It was an unlikely journey that led Rahul Gupta to become the public health commissioner for West Virginia, but it was one that followed his passion for treating the most vulnerable patients in the world, from plague victims in New Delhi to opioid addicts in rural America.
The son of Indian diplomats, Gupta was raised in the Washington, D.C., area, but returned to his native New Delhi for medical school. There, he worked on a vaccination campaign to eradicate polio. It was the first time such a campaign had been tried in the country, and it worked. “It gave me a sense of what’s possible,” Gupta says. “I’ve seen children die because of polio, tetanus and the plague. We don’t really see those public health problems in America, and that gives me a larger perspective for what I do.”
Gupta’s sense of medical possibility was reinforced for him when he returned to America to work as a doctor in Birmingham, Ala. He dealt with Medicaid patients who had trouble meeting $1 copays on their prescription drugs. He called pharmacies and found he could get them to waive those fees.
His work led him to West Virginia, where he won notice for his handling of the 2014 Elk River chemical spill, which left more than 300,000 of the state’s residents in nine counties without safe tap water. He was praised for working quickly to get clean water restored, preventing larger-scale public health problems. Soon after that, in 2015, Gov. Earl Ray Tomblin asked Gupta to be West Virginia’s public health commissioner.
Upon taking office, he was met with one of the worst epidemics in the state’s history. West Virginians were overdosing from opioids at an alarming rate. Nearly 900 people died from opioid abuse in 2016; even more died in 2017. “The opioid epidemic has been a punch to West Virginia. It’s crippled us,” says Danny Scalise, executive director of the West Virginia State Medical Association. “But Gupta has been the counterpunch.”
In order to curb overdoses, Gupta sought to understand exactly who the victims were and how they were falling into danger. He led a team that conducted what he calls a “post-autopsy autopsy.” The findings were illuminating: Four out of five of those who died had come into contact with the health-care system, and those who had visited three or more pharmacies getting prescriptions filled were 70 times more likely to die. Only 2 in 10 of those who died had received naloxone, the antidote to an overdose.
Gupta established an opioid response panel that asked affected communities what they wanted from the state. This year, as a result of the research and community input, the state legislature passed the Opioid Reduction Act, a multipronged approach that, among other features, expands the availability of naloxone throughout the state and limits when and how often doctors can prescribe opioids.
It’s too soon to say whether Gupta’s efforts and the new legislation will make a serious dent in the epidemic. Gupta himself will not be there to see the impact: He accepted a position with the March of Dimes in September. Still, Scalise says that the commissioner’s impact on the state will far outlast his tenure. “We are going to see a drawback in overdoses,” he says. “The reason we have any good news is because of Dr. Gupta.”