August 15, 2018

Opioids Up North

By Lynda Wheatley | Jan. 29, 2018

This fall, President Trump directed acting Health Secretary Eric Hargan to declare opioid abuse a public health emergency. The epidemic has taken hold all over the country, reaching across age, gender, and socio-economic lines — and, as anyone who reads the headlines is familiar, right here into what many perceive as our northern Michigan paradise.

While there’s no way to pinpoint the number of opioid abusers in the region, Benzie County led the state in its population’s proportion of opioid overdose deaths — 2.9 deaths per 10,000 residents — in 2015 (the last year the Michigan Department of Health and Human Services made data available). Antrim and Crawford counties weren’t far behind with 2.2 deaths per 10,000 people respectively.

Grand Traverse County, the focus of this story, had nine opioid-related overdose deaths, or one in every 10,000 residents. In 2016, according to Capt. Chris Clark, the Grand Traverse County Sheriff's Office documented 14 fatal overdoses (including those due to alcohol and non-opioid drugs). In 2017, that number dropped to eight.

Does credit for the slight improvement go to naloxone, the overdose reversal drug that the Grand Traverse County Sheriff's Office began supplying its officers in 2016, of which 14 applications have been used so far? Is it an effect of the Sheriff’s Department Interdiction Team, a specially trained unit that began operations in January 2016 to work closely with the Traverse Narcotics Team (TNT) and department detective bureau to target criminal activity related to drugs? Better prevention and education efforts in schools? Or is it simply one slightly better year amidst an increasingly growing problem?

Last week, the Northern Express gathered a group of people who have different roles in — and vantage points on — the opioid situation in the Grand Traverse Community:

• Tom Flitton, a sergeant with Grand Traverse Sheriff’s Office and supervisor of the department’s interdiction team

• Lynne Hertler, a Grand Traverse resident who lost her son, Michael, to an opioid overdose in September 2017

• Dr. Rob Smith, EMS med director for NW Regional Medical Control Authority, an ER physician at Munson Medical Center, a former paramedic and firefighter, and former SWAT doctor with Wayne County Sheriff’s Department

• Christopher Hindbaugh, chief executive officer of Addiction Treatment Center in Traverse City

• Michigan State Police Lt. Kip Belcher, task force section commander for the 7th district, overseer of three drug taskforce teams in 19 Michigan counties

Although each clearly has his or her unique view on the whats and whys of the situation, all started off the conversation in agreement on one central issue: We don’t have an opioid situation Up North. We have a crisis.

Northern Express: How would you describe what’s happening in the community with opioids?

Sgt. Tom Flitton: Over the last five years it’s exploded. We don’t see as many overdoses anymore because the opioid kits are out in the general public, in the community, but it’s definitely an increased problem.

Lynne Hertler: [Michael] really didn’t hang out with his using friends, that we knew, but when we’d talk about it, he’d say heroin and human trafficking is everywhere up here. I kept saying, I don’t understand it. And he said people from downstate would get women and men addicted and use them as drug mules, is that the right term?

Dr. Rob Smith: Right now, it’s an epidemic. It is a public health concern. Has it gotten a lot worse? It’s gotten a lot worse as far as with younger people. People have always overdosed on drugs, but now you have kids using. When you see a person addicted, their entire life centers around using the drug. There was a lady transported by EMS last week, and she wanted pain medicine so bad, she let them put in an intraosseous line, where they drill [fluids or medicine] into your bone. She turned out to be a psychiatric patient, but she was feigning abdominal pain and stating how much it hurt, and it was later determined she didn’t have anything wrong with her, but she wanted opiates so badly that she actually had that line put in; they couldn’t get an IV in anywhere else.

Express: How do you determine whether someone is really in pain or seeking drugs?

Smith: It’s Gestalt [an approach to therapy that emphasizes personal responsibility and focuses upon the individual's experience in the present moment]. If you’re in a bunch of pain, it’s hard for me to believe you have 10 out of 10 pain when you’re not sweating, your blood pressure’s not up — usually people will show signs. It’s mostly what’s Gestalt and what’s appropriate. If you’ve snapped your femur — that’s a pretty big bone, you need some pain medicine. But I’ve had parents of 12 year olds who ask me, “Aren’t you going to give him anything for pain for his sprained ankle?” And my response is Motrin or Tylenol …

The ER only writes 2 percent of the narcotic prescriptions. In general, we don’t write for more than three days. Are there people who come in and get pain medication? Sure. Some get one over on me, but I would have to write a big prescription for them to get addicted. The whole point of being a doctor is to alleviate suffering. If you think they’re in pain, you can treat them appropriately. But if they look they’re a normal person and after three doses of Dilaudid, they still say 10 out of 10 pain, and they need more, we say, ‘Well, it’s not working, let’s try some Tylenol.’ But that doesn’t happen too often. 

