Rehabbing the opioid addiction epidemic in the Steel City
The state of the problem is getting worse, and one doctor believes it’s because city leaders aren’t being aggressive enough.
PUEBLO — Almost as troubling as the addiction problem itself is how communities are coping and working to solve the opioid epidemic. There are few places that’s more evident in Colorado than Pueblo, which continues to see a rise in use, arrests and overdose deaths related to opioid use.
Those working on the issue, locally and at the state level, say there are resources — which are mostly limited — but it’s up to communities to recognize what they need and treat the problem aggressively.
State of an Epidemic
The evolution of opioid addiction in Colorado, particularly in Southern Colorado, has been aggressive to say the least.
In April, a multi-agency report under the Colorado Consortium for Prescription Drug Abuse Prevention showcased a grave picture of the problem across the state: heroin-related deaths doubled from 2011 to 2015, heroin seizures by Colorado law enforcement increased 2,035 percent during the same time period and the number of people who were in treatment for heroin addiction increased 128 percent.
In each 2015 and 2016, Pueblo County saw 12 overdoses related to opioid use — the highest death count in the state, three times the state rate. And according to Dr. Michael Nerenberg, who runs the mobile needle exchange program in Pueblo, the problem isn’t getting better. It’s getting worse.
At a February Pueblo City Council work session Nerenberg said over the course of a year — June 2015 to June 2016 — the exchange had a reported 3,020 visits, which comes out to just over 250 visits per month. The needle exchange saw 420 total new clients and distributed nearly 200,000 needles. 118,000 were collected by the volunteers, which Nerenberg said is a conservative estimate.
The month prior to the city council work session was a record month, Nerenberg said. That came despite raised awareness, more meetings and more people working to implement programs and solutions.
For areas around Pueblo, rural and with few resources, the problem is as pressing. More often than not there are no detox beds available in Pueblo County, let alone the region. Treatment is limited. The Colorado state health department reported opioid overdose death rates tripling between 2001 and 2015.
Resources Local and State
“The plan is that the needle exchange gets them through the door,” said Margaret Redmond, executive director of the Pueblo Human Relations Commission.
The commission recently opened a stationary needle exchange in Pueblo’s Bessemer neighborhood — and while it’s a good start, Redmond says it’s hopefully just the beginning of a bigger solution to Pueblo’s heroin addiction problem. The exchange has so far been operating as a mobile unit in Bessemer Park — but Redmond and Nerenberg said the city asked that they operate somewhere else.
Funding from the city, $30,000, and county, $41,000, helped make the more permanent exchange possible. But help from like-minded people around the state has been invaluable.
The Colorado Consortium for Prescription Drug Abuse Prevention helps communities across the state get resources for battling the epidemic — which is just one of the major aspects of the group. The consortium also has working groups that focus on public awareness, research and affected family and friends.
“You tell us what you need and we’ll go try to get it,” said Robert Valuk, the consortium’s coordinator.
A lot of federal funding for opioid addiction treatment can go to states, not local communities, Valuk said. So a big focus the consortium has is writing grants on behalf of communities across the state that are desperate, like Pueblo, for resources.
So far, Valuk said the group has been able to get over $33 million from the federal government. In March, Colorado’s Department of Human Services was awarded $7.8 million for opioid addiction.
Regularly a news release from U.S. Rep. Scott Tipton will outline what money federal money is available for opioid addiction. That’s the money the consortium is looking for.
Locally, Nerenberg, who has been substantially involved in helping get a handle on the epidemic, says there are resources available to Pueblo — local leaders just have to say yes. Nerenberg says they seem to still be hesitant.
This year the Colorado legislature included in its budget $7.5 million over the next three years for Law Enforcement Assisted Diversion programs, which aim to divert low-level drug and prostitution offenders to treatment instead of jail and prosecution.
“I’ve been talking to them (city council) for over a year and a half on this,” Nerenberg said.
At a city council work session, members told Nerenberg that the police department shies away from programs such as LEAD because possession of heroin is a federal felony.
If other communities have found a way around that concern, Nerenberg said he thinks Pueblo can too.
Other communities are interested in the available funding for LEAD programs, but Nerenberg fears Pueblo will see none of that specific aid because of reluctancy from the government.
On the other side of the problem is the lack of available healthcare providers who can administer and prescribe buprenorphine and other FDA-approved medications and therapies as part of providing medical assisted treatment to opioid-dependent patients.
But Pueblo legislators this session were successful in at least getting a pilot program off the ground to help resolve that issue. Successfully-passed Senate Bill 74, sponsored by Sen. Leroy Garcia and Rep. Daneya Esgar, designates $1 million from the marijuana tax cash fund go to assisting nurse practitioners and physician assistants obtain training that allows them to provide treatment to patients dependent on opioids.
The bill, which is only a pilot program for Pueblo and Routt counties, will have lasting impact, Garcia said. Once these healthcare professionals get training it stays with them.
This year, the legislature made a considerable amount of progress on the opioid epidemic, compared to years prior. Nerenberg believes it’s because opioid addiction now impacts so many the legislature has finally opened its eyes.
The Federal Angle: A Candidate’s Uncertain Promise
What happens next in fighting the opioid epidemic, at least in looking at resources and aid from the federal government, so far seems bleak.
In many cities on the 2016 campaign trail the topic of opioid addiction was front and center for Donald Trump. Many telling stories of a son or daughter overdosing on heroin or the long, grueling path that eventually led to rehab.
“I would dramatically expand access to treatment slots and end Medicaid policies that obstruct inpatient treatment. You’ve got to do this,” said candidate Trump at a New Hampshire campaign stop in October.
But leaked documents from Trump’s budget proposal didn’t reflect the same sentiment in May and had many worried about future resources. Opposite of the campaign talk was a 94 percent decrease in funding to the White House Office of Drug Control Policy and the elimination of at least two drug-related grant programs. So far it’s still unclear what lasting impact Trump’s budget could have on areas hit hardest by the epidemic — rural and blue-collar cities that tended to vote for Trump.
The president still hasn’t nominated a ‘Drug Czar’, which would oversee the office of drug control policy.
Trump’s budget still maintains funds for the $1.85 billion block of grants that make treatment for 2.5 million Americans possible. But the budget also calls for a cut in addiction research funding and would completely eliminate federal dollars for the training of addiction professionals.
Anti-heroin task forces, such as the ones that operate across Colorado, are expected to suffer under Trump’s version of the budget as well.
