Amy Saunders

Kevin Yingling

Jerry Gilbert

Steven Little

Angie Saunders

Lisa Zappia

Introduction

Creating Resiliency from a Community Opioid Crisis

A Framework for Healing a Community Negatively Affected by the Substance Use

Epidemic and Instilling Resiliency to Protect Against Future Crises of this Magnitude

According to the Oxford English Dictionary, Resilience is “the capacity to recover quickly from

difficulties; toughness”. The people of Cabell County define resilience. The tragic 1970 plane

crash that took the lives of 75 individuals, including nearly the entire Marshall University football

team and coaching staff, as well as many community members whose extended family continue

to call Huntington home, challenged the community to come together in the wake of the worst

sports related air tragedy in U.S. history. The university and the community have been forever

united by their ability to rebuild from this heartbreaking event. This experience has provided

the foundation for a uniquely strong bond between the community and its university that

supports a sense of hope and determination in the face of overwhelming adversity.

More recently, Cabell County, WV, has been ravaged by the harmful effects of the substance use

epidemic. This has culminated in increased drug activity, the highest rate of overdoses and

overdose deaths our nation has seen, and poor health outcomes. It has left in its wake

individuals, families, organizations and an entire community that must now determine how to

promote and achieve health and wellness across the lifespan.

In response to this crisis, community members and leaders in Cabell County quickly took action

through collaborative, innovative methods aimed at reducing overdoses, overdose deaths, and

other negative outcomes, and increasing the number of individuals entering treatment and

remaining in recovery. Still, with an epidemic this large, even the most impressive partnerships

and response pale in comparison to the intergenerational waves of traumatic impact that such

a crisis sends across generations and across social strata. Were the crisis to end today, the impact

would continue for generations to come. There is still much work to be done. What has become

evident is that developing these efforts has continued to demonstrate the distinct character of

our community.

Cabell County now seeks to fully develop a resilient community by sustaining the existing short-

term approaches and establishing the long-term solutions necessary to fully recover and prevent

this type of crisis in the future. We believe that this can best be accomplished through

collaboration, innovation, capacity-building, sufficient funding and resources, and a people-

focused and community-based approach. The initial successes of our extensive efforts make

Cabell County and the city of Huntington uniquely positioned as a national leader in how

struggling communities throughout the United States can effectively respond to the opioid crisis.

Areas of Focus

The following main areas of focus are recognized as necessary components

of any comprehensive strategy to promote community resilience:

Areas of

Focus

Prevention

Early

Intervention

Outpatient

Services

Inpatient/

Residential

Services

Healthy

Communities

/Social

Supports

Economic

Development

Educational/

Vocational

Services

Research

Legal/Policy/

First

Responders

Community

Partnerships

Spiritual

Care/Faith

Community

Where We Started

Substance use has become a public health crisis across the nation, becoming most apparent in

the past five years, but beginning nearly two decades ago. Today there are many opioid crises in the

United States, differentiated by overall overdose rates and rates of

growth in fatal overdoses from specific types of substances. The

demographics, economics, and status of labor markets in individual

communities also play a key role as contributing factors to the

differences in opioid crises seen in local communities and geographies

across the nation.

Among the types of opioid crises across the U.S., Cabell County

is not classified as an emerging crisis or even as a high overdose

community.* Cabell County is classified as a community considered

the most challenging of all – a community facing a syndemic

(“synergistic epidemic” where a set of linked health problems

involving two or more afflictions contribute to excess burden of

disease in a population) opioid crisis where the combination of high

overdose rates from

multiple opioids has

greatly exacerbated

the crisis.

Communities such as

Cabell that are

classified as syndemic

are facing multiple concurrent or sequential opioid

crises and are considered significantly worse, are of

much greater severity, and are the most challenging

to address.

Even classified as a syndemic geography, Cabell

County has been able to accurately track pertinent local data and statistics early on. Huntington

readily recognized the severity of the issue seen in reported rates of overdose, overdose-associated

deaths, and incidence of neonatal abstinence syndrome - the highest in the nation. The county has

also been monitoring the sharp rise in the incidence of infections and other diseases associated with

substance use, including hepatitis B and

C, sexually transmitted infections,

endocarditis, and most importantly - a

recent HIV cluster. In Huntington, as

heroin became more popular and

widespread, and the rates of infectious

diseases, overdose, and overdose death quickly increased, this culminated in a shocking outbreak of

27 overdoses in just four hours in the city of Huntington on August 15, 2016, attributed largely to

*Source: https://www.ineteconomics.org/perspectives/blog/place-based-economic-conditions-and-the-geography-of-the-opioid-overdose-crisis

fentanyl-laced heroin.

This highly publicized event further stimulated the community and key Huntington leaders,

including elected officials, to develop additional strategies that would slow and eventually reduce the

rates of overdose, overdose-associated deaths, neonatal abstinence syndrome, and infectious

diseases and demonstrate improvements in

closing gaps in the continuum of care. While

this is a huge point of pride and encouragement

in the county’s efforts to recover a syndemic

community struggling with the damaging

systemic effects of substance use, there

remains much work to be done.

The substance use issue in Cabell County is multi-generational in its impact and will require

additional resources directed at the long-term recovery of the entire community. Early evidence

suggests that infants born with prenatal exposure will require some degree of lifetime support.