Chris Hindbaugh: Speaking from our organization, Traverse City is on trend what’s happening in the rest of the country. We currently have 100 beds we offer in this community — all were full last night. Between residential care, our jail alternative program, and our recovery homes, we serve 2,500 people a year, and the vast majority from this immediate area. It’s overwhelming; it was about half that 5 or 6 years ago.

Express: Are you ever in the position where you have to turn people away?

Hindbaugh: Very often — especially in our detox unit, which is really, for a lot of folks, the gateway into other treatment options. We’re constantly bumping up against [its limits], and we incrementally add beds, but as soon as we do, they’re full. This field is underfunded. And only 10 percent of the people who need treatment really have access to treatment. This is the only disease that we don’t treat people until they get to the highest levels of acuity, and it’s often too late by that point because they’re entering other systems at that point, legal or otherwise.

Express: When did it start becoming apparent this area had an opioid problem?

Lt. Kip Belcher: Back maybe 7, 8, 10 years ago, there was a rash of pharmacy burglaries, all controlled medication stolen and most assuredly marketed. And then from there, it gradually evolved into a heroin market — heroin being much easier to obtain and cheaper than prescription drugs. What happened with the heroin is that the same identical distribution routes used for things like crack cocaine, marijuana, those didn’t change. You have to look at this thing from an economic perspective: If you’re successful with your marketing or routing it a certain way, why change that? So eventually, they began to bring heroin up, mainly from metro cities — Chicago, Detroit, Grand Rapids, Flint, Saginaw. A consumer demand develops. And then you see this progressive acceleration, which is what we’ve seen in the greater northwestern Lower Michigan area here.

And like with anything else, the people who market it have to continuously make it better. And how do you make it better? You make it more potent, stronger. You mix it because you want to be the top salesman, the person with the best material out there ready for sale. So the goal now becomes, for the consumers of it, to approach that point in time where they feel like they’re fading into the mist. In other words, they’re close to death. That’s the high that a lot of people want to achieve, and how do you achieve that? You mix it with something like fentanyl or carfentanyl — carfentanyl being a large animal tranquilizer used for surgical purposes on animals like rhinocerouses and African elephants. Often, the opioid reversal drugs are not at all effective when you have those high potency drugs added in with the heroin, which is high potency of itself.

Express: What is most pervasive here now — prescription drugs, heroin, fentanyl?

Belcher: It varies upon which section you’re in. In greater Traverse City/Cadillac area, it defaults to heroin, intravenous usage, which is the quickest way to obtain a high, right Doc? [RS nods.] The further east you get, into SANE’s coverage area, Gaylord up through the Straits, it morphs into more of a prescription drug, tablet form. But they still have some issues with heroin. Further over toward the far east side of the state, it’s actually shifted a little bit over to prescription drug items and a resurgence in cocaine [due to fears about what’s in the heroin].

Express: How are people getting into opiates? Is there a common denominator?

Hindbaugh: Multiple pathways. For us, we’re seeing a huge increase in a couple particular demographics: women — professional educated women in particular. It’s trending younger. And what we’re finding just in our data in our organization, those younger uses are using it recreationally very often and started at in high school. The other trend we’re starting to see more of is a boomer population. Probably the most significant, which isn’t a demographic marker, but — we’re seeing people who have no history of addiction ever and yet, one year after their first opiate use, they’re addicted to heroin. It’s just such a quickly progressive disease.        

