A few years ago, about two out of every 10 people seeking group treatment in Dickinson for drugs was dealing with an opioid addiction.
Now that number has risen to nearly seven out of 10.
“To go from two out of 10 to seven out of 10 is quite the increase in the past year,” Brad Brown, regional director of Badlands Human Service Center, said. “Years ago you saw a lot of heavy drinking, maybe some marijuana use, maybe some other narcotic use, but now it’s almost flipped completely.”
Brown said the cause of the flip is multifaceted. The high of using opioids or heroin is different from using marijuana, meth or drinking heavily, and it has become easier to access opioids, Brown said. In addition, once people are addicted to opioids it is very difficult to “break the cycle” and “come to grips” with what their addiction has done to their life.
“The awareness now is out there that opioids are not good, that you can get addicted and that they are harmful,” Brown said. “My concern is that as that goes down we might see something that’s a little more available or a little less expensive, like heroin.”
Drug-related overdoses claimed 61 lives in North Dakota in 2015. That was an increase from 43 deaths in 2014 and 20 deaths in 2013, according to the U.S. Centers for Disease Control and Prevention, which identifies opioids as the main driver of overdose deaths.
North Dakota's first lady Kathryn Helgaas Burgum, who has been in recovery herself for more than 15 years, said she and Gov. Doug Burgum are “very passionate” about what they can do together to address the stigma of addiction. Helgaas Burgum said only about one in 10 people seek treatment for the “chronic disease of addiction” because there is a stigma surrounding the topic.
Recovery Reinvented was created by the couple to start a conversation about what can be done to help more people begin to recover from their addiction. Helgaas Burgum said it is important that society get to the point where we treat addiction similar to cancer, where people are constantly trying to raise money, do research or do what they can to help tackle the problem. One of the first steps in doing that is talking about addiction.
“Just talking about it will remove the stigma,” she said. “... Addiction is a chronic disease, it’s not a moral failing.”
Helgaas Burgum said over time there has been more discussion about addiction and the stigma surrounding it. The recent and ongoing opioid crisis has especially helped propel these conversations because it affects all races, genders and socio-economic backgrounds.
“The disease of addiction does not discriminate,” she said.
Brown commended Helgaas Burgum for her work on ending the stigma surrounding addiction.
“We don’t shame diabetics, we don’t shame our cancer patients,” he said. “Mental health and behavioral health, for some reason there’s a stigma and a shame that gets applied to that and say ‘Let’s just celebrate the fact that they came in for help.’ … It doesn’t mean they aren’t going to struggle. It might take one person 10 years to get one year of sobriety. We’re trying to meet them where they're at.”
Access to treatment
Pamela Sagness, director of North Dakota's Behavioral Health Division, said the state has been focusing on behavioral health, including addiction, across the state for the last 10 years. She said the state has made strides in the last few years to address addiction treatment through programs like the Substance Use Disorder Voucher program, which provides funding to private providers to be able to provide services to individuals who don’t have insurance or have limited income.
When it comes to opioids specifically, Sagness said one of the biggest gaps in treatment is the lack of medication treatment providers, also known as opioid treatment providers. OTPs provide methadone to addicts. There are three locations in the state that can provide methadone: Minot, Bismarck and Fargo. While these services are available in the state, accessibility to them can be difficult.
“A lot of the individuals getting methadone they come in on a daily basis,” she said. “So, if you’re living in Dickinson and needing to drive to Bismarck every day in order to get your medication that still is a barrier to service.”
Brown said there is a priority list which starts with women who are pregnant and those who may be an “IV drug user.” Badlands will often refer people, especially those who have the ability to pay for an evaluation and treatment.
“We’re not turning them away, we’re just saying ‘Hey, this is the priority population we’re focused on, here’s the priority services we’re focused on. How can we get you in quicker somewhere else?’” Brown said.
Dickinson has a 15-bed unit, three of those beds are for long-term care, the other 12 beds are used for dual-diagnoses, mental health or substance use disorder. The facility has one crisis bed available, which is often used for a mental health crisis. The crisis bed is typically used for about two days and then the person may be transferred to a long-term bed.
Brown said there is also a team that can do an evaluation on a person and then send them to the state hospital in Jamestown for treatment there. The residential crisis center is also used as a “step-down” bed, which means someone could come back to Dickinson from the state hospital and stay there as they begin to transition back to their life in town, which can help make a transition a bit smoother.
Brown said the residential crisis center typically runs at or near capacity, but they do have the ability to work with other human service centers across the state to get people the help they need.
Need for workforce
The state was awarded a $2 million grant by Congress this year to address the opioid crisis. The grant is being used, in part, to engage potential prescribers to be a part of the solution by prescribing the drug buprenorphine as part of substance abuse treatment. This would not have to be a part of the OTPs and could theoretically be used by a physician to do medication-assisted treatment in Dickinson, if they have the right training, Sagness said.
The grant is also being used to help prescribers become more educated through Project ECHO, a program adapted from New Mexico that aims to give rural providers the tools to treat addiction.
While everyone is fairly well aware of the areas that need to be improved upon when it comes to opioid addiction treatment, one of the biggest hurdles to get over is lack of workforce, Sagness said. The Legislature set aside $500,000 to develop a strategic plan to address the behavioral health workforce issues in the state.
“That’s huge for North Dakota,” she said. “For us not just to have the idea about what we want to do but the funding to actually implement the strategies, that’s significant.”
Sagness said building workforce development is more than just getting bodies in chairs. It also means having individuals who have a specific skill set. In order to treat individuals with opioid use disorder they need doctors, nurses and other traditional health care workforce members to be a part of the solution.
“We have a broader definition today of behavioral health professional because we recognize that behavioral health is health,” she said.