Ongoing efforts are necessary to expand our understanding of the prevention, diagnosis, and

treatment of substance exposure throughout the lifespan. Additional support is necessary to address

the needs of children that are part of the more than 6,000 now displaced in West Virginia by parental

substance use and those being raised in kinship or grandparent-headed homes. Many of the youth

throughout the county have been adversely affected by parental substance use, peer substance use,

self-use of substances, or the generally poor

stigma and environment that currently exists

in the city. These youth are at a high risk for

substance use, and these risks must be

mitigated as early and effectively as possible.

Moving forward, prevention is a priority for

the community that has yet to be fully

developed and implemented.

Substance use disorder is a chronic

disease and must be treated as such, which requires a

capacity and infrastructure that enables immediate

access for those in active addiction and a lifetime of

supports for those living in recovery. This will require

extensive funding for access to treatment and

healthcare, increased education and job opportunities,

and more comprehensive social supports.

Huntington, WV, which comprises 52% of the

population in Cabell County, is becoming recognized

nationally and internationally as a city of solutions and an

example to other communities. Kim Darroch, the former

British Ambassador to the U.S., said of his visit to

Huntington, “What is happening here will be the model

for the path we should follow.” Long-term recovery for

the community means supporting a generation of individuals that have risen above the era of

substance use through individual

long-term recovery as well as through

the rejection of the initial first use of

any of these substances. Over the

next several decades, Huntington and

Cabell County seek to create a healthy

community that promotes healthy

people and healthy families.

Addressing the substance use

crisis must incorporate strategies to

address the more deeply rooted

socio-economic and healthcare issues

that affect the majority of our

population. This will require

continued efforts by and funding

sources for the local government,

healthcare organizations, business

community, local nonprofits, and education institutions in our city. The funding we have been able to

acquire to achieve these successes is limited both in the scope of programs it can address and the

sustainability of those it does address. Significant funding is needed to coordinate, implement,

evaluate, and replicate successful interventions across the lifespan. Cabell County has the solutions to

not only help our community but make lasting changes in other local communities across the nation.

Where We Are Now

Cabell County decided early on to confront the opioid issue head-on. Local community

leaders, including elected officials, recognized the problem and collaborated to address it, beginning

by properly recording and tracking key indicators such as overdoses, overdose deaths, criminal

activity specific to illegal substances, and drug use trends. This information has been invaluable in

determining how best to move forward in a data-driven and evidence-based manner. Additionally,

the continued gathering of any and all

information pertinent to the substance use

crisis and the programs and initiatives

developed to address it, has positioned

Cabell County, WV to leverage standard data

collection and evaluation to develop best-

practices and evidence-based approaches.

Cabell County, WV, has also

established strong community partnerships

as part of the foundation for addressing

substance use and a vision for creating a

resilient population and environment. The

county is uniquely positioned with the assets of Marshall University, the Joan C. Edwards School of

Medicine, and the Mountain Health System

that includes two major hospitals all within the

highest populated area of the county. In

addition, Cabell County has strong well-

established partnerships in place, including first

responders, the faith community, homeless

continuum of care, the judicial system, law

enforcement, the business community, and

local government. This has enabled

implementation of an integrated, system-level

response to the substance use crisis. The

approach taken in Cabell County also allows all

of the programs or initiatives developed to be

easily adapted in other communities across the

nation.

Image Source:

https://www.cdc.gov/publichealthgateway/publichealthservices/images/public-

health-system.png

We are just at the beginning of what will be a prolonged effort

to cope with the individual, family, and community effects of the

opioid epidemic. Cabell County is uniquely positioned to study,

address, and share information related to the crisis. Cabell County

is the ideal laboratory in the nation’s continuing search for reliable

solutions. This is due in no small part to the multitude of community

assets that can be brought to bear on the issue. These community

assets include: strong collaboration among a large healthcare system,

substantial social service capacity, respected academic institutions,

supportive local government, an active faith community, engaged law

enforcement, experienced first responder support, initiated innovative

collaborative approaches, and an established research infrastructure.

Such components set Cabell County, WV, apart from the rest of the nation.

Our crisis has been the worst, and our united response and successes have been the

most impactful. The unique level of collaboration among the medical institutions, the

academic institutions, and the political institutions of our county have brought

national and international recognition to the quality of our growing efforts. We are

equipped and eager to continue achieving success by executing a mass-scale

community wellness plan that reduces the impact of substance use and creates a truly

resilient community.

“Cabell County is uniquely positioned to study, address,

and share information related to the crisis. Cabell

County is the ideal laboratory in the nation’s

continuing search for reliable solutions.”

Local Landscape

Individuals struggling with substance use are overdosing and/or dying from

overdoses and overdose-related events at exponentially higher rates in Cabell

County, WV, than the rest of the nation.

 Cabell County has had the highest

overdose and overdose death rates in the nation

 Cabell County is experiencing a syndemic–

multiple concurrent and/or sequential

epidemics

 Available treatment and recovery

resources for substance use are insufficient for

the need

 The county and population experience a

higher number of barriers to accessing care

Substance use in Cabell County, WV, is an issue deep-rooted in overall poor

health and wellness within the general population, characteristic of syndemic

communities, that could no longer be ignored.

