KOKOMO — Howard County Commissioner Paul Wyman, during a public town hall meeting Thursday, rolled out plans to incorporate multifaceted Systems of Care (SOC) to combat opioid addiction and substance abuse in local communities.
It's a measure that has been prompted by the deadliest year for overdoses in Howard County history — a crisis impacted by street drugs like heroin, prescription pain medication, stretching back to the Wagoner Medical Clinic, and the increased presence of deadly synthetic drugs.
A crowd of people nearly filled the Inventrek Technology Park auditorium Thursday evening as Wyman presented the plan, which was a direct response to an opioid summit Wyman hosted Sept. 18, during which roughly 65 local officials devised long-term and short-term goals to effectively tackle the crisis.
In the weeks since, around 100 people, representing major institutions across the community, created in-depth plans for five distinct subgroups. Each subgroup is represented by a contingent of volunteers tasked with completing a list of long- and short-term goals.
“We have a lot of agencies and organizations in our community that do a tremendous amount on an annual basis for addiction. Lots of good people doing lots of good things," said Wyman.
"The whole point of the summit was to start connecting the dots, was to start bringing agency and individuals and people together to start learning more about what we each do, but also is there a way to share resources? Is there a way to leverage that together to tackle this issue on many fronts?”
The plight, stretching across the state and nation and all possible demographics, is one that provides no easy solution. But hope exists, explained Wyman, if the issue takes precedence.
Deadliest year
The numbers tell the story.
As of Thursday, 38 people in Howard County have died from drug overdoses this year, with one more case pending toxicology — making 2017 the deadliest year for drug overdoses in Howard County.
Howard County Coroner Steve Seele delivered those figures to the crowd Thursday night, breaking down the numbers into more specific categories. Twenty-four of the deaths were opiate-related, 13 included heroin, 11 involved Fentanyl and 10 included meth.
In 2015, there were 34 overdose deaths, followed by 24 in 2016. Nationwide, Seele said approximately 33,000 people have died from opioid-related overdoses in 2017.
Seele said it’s not unusual for an overdose victim to have multiple substances identified in their system upon toxicology examinations. But the most prevalent drug is deemed the primary cause of the overdose in those cases.
Seele, who also provides public quarterly death reports in response to the growing epidemic, highlighted in last month's report the issue of synthetic drugs.
“I have a major concern over the increasing use of the synthetic cannabinoids (spice), synthetic cathinones (bath salts), and ‘chemi’ which is short for chemical,” he explained. “‘Chemi’ is either shipped in from foreign sources or manufactured in clandestine labs.
“These substances have gained popularity amongst users that are involved with the legal system as a way of preventing a positive urine test. The user is entering the land of the unknown when abusing these substances which can result in instant cardiac death.”
Mental health and addiction
Each of the five subgroups has a list of goals — some long-term and others short-term. The first group Wyman addressed is centered on mental health and addiction.
That group is tasked with short-term goals of creating a comprehensive list of existing treatment opportunities in the community and region and their respective eligibility requirements.
Officials are also asked to identify any roadblocks or barriers that might prevent someone from accessing treatment. Wyman said SOC representatives will partner with the United Way’s 211 in creating the list.
Another task of that goal is creating an “emergency response team” to point out and recommend routes to treatment immediately following a non-fatal overdose.
Wyman noted his vision is to provide vital treatment information to families and addicts at a hospital about “how they can gain treatment at that time, instead of just simply releasing them on their own recognizance, because legally that’s the law and having them go on their way back to the same environment they came from.”
“There are some constitutional issues in there,” noted Wyman, adding that the plan specifies this process would work within the “ethics and legality of intervention.”
“We’re going to work through that, and we think that’s a perfect time to be getting in front of people. We’ve had conversations with state legislators already about this situation and what the law might be able to provide for us for people that OD,” he said.
One possible route, he said, was posing the idea of approaching an overdose the same way one would threats of suicide. Presently, a person threatening suicide in a hospital may be detained, but not a person revived following an overdose.
Another job of the mental health and addiction subgroup is to create an “intervention resource team” to present access to resources to a “chronic non-compliant” individual.
Wyman painted a hypothetical picture of sending such a team to the Kokomo Rescue Mission if alerted about an individual known to habitually abuse drugs.
Long-term goals for the subgroup include looking at long-term treatment facilities in other communities that include sober living programs, and from there create a plan to recruit and implement a similar program locally.
Additionally, they’re tasked with creating a program for first responders on crisis intervention. Both of those goals are set to take 6 to 18 months.
Prevention
The next subgroup Wyman covered focuses on prevention. The group’s goals involve creating a student prevention plan, similar to the DARE program, and gearing it toward much younger students.
“DARE’s a great program. It’s in our schools right now, but it may not be the vehicle we need. We may need something a little more comprehensive, a little more aggressive, and this group is going to work on that and get that in place," he said.
