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Fentanyl continues to be the main driver behind West Virginia’s overdose crisis. But the state prohibits more of the treatment scientists say would save lives.
From 2019 to 2022, most West Virginians who died from overdoses had fentanyl in their systems.
Opioid painkillers fueled the addiction epidemic in the state, and after crackdowns on those prescriptions, people transitioned to the similar street drug heroin. Eventually fentanyl, an even more deadly drug, became most prevalent.
Treatment with medication is the best way to help opioid-addicted people recover, according to the National Institute on Drug Abuse, a federal government research agency. And because of a growing body of science showing one stronger type of medication, methadone, is more effective for people addicted to fentanyl, researchers are calling for more methadone centers.
While recent data shows the rate declining, West Virginia continues to lead the nation in rate of overdose deaths.
Though the state has nine methadone clinics, state law prohibits additional centers from opening, making it the most restrictive in the country, according to a report from The Pew Charitable Trusts.
In 2007, following a rise in overdoses that involved methadone, lawmakers put a moratorium on new methadone clinics.
“It saves lives. That message has got to get out,” said Dr. Stephen Loyd, director of the state Office of Drug Control Policy.
EJ Drihmi used multiple drugs, from opioids to stimulants. By the time he entered treatment, heroin was hard to find.
“Everything on the streets is fentanyl,” he said.
Drihmi now works as an aide for seniors who need help living safely at home and a delivery driver for Walmart. He said the methadone he gets from the clinic makes his life possible.
“If you don’t have it, you’re calling off,” he said. “It’s helped me hold down a job and be able to pay bills.”
Drihmi also gets counseling and participates in support groups at the clinic, where he learns to cope with distress that increases risk of relapse.
Despite testimony on the benefits of methadone from a state health official and an addiction researcher, lawmakers left the 2025 legislation session without expanding access and having introduced one bill that would have closed methadone clinics.
But critics of medication-assisted treatment believe it is exchanging one addiction for another and people using it don’t become productive citizens.
Sen. Brian Helton, chair of the State Senate Select Committee on Substance Use Disorder and Mental Health, opposes ending the moratorium.
Helton, a Fayette County Republican, wants to see people not dependent on any substance, and he noted that methadone has been a contributor to drug overdose deaths.
”There’s no reason to go back in time and use something that was proven to be harmful to the public,” Helton said.
Years ago, Loyd supported the use of Suboxone, a less potent medication that staves off opioid cravings but thought methadone was too strong. But as heroin use diminished, and more people have developed higher tolerances using fentanyl, his position has changed.
“Anybody with two eyeballs saw heroin coming,” Loyd said. “If you cut down on the pain pills and people are already addicted, and you don’t do anything to treat them, they’re not going to stop,” he said. “What I didn’t see was fentanyl.”
And as a regular fentanyl user, Drihmi tried Suboxone first, but he relapsed.
Then two years ago, he was prescribed methadone, a stronger treatment. Now his cravings are gone and he hasn’t relapsed since.
Last year lawmakers voted to allow research on methadone treatment.
Dr. Todd Davies, associate director of research and development at the Marshall University School of Medicine, is overseeing Marshall’s role in that research.
He and his team are specifically looking for adverse effects connected with long -term methadone use and treating methadone more like Suboxone, by allowing people to schedule office visits and eventually take home methadone instead of having to visit clinics daily.
But to Loyd, earlier research finding that methadone is better at stemming fentanyl cravings and at getting people into treatment, shows that more access is needed, right now. He said, “I have absolutely screamed my lungs out here.”
Reach reporter Erin Beck at erin@mountainstatespotlight.org