 Cabell County, WV has some of the lowest levels of

academic achievement and highest rates of

poverty, unemployment, disability, and chronic

disease rates in the nation

 Individuals with poor living conditions and those

working labor intensive jobs have been

disproportionally affected by the influx of both

legal and illegal substances

 Substance use has evolved from predominantly

prescription medications, to heroin, to heroin laced

with other lethal substances (fentanyl, carfentanil,

etc.) and poly-substance use

Substance use in Cabell County has permeated beyond affecting only those

individuals struggling with substance use and has negatively affected the entire

community.

 Community members voice fear for personal safety, drug-related criminal activity, and the

impact of the opioid epidemic on local neighborhoods

 Politicians and policy-makers struggle with the substance use issue overshadowing other

important issues for the community

 A majority of family members, friends, coworkers, and acquaintances in the community know

someone struggling with substance use and experience their own issues and trauma due to

these relationships

 First responders are overwhelmed, fatigued, and utilizing a vast amount of resources on

overdose events and criminal activity regarding illegal substances

 Others such as healthcare professionals, correction officers, social service providers, and

public defenders are also experiencing compassion fatigue

 Business owners and employers worry about the financial impact of being located in an

undesirable community, as well as the lack of a safe, competent workforce

 The faith community voices concern of a need to be better prepared to aid those who come

to them for help or guidance regarding substance use

 Teachers and daycare workers are not trained on the special needs of children with a history

of prenatal or environmental exposure to substances

 The healthcare community is working diligently to incorporate substance use treatment and

prevention into all entry points to the healthcare system, while at the same time experiencing

high rates and cost of substance-use related hospitalizations and care

 There is a record number of children displaced from their homes in Cabell County, the

majority of those cases related to the opioid epidemic

July 25, 2019

What is needed in Cabell County, WV, to create a resilient community to

address the current substance use crisis and prevent this type of crisis from

occurring in the future?

 Addiction Science Institute

 Education for all members of the community

and healthcare professionals

 Transportation system to reduce barriers and

improve access to healthcare, treatment,

recovery, social supports, and wellness

components of care

 Expansion and sustainability of comprehensive

harm reduction services

 Increased and expanded outpatient services

and care coordination

 An educated and integrated active faith

community

 System for better addressing childcare as a

barrier to treatment, recovery, and

employment

 Increased and expanded capacity and

infrastructure for inpatient/residential

treatment

 Implement coordinated, community re-entry

efforts and legal supports to reduce recidivism

and increase the number of individuals being

productive members of society

 Increase and expansion of mental health

services

 Intensive, wrap-around social supports

 Safe, supportive housing

 Increased and expanded prevention and early intervention efforts

 Research-related funding and capacity-building

 Data collection and evaluation of the entire community both now and in the future

 Focus on reducing compassion fatigue in and better equipping first responders

 Framework for the revitalization of current businesses and investment in new

businesses/employment opportunities

 Increased capacity-building for education and vocational preparation for adults

 Expansion and sustainability of grant-funded programs/initiatives currently successful in

combatting substance use

Healthy

Communities

/Social

Supports

Early

Intervention

Inpatient/

Residential

Services

Outpatient

Services

Community

Partnerships

Legal/Policy/

First

Responders

Research

Education

/Vocation

Services

Economic

Development

Prevention

Spiritual

Care

Framework and Organizational Structure

Addiction Science Institute

Plan: Develop a centralized facility known as the Addiction

Science Institute that will house all of the resources necessary

to …

 Continue to build understanding of the efficacy

of existing efforts through evaluation

 Improve public health and reduce disparities

 Advance basic, clinical, population-based, and

policy-relevant research

 Develop innovative ways to identify emerging

drugs trends

 Provide technical assistance to local and state

agencies

 Provide training and workforce development to students and current health professionals

 Foster strengthening of existing community collaborations and partnerships

 Disseminate advancing information on evidence-based methods of prevention, treatment,

and management of substance use disorders

 Publish results of research and clinical initiatives (medical and behavioral)

 Address the problem of stigma through the education of community populations

 Provide a forum for policy development and action (local, state, national)

The development of an Addiction Science Institute (the Institute) provides the centerpiece of

this resiliency plan. The Institute will deliver a community-based cornerstone for collaboration and

communication by all stakeholders in the fight against the opioid epidemic. The new facility would

include space for advanced research, education, and representative offices for all community

partners devoted to these overall efforts. The Institute’s work would guide the resiliency plan going

forward, in response to the changing needs and changing understandings of the battle against the

impact of the opioid epidemic over the ensuing years. It responds to our recognition of the

importance of continual evaluation and assessment of the shifting nature of the crisis, as well as any

and all supported projects, in order to make evidence-based adjustments along the path toward

achieving future success.

The Addiction Science Institute will be administered by Marshall University’s Division of

Addiction Sciences and will draw upon well-established community resources, including but not

limited to: Marshall University, the medical school, the pharmacy school, the physical therapy school,

the local hospitals, multiple local agencies engaged in the response to the opioid crisis, and local

Addiction

Science

Institute

Long-Term

Approaches

Short-Term

Approaches

healthcare providers. It will serve as a community-based entity available to every organizational

partner contributing to reducing the impact of substance use and creating a resilient community in

Cabell County.

The Institute will house representatives from the community from areas such as law

enforcement, first responders, local healthcare providers, prevention, outpatient and

inpatient/residential treatment providers, social services, the faith community, the local Chamber of

Commerce, individuals in recovery, and the education system, as well as Marshall University faculty

and researchers. In partnership with Marshall University, this Institute can equip the community with

the personnel, equipment, and resources needed to explore important areas of research that need to

be addressed. The Institute will also coordinate existing efforts.