Parents will be invited to learn along with their children, and a similar education and prevention plan will be offered to business owners and employers.
By the first quarter of 2018, the group is tasked with creating a “Take Back Drug” event where people can turn in unused prescription drugs or dump any illegal substances. Similar programs exist in the community, said Wyman, but they aren’t well known.
A similar event held last month by the Indiana State Police was deemed a major success. In fact, the ISP Peru Post saw the third highest number of unwanted prescription pills dropped off October 28 during the Prescription Drug Take Back event.
The Peru post collected 100 pounds of medication from 10 a.m. to 2 p.m. Oct. 28. The Indianapolis post took in 253 pounds, and the Jasper post saw the biggest drop off with 340 pounds.
Statewide the Indiana State Police collected a total of 1,308 pounds of unused or expired medication. Collection sites were set up nationwide for expired, unused and unwanted prescription drugs to be turned in for destruction. The program is intended for liquid and pill medications.
Prescription abuse has been credited in large part for Howard County’s current drug epidemic, following the shutdown of the Wagoner Medical Clinic in 2013. Officials raided the two Wagoner Medical Clinic branches in March 2013, arresting several clinic doctors and employees roughly a month later in a case put together by Kokomo police and U.S. Drug Enforcement Agency officers.
Prosecutors say more than two dozen people died as a result of the illegal prescribing practices at the facility. It has likely caused dozens more deaths, as people have since moved from prescription drugs to easier to obtain and cheaper drugs like heroin.
Long-term goals for this group include implementing programs within faith-based organizations and creating an anti-stigma campaign.
“There’s a lot of people dealing with addiction in our community that are even afraid to either come forward and ask for help or afraid to show their face in some of the places that can actually help them because of the stigma that comes along with it,” said Wyman.
That stigma has specifically played a role in the acceptance of Narcan, say local officials.
The use of Narcan is described by the U.S. National Library of Medicine as a way “to reverse the life-threatening effects of opiate [narcotic] overdose.
In over half of overdose deaths, another person was present, noted Howard County Public Health Project Coordinator Jennie Cauthern, meaning someone was available to immediately deploy Narcan.
“I feel like there’s still stigma in the community, that people are afraid to come and get trained,” she said, explaining that the medication’s nasal spray makes it easy for nearly anyone to utilize.
About why a stigma still exists, Cauthern said people are often worried about getting labeled as someone associated with drug addicts when obtaining Narcan, even for a family member. There are also concerns, she said, about whether or not Narcan enables drug addicts.
“Even though first responders have it, if friends and families are reluctant to have it because they feel like it’s enabling the person that has substance use disorder” avoidable overdose deaths will continue, said Cauthern.
Additionally, the SOC Prevention group is to provide accurate data about addiction in Howard County to legislators.
Youth and family peer support
This group’s goals include finding facilities in the region specifically geared to treat youth, along with the requirements for such a facility and the resources available at each one.
Additionally, the subgroup will find organizations working with at-risk youth and determine existing gaps.
The group will also study a family therapy program that used to exist in the area that offered functional therapy to families in their home. The program lost funding and dissolved, said Wyman.
The group will look at the feasibility of starting it back up again.
Long-term goals for the group include a feasibility study to start a youth treatment facility “that can be accessed within 24 hours for parents of children suffering addiction.”
“We’ll tell you what it takes to put up a full-blown treatment facility — it’s not cheap. … You’re not getting away for less than a million, two million bucks, but if we can do something specific to youth, and what does that look like, how do we create that, how do we determine the feasibility of that, we think that would be phenomenal for our community.”
Finally, the group will attempt to match at-risk youth to mentoring programs.
Finance/sustainability
The finance/sustainability team will determine feasibility for pursuing nonprofit status, seek local funding opportunities and compile a list of all available grants at any level. Additionally, the group will create a budget, and is tasked with raising a $50,000 goal to give SOC some funding to kick off other initiatives.
Long-term goals include creating a program for people released from jail to fund treatment, and seek state funding.
Following the September drug summit, Jim McClelland, appointed earlier this year by Gov. Eric Holcomb to serve as the state's executive director for Drug Prevention, Treatment and Enforcement, touched on the importance of providing such treatment.
“The treatment needs to be available when and where it’s needed, and at a time when a person says, ‘I’m ready for help,’ or, ‘I want help,’ then let’s get them help then, because three days, or four days, or a week from now might be too late,” he said.
McClelland noted that the state will likely be receiving resources for residential treatment and recovery support services and is currently working on a solution for the challenges faced by local jails.
Community support and engagement
The last subgroup is community support and engagement. Their goals include creating a “map” of their care that representatives can navigate people through, creating a public awareness campaign, studying other community outreach programs to determine their feasibility for Howard County and installing campaigns geared toward faith-based organizations.
The subgroup will additionally strive to keep in contact with the United Way’s 211, updating the organization on their resources, and engage different avenues for community outreach.