This is the second part in a series on opioid abuse and addiction. — Eds.

A friend’s roommate. The daughter of a longtime Wyoming resident. A student.

People of both sexes and all socioeconomic levels grapple with opioid abuse — many hidden, suffering out of sight.

Just since July, St. John’s Medical Center CEO Dr. Paul Beaupre can recall three deaths from opioids, substances that are used medically for pain relief or that can be used illegally. These are not necessarily deaths of local residents.

In 2016 and 2017 there were seven opioid-related deaths in Teton County. Dr. Brent Blue, the county coroner, said it was “hard to know what those numbers mean” because previous coroners didn’t keep track of numbers to the extent he does. Some of those deaths are due to heroin, something that came as a surprise to Blue.

“As a practicing physician here, I’d never seen heroin here until about two years ago,” he said. “I was so shocked that I even sent a note to the county attorney and law enforcement because I was really stunned to see it.”

Complacency isn’t an option, Blue said. While Teton County may seem like a bubble, that bubble isn’t as protective as it may seem.

“The worst thing we could do is to think we could be immune from this,” he said.

Police say it’s too late to pretend they’re completely in front of opioid abuse. The best they can do now is to stay alongside it and not slip behind.

Although President Donald Trump declared a public health emergency in October to deal with the nationwide opioid epidemic, the declaration came with no money to fund responses. Trump has said he would like to focus on the law enforcement aspect, not the medical treatment.

Jackson Police Chief Todd Smith says his force has seen an increase in all drug cases in recent years.

“Our possession cases, our use cases,” Smith said. “Drugs in general are definitely on the increase right now. We’re also definitely seeing an uptick in opioids in general.”

Because police mostly respond to overdose-related calls as a medical assist — if emergency medical services even request law enforcement — Smith said he didn’t have an accurate number for responses or cases involving opioids in the community and he didn’t want to guess.

Teton County Sheriff’s Office Lt. Matt Carr also said giving a specific number would be difficult and inaccurate, but he said he sees everything from high schoolers abusing OxyContin, a prescription opioid, to heroin cases.

“What we hope from a law enforcement standpoint is that, if we can recognize this and try to educate early on, maybe we can make a difference,” Carr said. “Because so many communities are lost to this. They’re really lost to heroin addiction and they’re lost to drug abuse, and quite frankly law enforcement is at a point where they can’t do anything. We hope that we still have the opportunity to make an impact.”

Jackson isn’t that isolated

Jackson Hole aren’t as isolated as it might think, Smith said.

“Maybe we’re in this microcosm of our own, maybe we were insulated a little bit at first,” Smith said. “But eventually everything works its way here, and so we’re seeing what other cities and communities were seeing a little bit earlier.”

Carr echoed that sentiment, drawing parallels to the national housing crisis the Jackson community felt they were isolated from in 2007.

“When somebody says, ‘Oh, it doesn’t happen in Jackson Hole,’ yes, it does,” he said. “Sorry to be the bearer of bad news, but it does. And it’s a problem we need to recognize and we need to fight.”

A transient community will see national trends sooner or later.

“Most people have traveled here from somewhere else,” Smith said. “They don’t always come here and leave their problems behind. They bring those problems with them. And so if there’s an addiction or something like that in their old ZIP code, there will be an addiction in their new ZIP code.”

Law enforcement often sees the connection between prescription pill abuse and heroin use.

“They might be great people, but they may have gotten addicted to prescription opioids by legitimate means,” Smith said. “As soon as a doctor cuts them off and the addiction is still there and it exists, they’re going to scratch that itch somehow, and suddenly you see heroin coming back into the scene as a replacement.”

Opioids, both prescription and illicit, are the main cause of drug overdose deaths in the United States, according to the Centers for Disease Control and Prevention, the CDC. Opioids were involved in 42,249 deaths in 2016, and opioid overdose deaths were five times higher in 2016 than 1999.

The most common drugs involved in prescription opioid overdose deaths are methadone, oxycodone and hydrocodone. The numbers detailing prescription opioid abuse are bleak: In 2014 almost 2 million Americans abused or were dependent on prescription opioids; every day over 1,000 people are treated in emergency departments for misusing prescription opioids; and every day 1,700 children and young adults begin experimenting with prescription and over-the-counter drugs.

Sometimes the leap from prescription pills to heroin is because of price — heroin tends to be cheaper — but just because it may be cheaper in Laramie, for example, where many area students go to college at the University of Wyoming, doesn’t mean that trend extends to the Tetons.

“Everything is more expensive in Jackson,” said Teton County sheriff’s Sgt. Todd Stanyon. “Drugs included.”

The Curran-Seeley Foundation, an outpatient treatment facility for addiction treatment, has also seen an uptick in prescription opioid abuse. The percentage of clients addicted to prescription opiates or heroin has gone up in the last four years from 7 percent of its client population to 11 percent.

“We get three to five phone calls a week with questions,” said Trudy Funk, executive director. “It’s either, ‘I have a problem’ or ‘A friend or family member has a problem.’”

