Part 4 of a 4 Part Series
We analyzed the oversupply of prescription opioid medication in White Pine County and across the state of Nevada. We identified medical providers that played a part in the opioid epidemic. We examined law enforcement’s efforts and strategies to combat the opioid crisis that has led to rampant heroin use in our county. Now, as the nation and Nevada reels in the aftermath of the worst medical catastrophe in our history, the country, Nevada, and White Pine County are left with one question: what happens now?
Nevada and many other states are lining up to sue pharmaceutical companies to hold them accountable. The medical industry is examining guidelines and has adjusted how doctors dole out potentially addictive medication, and the Government of the United States is shelling out almost $2 billion in response to the opioid crisis that took the lives of over 400,000 Americans in the last two decades.
Regardless of who we blame; the patients that abused opioids; the doctors that over prescribed; pharmacists who filled the prescriptions; the pharmaceutical sales reps who lied about the safety of prescription opioids; the distributors and makers of the pills and the CEOs of these companies that put profit over protections; or governmental agencies that tracked sales of these dangerous pills and did nothing to prevent the epidemic from reaching fever pitch, or the medical associations that allowed pharmaceutical lobbyists to draft medical industry standards that systemically enabled everyone to participate in the drugging of a nation; now comes the time to heal.
While courts and judges determine settlements and pharmaceutical companies either declare bankruptcy or pay multimillion dollar fines, White Pine County, along with everyone else, must look towards a future free from prescription and illicit opioid addictions. Treatment for the problem is the point in the road where we and a country have come to find ourselves, despite who’s to blame.
Unfortunately, for White Pine County and other parts of rural Nevada, treatment has been a long way away, geographically speaking. With no addiction treatment facilities in White Pine County, those facing the stigma and hardships associated with addiction, clinically referred to as Substance Abuse Disorder (SAD), they were burdened even more by feeling isolated, alone, and lost. Often the only treatment options for addiction here are found through drug court, after a criminal prosecution.
Until recently options in White Pine County were limited. Austin Sorensen, a Clinical Social Worker Specialist in Ely, suggests, “Any treatment is better than no treatment. The more connected someone is, the more contact they have with others who can help, the more chance they have at successfully breaking out of addiction.” Sorensen added, “Seeking out a member of the clergy, a counselor at Ely Mental Health or psychologists, people need to connect to others, the more connections the better.” Soon, those addicted to opioids will have more options to connect to more resources.
William Bee Ririe Hospital, the leader in medical treatment in White Pine currently has no addiction treatment programs. During an interview with Matt Walker, CEO of the hospital, noted that they are doing more on the preventative side of the problem. Walker stated that after the opioid crisis became apparent, “We started having safety meetings with our providers, pharmacists, our Chief Nursing Officer, and we pulled records of all patients on opioids over a certain level and created treatment plans incorporating alternative pain management modalities and reduced their opioid doses. If patients were resistant, then the doctors had difficult conversations and cut them off or dramatically reduced their dose.”
Detailing the reactions of patients, Walker reflected, “Many of them were very upset at the beginning, because you do get psychologically attached as well, but we saw patients that were decreased to half of what they were on over an extended time frame, came back and said they felt better than they ever had.” The prescription monitoring program, known as Assembly Bill 474, has also empowered more clinical awareness of how many pills are being given out by doctors to each patient, preventing over prescribing.
Sheriff Henroid pointed out in our last article, “With the Legislature getting more stringent on the medical side, we’ve seen, because it’s tougher to get opiates, heroin is on the rise.” The Drug Task Force and the Sheriff’s Office are finding more and more heroin in their local busts of dealers with methamphetamines and other drugs, “Now it’s coming into common place, because opioid prices have gone up and the price of heroin has gone down,” Henroid stated. The problem isn’t going away, it’s getting worse and, with few treatment options available, will only take more lives.
