Daily Sitka Sentinel

Sitka Marshals Grants to Fight Opioid Crisis

By ABIGAIL BLISS
Sentinel Staff Writer
    The White House announced Thursday that President Trump has donated his third-quarter salary of some $100,000 to the Department of Health and Human Services for the purpose of addressing the country’s opioid epidemic. In October he called the opioid crisis a public health emergency, directing national attention toward an epidemic responsible for most of the 64,000 U.S. drug overdoses in 2016.
    Even before the president acknowledged the scale of the crisis, a coalition of Sitkans was working to curb the epidemic as it affects their own community.
    The HOPE Coalition derives its name from its goal: Health Organizations, People, and Environments. It has representatives from 12 sectors of the community, including the Sitka Police Department, Sitka School District, Sitka Public Health Center, City and Borough of Sitka, and Youth Advocates of Sitka. Its aim is to create a coordinated effort to treat and eliminate drug abuse and misuse in the city.   
    “At this point, we’re trying to catch up to the issue,” HOPE director Loyd Platson said in a Sentinel interview at Sitka Counseling and Prevention Services’ Metlakatla Street facilities. “It came on relatively fast. We tend to keep sliding by until we have a crisis. Families do that, communities do that, individuals do that.”
    He believes that only through exposing the ugliest aspects of the issue and examining their causes can the community begin to turn things around.
    “A few months ago, there were actually seven overdoses in one weekend in the community, and nobody knew about it,” he said. “If you can’t talk openly about an issue, you can’t solve it.”
    The crisis, he said, damages the health of individuals, interpersonal relationships, and the community as a whole.
    Police Chief Jeff Ankerfelt said he’s observed a spike in opioid trafficking and use in recent years. When asked if police had seen an increase in the percentage of incidents related to opioids, he responded, “Oh, yeah. Absolutely ... So many of the thefts and burglaries, the purpose of them is to provide money for drug use.”
    Platson expressed optimism that two recent grants, in particular, could enable his team to suss out the trends of opioid and other substance abuse in Sitka, share the findings among Sitkans, and use the gathered data to improve local treatment and prevention programs.
    “Data should really drive everything,” he said. “It should be used for evaluation. It should be used for a baseline. It should be used for programmatic guiding. That’s the first step – gathering data for a baseline, to see where we’re at as a community.”
    HOPE has already received sizable grants in support of its work.
    In September it was awarded the Drug Free Communities Grant to address substance abuse among the city’s youth. The grant will provide $125,000.000 per year for five years, with the possibility of reapplying for another five. Though the grant is aimed specifically at assessing and educating youth populations, Platson believes that the HOPE Coalition’s work among kids will have a ripple-out effect on the whole community, extending to parents, teachers and youths who will eventually become local leaders in their own right.
    The September grant builds upon previous funding, the Strategic Prevention - Partnerships for Success grant, awarded to the HOPE Coalition and Sitka Counseling and Prevention Services in the summer of 2016. The grant consists of $150,000 per year for four years and, while federally funded, is administered through the state. It focuses on a wider slice of Sitkans, ages 12-25.
    Sitka is the only community of its kind – small and rural – to receive the grant, Platson said. The other beneficiary municipalities serve significantly larger populations.
    With this grant, the local agencies were able to get the ball rolling on gathering data about opioid abuse in Sitka. More often than not, they were starting with a clean slate.

GATHERING INFORMATION
    The first step in filling in the gaps in their knowledge was a community assessment phase, in which local systems for coping with substance abuse were evaluated. The community scored low on the readiness survey.
    “They break it down into nine levels,” Platson said. “We’re at a level two. Level nine is the most ready, when systems are established.”
    Because of Sitka’s small population, the results of national surveys of substance abuse in this community were often withheld by the organizing agencies in order to protect the confidentiality of the small sample size, Platson said. The Youth Risk Behavior Surveillance System, a survey conducted every two years across the country and administered in Sitka through the school district, will often provide aggregate figures for the prevalence of substance abuse in Sitka, but refrain from breaking the issue down by demographic, omitting information crucial to combating the crisis.
    In order to gather a robust local data set, the HOPE Coalition brought a specialist in the evaluation of education and community health initiatives, Dr. Paul Cotter, on board a year ago to adapt those national surveys as local instruments for gathering information.
    “We’re trying to get a fairly holistic view of what the community looks like, but with a limited amount of data,” Cotter said. “If we’re looking at intervention work, there’s no way to know if those interventions are working unless you have a baseline, assessment data. You know, what’s the state of affairs now in the community?”
    So far, the answer to that question has proved complex.
    “Some of the data were really confusing and somewhat conflicting,” Cotter said. “There were suggestions that, per youths’ self-reporting, use of heroin and opioids is 2.5 the times of what it was in the rest of the state, and yet we’re not seeing some of the other indicators like emergency room visits in that age group.”
    So, too, awareness of the issue has proven inconsistent across the community.
    “If you’re talking to behavioral health professionals, they have a pretty good grasp of what’s out there, what’s being used, and who’s using. Pretty much the same story from law enforcement: they’re seeing it, it’s prevalent, it’s here,” Cotter said.
    In public discourse, however, the topic remains largely undiscussed and unexamined.
    “There’s not a lot of awareness out there,” Platson said. “There’s kind of this attitude that ‘There’s not any problems here in Sitka,’”
    While the details of what’s happening in town may be hard to tease out, the cause of the crisis has been obvious from the get-go, Platson said.
    “How we got here was over-prescribing, and some false information from some of the pharmaceutical companies about how safe the opioids were and really targeting physicians to prescribe the opioids,” he said.
    For example, he said, in the past medical professionals have often been evaluated based on client satisfaction, a measurement that engendered a propensity to prescribe to the patient’s wishes, rather than needs, even if they had developed an unhealthy relationship with pain medication.

