Facing the crisis: How small communities respond to the opioid epidemic

By Cameron Rasmusson
Reader Contributor

It was a wake up call when Sandpoint local Kim Smith learned how drug abuse can transform a family.

When one of her family members was convicted on criminal charges stemming from a drug addiction, she was left with a multitude of questions. How did the situation get so out of control? What could have been done to prevent it? What had happened to a beloved relative who still held so much promise and potential?

“He did something horrible, but he wasn’t always that person,” she said. “In fact, he was the complete opposite of that person. You’d look into his eyes and see the gold-hearted human being that you trusted.”

The experience inspired her to lend her time and energy to the fight against drug abuse. It’s a fight that needs all the recruits it can get. Over the past decade, the opioid crisis — a drug abuse epidemic instigated by the over-prescription of pain medication — has spiraled out of control. It affects millions nationwide, resulting in addiction struggles and even death.

“The opioid crisis isn’t just a national crisis,” said Kevin Knepper, CEO of Kaniksu Health Services. “It’s a local crisis, and it’s having a significant negative impact on our community. … We need to be brave and innovative in trying to address the issue.”

According to the Centers for Disease Control, more than 702,000 people died from a drug overdose between 1999 and 2017. Almost 68% of those deaths resulted from opioid use, either acquired illegally or through a prescription. According to data from Kaniksu Health Services, opioid abuse killed 64,000 people nationwide last year alone, making it the leading cause of death for individuals under 50 years old. It outpaces car accidents, gun fatalities and the height of the HIV epidemic in deadliness.

National data shows the rate of opioid prescriptions written per 100 people in Bonner County was 56.1 in 2017 — below the national average of 58.7 and the lowest of the five northern counties in Idaho. The highest is Shoshone County, with 95.5 prescriptions per 100 people.
Screen capture, Centers for Disease Control and Prevention.

Figures from the U.S. Drug Enforcement Agency show that 12,246,020 prescription pain pills flooded Bonner County between 2006 and 2012 — enough for 43 pills per county resident per year. The McKesson Corporation was responsible for the majority of the distribution, while SpecGx LLC manufactured a majority of pills.

While those numbers are surprising, they don’t touch those of many other Idaho counties. Shoshone County, for instance, received 75 pills per person per year during the same time period. Even that pales in comparison to the hardest-hit counties in the nation. Charleston County in South Carolina received a shocking 248 pills per person per year. 

Meanwhile, a 2018 needs assessment study published by the Idaho Department of Health and Welfare concluded that while “Idaho is most definitely experiencing a significant increase in opiate and heroin use, misuse and death, the opiate epidemic here has not yet reached proportion that other states in the Midwest and East Coast are facing.”

“Thus, coordinated efforts to combat this epidemic are just now coming to fruition in this state,” the report added.

Comparative severity notwithstanding, Idaho law enforcement and health care communities face a test like no other with the opioid crisis. According to Kaniksu Health Services, one out of five high-school students “have used a prescription drug without having a prescription, and Idaho’s rate of drug overdoses is double what it was in 1999.” Opioids are pervasive enough to claim the life of one Idahoan every 45 hours, and a person can become addicted to them in as little as a week.

So how did Idaho — and the rest of the nation — get into a predicament where dozens of opioid pills exist per resident? According to Adam Kusler, behavioral health director of Kaniksu Health Services, the medical community is largely to blame: specifically the easily abused financial relationship between pharmaceutical companies and doctors. Incentives to push opioid painkillers have resulted in over-prescribing on a massive scale. The effect has been particularly severe in rural areas, where a small number of doctors build closer relationships to their patients and their circumstances.

“It seems in those small communities there tends to be a little less objectiveness in terms of prescribing according to the actual medical necessity,” Kusler said.

The crisis sparked an explosive legal response. On June 6, 2019, Idaho sued Purdue Pharma, the maker of painkiller OxyContin, and eight members of the Sackler family, which owns the pharmaceutical company: Richard Sackler, Theresa Sackler, Kathe Sackler, Jonathan Sackler, Mortimer D.A. Sackler, Beverly Sackler, David Sackler and Ilene Sackler Lefcourt. As ABC News reported, the naming of individual family members was a somewhat unusual touch from Idaho Attorney General Lawrence Wasden, but the lawsuit itself wasn’t. By summertime, nearly every state in the country had sued the firm.

“Between 1999 and 2017, Idaho’s opioid-related death rate nearly tripled. In 2015 alone, approximately 1.3 million opioid prescriptions were written in Idaho — nearly one prescription for every man, woman and child in the state,” the lawsuit reads. “This crisis and its consequences could and should have been avoided.”

While state and U.S. officials hope to extract some justice from those allegedly responsible for the crisis, local communities are left to mitigate the damage as best they can. There’s a reason opioid addiction is so devastating: It manifests in particularly insidious ways.

According to Kusler, an opioid addict can present as productive and fully functional while their addiction is being fed. It’s only when their supply dries up and withdrawal sets in that their problem becomes obvious. If there’s one consistent element to the opioid addiction experience, it’s that withdrawal is a misery most try to avoid at all costs, Kusler said.

“Imagine the worst flu you’ve ever had in your life, and times that by 20,” he added.

But feeding an addiction isn’t as easy as it used to be. Because of new rules and regulations, pharmacies that once freely distributed opioids now keep a tight grip on the pain medications. The upshot is a surge in heroin trafficking as addicts look for other means to satisfy their dependency. Idaho State Police data indicates that between 2014 and 2015, the amount of  heroin seized in the state exploded by 800%.

Too often, drug addicts wind up in the justice system, not a treatment program. Whether the addict uses legally obtained painkillers or heroin, addiction-related behavior or possession of controlled substances can land them in front of a judge. The problem, Kusler says, is prison terms don’t address the underlying problems.

“[The justice system] does nothing to impede a person’s addictions,” he said. “In fact, it does the opposite. They become better criminals, more capable addicts.”

The good news is treatment programs are available for those who choose to seek help. The World Health Organization defines buprenorphine and methadone as “essential medications” in fighting drug abuse. But according to health professionals, every individual’s situation is unique, and effective treatment can vary from patient to patient.

Kaniksu Health Services, for instance, centers its treatment on a buprenorphine-based medication called Suboxone. The drug is engineered to ease opioid cravings while limiting the potential for abuse of the treatment itself. The treatment is combined with a robust program of counseling and examination.

But Kim Smith sees another important factor in the fight against drug abuse going unaddressed: open acknowledgement of the problem.

Drug problems can be embarrassing for both the person struggling and their family. It’s a difficult problem to discuss in a tourism-dependent town reliant on a well-polished surface. But ignoring the problem doesn’t make it go away, Smith said.

“That’s what I’m really hoping to achieve: conversation,” she said. “You’re not the only one dealing with this.”