The Invisible Monster: Heroin Invades Our Community

Here is a link to a story I wrote about Heroin invading Fargo, ND area and efforts being made on a legislative level to effect social change. The story features two local social workers and lobbyists who lost their son and brother to a heroin overdose and are lobbying for Good Samaritan laws in MN:

A family ripped apart

Jenenne Guffey’s alto voice cracks and her jade eyes brim with tears as she holds a dusty, faded photo of her son Josh Nelson. Nelson tragically died of a heroin overdose July 2013 in the bathroom of a Fargo bar.

“About a year before Josh died, we went to the grocery store together so he could pick up the food he likes. I was worried about his drug use and addiction. I said, ‘I just want you to choose to live.’ Josh opened his arms, pulled me in, and proceeded to rock me, gently patting me and comforting me like he was the parent and I was the child. Josh said ‘It’s okay mom, it will all be over soon.’ This memory sticks out to me because it was a glimpse of the man he was becoming,” Guffey said.

Nelson’s sister, Ebonee Ronningen, echoed their mother Guffey’s sentiments. “Josh always hugged me and said, ‘I love you.’ Those were the last words he ever said to me.”

Nelson had a cursive black ink tattoo of the word “loyalty” scrawled above his heart—a symbol of how important family and friends were to him. After his death, Guffey tattooed an identical insignia above her heart in his memory, and Ronningen got the same on her tricep.

Gloria Johnson, Nelson’s grandma, described him as a “wild child full of kindness.” Guffey said Nelson began experimenting with pot at a young age, then moved on to prescription pain pills and, eventually, heroin.

“There is a rise in availability [of heroin] in Fargo, especially with young people. They begin with prescription pills then move on to heroin because it’s a cheaper high,” Ronningen said.

Ann Stark, counselor and chemical dependency services coordinator at NDSU Counseling Center, agreed with Ronningen. “Although heroin has been present in this area prior to this, we are seeing an increase of use here in relation to the increased supply in the Twin Cities area.”

With soft, wavy blond hair, blue eyes, a clean-cut look and aspirations to have a big family and attend college, Nelson was far from the typical stereotype of a drug addict. The day of his overdose, he was supposed to go to his mother’s house to complete financial aid forms to attend Minnesota State University Moorhead.

Tragically, Nelson was never given the chance. His story is just one of many heartbreaking heroin overdoses that have affected our community, such as talented local blues musician Cody Conner.

The day of Nelson’s death, Guffey and Ronningen both decided that they wanted to do something “to effect social change” for opiate addiction.

“Everyone is living underneath a shroud of stigma and guilt. Heroin and addiction is way more prominent than people know, and people don’t want to talk about it. Too many addicts and families are suffering in silence. I want to be a symbol of the tragedy heroin can cause and speak out,” Guffey said.

The spiraling descent from pain pills to heroin that Nelson experienced is painfully familiar. Amanda Decker, a licensed addiction counselor at Southeast Human Service Center in Fargo, reported, “I started seeing the rise in prescription pill abuse in the mid to late 2000s. People started turning up a lot more in ERs for pain meds.”

Unfortunately, heroin and prescription opiate abuse is also rampant on college campuses. Stark said, “Here at the NDSU Counseling Center we have evaluated people struggling with heroin and other opiate addiction. However, typically due to the functional barrier that addiction imposes on the individual’s life, people who were registered as students are often not able to continue to participate in academics and typically need a higher level of care than outpatient therapy to begin with due to withdrawal potential.”

Shifting the paradigm with harm reduction

“People will keep dying unless we have some different strategies to help and deal with people and not condemn, stigmatize and keep addicts on the fringe. We need to come up with alternative treatments and harm reduction strategies with ways to help people find dignity and purpose in their lives,” Guffey said.

According to the book, “Harm Reduction: Pragmatic Strategies for Reducing High Risk Behaviors,” harm reduction aims to reduce damage caused by high risk behaviors, such as intravenously using drugs and to improve the addict’s quality of life.

“Harm reduction is helpful in terms of appreciating the complexity of this illness and understand it’s not as black and white as use or don’t use,” Decker explained.

Harm reduction strategies include substance abuse treatment and opiate replacement therapy such as Suboxone or methadone. Another crucial piece of harm reduction is peer administration of the heroin overdose antidote Naloxone (Narcan), which helps people breathe again until EMTs arrive, essentially reversing respiratory depression that often leads to deaths. It can be administered by injection or sprayed into the nose. One police department in Massachusetts reported a 95 percent success rate in saving patients by administering Naloxone.

