Town hall meeting addresses opioid epidemic

    Members of the law enforcement community, medical professionals, and people who have personally dealt with the effects of addiction came together to speak to the public on the problem of the opioid epidemic in the local area. A town-hall-style meeting was held at the Steelville Community Building on July 10, and was sponsored by the Your Community Cares Rural Health Coalition.

    The meeting included a number of attendees who have also had personal experiences with addiction—with several speaking out on their frustrations with the system—especially as parents of adult children using drugs.
    Felisha Richards, Rural Opioid Response Planning Project Director with Your Community Health Center and the coalition, facilitated the meeting. She noted that the group has held 15 meetings so far in the area, providing the opportunity for education and awareness along with community conversations on the issue.
    Local law enforcement personnel on the panel included Steelville Police Chief Mike Sherman, Cuba Police Chief Doug Shelton, Crawford County Prosecuting Attorney David Smith, Crawford County Sheriff Darin Layman, and a task force officer with the Lake Area Narcotics Enforcement Group who was introduced only by a first name.
    Sherman, who is also a member of the coalition, was the first of the panel to speak. He told those present that he has spent 23 years in law enforcement in this county. “We see a lot of epidemics,” he said. “When I was starting, the biggest was methamphetamine. That has changed. Meth is harder to make because of the tracking of pseudophedrine, so now people have moved to another drug.”
    Sherman spoke on statistics, reporting that Crawford County ranked sixth in the state between 2013 and 2017 in opioid overdose deaths per 100,000 people. The four other counties that ranked higher are Jefferson County, Franklin County, Worth County, St. Louis County, and the fifth area with more overdose deaths was St. Louis City. Sherman noted, however, that Worth County is the smallest county in Missouri, according to population, so that rank was a bit skewed at a result.
    One of the issues related to overdoses involves those who have been in jail, and use again upon release. One woman in the audience asked, “Does anybody in the medical profession try to tell them you can’t go out and keep doing this?” Sherman noted that the Crawford County Sheriff’s Department works with inmates to try to deter them from using when they get out.
    Richards pointed out that the highest risk populations for fatal overdoses are those leaving prison, and those who survive an overdose. When a person is in jail, they go through a forced withdrawal from the drug. They will experience cravings when they are released. “That’s when their tolerance is down and they try to use the same amount and have a fatal overdose,” she said.
    Sherman also spoke about the need for those who are concerned about their friends and family members who are using to communicate with law enforcement. “Most law enforcement is reactive,” he said. “A lot of our information we get is third party.” He talked about the fear of many that ‘snitches get stitches’—most people are afraid to talk to law enforcement,” he said. “A lot of people don’t want to relay firsthand information to us. I’ve really taken this part to heart. If we can’t communicate as a community to our law enforcement, we can’t expect us to fix the problem.”
    Prosecutor Dave Smith spoke next, first providing some of his personal background. He served in the military, then almost 15 years in law enforcement—for several years as a narcotics investigator. He explained that, at that time, he had a “very black and white view of users,” one that viewed them as the “scum of the earth,” and he noted that’s not just “cop mentality,” but one that many people have—a view that includes a very negative connotation, and often involves character assassination of that person.
    He went on to explain how his view had changed. “At this point in my life, I have seen enough people in my life dealing with addiction…that I want to try to help at least be part of a solution that helps break the cycle of addiction, to help other people in the community to recognize it to hopefully bring about positive change,” he said. “I see a person suffering from drug addiction as a person in crisis.” And he noted, “Everyone is here because we want to see a positive solution.”
    Smith spoke on a Good Samaritan statute—one he explained is very specific in its application—related to those who report a drug-related medical issue. If an individual contacts law enforcement or emergency medical services because a person is suffering from a medical issue involving drug use, narcotics found at the scene can’t be used against the reporting party. “But it has to be a call for help,” he emphasized.
    Smith also spoke on a common misunderstanding with some—that law enforcement officers file charges against people. “That is not true. The only person who files charges in this county is me,” he said. “I have a lot of discretion on whether a case is filed or how a case is filed.”
    He talked about a recent change in the judicial system that will prevent him from using a tool he felt had been helpful in addressing drug-related offenses. “When an individual gets arrested for felony drug events, most typically, I file charges and apply for a warrant,” he explained. “The judge issues a warrant with a bond; if they can’t come up with bond, they may sit several months in jail, and it’s kind of a forced detox because they’re in jail.” He had also supported release from jail to a treatment center in those cases.
