By Stephen Smoot
West Virginia between 2023 and 2024 recorded an astounding 42 percent drop in drug overdoses statewide. Real numbers of overdose survival may exceed official counts, since a number of those who administer the life-saving drug narcan to stave off overdose death do not follow up with a hospital or clinic.
Neither state officials nor addiction and recovery specialists have declared victory, however.
Raj Masih with the West Virginia Office of Drug Control Policy and Potomac Highlands Guild has been working with a pilot project that brings cutting-edge technology to addiction recovery and overdose prevention. Currently over 80 throughout the Potomac Highlands participate with Masih hoping to soon get a total of 100 enrolled.
Masih explained a common problem with traditional therapy and related support programs, sharing the hypothetical story of an addict who has a successful therapy session on Thursday. The addict did well, took home assigned tasks to work on and scheduled another session the following week.
Then the therapist learns on Sunday, to their horror, that their patient has overdosed, leading to the agonizing question of “is there anything we could have done?”
Masih relates that one serious problem comes from lack of contact. He said that most overdoses are “preceded by painful cravings” that can stem from “anxiety, depression, stress. Severe dysfunction is a signal.”
That said, Masih also explained that the cravings, though extremely powerful, usually pass in 10 minutes. The key lies in getting the addict through the critical 10 minutes.
An app called CRAVAlert could provide that bridge across to prevent relapse and, possibly, overdose.
According to an academic paper written by Masih and 11 other experts, CRAVAlert “integrates wearable technology and remote patient monitoring with just-in-time peer interventions to support individuals in early recovery from substance abuse disorders and mental health conditions.”
The patient has a biopatch monitor attached to his or her chest that measures a set of vital signs. Through bluetooth technology, it connects to a specially designed smartphone that transmits vital signs through the cloud to a central location.
A patient wears the biopatch for four hours to set their individual baseline. After that, the patch monitors deviations from that. If abnormal deviations go beyond the parameters and appear consistent with a person who is overdosing, or even about to relapse, the system kicks into action.
A peer recovery specialist, any time day or night, will place a call to the patient. They have specific limits on their job that do allow them to listen to problems, provide support, and relay motivational messages and coping strategies. These could include prayer, a cold shower, music, exercise, or reaching out to a friend.
Masih shared that the system follows a “built-in escalation protocol” that has peer recovery specialists transfer the call to specific professionals who can handle more serious problems.
He also explained that the process of addiction usually sees those who suffer from it alienating family, friends, and others in their support system. That isolation can push those in a fragile mental state in early recovery to using, especially in critical periods such as late at night.
Combine that with the problem that those in recovery have their drug resistance lowered. Also, says Masih “the drugs we have today . . . it’s like playing Russian roulette.” Fentanyl and other powerful drugs used by dealers to increase potency cheaply can make a single dose deadly.
In the near future, the program could be augmented by machine learning and artificial intelligence technology that could use data to predict relapses with increasing accuracy, leading to more successful interventions even before the addict takes the drug.
Effectiveness with this program also dovetails with another accomplishment in the battle against addiction and death in West Virginia. Masih explains that an overdose prediction model is currently in place, using data from the federal High Intensity Drug Trafficking Area program. “We start by looking at where do drugs come from” that end up in West Virginia. Hotspots for drugs that come to the Mountain State, such as Anne Arundel County, Maryland, Allegheny County, Pennsylvania, Roanoke and Salem, Virginia, as well as Cleveland and Columbus, Ohio will often see massive spikes of overdose instances when a “bad batch” of drugs laced with deadly substances hits the streets.
Predictive models show the expected time that the wave of effects from the laced drugs will hit various communities in West Virginia, following the path of trafficking. For example, an overdose spike starting in Baltimore will hit Martinsburg and Berkeley County within 38 hours. First responders, social workers, and other stakeholders in the field get an overdose spike alert with important information.
In the color coded system, red means 95 percent confidence that a significant problem is headed toward West Virginia communities. Last Friday, Cabell County received a red coded message as overdoses began to rise in Ohio. Several years ago, that same area saw dozens die in a single day as deadly drug concoctions filtered into Huntington.
Potomac Highlands Guild partnered with Pendleton County-based Future Generations University on the CRAVAlert project. FGU, according to Luke Taylor-Ide, entered “a formal MOU with the Potomac Highlands Guild to advance a clinical trial. The purpose was to demonstrate the efficacy, safety, and provide a proof of concept for the CRAVAlert system.”
FGU’s contributions included the study’s design, ethical oversight, financial support, and the patent for the CRAVAlert technology. PHG led implementation of the trial by identifying and recruiting participants and also training the peer recovery specialists, Taylor-Ide also stated that FGU “is West Virginia’s only member of the International Consortium of Universities for Drug Demand Reduction and has strategic partnerships with key organizations, including the West Virginia Office of Drug Control Policy.”
Mike Landis, with Potomac Highlands Guild, shared that “we’ve been at this for five years.” He went on to add that the program has been “very positive. Some people have really benefited. The key is knowing that the person on the other end is saying ‘let’s help.'”
Masih added that the constant monitoring has also helped to identify other potential health issues. Since it gathers information on heart rate and respiration, it can also relay abnormalities from reasons other than drugs. Once, Masih shared, it identified a malfunctioning CPAP machine. These devices treat sleep apnea which, without them, can lead to strokes or heart attacks.