In the spring of 2014 Funk noticed her first heroin-addicted clients. A cluster of nonlethal overdoses and arrests during the summer of 2014 seemed to decrease use for a bit. But prescription opiate referrals have remained steady, she said, and in the last 18 months the availability of heroin has increased.

During the summer of 2017, Funk said, heroin and methamphetamine referrals increased, and in the first two months of the season alone almost 10 people were put into residential treatment centers for the use of those drugs.

“We just haven’t seen numbers like that before,” she said.

Law enforcement reacts

Cracking drug cases is like peeling an onion.

“When we break into one of these cases, you just start peeling back the layers of the onion,” Carr said. “And more and more comes out. It very quickly can overwhelm our investigators. These are big cases; it takes a lot of work; they are sometimes felony cases. We react very quickly and throw everything we have at them because it’s about keeping the community safe, not introducing more heroin into the community and getting it out. But it becomes a huge resource crunch for us.”

Carr said that while the drug problem may not happen in waves, law enforcement’s interaction with it does. Local law enforcement often works with the Wyoming Division of Criminal Investigation on cases that are bigger than the county or even the state.

“We’ll have a big case and it’ll lead to three or four others,” Carr said, citing a string of 2014 cases when a Jackson man was busted for selling heroin. “Then we’ll shut that down, work that case through, and then it’ll go quiet for a while. Maybe that’s just the nature of law enforcement investigations. I wouldn’t want to say the problem ebbs and flows, but our interaction with it certainly does.”

Police often become involved when they are called as backup for emergency medical personnel responding to an overdose. Once the medical situation is resolved, an investigation begins. A good example recently was the case of Daniel McCullough, who delivered heroin to a friend who overdosed but survived.

More often than not in Jackson, law enforcement comes across cases at the ground level. It’s more common for cases to revolve around addicts than dealers here, so the source is often out of the community.

“There aren’t really major dealers here,” Stanyon said. “What we’ve seen is users who are selling to support their habit.”

Taking initiative

One step the sheriff’s office is taking to combat drug abuse comes in a furry form: the new K-9 officer, Randy, a springer-Lab mix.

“I look at our new drug dog as a proactive and a reactive piece,” Carr said. “Obviously we’re reacting to a situation that we feel like necessitates the use of a second dog. But we can also use a canine in a proactive approach so that people see that we’re here and we’re looking for it.”

The Jackson Police Department is excited about five recently acquired kits of Narcan, a prescription naloxone drug that can save the lives of opioid overdose victims.

Time is critical for overdose victims, Blue said, who often suffer from brain damage when they stop breathing.

“It’s an incredibly safe drug,” said Blue, who is looking into offering courses for people interested in learning to administer it. “If you gave it to someone that wasn’t in an overdose situation the worst thing that would happen is nothing. It’s a way to save a life and definitely save brain cells.”

Narcan doesn’t last as long as an opiate high, so calling 911 is still necessary. It’s also worth noting that people with an opioid addiction have reported severe withdrawal symptoms after using the drug, since it binds to opioid receptors to block its effects.

Each police kit contains two 4-milligram doses of the drug in what looks like a nasal inhaler. The drug is temperature-sensitive and will be brought in and out of patrol vehicles on every shift.

A few years back the state of Wyoming started seeing more heroin, a problem the Wyoming Chiefs and Sheriffs Association brought to the attention of the Legislature. The Legislature directed the state Department of Health to look into grant funding for Narcan. The law was changed to allow police to administer the drug to overdose victims without civil or criminal liability.

As long as the grant exists, Narcan will be paid for. When the grant runs out, there will be a discount.

Police officers followed protocols, like creating a policy and undergoing training by Blue, to properly administer the drug nasally. By the end of December all the training was done, but by the time the drug shipped it was late January before Narcan arrived in Jackson.

“I wanted to jump on the opportunity,” Smith said. “Because the worst thing I envisioned that could happen is we have someone overdose. The law is allowing us to do it and we don’t have it. So let’s not drag our feet. So we really pushed to get it done quickly so we would have it in the cars and available to the people that live here.”

The sheriff’s office does not have Narcan at this time at the advice of its own medical advisor, who recommended officers work on basic life support skills instead.

“I applaud the police department for what they’re doing,” Carr said. “We will monitor their successes or their challenges with it and it may be something we implement in the future.”

The News&Guide is publishing a series on opioid abuse in Wyoming. See part one, a family grappling with loss after an overdose, herePart three, the medical community's response, can be found here.

Contact Kylie Mohr at 732-7079, or @JHNGhealth.

(3) comments

Doug, thanks for writing. According to our research, they seem to be interchangeable. Would love to see what source you have.

Sam Campbell

Most any medical resource will get you there. Opiate refers to naturally occurring compounds derived from the opium poppy- ie morphine, codeine. Opioid refers to the synthetic or semi synthetic compounds that act on the same receptors as the opiates. Opioids has come to be commonly used as a blanket term to cover both the naturals and synthetics. So it could be said that all opiates are opioids, but not all opioids are opiates.

Doug Vlchek

JH news: your headline uses the term “Opiates”. The correct term should have been “opiods”. They are not interchangeable. They mean two different thing. Doug Vlchek

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