EDUCATING THE COMMUNITY
    As Platson, Cotter, and their coalition partners gather information about substance abuse, they are disseminating their findings in the community in the belief that education is crucial for change.
    “Without awareness, there’s no conversation,” Platson said. “Without the conversation, there’s no healthy response.”
    At Pacific High School, for example, Platson has worked with teachers to develop a program in which students interview people in recovery from substance abuse, develop a script based on the interview, and transform the script into a performance.
    “It’s not only working to raise awareness, but to engage youth in the process of what’s happened to people who have been addicted,” he said. “What’s their life story, and what pitfalls did they fall into? And then also engage them in camera skills, writing a script, editing, performance. We’re trying to use the resources that we have, and that’s just one example.”
    Looking further down the line, Platson expressed confidence that the focus on social and emotional learning in the schools would address several underlying issues fueling the opioid crisis, such as low self-esteem, unresolved trauma, and unacknowledged familial conflict.
    “You’re looking five, ten years, maybe more, down the road to see the impact of those things,” he said. “But we’re starting those things, and we need to do that.”
    In addition to educating students in Sitka, the HOPE Coalition has set out to improve awareness among parents as well.
    Platson said many parents are reluctant to engage in crucial conversations with their kids about opioids due to discomfort or because they’re struggling with substances themselves, Platson said. Those who do, however, decrease the likelihood that their kids will use, he added.
    “If we can raise parental disapproval, that will influence youth usage,” he explained.
    Vera Gibson, a mother of two high school students and a recent addition to the Sitka Counseling team, said that those pivotal conversations can prove instructive for the parent, as well as the child.
    “I didn’t realize how much of a problem it was. I didn’t know people who were users,” she said. “My older high school kid, he tells me every once and a while, ‘If I wanted to go buy, I know who sells it, I know where to get it ... My older kid even said, before we go the marijuana stands, or whatever you call them, that you could actually get opioids easier than you could get marijuana if you wanted.”
    Cotter expressed hope that, through the promotion of alternative pain management strategies – a term that encompasses practices such as yoga, acupuncture, and herbal remedies – patients and physicians alike would be less likely to turn immediately to opioids.
    Alternatives can be “effective, available, and cheap,” he said. “They can become community knowledge at some point. These are not pie-in-the-sky things, really. Twenty years ago, (physical therapists) weren’t really around, and now everyone goes to PT ... and the public recognizes that value.”
    Cotter emphasized that all community members, even those fairly educated on the subject already, could stand to be better informed.
    “It’s not just the public,” he said. “It’s the prescriber, it’s the behavioral health professionals ... We know that behavioral health professionals want more information. They want to learn more about effective treatment strategies, better materials to be able to provide to their patients and people who are using their resources.”
    Not all the answers are readily available, he said, and change is slow; while using education to work toward wider systemic change and gathering the information to support data-driven information, the HOPE Coalition is employing stop-gap measures to reduce access to opioids.

PREVENTION AND TREATMENT
    In order to curb abuse, HOPE is giving out household bags that encourage the safe disposal of medications, working towards the addition of more prescription take-back boxes like the one at SEARHC, and encouraging families to use storage safes for medications in their homes. Platson described these efforts as short-term preventative measures.
    “The number one place that youth get their – whether its opioids or alcohol – is family and friends,” he said. “Trying to reduce access points is kind of a short-range prevention program.”
    As for treatment of opioid abuse, Sitka is severely lacking, he said.
    While there is a transition facility where people who have already detoxed can work towards living independently and soberly in Sitka, there is no in-patient facility in town. As a result, individuals seeking help for addiction are sent to Juneau or Anchorage, a journey that can be trying for those in a crisis and expensive for the community. More often than not, Platson explained, individuals seeking help don’t get it.
    “Typically, what happens is they either go to jail or they get released,” he said.
    “I interviewed one fellow,” Cotter added. “He said he self-admitted three times and was turned away three times. He wanted help. He got himself there. He got turned away ... It’s no agency’s fault; it’s a systemic problem.”