Another key aspect of the Addiction Science Institute is an area dedicated to community

outreach. For the local professional healthcare students, there would be space to gain specialized

education from the center of addiction science. For the community, there would be public spaces for

the hosting of trainings and meetings to provide an evidence-based education on addiction. This

would serve to expand needed addiction-specific capacity among healthcare providers, reduce

misinformation, and reduce the harmful effects of stigma related to substance use so prevalent in the

community. Offices co-located in the Institute will further enhance our collaboration and

partnerships in addressing all of the growing community needs associated with addiction and one

that is building resilience. This will also provide the information necessary to promote best practices

throughout the community’s recovery efforts and enable us to disseminate this information to similar

communities throughout the nation.

Short-Term Approaches

Plan: Implement systems-level approaches to reducing the immediate physical, behavioral, and

social needs of infants and children adversely affected by opioid use

With some of the highest rates of Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid

Withdraw Syndrome (NOWS) in the nation, opioids have caused significantly negative physical

consequences in children with prenatal exposure. Additionally, environmental exposure to opioids,

primarily through parent/guardian use, has immediately serious consequences on infants and young

children and their development.

Infants with NAS, NOWS, or any evidence of prenatal exposure experience a myriad of poor

health outcomes from birth. Long, intensive hospital stays, CPS investigations, and isolation are just a

few of the consequences of these poor health outcomes. These cases are not only detrimental to the

early development of these children, but also come at a high financial cost to taxpayers, hospitals,

and families. Further developing and implementing evidence-based models that are cost-effective

and provide optimal care for these infants is an immediate concern of the entire community.

The large numbers of young children in the early stages of development who had prenatal

exposure to opioids are unprecedented in this area and require their own unique interventions. Our

current daycare and early education facilities and schools are struggling with a lack of available

resources for dealing with these children and their unique needs. There is a desperate need for both

specialized care and research on the physical, behavioral, and mental wellbeing of these children.

Children of all ages who are regularly exposed to parent/guardian opioid use are highly

susceptible to Adverse Childhood Experiences (ACES) that in turn increase their own risk factors for

substance use. The resulting unstable home life of these children is correlated to poor health and

wellness outcomes of all kinds, further perpetuating the multi-generational impact of this opioid

epidemic.

The immediate implementation of child interventions addressing opioid use could reduce

both the number of children adversely affected and the extent to which these children are adversely

affected. These interventions will require expanded school-based efforts, mentorship programs,

quality after-school programs, specialized clinical and behavioral services for children below school-

age, and expanded services for the care of infants with prenatal exposure.

Plan: Utilize and disseminate evidence-based substance use education.

Spreading community awareness and correct health information, particularly surrounding

substance use and those who suffer because of it, is an integral part of good population health. When

done properly by trained individuals, health education can substantially aid in promoting health.

Regarding substance use, it can decrease stigma, which reduces barriers to accessing treatment. It

also equips citizens with the basic knowledge necessary to aid in a situation involving substance use

or overdose, to potentially save lives, as well as aid or refer any individual they come across

experiencing a substance use disorder.

Many individuals in the community may become more helpful to those with SUD, become

more willing to house or employ individuals with SUD, or be generally supportive of efforts to reduce

substance use if they are properly educated on the issue. This promotes existing city-wide efforts.

There is plenty of misinformation available throughout the community, particularly in social media.

Access to health education in places such as the potential Addiction Sciences Institute could provide

the community with quality information from experts in the field and ultimately aid in improving the

health and wellness of the community.

Increasing medical and behavioral clinical capacity requires a robust system of education and

support for health care providers at various levels of training and practice. The development of an

effective and accessible means for such training across multiple disciplines and stages of

development is critical to the success of our efforts.

In addition to general education concerning substance use, naloxone education continues to

be a priority in the midst of the substance use epidemic. Making naloxone more available throughout

the community requires members and organizations within the community to be open to the

training, which will require the use of community engagement specialists. Even those who are not

ready to carry naloxone should be educated on the reasoning for why it is an important tool to have

out in the community.

Plan: Implement innovative strategies to reduce transportation as a barrier to health and wellness-

particularly as a barrier to receiving SUD treatment and recovery services.

Cabell County and its surrounding areas are in the heart of the Appalachian region -- an area

with deeply geographically isolated populations. As one of the most populated counties in the state,

Cabell County still has very rural areas where transportation is a challenge and barrier whether it is to

access healthcare services, employments, etc. Transportation barriers result from limited public

transportation, income that is insufficient to afford cars or private transportation, and widespread

community resources that are not within walking distance. Individuals cannot be successful in

achieving health and wellness if they are unable to reach healthcare provider facilities, grocery stores,

pharmacies, work, childcare, or any other daily-living stops.

Transportation has been a consistent issue across the entire spectrum of individuals and

organizations addressing substance use recovery. In order to overcome this barrier, there needs to be

an established coalition of community leaders who can lead implementation of innovative

transportation strategies in the short-term while implementing a transportation network that is

sustainable in the long-term.

Plan: Sustain and expand comprehensive harm reduction program services.

The Cabell-Huntington Health Department has been an integral part of curbing the negative

effects of the substance use epidemic. With a high number of individuals served, this program has

been successful in reducing disease transmission through comprehensive harm reduction program

services, including naloxone education and distribution, family planning services, expanding sexually

transmitted infections and other infectious disease screenings, providing vaccinations, a syringe

service program, general medical care, and incorporating peer-recovery coaches to increase referrals

into treatment. Despite all of these successes and a continued need, there is a tight budget and

limited funding for current services with no room for needed expansion.

