by Laura Ungar, Louisville Courier Journal –
Stacy Usher became addicted to pain pills after a high school soccer injury in Wisconsin. Addiction would follow her through college. When she moved to Wolfe County, Kentucky with her family in 2014, she wasn’t aware of the drug issues in the area. Alton Strupp/CJ
ZOE, Ky. – Andiria Tipton figured it was her job, as the older kid, to crawl around under a bed and pick up dirty drug needles.
She’s matter-of-fact about why: “I had to keep them from my little sister.”
Andiria has learned a lot about the hellish world of addiction in her short 10 years. But she’s also found refuge from it as one of eight kids being raised by Lisa Lacy-Helterbrand, who takes in children of people struggling with addiction. All but one began life in drug withdrawal.
Addiction is endemic in these Appalachian hills. It’s gained so much ground that the nation’s foremost health experts fear one plague will spawn another, that rampant intravenous opioid use will lead to a drug-fueled HIV outbreak like the one that struck Austin, Indiana in 2015. That outbreak was the largest to hit rural America in recent history, with a rate comparable to countries in Africa.
Lee County, where Lacy-Helterbrand’s family lives, is one of 54 in Kentucky and 220 nationwide identified by the U.S. Centers for Disease Control and Prevention as the most vulnerable to a similar outbreak. Neighboring Wolfe County tops the list as the most likely place to become the next Austin.
Kentucky leads the nation in vulnerable counties, with most clustered in an Appalachian region marred by drugs, doctor shortages, economic ruin and hopelessness. One drug needle shared by someone with HIV could easily be the match to this powder keg.
Yet only 33 of the 220 vulnerable counties have working exchanges where addicts can trade dirty needles for clean ones, Courier Journal found. Of Kentucky’s 54 vulnerable counties, 33 lack needle exchanges. Among them is Wolfe, which approved an exchange but is still trying to come up with money for the needles.
Experts say forsaking these places could lead to the resurgence of a disease many Americans consider an old threat. Drug-related HIV infections are already creeping up across the nation. Even now, an outbreak may be quietly brewing.
“People have forgotten about HIV. … But it’s becoming clear you have the stage set for a major increase in these infections (in places) we’ve basically ignored,” said Dr. Paul Volberding, director of the University of California, San Francisco AIDS Research Institute. “Whenever we have an infectious disease and we turn our back, it bites us.”
Many believe the solution begins with fighting addiction in each family, school and community. But the sheer scope of the drug scourge dwarfs grassroots efforts – even by dedicated residents like Lacy-Helterbrand, who not only takes in children but also directs an organization that helps other needy Appalachian kids.
Soon after, Lacy-Helterbrand stopped in on Priscilla Spears, 27, who got presents from the ministry when she was younger. An unleashed dog hopped between them on a driveway as Spears described struggling with pills and watching her toddler endure the pain of withdrawal at birth. She’s clean now, she told her friend, and hopes to stay that way, given what’s at stake.
She cast her eyes down, rubbing her pregnant belly.
Place in deepest peril
Appalachia jumps out from a national map of vulnerable counties.
CDC researchers searched for places like Austin, Indiana, a tiny city with scarce medical resources where HIV sickened more than 200 people out of a population of 4,200. Before the outbreak, Austin never saw more than a handful of cases. But a combustible mixture of poverty and drug abuse hinted at the plague to come.
To find the next such place, researchers looked at statistics tied to injecting drugs, such as overdose deaths, prescription opioid sales, low income and unemployment. Their analysis, published in the Journal of AIDS last November, izdentified vulnerable counties in 26 states. A US Department of Health and Human Services presentation in October showed drug-related HIV infections – one in 11 new HIV cases overall – rose 4 percent nationally in 2015 after a decade-long, 63 percent decline.
Wolfe County, about 2 ½ hours east of Louisville, fared badly on all the CDC measures. Home to just 7,159 people, it lost 14 to drug overdoses in five years. Per-person income stands at $13,901, less than half the national average. And more than 30 percent of residents live in poverty, compared with about 13 percent nationally.
Surrounding the 1-square-mile county seat of Campton, the rolling green landscape is dotted by a mix of dilapidated single-wide mobile homes, sagging old houses and well-kept homes, with a tiny commercial strip and about a dozen churches. Dense sloping forest is shot through with a maze of ATV trails.
Stacy Usher rides those trails, sometimes finding spent needles in clearings. She once discovered a bundle of needles and drug “works” in a daycare parking lot while dropping off a child. She figures they fell out of another parent’s car.
Usher works as a service corps coordinator for the Eastern Kentucky anti-drug group Operation UNITE, teaching kids at Campton Elementary School how to avoid drugs. She asks each class: “How many of you know someone who is addicted or has been addicted?”
All raise their hand. Every time.
“It’s not pretty out here,” she said. “Every single student that I have, every person I know, has been negatively impacted by drugs in this county.”
That includes her. Growing up in rural Wisconsin, Usher got hooked on oxycodone after blowing out her knee playing high school soccer. She managed to get through college while addicted, but stopped cold turkey with the help of a friend after her 5-year-old brother on graduation day asked: “Why do you take so much medicine?”
