The opioid abuse epidemic, now officially a public health crisis, has not spared Montana, with a potent, deadly drug now hitting the region along with a new wave of younger-than-ever addicts.

For the first time this year, both fentanyl and carfentanil, a fentanyl analogue used to tranquilize large animals like elephants, have shown up in Billings. Fentanyl is a painkiller that is between 50 and 100 times more potent than morphine, according to the Centers for Disease Control and Prevention.

Carfentanil showed up recently in lab results following an overdose death, according to Billings Police Sgt. Brandon Wooley.

And the drugs aren’t confined to Billings, according to Stacy Zinn-Brittain, group supervisor for the Billings Tactical Diversion Squad of the Drug Enforcement Administration. Fentanyl and carfentanil overdoses have been recorded in North Dakota, Bozeman, the Rocky Boy’s Indian Reservation and other areas of the state.

Legally, fentanyl is mostly used for cancer patients or other conditions with extreme pain, but it’s increasingly being produced and distributed illegally. That manufacturing typically happens in China, sometimes getting shipped to Mexico, where it’s mixed with other opioids, such as oxycodone or heroin, Zinn-Brittain said.

Fentanyl and carfentanil are so potent that they can cause a fatal overdose simply through skin contact or inadvertent inhalation, introducing a new risk to law enforcement officials and first responders.

Local drug task force members and Billings Police Department officers with K-9 units are now carrying naloxone, an overdose reversal drug, and the BPD is working to provide kits and training to all patrol officers. None of the naloxone kits have been deployed to date, but officers are now approaching problem areas and houses with extra caution, BPD officials say.

Painkiller abuse has existed in the state for decades, in keeping with national trends.

And heroin use, barely a blip on the state’s radar a decade ago, has climbed quickly in recent years, from just four heroin violations statewide in 2005 to 116 in 2015.

But fentanyl has been slower to hit rural states like Montana, where meth remains the most-abused hard drug. (Marijuana accounted for 57 percent of drug violations in 2015, with meth No. 2 at 31 percent.)

Billings typically lags about a year behind urban areas on drug trends, Police Chief Rich St. John said.

“We see everything the big cities do, it’s just a little bit delayed,” the chief said.

Younger addicts

Another new and disturbing trend in local opioid abuse is the age of the addicts. Zinn-Brittain, the DEA agent, said high school athletes in Billings are getting hooked on painkillers being prescribed for sports-related treatments like knee surgery. When their doctor cuts them off from the painkillers, they look elsewhere, trading for pills, stealing merchandise from stores or burglarizing homes to fund their addiction.

Zinn-Brittain said that due to ongoing investigations, she could not provide numbers on the scope of the problem, but that it was a “hefty number” of young adults becoming addicted.

“So it’s something new for us here, for DEA Billings, that we have not seen in the past,” she said. And if it’s happening here, it’s likely happening elsewhere, she added.

Addiction to painkillers is so hard to kick, Zinn-Brittain said, that she’s heard of people turning to meth to try to quit using pills.

St. John, the police chief, said that in Billings, people use a variety of methods to get access to painkillers.

They might “doctor shop,” bouncing from doctor to doctor seeking painkillers. They might steal a prescription notepad and forge their own prescription. Sometimes doctors overprescribe, although St. John and the DEA agent both said they have seen less of that in recent years. Other times people break into homes, going straight for the medicine cabinet in search of pills, either for their own use or for resale.

Hospitals, state agencies respond

Hospitals have been hard-hit by opioid abuse, nowhere more so than in emergency departments.

From July 2016 to June 2017, Billings Clinic saw 567 opioid addiction-related visits to the emergency department. That’s more than 10 a week. At St. Vincent Healthcare, officials declined to compile the numbers.

Dr. Raymond Wright, a Billings Clinic physician, has been leading efforts to address opioid abuse with the clinic’s emergency department.

“In most states, deaths from opioids have surpassed death rates from trauma,” he said in an emailed statement.

In 2007 the Billings Clinic started a program to combat opioid abuse, educating patients at risk of opioid abuse, working to eliminate opioid prescriptions for chronic conditions in the emergency department and directing patients away from frequent emergency department visits and toward rehabilitative services, primary care providers or other alternatives.

RiverStone Health, the county’s public health arm, is also in on the fight, with various requirements for patients to receive prescription painkillers, such as a three-visit minimum, limits on prescription refills and, in many cases, random drug testing. A multidisciplinary board at RiverStone is dedicated to combating prescription drug abuse.

Prescription drug abuse has been on the watch list for state officials as far back as 2008, when the Montana Pain Initiative provided guidelines for responsible opioid prescribing to Montana doctors. Since then, efforts have expanded to include various drug abuse grants, pharmacy-based initiatives to combat abuse and public awareness campaigns.

The Department of Public Health and Human Services is set to announce a new statewide opioid strategic plan soon.