Cabell County is on the cusp of various epidemics with an already dangerous HIV cluster

identified in the county. Increasing harm reduction services is necessary to slow down and reduce the

spread of infection in our population. This needs to be done through increased funding for the harm

reduction services including funding for mobile services to reach the rural areas of the county. Mobile

harm reduction services could be instrumental in both reducing the impact of substance use and

promoting recovery options to previously unreached parts of the county.

Plan: Expand outpatient service capacity for SUD treatment.

Outpatient services are the most accessible form of treatment for most individuals in

recovery. They are also more cost-effective than most inpatient/residential forms of treatment.

These services have been implemented successfully in Huntington through various healthcare

providers. Despite this, there remains a desperate need for expanded capacity, specifically for

Medication Assisted Treatment (MAT) providers and therapists county-wide. Training, hiring, and

providing the space for MAT services both in Huntington and the more rural towns, incorporated and

unincorporated communities in the county, would increase the number of individuals in treatment

and recovery services and reduce barriers to accessing such services.

Within the outpatient services currently available, there is a need for expansion of services

offered alongside standard treatment to promote sustainable recovery. Examples of needed services

include access to and navigation of social supports and obtaining employment, which requires

additional capacity of personnel and resources. Outpatient services are also needed in more rural

areas through the use of mobile services or additional sites.

Plan: Implement innovative strategies to reduce childcare as a barrier to treatment, recovery, and

employment.

Many of the local individuals seeking services and those service providers have encountered

childcare as a major barrier to entering treatment, maintaining appointments, and re-entering the

workforce in their efforts to maintain recovery. Safe, affordable, accessible childcare is out of reach

for many individuals, particularly in the low-income Appalachian region. Facilitating this type of

childcare through vouchers, expansion of proper childcare facilities, and adequate transportation

would reduce a major barrier to recovery that disproportionately affects families with substance use

disorders that have young children.

Plan: Expand inpatient/residential service capacity for SUD treatment.

For some individuals with SUD, there is a need for a higher level of care than traditional

outpatient services can provide, especially for individuals with intense co-occurring disorders. Certain

hospital facilities need to be expanded to accommodate inpatient services for individuals in need of

treatment with prolonged hospital stays, patients admitted to the hospital with severe mental health

issues in addition to their substance use, and infants with prenatal exposure and their mothers. Initial

expenses for these renovations/expansions would be costly, as would long-term care, but these costs

could be minimized by proper billing and protocols. This type of care could also reduce long-term

healthcare costs by providing more intense initial treatment that reduces the need for repeat visits.

In addition to the general inpatient/residential capacity that needs to be built out for the

community, there is a need for tailored residential services to address special populations such as the

individuals experiencing homelessness, those who are chronically ill, and individuals with a disability,

among others. The individuals in this category are largely underserved and have unique

circumstances that require a specialized, intensive, wrap-around approach.

Transitional housing that offers a step-down level of care for individuals who complete

inpatient/residential services is also a high need for both the general population and special

populations that are able to take a more independent step in sustainable recovery. This requires the

coordination of case navigators and stable housing without the full-time treatment component

previously experienced. Establishing community-based models for transitional housing is a priority of

Cabell County in the continuum of care.

Plan: Implement coordinated reintegration strategies and legal supports to reduce recidivism

among individuals in SUD treatment or recovery.

While there are several localized efforts to address re-entry in Cabell County, these efforts

have had little support, little direction, and poor community buy-in. These efforts are also negatively

impacted by stigmatizing community attitudes regarding SUD and those who battle it. There is a need

for the community to invest in these efforts to incorporate levels of change regarding recidivism and

successful re-integration into society.

Many individuals enter the legal system through drug-related crimes, and many individuals

leaving the legal system easily fall back into drug-related environments. Properly addressing

substance use among inmates, preparing these individuals to re-enter society through social

supportive services and treatment and recovery services, and facilitating a sustainable recovery

through housing and employment is vital to reducing drug-related recidivism. This can be

accomplished with improved efforts to integrate treatment and recovery with court system and

judicial system-populations.

In addition, legal barriers desperately need to be addressed in re-entry. One of the major

barriers to re-entering society as a previously incarcerated individual is the complicated legal process

associated with identification, housing, gainful employment, and receiving social supports. Breaking

down barriers to success and resiliency in re-entering society will simultaneously break down many of

the same barriers to success and resiliency in recovering from substance use disorders.

Addressing re-entry also requires addressing halfway houses and sober living homes. Many

individuals are released from the legal system into these types of facilities, regardless of whether

there are proper treatment and recovery protocols in place. Peer recovery coaches and case

managers trained regarding substance use and the local resources are a necessary part of successful

re-entry efforts.

Plan: Increase the workforce for and expand access to mental health services.

Addressing mental health is a key component to addressing, preventing, and treating

substance use disorders. Substance use treatment options that do not properly address the mental

health component of an individual’s recovery are not sustainable. Increasing the number of available

mental health services, as well as the accessibility of those services, largely depends on the mental

health workforce available in the community. Cabell County is a HRSA-designated Health Professional

Shortage Area for mental health. This must be resolved in order to properly address mental health

service needs throughout the county and increase the effectiveness of any opioid related recovery

efforts. Training, recruiting, and providing the resources necessary for these mental health workers is

an immediate need.