Usher and her husband moved to Eastern Kentucky in 2014 to give their three boys the country upbringing she had. But “after we got here, we realized this was actually the worst place to move” because of drugs. Though she loves the people, she worries for her kids every day.
Cyndi Tapley does too. She grew up here and watched poverty deepen as employers, like a computer board factory where her mom and sister once worked, closed their doors. For many, hope disappeared with the jobs, and opioid abuse took root. Needles turned up in Campton’s playground. Tapley’s 10-year-old son Clayton walked by them on roadsides.
“Three out of every five people I would say have a drug problem, so you see it all the time,” said Tapley, who also has a 13-year-old daughter. “A lot of times kids are strung out and in jail.”
Even promising lives are derailed. Jonathon Terrill, a 32-year-old father of two in Wolfe County, was a high school salutatorian. After taking painkillers for a sports injury, he cycled through addiction, treatment and relapse for years, once pawning his wife’s wedding ring to pay for drugs. He eventually sought help with an addiction medicine called Vivitrol and has stayed clean 18 months.
Today, Terrill works long hours on a pipeline. “I could’ve been behind a desk somewhere,” he said. “Now I’m working physical labor to make ends meet.”
Such stories are familiar to Ernest Childers, a 72-year-old former trucker and alcoholic who pastors the Lakeview Church of Truth in Rogers, Kentucky. Sober 37 years, he has long run an addiction recovery program.
“I’ve seen it all,” Childers said, standing near a pulpit displaying guitars, a quilt-covered piano and an American flag. “This year, I’ve done three OD funerals. I’ve seen children crawling on the floor with uncapped needles … I had one man, a 30-year-old, whose mother stuck him with a needle at age 10. All I could do was hug him.”
As Childers spoke, neighbor Sam Spencer walked down the church aisle and settled into a pew.
“This dope business, I’ll tell you what …” Spencer began, going on to describe how a thief stole more than $3,000 worth of tools from him just that day.
The two men commiserated about rising drug crime, about carrying guns for protection.
“It ain’t good, Sam, and it’s gonna get worse,” the pastor said, shaking his head. “We’ve watched this grow into a festering sore.”
Harbinger of HIV
It’s a festering sore that invites infectious disease, and the threat stretches far beyond Wolfe County. Seven other Eastern Kentucky counties also rank among the nation’s top 10 most vulnerable – including Perry, which is under particular scrutiny because some Austin, Indiana residents have relatives there.
HIV has been found across Appalachia, though known rates so far are lower than in urban Kentucky, where testing is more common. April Young, a University of Kentucky assistant professor of epidemiology, said less HIV testing in Eastern Kentucky means the disease could be spreading silently.
An outbreak is almost inevitable, UK researcher Jennifer Havens said. “It’s just a matter of time.”
Researchers point to an explosion of HIV’s widely-accepted harbinger: the potentially deadly liver disease hepatitis C.
Like HIV, “hep C” can be spread by sharing needles. And it’s easier to contract, so it’s not uncommon to have both diseases. Most Austin patients do.
From 2008-2015, Kentucky had the nation’s highest rate of new, acute hep C infections, with 1,089 cases. Another 38,000 Kentuckians livewith chronic hep C. Havens’ long-term study of Eastern Kentucky drug users found that once they start shooting up, most get hep C within a year.
At Hickory Hill Recovery Center, located atop a steep rural road near Hazard, the majority of clients arrive with the disease.
Client Joshua Hatfield of Knox County, 34, contracted it more than a decade ago from sharing needles with a girlfriend. After getting hooked on painkillers he was prescribed in high school, he went on to shoot up nearly every drug he could find – OxyContin, cocaine, meth and even fentanyl squeezed from a patch. As his life spiraled downward he twice tried suicide.
Client Ryan Thaxton, 27, of Pulaski County, was diagnosed with hep C in 2015 after sharing a needle with a woman he knew had the disease. Years of shooting up cocaine, heroin and other drugs made him too desperate to care. And even after his diagnosis – which he brushed off as “normal” – he kept sharing needles, figuring most other users also had hep C.
Many clients, such as Jordan Weddle, 25, of Pulaski County, don’t learn they have hep C until they get to Hickory Hill – meaning they could have been unknowingly transmitting the disease for years. Weddle admits he probably shared needles with up to 10 people before seeking help.
That’s a recipe for the rapid spread of a virus that can lead to cirrhosis, liver cancer or worse, said Wendell Carmack, executive director of Chad’s Hope in Manchester, a faith-based program where about 30 percent of clients have hep C.
“If you don’t know you have it and you’re sharing a needle,” he said, “you’re sharing death with someone.”
Too little, too late?
To reduce the threat of disease, the CDC reached out to states with vulnerable counties and shared its findings through webinars, then later consulted with health departments about their risk of HIV outbreaks or drug-related hep C spikes. Showing evidence of an outbreak or serious risk makes them eligible for federal funds to help pay for needle exchanges – but not for the syringes themselves.
