PENNINGTON GAP, Va. - A small, rural area of southwestern Virginia was a launching pad in the 1990s for a then-newly-approved pain-relief drug, Oxycontin. According to locals, drug addiction and crime became rampant as a result.

The town of Pennington Gap was populated mostly by coal miners and loggers, the kinds of occupations prone to accidents and physical strain. It's also an area with a high rate of Medicaid recipients, which meant the drug would be accessible, despite lower incomes.

Beth Davies, executive director of The Addiction Education Center in Pennington Gap, says the release of Oxycontin changed the face of Appalachia.

"Once this drug came on the scene, it was totally different. Everything changed almost overnight because of this drug, and people became so quickly addicted to it; it was so powerful."

Now, Oxycontin addiction is an issue nationwide that knows no racial or socio-economic boundaries. Davies advocates treatment and drug courts for nonviolent offenders who end up in the criminal justice system as a result of addiction issues.

She says the once-sleepy town saw a sudden crime wave, as people began breaking into pharmacies to steal Oxycontin, and into homes, to steal whatever they could to get money for the drug.

"We had 105 people in a jail that would house something like 30 people, on the floor, no beds for them, and so forth. That was in our little county jail."

At the time, there were no drug courts in the rural area, so Davies says her organization, along with others such as Virginia Organizing, worked with judges and law enforcement to find alternatives to jail.

"Financially, it would cost a lot less if we could get people treatment rather than paying to incarcerate them, only to come out and, because they didn't get any treatment, return almost immediately to prison."

Davies says recent research show drug courts reduce crime by as much as 45 percent compared with traditional sentencing models. About 75 percent of those who complete drug court are never arrested again.

In this year's Virginia General Assembly, legislation to allow federal funding for drug courts failed in the House after passing the Senate. Drug court advocates will push for similar legislation next year.


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A guaranteed income pilot program in Oakland improved housing stability and employment among its recipients, according to a new report from the University of Pennsylvania's Center for Guaranteed Income Research.

Starting in 2021, 300 low-income families in Oakland received $500 a month in cash for 18 months.

Jesus Gerena is the CEO and president of UpTogether, a nonprofit based in Concord that administered the program alongside the group Oakland Thrives.

"The income guidelines are at or below the federal poverty line," said Gerena. "They had to have at least one child under the age of 18, and then the average age for participants was 38 years old. Eighty-four percent of them were women."

The report showed that participants often made significant gains. Participating adults were 44% less likely to experience homelessness after one year in the program.

And contrary to popular belief, the extra money did not hurt employment. Full-time employment rose 11% for those in the program, compared to a 4% increase in a control group.

Gerena said even though the pilot program is now over, he hopes its success will convince authorities that poverty is a policy choice.

"If we trust and invest directly in people and their abilities, who are facing financial hardship," said Gerena, "they're more than capable to be able to identify goals and figure out what they need to do to be able to find success in their lives."

Researchers also found that families receiving the cash also reported an increase in their children's academic performance.

The program was funded by private donations. Once it ended, many of the gains receded.






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Minnesota is in the top half of states when linking Medicaid coverage with needs for maternal care in rural areas.

That's according to a new report from the Center for Children and Families at Georgetown University.

In rural Minnesota, more than 23% of women of child-bearing age are covered by Medicaid. That's in line with the national average and 4% higher than the state's metro counties.

The University of Minnesota Professor in the School of Public Health Dr. Katy Kozhimannil is part of the broader research community looking at this issue.

She said these numbers come amid a continued decline of obstetric care in these communities.

"More than a decade into a maternal health crisis in this country," said Kozhimannil. "Fewer and fewer U.S. hospitals provide obstetrics every year with rural hospitals experiencing the greatest losses."

Researchers say this care is expensive and big Medicaid adjustments create more harm for rural providers, putting the health of mothers and babies at risk.

House Republicans are considering program reforms, including work requirements, to help pay for tax cuts.

The GOP says streamlining services keeps the program strong for vulnerable people, but the Congressional Budget Office estimates nearly 8 million people would lose coverage.

With that CBO forecast, Democrats and health advocates contend the proposed changes amount to massive cuts.

The Georgetown Center's Executive Director and Co-founder Joan Alker said the current debate over Medicaid is one of the more consequential ones she has seen in her time tracking federal policy.

"And the reality is that these cuts," said Alker, "could be extremely pernicious and dangerous for rural communities."

The report says in 2023, Medicaid covered 41% of births nationwide, but nearly half of all births in rural areas.

As for the chance of increased health risks, these researchers note that rates of infants with low-birthweight in rural counties tend to be higher than those in urban settings.

National EMS Week is underway, and South Dakota ambulance providers serving smaller towns and cities say they're barely getting by, with aging crews and whatever funding they can cobble together.

A legislative committee will soon study these issues. This summer, the interim panel will look at staffing woes for emergency medical services across the state.

It'll also dive into access barriers to trauma response in remote areas.

Brian Hambek, executive director of the Spearfish Emergency Ambulance Service and president of the South Dakota Ambulance Association, said these problems have been examined before, but the challenges aren't going away.

For example, he said his crew in Spearfish has two 82-year-olds helping out.

"We can't seem to get a lot of the younger kids to do this," said Hambek. "And a lot of that is because of the finances -- we're having a hard time paying people what they deserve and what they need."

Hambek said reimbursement rates from private insurers, as well as Medicaid and Medicare, aren't high enough for ambulance providers to keep up with operational costs.

States can set their own rates, but there's a bipartisan bill in Congress to help rural areas. However, it's unclear if it'll gain momentum.

In the meantime, Hambek said he hopes the South Dakota committee identifies lasting solutions.

Hambek credited the state for enhancing EMS support in recent sessions. But a bill this year that would have classified these services as essential failed in the legislature.

Unlike police and fire, Hambek said an ambulance provider no longer able to stay in business could shut down with little warning.

"We do almost 3,000 calls a year here on Spearfish," said Hambek, "and I could talk to my board tomorrow and say, 'We're closing the doors as of the first of June,' and there's nothing the city or county could do."

There was disagreement over the proposed funding mechanism to ensure all South Dakota communities had access to EMS.

Ambulance providers from larger cities say they sometimes have to assist with calls from surrounding towns where there are coverage gaps, leading to longer response times.




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