Plan: Provide intensive, wrap-around social supports needed as a result of the opioid crisis.

Successful recovery and successful healthy living as a whole is dependent upon having the

proper social supports in place. When individuals from vulnerable populations are seeking a better

life, the systems and resources available to them are often too difficult to navigate on their own. The

availability of case management and certified peer support specialists is a crucial first step in

providing wrap-around social supports. Incorporating these case managers into various settings that

have previously been unbillable is necessary to curb substance use and increase community wellness.

These are especially necessary in the most difficult-to-serve populations, such as those experiencing

homelessness.

With case managers and certified peer support specialists in place to aid individuals anywhere

along the continuum of care (whether they are on the street, in a shelter, in treatment, or in long-

term recovery) the community can develop more services specific to the various needs of the

population. Finding housing, obtaining health insurance, gaining employment, obtaining legal aid,

entering treatment, attending medical appointments, acquiring proper mental health services, and

many other issues are capable of being addressed with proper funding, navigation, and guidance. By

coordinating the care of those with the most intensive needs, we can anticipate improved utilization

of available community resources.

Implementing and expanding the care coordination efforts currently being developed in Cabell

County and the southern WV region could provide a solid foundation for wrap-around services

geared toward creating sustainable, healthy communities. Models for approaching treatment and

recovery through proper care coordination will promote higher long-term success.

Plan: Develop a more comprehensive system for providing safe, supportive housing.

Addressing an individual’s most basic, vital needs is always a necessary first step before

addressing other serious or less-important needs. For individuals with substance use, safe, supportive

housing is necessary to achieve sustainable recovery. The home is often representative of one’s

overall health and wellness. The complications associated with homelessness are often difficult to

overcome and compounding those complications with those associated with substance use recovery

makes success less likely.

In addition to those who are currently unhoused, there are substantial numbers of individuals

in the community who are housed unstably. Many individuals living in houses that are unsafe are in

environments that make it difficult to achieve sustainable recovery and success. Achieving a healthy

community is not possible without healthy neighborhoods and homes.

Due to the SUD epidemic, Cabell County lacks adequate resources to develop safe, affordable,

accessible housing and provide reasonable methods for obtaining and sustaining that housing. Cabell

County is in need of programs in place to develop safe, affordable, accessible housing and provide

reasonable methods for obtaining that housing. This will likely need to be coordinated through the

homeless coalition, local authorities, and business community. Investing in the revitalization of

neighborhoods, tearing down unsuitable houses, rebuilding of salvageable houses, and development

of well-integrated homes and apartments throughout the community is a necessary start to achieving

safe, supportive housing.

Long-Term Approaches

Develop protocols and resources for ensuring comprehensive

care of the life-long physical, behavioral, and social needs of

infants and children adversely affected by opioid use

Increased and expanded prevention and early intervention

efforts

Research-related funding and capacity-building to define what

works and disseminate best-practices

Data collection and evaluation of the entire community both

now and in the future

Focus on reducing compassion fatigue in and better equipping

first responders

Coordinated efforts between legal/judicial system and

healthcare system to reduce substance use

Framework for the revitalization of current businesses and

investment in new businesses/employment opportunities

Increased capacity-building for education and vocation

preparation for adults

Expansion and sustainability of current grant-funded

programs/initiatives currently successful in combatting

substance use

Expand services to combat multi-generational effects of adverse

childhood and family experiences

Plan: Develop protocols and resources for ensuring comprehensive care of the life-long physical,

behavioral, and social needs of infants and children adversely affected by opioid use.

The multi-generational effect of the opioid epidemic on our community is one of the most

difficult consequences to address. Our infants and children, as well as the decades of infants and

children to come, will be suffering these consequences long past the implementation of our current

efforts. Putting in place the infrastructure to reduce the impact of opioid use long-term is the main

priority and center-piece of much of this proposal.

The primary prevention of opioid use affecting children is to be attempted through many

different pathways that reduce the number of children born with prenatal exposure as well as

reduces the number of youth who ever first use opioids. The secondary prevention of opioid use

affecting children is to be accomplished through best-practices in the healthcare and education

systems that use widespread screening and early intervention tools. Protocols and resources that

capture this population of children as early as possible will promote the children’s health and

wellness and reduce the negative long-term effects caused by opioids.

Tertiary prevention of opioid use affecting children has the potential to be among the most

difficult and costly efforts in this proposal. With the number of opioid-affected infants and children

currently unknown and the magnitude of their long-term physical, behavioral, and social needs

unprecedented, Cabell County must address all areas of expected outcomes for their future. This will

continue to be an area of research in the community that will not only promote good health

outcomes in children adversely affected by the opioid epidemic, but aid in developing long-term

approaches that close the gaps in the continuum of care of these children across their lifespans.

Plan: Increased and expanded prevention and early intervention efforts.

Prevention is a high priority of Cabell County, WV, that has the attention of all stakeholders

involved in the development of a resilient community. It must be a high priority for any plan

designed to address the opioid crisis we face. The combination of poor socio-economic living

conditions and high rates of substance use in the community has created an unprecedented

generation of at-risk youth. Enhancing individual and peer resilience through prevention-focused

initiatives is crucial to reducing the long-term impact of opioids on our community.