Other harm reduction methods include increasing availability of Naloxone and clean needles, encouraging people to not use alone, providing community opiate replacement clinics, advocacy and education.

Minneapolis’ Travis Norton, formerly of Fargo, is proof that harm reduction methods work. Norton begins each day by gently pressing an orange-colored, rectangular film called Suboxone (generic name buprenorphine or bupe) under his tongue.

Suboxone is a slow-release, long lasting “opiate substitute” like methadone used to treat opioid dependence by attaching to the natural opiate receptors in the brain, according to Norton.

“Suboxone eliminates cravings, allowing the stereotypical dysphoric state opioid addicts find themselves in [for years after complete cessation] to dissipate almost immediately. It is allowing them to move on positively with their lives,” Norton said.

Norton was recently interviewed in a New York Times article called “Addiction Treatment With a Dark Side.” Norton has been clean for three years and has resumed his career as a licensed addiction counselor thanks to Suboxone.

The dark side to Suboxone is that it has caused overdose deaths. The New York Times called Suboxone “both medication and dope: a treatment with considerable successes and also failures, as well as a street and prison drug bedeviling local authorities … it has caused more health complications and deaths than advocates acknowledge.”

Unfortunately, Fargo offers little in the way of opiate substitutes. The Plains Medical Clinic has one doctor who prescribes Suboxone, but the waiting list is long. The Fargo Psychiatric Clinic also offers Suboxone and opiate replacement therapies. Yet it is a private clinic that requires patients to have insurance or pay expensive out-of-pocket costs. Prairie St. John’s used to offer a Suboxone clinic, which is still listed on their website. However, they no longer offer the service and refer patients to Minneapolis.

“(I) left Fargo because my failure to attain the popular ‘ultimate goal of abstinence’ almost killed me, and appropriate services weren’t available to me within the state,” Norton said. “I had already been a clinician for some years at this point, so I knew there were options elsewhere. I imagine if I didn’t know that, I would not be relaying this today.”

The paradigm in local treatment facilities revolves primarily around the abstinence-only, 12-step model practiced by Alcoholics and Narcotics Anonymous programs. While the programs have saved many lives and are helpful peer-run support groups, they are not effective for everybody. Like any other disease, addiction cannot be addressed with a simple “one size fits all” approach.

Norton said his counselor and psychiatrist told him he may as well just be using heroin because “Methadone and Suboxone are just other drugs.”

“Some people look at Suboxone as the less-of-two-evils argument, but I don’t,” Norton said, “because traditional or abstinence-based approaches, including 12-step recovery, fail for the vast majority of patients (especially opioid addicts) in the long-term.”

Guffey and Ronningen are working to shift this outdated abstinence-only paradigm. Ronningen is beginning independent study for her masters in social work thesis about harm reduction at a policy and legislative level with the goal of saving lives. Harm reduction policy will be reintroduced in the 2015 legislature in North Dakota. Meanwhile, Guffey is lobbying for policy change in Minnesota.

“There are two parts of the Minnesota law called ‘Steve’s Law,’ named after the Rummler’s son Steve who died of a heroin overdose. The first part of ‘Steve’s Law’ provides limited immunity from prosecution for reporters of overdose, and the second part of the bill puts the overdose antidote Naloxone/Narcan into the hands of all first responders and trained lay people.”

As of press time, the bill for “Steve’s Law” was pushed forward to the Minnesota Senate Judiciary Committee. A House version of the bill has been referred to the Judiciary Housing and Finance Committee, according to MPR News.

Good Samaritan laws are crucial because people often do not call 911 out of fear of prosecution for using, possessing or selling drugs.

“People are resuscitating each other often, which is frightening,” Ronningen said. Addicts attempt methods to revive someone suspected of an overdose, which sometimes cause more harm than good—such as putting a potential overdose victim in a bath of cold water, slapping the individual or trying CPR, despite being untrained.

“People are so misinformed … Because of criminal behavior that’s often associated with opiate dependence or drug use/abuse, people perceive these individuals of having lower level of morality. They don’t understand the desperation of addiction, take time to learn about it or subsequently develop any empathy for what they’re experiencing.”

Myths and misinformation that people will be “more apt to use” often prevent these laws from getting passed, Ronningen said.

Luckily, advocates in both North Dakota and Minnesota are working to counter this misinformation, provide education and open harm reduction clinics.

