In a beige conference room in Morgantown, West Virginia, Katie Chiasson-Downs, a slight, blond woman with a dimpled smile, read out the good news first. "Sarah is getting married next month, so I expect her to be a little stressed," she said to the room. "Rebecca is moving along with her pregnancy. This is Betty's last group with us."
"Felicia is having difficulties with doctors following up with her care for what she thinks is MRSA," Chiasson-Downs continued. "Charlie wasn't here last time, he cancelled. Hank ..."
"Hank needs a sponsor, bad," said Carl Sullivan, a middle-aged man with auburn hair and a deep drawl. "It kind of bothers me that he never gets one."
"This was Tom's first time back in the group, he seemed happy to be there," Chiasson-Downs went on, reading from her list.
"He had to work all the way back up," Sullivan added.
Chiasson-Downs and the other therapists with the Chestnut Ridge Center's opiate-addiction program had gathered to update each other on the status of their patients before launching into the day's psychotherapy sessions. Here in West Virginia, where prescription painkillers have long "flowed like water," as Sullivan said, the team works to keep recovering addicts sober through a combination of therapy and buprenorphine, a drug used to treat painkiller and heroin addiction.
Chiasson-Downs' patients are in the "advanced" group—so called because they're well into their recoveries. She relayed a few success stories—a new baby here, a relapse averted there—but even years after they've found sobriety, her charges' lives are still precariously balanced.
What Tom (not his real name) was attempting to work his way back up from was the weekly "beginner" group, where advanced patients are sent if they relapse and cannot stay clean. It happens fairly frequently, Sullivan, the director of the treatment program, said.
For patients in the less advanced groups, the therapists' updates are gloomier.
"Trent called in crisis last week, and he didn't come," said Laura Lander, another therapist. An acquaintance who was supposed to give Trent a ride to the clinic instead stole his money and medication and then left him by the side of the road.
"He went without his meds," Doug Harvey, the case manager, added.
"He will have used this week," Sullivan concluded.
"Jessica, she's still living with her boyfriend, who is actively using." Lander said.
"So she's craving every day," Sullivan noted.
"She's financially dependent on him," Lander said. "Three kids and nowhere to go. He's a jerk to her."
"She lives out in the middle of nowhere," Sullivan added. "She talked about her neighborhood being full of people who use. Her family all uses. I'd be surprised if she's clean today."
The therapists' stories go on, sketching a picture of a region that's understaffed and under-resourced, and that found itself unprepared for an epidemic it has disproportionately been affected by. One woman has been skipping meetings and "doing weird things with her meds." Another patient filled his prescription with a new doctor, raising the possibility he was "doctor-shopping," or getting multiple prescriptions from different physicians simultaneously. A woman who lives more than two hours away wasn't going to make it in—the Medicaid van that normally brings her fell through this week.
