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This perfect storm of more varied and widely-available opioids entering the market (marketed aggressively as less-addictive and safer), and a call to more thoroughly treat pain or be seen as doing a disservice to your patient, is likely one of the primary reasons for the opioid epidemic. Purdue Pharmaceuticals released Ox圜ontin in 1996, billing it as a safer and less addictive opioid. At the same time as this push for better pain management began, however, several new opioid drugs hit the market. As providers, we want to be able to do something to alleviate pain for our patients. Pain became known as the “fifth vital sign”, and a whole generation of providers was schooled in this new understanding of pain. In the late 1990s and early 2000s, there was a push to improve treatment of patients with pain. Today’s opioid epidemic is, in part, an unintended consequence of providers trying to better serve their patients. So why has West Virginia been hit so hard by this crisis? And what are health leaders here doing about it? Here on the ground in the Cabin Creek Clinics, nearly every patient we have seen has been directly touched by opioid addiction in some way. Opioids are killing 40 people per 100,000 that use them in West Virginia–a truly staggering number. According to the Centers for Disease Control, West Virginia has the highest rate of drug overdoses in the country. Getting to spend time with them is enlightening, and helps to illustrate the brutal legacy of occupational hazards endured in the pursuit of profit in this country.Īppalachian communities are among the hardest hit by the national opioid addiction epidemic. These miners worked very hard, in very dangerous settings, out of a necessity to provide for their family in a place with few other options. This is a unique experience, as this disease is rarely seen outside of Appalachia. Many in our group have able to spend time in the Breathing Center, learning about black lung and seeing patients in pulmonary rehab.
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These benefits make a huge difference to the miners and their families. It’s an arduous process, so navigation help is critical. This is a federal law that provides monthly payments and medical benefits to miners disabled by black lung. Importantly, the clinic also provides legal help to miners filing a claim for benefits under the Black Lung Benefits Act of 1973. The clinic provides pulmonary testing and rehabilitation, and a community-centered approach that allows people suffering from this difficult disease to come together and support each other. Here in Cabin Creek, The Breathing Center in Dawes, WV is a comprehensive pulmonary function facility with a rehab clinic and a federally approved Black Lung Center. Those laid-off miners are now coming in to clinics for care–and black lung diagnoses are sky-rocketing. With the decline of the coal industry, more than 40,000 miners have lost their jobs since 2010 and six hundred mines have closed. Although it is against the law to fire miners for getting chest x-rays or being diagnosed with black lung disease, many believe that if the mining company finds out that you’ve been tested–they’ll find a way to replace you. More miners are also coming to clinics for care.
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This may be the reason that case numbers of the most serious form of black lung have risen dramatically. The rock in these mountains contains high amounts of silica, which aerosolizes into very fine particles and is implicated in other fibrotic diseases of the lung. As the coal seams that are being mined shrink in size and become more difficult to reach, mining operations must break up more rock to get to the coal. Why the resurgence now? Many attribute the rise to changing mining practices. The Centers for Disease Control estimate that more than 76,000 Americans have died as a result of black lung since 1968. It is progressive, incurable, and deadly. Black lung causes shortness of breath, fits of coughing, and chronic bronchitis. The dust particles settle in the lung where they cause inflammation and, eventually, fibrosis. Miners develop black lung from breathing in coal dust. There has been a major resurgence of the deadly disease, also known as coal worker’s pneumoconiosis. Across Appalachia, coal miners are suffering from black lung in record numbers.