Norton has started his own counseling practice in Minneapolis called TPN Service Companies. He has a “large collaborative network of harm-reduction and medication-assisted therapy prescribers/services for populations like myself, who have typically tried many other ‘conventional’ options only to fail again and again, usually being told that they must have just not wanted it badly enough the last time.”

Ronningen hopes to develop an opioid task force in Fargo of emergent personnel such as police, firemen, EMTs, public health workers and those in the addiction field. Nationwide studies, such as the previously mentioned Massachusetts study, have demonstrated the effectiveness of such prevention programs. US Attorney General Eric Holder is also in support of opioid replacement and prevention, calling the heroin epidemic a “public health crisis.”

Decker said a paradigm shift is coming; “evidence-based practices are required by insurance companies because they show that treatment modalities are effective and have results.”

Resources available, yet lacking

Decker states a wide variety of treatment options are available in Fargo. For those who are seeking help for themselves or loved ones, Decker suggested, “Do research online to find providers and see what their specialties are, make phone calls, dial 235-SEEK helpline, schedule a CD evaluation and see what resources are available.”

Treatment facilities are required to prioritize pregnant woman and IV drug users, moving them to the top of waiting lists for programs and evaluations.

“The level of care that a person would need depends on many factors but can be summarized by saying the poorer the functioning of the individual, the more severe the problems, the higher the level of care required to treat the problems. In an emergencies such as withdrawal, it is best to present to the hospital ER,” Stark said.

While efforts are being made, Norton asserted this is not enough. “My argument is usually that the real evil lies in denial of appropriate services to the appropriate populations. If in any other area of medicine, it would be criminal to play Russian roulette with patient’s lives by withholding and/or demonizing proven life-saving medications and services such as methadone and Suboxone. The fact is that we now have medications available within the privacy of a doctor’s office that are so effective, thus eliminating the federal guidelines and red-tape as well as stigma related to opioid replacement clinic [methadone clinic] settings has to be available more widely.”

Like any controversial issue, opening methadone clinics, passing Good Samaritan Laws, and increasing access to Naloxone will take diligent efforts to happen in North Dakota. Resistance to these laws is common due to misinformation and stigma that still surrounds addiction. Luckily, there is a devoted nucleus of community members such as Guffey and Ronningen educating, advocating and lobbying for these laws.

Being so active in a movement that is close to their hearts has both costs and benefits.

Nelson’s mother, Guffey said, “I ebb and flow with being involved [in the Steve’s Law and harm reduction movement] because there is so much stigma and resistance. It empowers me, yet it’s also bittersweet because I could not save my own son’s life. He kept saying it wasn’t going to happen, and I knew it was a very real possibility.”

The tragedy of heroin, and of any addiction for that matter, is the magnitude of suffering that it causes and how it unravels the kind yet fragile, addicted souls that bind our families and communities together. We must collectively work to illuminate the darkness of addiction’s shadows—by advocating, by educating, by fighting. Lives depend on it.

GET HELP:

Sharehouse, Inc: (701) 282-6561
Southeast Human Service Center: (701) 298-4500
Prairie St. Johns: (701) 476-7200

Written By Tessa Torgeson

This story was originally published at http://hpr1.com/feature/article/the_invisible_monster_heroin_invades_our_community/ and was shared with the author’s permission.

Sources
Personal interviews with Jenenne Guffey, Gloria Johnson, and Ebonnee Ronningen (Survivors of Josh Nelson and Policy Advocates for Opiate Addiction and Overdose Prevention), Ann Stark (Licensed Addiction Counselor and Director of NDSU Addiction Counseling Services), Amanda Decker (Licensed Addiction Counselor at Southeast Human Service Center), and Travis Norton (Licensed Addiction Counselor and Owner of TPN Counseling Services, Minneapolis and Recovering Addict).
“Addiction Treatment with a Dark Side.”  http://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html?_r=1&
“Heroin OD Drug Bill Progresses at Capitol.” http://www.mprnews.org/story/2014/03/11/heroin-od-drug-bill-progresses-at-capitol
Marlatt, A. G., Lamier , M. G., & Witkiewitz, K. (2012). Harm reduction: Pragmatic strategies for managing high-risk behaviors. (2nd ed.). Newy Ork: The Gillford Press.
“Steve’s Law.” http://www.rummlerfoundation.org/content/911-good-samaritan-naloxone-campaign-kickoff-steves-law