The nationwide availability of resources to target preventative efforts has been inadequate; a

serious concern for an area as susceptible to substance use as Cabell County, WV. Prevention of

future substance use, prenatal exposures, overdoses, and overdose deaths is a necessity that we

have been previously unable to invest in. With the proper resources, the county intends to not only

put measures in place to minimize the effects of substance use on future generations, but to also

equip the community with measures that promote a general wellness that is preventative of a

multitude of co-occurring public health concerns that both perpetuate and result from substance use.

As with prevention, early intervention is an area of focus that struggles to receive attention

amidst all of the current efforts to reduce opioid substance use. The harm reduction program within

the city has been largely successful in providing intervention among individuals with advanced

substance use, but there is a need for resources and programs directed at intervening much earlier in

the continuum of care, particularly in teenagers and young adults.

Plan: Research-related funding and capacity-building to define what works and disseminate best-

practices.

There are many areas of research surrounding substance use that are immediately relevant to

the community, will better equip other communities like ours, and will be essential and relevant in

future generations. Research of the current local environment and programs surrounding substance

use needs to be prioritized, and future research needs to be prepared for and planned.

Research is a priority of the entire community and is important in establishing the details that

led up to this substance use crisis, where we are now, what efforts are successful, how to aid other

communities, and how to prevent such a crisis from happening again. By housing addiction research

efforts under one roof that is not owned by any one entity, such as the Addiction Science Institute,

we can put an infrastructure in place to maintain comprehensive, up-to-date, community-owned

databases for various research plans, ensure that there is a high-level of collaboration across

organizations, and link the most appropriate individuals for pursuing various research plans. A robust

research staff is necessary to accomplish this goal.

In addition to the research performed by the existing parties invested in addressing substance

use, the institute could provide research opportunities for pre-professional students and current

professional healthcare students to grow the research capacity of the local academic institutions. This

would also grow a workforce of research-capable individuals for future employment and attract

students to attend schools with this resource.

Plan: Data collection and evaluation of the entire community both now and in the future.

Short-term and long-term research spans every area of the community and would require

communication and collaboration to be executed effectively. In order to accomplish this, there is a

need to invest in recruiting, training, and staffing individuals that can properly manage and

coordinate the large amount of data regarding substance use and wellness in the community.

The more comprehensive, collaborative, and constantly updated data we have available to the

community, the more able and equipped we will be to provide best-practice care and address the

most important needs in the community related to the impact of the SUD crisis.

Plan: Focus on reducing compassion fatigue in and better equipping first responders.

Across the entire nation, compassion fatigue is creating an unhealthy working environment

for first responders such as law enforcement, firefighters, emergency personnel, and ER nurses.

Opioid overdoses and other substance use-related incidents have caused a spike in traumatic

emergency calls and situations that are not only negatively impacting the first responders, but the

individuals and community they are serving. First responders see the worst parts of the substance use

epidemic and receive little to no supports for how to cope with the personal impact of their

experiences. In addition, they rarely see the recovery side of this epidemic which shows promise and

hope.

Implementing comprehensive support services and better equipping our first responders to

thrive in their duties despite the difficulties associated with substance use is necessary to maintain

healthy, safe workers and healthy, safe communities. Established and recently implemented

compassion fatigue services designed to create mental and physical wellness among the first

responders need to be further supported and expanded. There are groups of individuals experiencing

high levels of compassion fatigue that are currently unreached even beyond the first responders,

including (but not limited to) emergency service personnel, nurses (particularly those in the ERs),

corrections officers, social service providers, and public defenders. Overdoses and drug-related crime

have created a toxic environment for first responders and others involved in the care of individuals

suffering from opioid addiction. It is pertinent that in our efforts to address the substance use

epidemic and create a resilient community, we work to reduce and improve the detrimental impact

of substance use on all affected.

Plan: Coordinated efforts between legal/judicial system and healthcare system to reduce substance

use.

Criminal drug activity is an ongoing concern for Cabell County residents in the midst of the

substance use epidemic. Public safety is a crucial part of health and wellness for any population, as

well as a community’s business environment and economy. In order to promote safe, healthy,

resilient communities, there is a need to coordinate efforts between law enforcement, the justice

system, and the healthcare system.

These efforts should focus on best-practices for law enforcement engaging individuals with

substance use and substance use-related incidents, advocacy and best-practice for those

encountering individuals in the legal system due to substance use, and providing the support our law

enforcement and judicial/legal workers need to serve the community. Constant communication

between the healthcare organizations and providers addressing substance use and those involved

with the law/legal/judicial side of substance use needs to be cultivated. Additionally, there needs to

be a constant sharing of successes and concerns between these populations. This will be facilitated

through the collaborative partnerships of representatives within the Addiction Science Institute.

Plan: Framework for the revitalization of current businesses and investment in new

businesses/employment opportunities.

Due to the high rates of substance use in our community and associated events such as

overdoses and crime, current businesses in Cabell County have been negatively impacted.

Additionally, there is a negative impact on bringing in new businesses, as the environment is

perceived as highly unfavorable to most investors and business owners. This issue then perpetuates

the substance use crisis, as many good jobs have become uncompetitive and unavailable, leaving

individuals more susceptible to continuing or returning to substance use.

One of the major reasons that new businesses are not attracted to any given area is the

unavailability of a ready workforce. In conjunction with efforts to create a safer physical environment,

Cabell County needs to create a more skilled, employment-ready population. The community intends

to develop resources that would equip individuals in recovery to become these skilled workers and

equip employers with favorable offers of employment to these individuals. Mutually sustainable

employment opportunities for both employees and employers could work to revitalize current

businesses and attract new businesses.