Walker is aware the hospital has seen increases in methamphetamine and heroin use and addiction in recent years. While he and the hospital are working on developing treatment options, currently on staff, Walker says, “Dr. Wesley and Dr. Blitsch are working together to help with patients on oxycodone and hydrocodone or the few patients on methadone, between drug counseling and low-dose opioids, but most heroin addicts don’t want the help. If they don’t get what they want they go back to the street.” In order to get help, patients need to want to kick their habit, but they cannot do it without more options.
Moving into White Pine County to offer help and treatment assistance to those with Substance Abuse Disorder (SAD) and bolster the hospital’s response to prescription and illicit opioid addiction is TRAC-B, a non-profit group in Nevada specifically set up for modernizing and coordinating state and local efforts to combat opioid and heroin addiction as well as promote harm reduction and prevention education.
Chelsi Cheatom, Trac-B’s Program Manager, laid out her agency’s strategies and the goals she and local community leaders in White Pine County are working together on when addressing treatment options for our area and others in rural Nevada, “ In order to find out where the issues were going on we went to every area across the state, interviewing people from all over the spectrum, from prevention coalitions, law enforcement, local government, and found a few areas that really wanted to receive our help were Elko, Dayton, and Ely.”
Perpetuating Trac-B’s motivation to move into White Pine County and other rural Nevada areas, Cheatom outlines, “We’ve been focused on working on what looks best for the community of White Pine in the areas of harm reduction, needle exchange, opioid treatment and getting people into treatment as quickly as possible, and also helping people with other issues that might be preventing them from getting into treatment that, if we’re able to help them with, they would go seek treatment.” Understanding the difficulties communities like those here in White Pine face, Cheatom and Trac-B are hitting the ground running in order to offer much needed support in the fight for recovery from opioid addiction.
With increased support comes increased opportunity. Trac-B’s goal is to hire locals to help locals with addiction problems, “We are trying to find individuals to work locally as Peer Recovery Support Specialists, in conjunction with licensed drug and alcohol treatment specialists or counselors, to help people figure out what would be best for them, whether it’s finding medication assisted treatment or an inpatient treatment facility.” Cheatom outlined the peer support specialist would find and help eliminate treatment obstacles.
Cheatom brings years of experience working in this field and notes that, “Often times the issues are bigger than simply transportation or figuring out where they want to go, but how to ensure child care, pet care, or coordinating with employers to schedule time off from work for days, weeks, or months, to receive treatment The peer we hire will help them through all of these steps. Luckily we have a lot of treatment options in the State – in Elko, Las Vegas or Reno, where providers are available.
Treating Substance Abuse Disorder takes more than getting into a program, making sure someone is not at risk of relapsing or overdose if they start to use again isTrac-B’s goal. Being able to hire peers that have lived experience with opioid use and are in long term recovery will help others more sustainably and be enabled through the federal government’s recent allocation of between 4 and 7million dollars in aid for Nevada, specifically for opioid and heroin addiction treatment.
Treatment is an increasing need in all areas of our state, as Cheatom explains, “In two years we have gone from about 2700 people coming to see us in the first year to our second year having about 4000 utilizing our services. Now that there is more prescription monitoring and people can’t get prescription pain pills they tend to turn to street level drugs, pressed pills, heroin and other things.” The problems arising in the aftermath of the opioid epidemic are worsening people’s addictions.
Trac-B has seen methamphetamine as the second most common thing people are using, and using them in combinations, mixing meth and heroin together. Fentanyl also is an inexpensive synthetic opioid causing a very strong short lasting high and causes the majority of overdoses since people tend to inject more, which puts them at increased risk of overdose, abbesses, HepC and HIV transmission.
Trac-B is a needed service here in White Pine. A City of Ely EMT noted they have used Naloxone, or Narcan, an injected overdose prevention medication, many times in the last year. Trac-B’s many services can benefit the area since people often share needles when using heroin, putting them at a much higher risk of contracting Hepatitis C and HIV and there are no facilities in our area that specifically tests for these life-threatening infections. Trac-B wants to get out ahead of this problem, before it becomes an outbreak.