    As of July 1, the Missouri Supreme Court issued new rules that require granting an OR (own recognizance) bond or a release-on-summons if a person can’t post bond, or is charged with a non-violent crime. Most often, drug-related offenses are not considered violent crimes.
    Smith concluded, “I’ll be the first to tell you, I don’t have a solution. I think our best chance of success is events like this.”
    Both Smith and Sherman emphasized that they want to “bridge the gap” between the entities involved in this issue and find solutions to help those struggling with addiction.
    Dr. Matthew Porter, a former family physician with the U.S. Army, and currently the medical director at Your Community Health Center, spoke about the medical community’s response to the opioid crisis.
    He explained recent changes in how medical professionals are addressing addiction. Up until just a couple of years ago, doctors were trained to send those diagnosed with a substance use disorder to a treatment facility. He noted that, previously, the idea was that addiction was a result of a person’s bad choice, and they should go get themselves fixed.
    Most physicians had not been prepared to help with medication, so there was a call to action for more of them to take the necessary steps to do so, and Dr. Porter was one who did.
    “I see addiction now as a chronic disease,” he said, noting that change in thinking opened up new possibilities, including communicating about the problem with others. “When you look at it that way, instead of a bad decision, it makes more sense to talk to others,” he said. He compared addiction to diabetes—a disease where the person must have medicine to treat it, but will always have the condition—“a chronic disease that can be well-managed. That (way of thinking) really changed things for our clinic,” he said.
    He noted that meant they worked to treat patients where they are at—and sometimes that is an acute situation.
    A woman from the audience interrupted the doctor to disagree with his statement that the Your Community Health Center worked well with patients with serious issues. “No you don’t,” she said. “Four hours I was on the phone to try to get my son Suboxone. And now he’s dead.”
    Another woman said, “You can’t get help if you haven’t got good insurance.” And another added, “As a mother, why can’t they understand we are trying to help?”
    Dr. Porter expressed condolences, and added, “Any time you need to be seen, come to the clinic. I’m the medical director—if you need help, and you show up, we will help. We treat insured and uninsured the same. The money should not be an issue.”
    In the discussion, the first woman revealed her son had been 23 years old. Because of medical privacy laws, medical professionals are not allowed to speak to another person about an adult without permission.
    “There are some things we can’t do,” Dr. Porter said. “I can’t go get a patient. There are some basic medical rules. If someone calls and says, ‘Call this person,’ I can’t. They are some privacy rules that we have to follow.”
    Dr. Porter continued, discussing current treatment, which is now outpatient-based, and includes medication administered right away. He said that the medication-first philosophy works, helping to reduce withdrawals and cravings. “Any delays in starting medication, and you might not see the patient back,” he said. “This is a whole other animal on what doctors are trying to treat—patients that might die before you can see them again. This is new to physicians. The concept of medication first (addresses that). Just get it started.”
    He noted that former ways of dealing with the issue was essentially treating them like children, in telling them to get a job, or seek therapy, etc. “We encourage them to do those things, but maybe the first week of withdrawal, they may not want to talk about their feelings,” he said. “It’s a very different thing your physicians are going through on how to treat.”
    One woman took exception to the comparison of substance abuse to a disease like diabetes. Privately, she told Three Rivers Publishing that comparison had bothered her because addiction does at least begin with a choice, while a chronic condition like Type 1 Diabetes does not.
    Following the information presented by law enforcement and the medical doctor, Richards concluded, “Where does that leave all of us? We’re learning we have to manage this differently. There are changes coming. We’re changing to meet the person where they’re at, and advocating for people being able to share information.”
    She noted that the federal government is asking the question, “How do we save people?” and she said, “That’s what we’re working on day in and day out.” She noted the diverse panelists—representing different perspectives—who were present, and reiterated the need for community support.
    She said many ask, “What can I do?” and encouraged people to “treat one another as human beings,” and to share the knowledge that substance use disorder is a medical condition. “A lot of people still don’t think substance use is a disease and it is,” she said.
    Richards said there has been a three-part wave in the current opioid epidemic, starting with prescription medications, then heroin, and now synthetics.

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