Hertler: You know, I’m not sure [how and when Michael started using]. He had two hernia repairs and deviated septum fixed in high school. I remember the first time he took a pain med, the next morning he said, “I had a dream last night! And I never remember my dreams!” I remember the next day he wanted to drive, and I said, No, not while you’re taking these, and I took them, and he was perfectly fine with that. I don’t know if it started then. Somebody reached out after he died and said they’d been using with him eight years ago, which I didn’t know. A lot of these people struggle to keep everything OK, does that make sense? He would have really bad times, and we’d talk about getting help, and he’d say, “I got this, Mom,” and then he’d work and we’d go on family vacations for a week, and I didn’t know much about [opiate addiction]. I thought he’d be shaking in a corner if he was still on it, so I thought he was doing well. I though, he’s gaining weight … It’s a rollercoaster. A roller coaster. And you know, he always insisted he wasn’t doing heroin. I think he was scared of the stigma, ashamed. His friends — his true friends — said they had no idea. He never talked about it to them.

Express: Are any of you surprised by who you’re finding addicted?

Flitton: Yes, there’s a stigma of a junkie that people think of, that their life has spiraled out of control to get to the point where they’re sticking a heroin needle in their arm. And that’s not what we’re seeing. We’re showing up at houses where an 18- or 19-year old kid has overdosed, and we’re giving the naloxone and getting a save, and this kid has zero criminal history — we have no idea who they are. That’s been the most alarming thing for us on the road is that, we have no way to get ahead of this or know who’s using. I think a lot of it is a very private thing for them, a very shameful thing. Heroin’s not a party drug — it’s not ‘Let’s get together.’ It’s, ‘Hey, I got a dose, I’m going in my room, and no one’s going to see me for a little bit.’

Express: What’s the youngest age you’ve seen so far?

Flitton: I have one female I’ve been in contact with, I know she started using at 16. I haven’t seen younger than that.

Hertler: A woman I used to work with brought her 14-year-old son to my son’s funeral. He’s using heroin.

Express: It seems like every time a dealer is shut down, there’s another to take his or her place. Do you ever feel you’re banging your head against a wall?

Belcher: Well no, and I’ll tell you why. As long as we’ve got one single overdose or one near overdose, I don’t know how you can characterize it as ‘banging your head against a wall.’ There’s work to be done, but it’s not entirely a law enforcement circumstance. It’s everyone in this room, working collectively together to solve that problem. I do not, have not, and will not perceive this problem as head-banging, or not being the most efficient use of time. We still have people who are finding themselves in this circumstance who are using this drug, provided by others, who are not surviving their experimentation with it. We need to eliminate that problem, and the most efficient way is to identify the highest end distributors that you can and put those people out of business.

Express: Do you find yourself spending less time pursuing marijuana busts when there is this deadly stuff going around? 

Belcher: In contrast to what you might see in social media posts, very little time is spent by any of the [drug] task forces across the state with marijuana enforcement. 

Express: What one thing, in terms of policy, federal or state laws, or whatnot — what would you change?

Belcher: One of the things that would be helpful to us is to have better access to the people who survive overdoses and don’t die. Having an opportunity to talk to them, without there being any fear of a criminal charge, so we could obtain that distributor information and develop a criminal case. It’s very challenging for us right now, with rules in place that provide patient privacy. And I understand that, but it also produces a bit of a blockade for us from having the opportunity to lock that distributor up and prevent the next overdose from happening. 

Express: Michigan State Police has the Angel Care program, which allows addicts to walk in any MSP post and seek help for their addiction without fear of arrest. Does the county have anything like that in place?

Flitton: There’s no program set up like that in the sheriff’s department. There is a new state law, the Good Samaritan law passed about a year ago. If the police have contact with you as a result of medical treatment, say you call in with an overdose and we get sent there, the person who is the victim of the overdose and anyone who called for assistance cannot be charged with any sort of crime. That is statewide, across the board.

Hindbaugh: Access to care is significant. Only about 10 percent of the people who need treatment have access to it. The treatment system we have is really focused on acute care, and we don’t have people access it early on in their addiction. There’s very few who are in active addiction who want to be there, but we don’t have mechanisms, we continue to build shame around the issue. We hear this very often: It’s the stigma that kills in the end. There’s medicated treatments that we know are best practices, but there’s inadequate providers there — definitely in Traverse City but also around the country. There’s new methodology, but we don’t have the systems, the mechanisms to manage it.

Express: So what does a family without means do if they can’t afford rehab for a loved one who’s addicted?