CHALLENGES
    In addition to lacking a detox center, there are several challenges unique to Sitka’s struggle to curb opioid abuse and addiction.
    Sitka’s small population, for example, makes it difficult to gather and share information without compromising confidentiality. It’s the reason that the federal Youth Risk Behavior Survey does not release detailed information about substance abuse in Sitka, and Cotter has also found that people familiar with the rumor mill of a small town are reluctant to speak about such a sensitive issue outside of the national survey.
    “It’s not something that people are willing to just jump in and talk about,” he said. “It can be pretty sensitive information.”
    Platson also identified the transient nature of many Sitkans as an obstacle to generating sustained momentum in his efforts with the HOPE Coaltion.
    “Sitka’s kind of a weird town because people are coming and going all the time,” he said. “There’s no one consistent that comes to the regular meetings, except maybe five or six of us.”
    While an island may offer fewer entry points for drugs than a community in a road network, the isolation also makes it more difficult to dispose of drugs safely.
    “Being on an island, it’s a little bit harder,” Platson said. “We don’t have the facilities to destroy the drugs, so we have to ship them out ... it’s $250 every time we ship prescription drugs out to be destroyed.”
    The biggest obstacle the HOPE Coalition aims to overcome, however, is a lack of coordination between the community’s many nonprofits and public service-oriented citizens, many of whom are often working towards a similar goal, Platson said.
    “We’re resource-rich, but coordination-poor in our community,” he said. “When you look at the ratio of doctors to patients, mental health professionals, we’re better than most communities, really ... As a community, why don’t we come together and get all of our data into one place, where we can manage it, tease it out, and use to evaluate our programs, guide our programs? It costs all of us less if we do that.”
    Cotter echoed the sentiment, explaining that, when he arrived in Sitka with fresh eyes one year ago, he was surprised by the amount of expertise in the community and dismayed to discover that experts often operated in silos.
    “Every component of [the issue] is ten dissertations in and of itself,” he said. “And, there’s at least one person in town who’s an expert on every one of those issues...It doesn’t have to be a really tight, cohesive group, but everyone should have the right phone numbers.”
    In addition to possessing the expertise needed to prevent and treat opioid misuse and abuse, Sitka has other advantages that may prove vital in the HOPE Coalition’s efforts.
    It can be easier to track, for example, the ways substances enter the community; Platson knows that there are spikes in the influx of drugs during fishing openers and closers.
    “We’re very fortunate to live on an island,” Chief Ankerfelt said. “It really inhibits the ability for outside traffickers to come up here and establish a market.”
    So, too, law enforcement in a small community becomes intimately familiar with the major players on the scene.
    “One of the advantages of a small town is that everyone kind of knows who’s doing what – who’s selling, who’s using, who’s over-prescribing,” Platson said.
    “Relationships matter in a community like ours,” Chief Ankerfelt added. “It’s very helpful for the police that people know about people that are suffering and are willing to share that information with us.”
    He noted that community members are equally willing to share tips about people distributing drugs in the community, which proves helpful to his efforts to clamp down on opioid trafficking.
    Finally, a community the size of Sitka is more nimble than a larger metropolis; should one preventative or treatment measure prove ineffective, it’s easier to shift resources in a new direction.
    “If something’s not working, we don’t have to try to change the direction of a huge ship,” Platson explained. “The bigger the ship, the longer it takes to change direction.”

THE BIGGER PICTURE
    Platson was quick to point out that, while opioids may be the buzz-word of the moment in both the president’s statements and the press’s headlines, the abuse of all substances are interconnected, as they stem from and beget social issues.
    “A few years ago, methamphetamine was very popular,” he said. “What happens, oftentimes, is that there’s a drug-du-jour. Now it’s opioids.”
    In conducting interviews with users in the community, Cotter found that people who were using could be intent on using regardless of the substance at hand.
    “One was telling me, ‘Yeah, opioids are a problem, but if I want to be using, I’ll just get whatever I can get my hands on at the time,’” he said.
    Chief Ankerfelt estimated that in 80 percent of incidents “in which individuals deliberately make a victim” involve a substance. While the prevalence of opioids has risen in recent years, he said, alcohol has remained a constant.
    “(These are) not just scary things, but also things that affect the livability of our community,” he said, pointing to boat-related incidents or property crimes as examples.
    Cotter expressed optimism that the HOPE Coalition’s longterm goals of addressing the underlying issues of both historic and childhood trauma would go a long ways towards community preparedness for substance abuse of any kind.
    “Regardless of the substance, these are individuals that are suffering, and families that are suffering, and whole communities that are suffering,” he said. “You don’t have to dig too far to recognize that it’s here.”