Cheatom notes, “We focus on rural areas because these regions are often more likely to have Hep C and HIV outbreaks since often there is not a lot of testing going on and not a lot of harm reduction or syringe exchange programs. People are less likely to know that they have a virus before spreading it to other people. We want to make sure we get to rural areas before the worst case outbreak scenarios occur, similarly to an outbreak like that which occurred in the rural area of Scott County Indiana, where over 200 people contracted Hep C and HIV before then Governor Mike Pence signed a bill allowing syringe exchanges to open in the state.
Many people may balk at the idea of syringe exchange, but harm reduction programs are more than just handing out clean needles to drug users. Cheatom explains, “it’s creating a comfortable space for people that might be at risk of Hep C or HIV or sharing syringes and drugs or are at higher risk of overdose. We are there working with people suffering from Substance Abuse Disorder all the time, so we are able to help them figure out what tests they need and what resources they and information they need to get into treatment.” With a 25% positivity rate of people tested for HepC and about a 1% for HIV among Trac-B’s clientele, once local testing begins, it is likely numbers in White Pine will be similar.
Having Trac-B come to our area will assist our youngest populations, most importantly. The majority of the non-profit’s clientele are over the age of 18, but evaluations of their clients show most started using opioids by an age of onset of 16 years old with most reporting the onset of injecting drugs was slightly older.
Locally, it is important for communities to come together and talk about if the issues are around syringe use or Substance Abuse Disorder, and to start looking for solutions. Working with agencies like Trac-B, that are able to work across the state to provide resources like syringe exchange, syringe clean up, naloxone distribution, and other options can also help set up assets in the areas of education by clearly identifying what each community needs.
Ely’s Mayor, Nathan Robertson, Sheriff Henroid, NDI, Ely Mental Health, WBRH, all acknowledge there is a problem, and everyone is focused on how to combat the problem. Trac-B is now actively working with the community to figure out how to solve it. Cheatom says, “We are all looking at how to get people who have SAD into treatment; how to encourage people who share needles to get tested for Hepatitis C and HIV; how to get peer recovery communities established so, when people go into treatment and come back, they have groups that can help them prevent relapse.”
Other solutions being discussed is to get Naloxone into the community as much as possible to reduce the risk of overdose and to start talking about novel approaches like syringe vending machines that are able to vend sterile syringes, and sharps containers to collect used syringes and prevent needles from ending up in places that are dangerous to the community.
Trac-B will also be coordinating with WBRH to establish a next-level care program in the form of a Mobile Recovery Outreach Team. Cheatom presented the idea as a win-win for everyone,“If someone comes in to the hospital for an overdose or other opioid related incident, or is talking to a doctor about using substances there will be a peer, someone in long term recovery, hired in Ely, who can meet with them immediately and find out what services they need, provide them with Naloxone, work with them to get them the services they need to get them into treatment. This is a unique strategy that has been successful in more urban areas like Las Vegas and Reno. I believe WBRH is the first rural hospital to implement this type of resource.” Connecting current users to recovering users has been a success in other areas.
Cheatom continued, “We are really excited to be working with WBRH on this. The next step is to hire someone in Ely, who will be able to work as that peer, with a lived experience that is willing to be the guiding light and show people what can happen to your life after you get over substance abuse disorder.”
Community leaders and stakeholders in patient care, mental health, counselors, professionals in addiction treatment, law enforcement, and members of White Pine education centers will be meeting with Trac-B on September 30th to discuss harm reduction programs and the next steps White Pine County as a whole can and will be making towards an addiction free future.
If you have a prescription opioid addiction or are addicted to heroin or other illicit drugs, you are not alone. Help is a phone call away. Call Carson-Tahoe Behavioral Health at 775-445-8000. Or call the Mallory Center: 775-445-8889. Locally, you can call the Sheriff’s Office at 775-289-8808.