Opioid crisis

Stakeholders highlight need for local response to opiate abuse

Jill Schramm/MDN Sen. Heidi Heitkamp holds a drug fact sheet from First District Health Unit as Renae Byre from the health unit looks on during a forum in Minot Thursday.

Opioid use has exploded in the Minot community, and services to help the addicted have not kept pace, according to agency officials and family members who participated in a forum held by Sen. Heidi Heitkamp, D-ND, in Minot Thursday.

Testimony that was at times emotional or eye-opening offered a stream of information that all pointed to a need for a community-based, collaborative approach to solving the local drug problem.

Forum panelist Paul Stroklund of Minot, a parent whose daughter has struggled with opioid addiction, looked over an audience filled with individuals representing law enforcement, government, health care, the faith community, veterans, social services and economic development.

“Three years ago I wish I could have found half the people in this room to help us,” Stroklund said. “I couldn’t find any help. I knocked on every damn door in this town. Everybody sitting in here, working at a facility, I knocked at the door, begging. Nobody was there to help me.”

His daughter eventually received treatment in Bismarck and later in Fargo until the state cut funding for the facility she was in, forcing clients out on the street.

“Three of them died that week from overdose,” Stroklund said.

Other parents in the audience also voiced their frustration over the lack of resources for their addicted children.

Mitzie Nay of Minot, whose son died from his addiction, said as a parent, she didn’t recognize the signs and had to educate herself. She invited community organizations to take an active role in making resources available both to educate people and help fight addiction.

“We need that. We need it so badly. I am a parent who lost a child to this,” she said.

Candis Mock, a licensed addiction counselor with North Central Human Service Center, Minot, said her agency has out-patient and residential day treatment, long-term transitional living, after-care programs and adolescent treatment, but in no case is it enough. Nor are staff resources adequate to meet urgent needs.

“”We are able to see up to six people a day. Some days there may be 15 people sitting out in that waiting room to be seen,” she said. “We have what is called a triage team and they assess who is at the highest need and we will see them first. The others are not turned away. They are asked to come back the next day.”

Mock said other agencies, including Trinity Health and Dakota Boys & Girls Ranch, also offer services. Still, North Central is having to place people on waiting lists – engaging them however they can accommodate them in the meantime – because of a shortage of services throughout the community. North Central also is taking addiction clients from Williston because of an even greater shortage of services there.

Last summer, Community Medical Services opened North Dakota’s first methadone clinic for opioid treatment in Minot. Since August, the clinic has served 90 clients, director Mark Schaefer said.

More than 40 percent of clients are able to afford treatment because of a state voucher program that provides financial assistance, he said. A funding bill in the Legislature came out of the House with a cut to voucher funding from $1.5 million to $350,000.

“It would last for about four more months, which is terrifying,” Schaefer said.

Heitkamp suggested residents contact their legislators.

“You have this enormous resource right here in your community,” she said of the CMS clinic. “Do not let this fail because we were pennywise and pound-foolish.”

Heitkamp referred to the $38 million Ward County jail expansion, undertaken to handle the growing inmate population.

“Do you want to spend money there or do you want to spend money to help people recover?” she asked.

Maj. Bob Barnard, acting Ward County sheriff, said the jail housed 1,372 people on drug-related charges in 2016. So far in 2017, the number is 824.

As a long-time law enforcement officer, he has been surprised at the increasing number inmates who, upon admission, ask correctional officers to keep an eye on them for detoxification issues.

“The other thing is the phone calls that we get from family members, pleading us to keep their loved ones in jail because they know that’s the only place that’s actually going to detox them,” he said.

Rob Brown with the North Dakota Bureau of Criminal Investigation’s Drug Task Force, estimated law enforcement encountered only a handful of heroin cases and no more than 20 total opioid cases in the 15 or so years before 2015.

“Starting in 2015, it just went crazy,” he said. The year from 2014 to 2015 saw a 440 percent increase in heroin cases. Once the people had a taste of opiates, the state became a destination for opioid dealers, particularly with the growth from the oil boom, Brown said.

It is easy to tell how much of a drug is in the community by the price, Brown said. Competition with more dealers and more drugs drives the price down.The price for an opioid pill has dropped from $87 to $50, he said.

Heitkamp said reducing the supply won’t solve the problem, but if law enforcement isn’t on the street removing product, prices will fall.

“The lower the price goes, the more usage we are going to see,” she said.

Dr. Jeffrey Sather with Trinity Health emergency care, said the emergency room sees patients almost weekly with a diagnosis of methamphetamine psychosis, but heroin emergencies are less frequent for good reason.

“Heroine overdose usually leaves the patient dead and they don’t get a chance to see us,” he said. He mentioned the push to get an antidote medication into the community to prevent overdose deaths.

The U.S. Centers for Disease Control and Prevention reported 61 drug overdose deaths in North Dakota in 2015, up from 20 in 2013. Heitkamp said North Dakota has one of the fastest growing rates of overdose deaths in the country. Williams and Rolette counties have led the state.

Last year, drug overdose/abuse was the primary diagnosis of 228 patients presenting at Trinity’s emergency room. Of those, 67 had narcotics as part of that diagnosis, Sather said.

What has skyrocketed in the emergency room is weapon-related violence.

“We see gunshots and stabbings almost on a weekly basis now here in Minot,” Sather said. “If we know the details or the story starts to come out, they are drug-related in some way.”

Sather also spoke about education efforts with physicians to reduce the number of opioid prescriptions, which are a major pathway to addiction. Renae Byre with First District Health Unit in Minot told of the health unit’s efforts to provide prescription education for physicians and information for people trying to get off opioids.

John Vastag, coordinator of the Blue Ribbon Commission on Addiction, addressed the group’s efforts to combat addiction in the Fargo area. The mayors of Fargo, West Fargo and Horace, along with Moorhead and Dilworth, Minn., formed the commission, which draws on local expertise to find local solutions.

The current focus is on developing an awareness campaign, creating a clearinghouse for information so families have a place to turn, providing medical detoxification and establishing transition housing and services.

“There are some things that can happen at the federal level. They can really support us and get us some funding. There are some things that can happen at the state level. But the reality is, folks, if we are going to fix this, it has to happen in our community because nobody knows our community better than you folks do,” he said. “As servant leaders in our community, we have a responsibility to use our resources the most efficiently and effectively as we can. The only way we are going to do that is through collaboration and coordination.”

The goal should be to become less reactive and more proactive with prevention and promotion, Vastag said.

“Right now, that’s all we are doing is reacting,” he added. “It’s inefficient and we are losing lives.”

Heitkamp discussed her LifeBOAT legislation, which proposes to tax opioid prescriptions at a penny a milligram, raising about $1 billion nationally for addiction services.

“We have to quit believing that we can solve this problem without resources,” Heitkamp said.

She acknowledged the budget mood in Washington with a new administration will be a hurdle to getting more funding for addiction services. Nearly 20 percent of North Dakota’s drug treatment dollars come from Medicaid Expansion, which is at risk of being cut, she said.

Heitkamp also heard from forum participants and audience members who spoke of the stigma facing recovered addicts, making it difficult to find jobs or housing. Often with felony convictions, they aren’t eligible for student loans to get an education.

Heitkamp said the solution to the opiate crisis must include a change in policies and the justice system to promote recovery over punishment.

“If people feel like they have no hope, they will not be successful. But if they know the community is behind them, they can be,” she said.

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