Officials in the hardest-hit states – Kentucky, Tennessee and West Virginia – argue they’re responding as well as they can. Critics say they haven’t done enough.
“In general I think much more needs to be done,” said University of California’s Volberding. “Especially in post-industrial areas… (and) definitely including rural areas – exactly those places that had probably assumed they no longer had to pay attention to HIV anymore.”
One big concern is the availability of needle exchanges. While public health experts call them an essential tool to control disease and link people to testing and drug treatment, opponents say they enable drug use.
Such exchanges were a major focus of a task force created in fall 2015 in Tennessee, which has 41 vulnerable counties, most of them bordering Kentucky. Tennessee also approved $1.4 million per year to boost HIV and hep C testing and got $250,000 from the CDC for hep C tracking.
But it took until last May for Tennessee to legalize needle exchanges, and none have yet been approved.
West Virginia has 11 exchanges, and like Tennessee boosted disease tracking, testing and prevention after the CDC warning. Still, most of the West Virginia’s 28 vulnerable counties lack exchanges.
In Kentucky, 33 counties opened exchanges after they were legalized in 2015, and sevenmore approved them. Such efforts got a small boost from the state’s Agency for Substance Abuse Policy, or ASAP, which spent $41,063 on needle exchanges in fiscal 2016 – 9 percent of its annual “harm reduction” budget.
Still, 30 of Kentucky’s 54 vulnerable counties haven’t given the go-ahead for needle exchanges. And programs approved in the vulnerable counties of Wolfe, Perry and Letcher have yet to open.
Elizabeth Turner, director of the district health department covering those counties, said they’ve managed to partly fund Wolfe’s exchange but are having trouble buying needles because some of the grant money can’t be used for them. She explained the situation to a state health official this week, she said, and was told Kentucky just received harm reduction funds that will be sent out to counties, including Wolfe.
Although this money also can’t be used for needles, Turner is hopeful it could offset other expenses, “and we could maybe afford to (buy) the needles.”
Nurse administrator Elizabeth Turner discusses the Kentucky River Health Department’s needle exchange program that is currently operating in Owsley and Lee counties and is approved in Wolfe, Letcher and Perry counties. Alton Strupp/Courier Journal
Tight finances also make disease testing a challenge. While many area doctors test for hep C, Turner said few test for HIV, and her department can’t really fill the gap because it’s stretched for staff.
Kentucky officials said the state’s HIV program tries to help, giving free test kits to every local health department and providing money for testing: $476,799 for HIV in the past fiscal year, plus around $46,000 for hep C. The state health department got another $49,000 from the CDC for hep C testing this spring, and in August hired a hepatitis program coordinator and epidemiologist. Before that, the program had just one staff person.
“Kentucky has made a lot of really good strides,” UK’s Young said. “But then there’s a lot more that can and needs to be done.”
And, experts acknowledge, a lot more formidable obstacles to overcome: doctor shortages, a dearth of drug treatment, and poverty that has persisted for decades.
Soldiers in the fight
Against all of this, teachers, preachers and regular folks keep trying to change a landscape Carmack likens to walking through “a zombie apocalypse.”
They work on preventing drug abuse before it starts, like the Operation UNITE workers and volunteers in Wolfe County who teach schoolchildren about goal-setting, hold summer camps and support archery teams that give kids something to do after school.
“We have to create a positive atmosphere and give them love,” said archery coach Jonathan Mayabb. “When they’re here, they’re safe.”
They give refuge to addicts and their families, like Jenell Brewer, who helped launch SPARK, a nonprofit organization in Powell County offering support groups and counseling. Brewer, who is raising a grandchild because of her daughter’s addiction, has an office across from a courthouse bursting with residents accused of drug crimes.
And they try to fight addiction with love and generosity, the way Lacy-Helterbrand does it.
Unable to bear children of her own, she’s been taking in kids for more than two decades. She has custody of seven and takes care of Andiria’s sister part-time. She lets the kids stay in touch with their birth families, and helps those families when she can.
It hasn’t been easy. Many of the children come to her with problems. After being born drug dependent, baby Gabe came home from the hospital crying eight hours a day. Lacy-Helterbrand, 47, had to massage his legs regularly until he was 6 months old.
Besides tending to their physical needs, she tries to teach her kids the importance of hard work and helping others. Andiria helps hand out clothes to local children living in government housing. And all the kids participate in Appalachian Ministries events, such as the big Christmas party featuring presents and a Santa, played by Lacy-Helterbrand’s white-bearded father, Garland Lacy.
Andiria alternates between being a little kid who climbs trees and a little mom who helps out with the younger ones and speaks with the knowing presence of a grown-up. Pouring Cheerios onto Gabe’s highchair tray, she said she appreciates Lacy-Helterbrand “so much” for giving her a chance for a good life.
Even at 10 years old, she knows that’s precious in these hardscrabble hills.
Laura Ungar: 502-582-7190; email@example.com; Twitter: @laura_ungar; Support strong local journalism by subscribing today: www.courier-journal.com/laurau.