Hindbaugh: So the irony is, the family without means has a higher likelihood of getting care, because it’s Medicaid or block grant funding. It’s the professional with insurance who has a harder time accessing care. Which is part of why the stereotype continues and why Dakoske Hall is for ‘those folks,’ right? Because it is! Because those are the only folks that can access care! You’re in the criminal justice system. You’ve lost your employer, you’ve been kicked out of your house and so it perpetuates that stereotype. Historically, it’s easier to get care if you’re at either end of the socioeconomic spectrum. So if you have the means, you leave town. You go to Malibu or Minnesota Hazleton, Betty Ford, that sort of thing. But for general population, it’s becoming more accessible — there are parity laws that have been passed that are supposed to give people more access — but we’re still waiting for that to materialize.

Express: Are there any stop-gap options for families and/or people struggling with addiction?

Hindbaugh: We are in the middle of a public health crisis. But we have yet to create the public health response. So if you think about the HIV epidemic in the ’80s, it was mostly gay men that raised their hand — the population that had the highest prevalence of dying. They said, ‘We’re not going to put up with this,’ and demanded a public health strategy. Within a number of years, we had better prevention and education, money toward research, money for ongoing recovery. Again, with an acute care model [our current response to addiction], it’s, well, put somebody in rehab, and if they mess up, then that’s the end. There’s no after-care, and there’s very little prevention and education. It’s hard to fathom a society that loses the equivalent of an airplane full of people going down every single day — and we don’t have the public will to take that seriously? It’s unfathomable, but that’s what’s happening right now.

Hertler: I believe a 30-day program is about $37,000, is that right?

Hindbaugh: Yes, not ours. But yes, it could be that much.

Hertler: And if you leave after three days, there’s no refund.

Hindbaugh: That’s another part of the system. It’s either private pay or nonprofits that are underfunded. There’s no in-between. 

Rob: A week and a half ago, I just put a friend of a friend in rehab. He’s 25. He’s addicted to Vicodin. And for an eight-day detox with a 28 day rehab, it’s $10,000 — and you have to come up with a $1,500 deposit. When we know that the majority of Americans would have trouble coming up with $400 on a moment’s notice, to tell a family, ‘We’re going to need $8,000 or $10,000 within 36 days for you to complete this program’ — I’m just not really sure how that’s acceptable when we spend 40 percent of our health care dollars on the last 30 days of a person’s life, keeping the 94-year-old lady who’s in a vegetative state alive so that Aunt Connie from Florida can fly in and say goodbye at a cost of $30,000 to $40,000 a day in an intensive care unit, when she’s already passed her expiration date by 16 years, and she’s vegetative! We put money toward that! What if we took that money and put it [toward addiction help], where it’s better spent — I mean, this is killing off people who are younger and younger. It’s killing off people who are the future of America.


At What Cost?
According to Sgt. Flitton and Lt. Belcher, the prices for heroin are roughly $240 to $280 a gram in Traverse City. In Detroit, it costs about $80 to $100 for a gram. “Considering the typical dosage of heroin is just a tenth of a gram, or a half of a tenth of a gram, you understand the economic dynamics at play here,” said Belcher. “[For an addict,] it could easily transcend to $200- or $300-per-day need for that particular drug, so that’s often leading to other criminal activity — larcenies, burglaries — to help support that, because the drive, the demand produced internally for heroin and other opiates is so extreme that it becomes your sole focus. And you are going to find a way to obtain that $250 you need for that day’s worth of heroin. You will do whatever is necessary. You’ll steal from relatives, you will assault people, you will steal and rob people. And you may have been, prior to that, a great person, a great kid.” 

What are Opioids?
Opioids are a class of highly addictive drugs that include the illicit drug heroin, as well as legal, physician-prescribed pain relievers like oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, fentanyl, and more. Opioids work by attaching to specific proteins found on nerve cells in the brain, spinal cord, gastrointestinal tract, and other organs, reducing the perception of pain, and producing a sense of well-being or euphoria.

Opioid-related Deaths Up North
Opioid-related deaths reported elsewhere in the Northern Express coverage area in 2015: Mackinac County had .9 per 10,000 residents, Missauke County had .7 per, Emmet and Kalkaska counties each had .6 per; Leelanau had .5 per; Wexford had .3 per, and Manistee had .8 per. Charlevoix, Cheboygan, and Otsego had no overdose deaths related to opioids. It should be noted, however, that all of these numbers don’t include all deaths related to opioid overdose; only those whose death certificates specifically list an opioid as the cause of death. 

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