ABINGDON, Va. (AP) — Kicking off a national tour on opioid addiction, Agriculture Secretary Tom Vilsack brought together the governors of Tennessee and Virginia on Thursday to talk about stemming Appalachia's drug abuse epidemic.
The town hall reinforced President Barack Obama's call for Congress to pump $1.1 billion more into substance abuse treatment. It also was an opportunity to show that governors of opposite parties want to expand Medicaid under the Affordable Care Act, despite Republican efforts to stop them.
Democratic Virginia Gov. Terry McAuliffe and Republican Tennessee Gov. Bill Haslam see solutions in a mix of treatment, prescription monitoring, drug courts, education and new economic opportunities.
West Virginia leads the nation in drug overdose deaths, with 35.5 per 100,000 people. Kentucky has the fourth-highest toll and Tennessee the eleventh, according to the U.S. Centers for Disease Control and Prevention.
"It's everybody's problem," McAuliffe said. "Of course, we need money."
Vilsack said Appalachians need more opportunities as the region's once-dominant coal industry crumbles. He cited Obama administration plans to facilitate the transition from extractive industries to more sustainable jobs in areas such as new manufacturing, small farms and conservation.
"You're going to see a different attitude, I believe, in smaller communities," Vilsack said. "You're going to see a more hopeful, more futuristic, things-are-going-to-get-better kind of attitude."
Many in Appalachia blame Obama's climate-change strategy of limiting pollution from coal-fired power plants for the region's job losses. West Virginia's unemployment rate the worst in the country.
Brutal economics dictate a grim future for coal, even without the carbon rules. Declining prices for natural gas and renewable energy, thinning Appalachian seams, competition from other U.S. coal regions and dim markets both domestically and abroad are all hastening the industry's decline.
But addictions aren't fed only by the lack of jobs, Haslam said. He also blames cultural factors.
"We have somehow decided that we deserve a break today and we should never be in any pain of any kind. And that's just not realistic," Haslam said. "That's just not how it is. We live in a painful world."
And once hooked, drug users can be too embarrassed to seek help, particularly in small towns, Vilsack said.
"It's that kind of, 'I'm tough, I'm going to get through this,'" Vilsack said. "Or, it's 'I don't really want my neighbors to know everything about my family.'"
McAuliffe said there's simply too much advertising by drug companies, and far too many prescriptions filled.
Obama tapped Vilsack to lead an interagency team on the opioid epidemic after leading a discussion in Charleston, West Virginia, last October. The former Iowa governor described a personal connection to addiction, saying his mother was an alcoholic and abused prescription pills.
Vilsack has said drug abuse bills in Congress are woefully short on cash. Adding $1.1 billion would create more treatment centers nationally; train about 700 new psychologists, psychiatrists and physicians specializing in drug treatment; and evaluate the results, Vilsack said.
Virginia could receive up to $17 million over two years; Tennessee, $24 million; West Virginia, $10 million; and Kentucky, $18 million.
Vilsack said he learned Thursday that some medication-assisted treatment centers only provide medication, not comprehensive services, with counseling and other offerings.
West Virginia just enacted a law cracking down on clinics dealing in cash, and requiring counseling at centers that often use Suboxone. The brand of buprenorphine is used to wean people off opioids, but can itself be abused.
On Thursday, Vilsack also announced $1.4 million for telemedicine grants in Kentucky, Tennessee and Virginia. The opioid tour heads to Missouri next month.