Plan: Increased capacity-building for education and vocation preparation for adults.

Communities in Cabell County are experiencing a multitude of poor public health outcomes

and significant medical issues associated with the substance use epidemic. The socio-economic and

environmental factors that perpetuate this cycle of poor wellness and high drug use throughout the

community include poor housing, low education and employment, poor healthcare access, and poor

family units, among others. Cabell County has implemented programs that seek to address the

education and employment issues that are both preventative of poor health outcomes and part of

the recovery process for many individuals to lead sustainable lives. By investing in the education and

employment of individuals in recovery we can begin to break the cycle of substance use, generational

poverty, and poor health.

Sustaining and expanding the mission and services of such programs is a priority for Cabell

County. The limited resources and staffing currently dedicated to addressing this area of need, while

successful in their beginning efforts, are insufficient for the large number of individuals affected by

substance use throughout Cabell County. There is a need for additional services beyond the current

scope of developed programs that are vital in preparing and training adults for the workforce.

Creating a community with more stable sources of income through an investment in

education and vocation aids in reducing the frequency of relapse, eases the financial burden of local

government, eases the financial burden of local healthcare communities, promotes more sustainable

family systems, lowers the risks for poor health outcomes, increases the general health and wellness

of the community for current residents, and works to attract and recruit more talented individuals

from outside of our region.

Plan: Expansion and sustainability of current grant-funded programs/initiatives currently successful

in combatting substance use.

It is vital that Cabell County’s current programs and initiatives that have been successful in

slowing the aggressive growth of substance use, overdoses, and overdose deaths are maintained and

expanded where possible. The majority of these programs and initiatives are funded through

temporary, limited grant awards. In order to move forward in addressing the gaps in the continuum

of care being created in the community, we must first reinforce and sustain the efforts currently

addressing areas of need.

Plan: Expand services to combat multi-generational effects of adverse childhood and family

experiences.

The effects of the epidemic will no doubt impact individuals, families, and communities for

decades to come. Therefore, it is our priority to ensure that the results and standards set through

these plans combat opioid use and its widespread effects for generations to come. Whatever is

achieved through this proposal will by necessity be transferred to following generations. Creating a

resilient community over the next several decades requires that we instill resiliency in our children

and families and work diligently to minimize adverse childhood and family experiences that lead to

risk for opioid addiction.

The future impact of the present crisis has only begun to be recognized. Our plan provides for

continuing vigilance in assessing the impact going forward and provides a means for adjusting our

response to the changing community needs in a timely manner so as to increase the likelihood of

success in moving toward a truly Resilient Community.

Governance Structure

To govern the funds directed toward the Cabell County Resiliency Plan, a

governing board will be established with volunteer representatives from the following

five organizations: Cabell Huntington Health Department, Joan C. Edwards School of

Medicine, Marshall University, the Cabell County Commission, and the City of

Huntington. Additionally, this Board will include a rotating representative from the

various county partners involved in addressing the opioid crisis, and an individual in

stable recovery from Cabell County. The governing board will vote on the allocation

and approval of funds. Additionally, this governing board can vote on addendums to

this plan to ensure that it acts as an organic, flexible document that stays in line with

the current needs of the community. The board will establish appropriate procedures

and reporting requirements to hold grant recipients accountable for the proper

utilization of any and all funds provided. It will also insure the distribution of

information regarding data, models of care, and outcomes for the benefit of other

suffering communities.

There will be no controlling interests tolerated within the governing board. The

governing board’s actions will rely on the fundamentals of the resiliency plan in

coordination with input from the collaborative community efforts centered in the

Addiction Science Institute. The purpose of this structure is to guide the funds into the

appropriate places, as well as follow-up on the successes and evaluation of where the

funds are distributed to ensure adherence to this overall Resiliency Plan. This

information, including distribution of funds and the progress of the efforts funded will

be reported quarterly with public access so that the community can stay up to date on

the changes these funds are creating in Cabell County.

Cabell

Huntington

Health

Department

Joan C.

Edwards

School of

Medicine

Marshall

University

Cabell

County

Commission

City of

Huntington

Rotating

Community

Organization

Member

Individual in

Long-term

Recovery

For the County, the Region, and the Nation

Cabell County, West Virginia, is the Appalachian region’s nerve center with

respect to the opioid crisis. The benefits of creating resiliency in Cabell County through

the implementation of the efforts outlined in this proposal will permeate benefits

across the county, the Appalachian region, and the rest of the nation. Understanding

that this opioid crisis is multigenerational in its effects, this plan is designed and

constructed for long-term stability with all aspects having a built in sustainability

framework.

The plan will serve as a model for responding to the impact of the opioid crisis in

other communities so affected. The Institute will provide the means for assessing and

evaluating innovative and evidence-based initiatives, and provide a center for regional

and national dissemination and education regarding those initiatives. As the epicenter

of the epidemic, Cabell County offers the ideal setting for implementing and evaluating

creative evidence-based programs in prevention, early intervention, treatment, and

recovery. The county is uniquely positioned to act as a community laboratory in the

nation’s continuing search for reliable solutions and offers an outstanding opportunity

to contribute in a meaningful way to solving the local, regional, and national crisis.

of Funds