Withheld: Stigma, statistics and multi-million dollar settlement funds

Funding is often the largest hurdle to improving access to data and resources in Wyoming. But amid the opioid crisis, another challenge has emerged: deciding how to spend millions of opioid settlement dollars flowing into the state. 

In late January, the Wyoming Department of Health reported it would use part of its $4.38 million in anticipated settlement money to expand access to opioid use disorder treatment, training and outreach. 

As far as data goes, WDH plans to spend $575,000 on educational media,  a website to inform the public about the opioid crisis and personnel to monitor opioid overdoses. 

“The resources that the Department of Health has, while limited in some cases, have absolutely been deployed for our opioid prevention strategies,” WDH Director Stefan Johansson said. “We’re acutely aware of what locals and law enforcement are dealing with and the growing burden that it has.”

While WDH is receiving 35% of opioid settlement funds, local jurisdictions like counties and towns will get the rest, according to the OneWyo Opioid Settlement.

The department has plans for outreach in communities tackling the crisis, Johannson said. Providing those towns and counties with detailed information about their area, however, may not always happen because of privacy and accuracy concerns — a tension WyoFile reported in part one of this series.  

“I think folks have maybe good intentions on looking at numbers and assuming that that the situation is worse than it is,” he said. “It’s just a difficult tension to navigate.”

While challenging, getting local or even regional overdose information into the hands of folks who can use it is important, according to Rodney Wambeam, a senior research scientist with the Wyoming Survey & Analysis Center. A lack of locally applicable information can, among other problems, make it difficult to convince key stakeholders that there’s a problem, he said. 

There’s a phenomenon when it comes to opioid use and opioid overdoses in rural states, Wambeam said, “of not on my front porch. And if it’s not a problem that’s on my front porch, it’s not my problem at all.”

Even when rural communities have access to data, the small numbers can reinforce skepticism and stigmatization of those with opioid use disorders, Wambeam said. It can be tough to convince people that it’s important to prevent even a few overdoses.

“What we’ve seen anecdotally is people who said it was never my problem — until it happened to my son, right? And then all of the sudden it is my problem,” he said. “There is a — for lack of a better phrase — a marketing side to it, which is convincing people that these problems, while not big, are serious, and it benefits all of us to help take care of them.”

For now, though, many local officials — the people who will decide how to allocate the fresh influx of resources — are working with limited information about overdoses happening in their communities and how best to combat them.

Data, context and expertise

Data limitations haven’t kept advocates or governments from working to prevent overdoses. The federal Food and Drug Administration, for example, recently approved Naloxone for over-the-counter access and efforts are afoot in Wyoming to distribute the opioid-reversal drug.

Campbell County, too, has begun to address the opioid crisis and spend its first bit of settlement money: $300,000. 

County Commissioners started by asking what their own departments needed, including fire and public health, County Administrative Director Denton Knapp said. Their inquiry garnered requests for equipment, training items, marketing information, Narcan and funding for the adult treatment courts’ diversion program. That totaled about $100,000, Knapp said. 

From there, local experts and employees of Personal Frontiers, which offers substance abuse treatment in Gillette, were given space to tell commissioners about where they believe the rest of the money should go. Family treatment and medically assisted treatment topped the suggestions list, Commissioner Colleen Faber recalled. 

“I was encouraged that we had people who were really concerned and had really good, solid information about what they felt were the gaps in our community for treatment,” Faber said. 

Stakeholders also spoke to the need for regional longer-term behavioral health facilities, Faber and Knapp said. Such facilities could offer a closer and lower-barrier alternative to the state hospital in Evanston, which is nearly seven hours away from Gillette — when the roads are open. 

Mental illness and trauma are often contributors to substance use disorders: More than 10% of the drug overdose deaths in Wyoming between 2018 and 2022 are believed to be suicides.  

Faber and Knapp said that more local data, and a better understanding of the scope of the problem, would be helpful, too. 

Laramie County Commissioner Gunnar Malm agreed. His county is working closely with local stakeholders to spend its more than $1 million share of settlement dollars, he said, but data updates from the state would be helpful. 

“County government only has so much funds to have employees that track these kinds of things [like local overdose data],” he said. 

“$1.2 million is a lot of money, no doubt. But it’s not sustained money,” he said, so officials have to be careful how they allocate it over the long term. 

Even a monthly email to counties outlining new data would be useful, he said, though figuring out who best to send that email to in every county could be challenging.

Broader and more timely data distribution could also help the Wyoming Harm Reduction Collective relay information to those on the ground. The long-held skepticism of law enforcement among those who use drugs means that police notices or social media posts about overdose news aren’t always the best way to reach those who need to know, according to volunteer Ariel Bernath. 

Harm reduction organizations and people who use drugs often rely on each other instead, she said. 

“The community is taking care of itself,” she said.

Levi Wardell of Cheyenne has been there. In the depths of his addiction, he didn’t always care if he lived or died. But today, as the clean and sober father of a young daughter with another baby on the way, he wants access to on-the-ground data to help him safeguard his family. 

“Do you remember when COVID started happening?” he said. “You saw the map, you saw where places were getting red, where hotspots were … Why would that not be available for this?”

Wardell prays his daughter doesn’t face the challenges he faced, but said he’d want to know if dangerous drugs were coming into the area so he could talk with her about it. 

“Are we getting bad batches?” he asked. “I don’t know any negative reason, one good reason why we shouldn’t have access to that.”

Missouri’s Department of Health and Senior Services publishes overdose fact sheets for counties and localities, according to LeighAnna Bennett, a senior research analyst with the department.

To preserve privacy in rural areas, Bennett said, some of the data might include information from two or three years or group it into a larger region with a few counties — but they’ve still been able to get that targeted, local data out. 

“We provide a lot of fact sheets for our harm reduction coordinator,” Bennett said. “She travels around the state [to] different areas and does different harm reduction trainings, and those are really well received there. So she tries to reach out to us and have us create tailored factsheets towards the regions and the counties that she’s visiting.”

“So that’s one way that we’re able to kind of work with those smaller rural areas while not identifying anybody,” she added. 

Missouri has more people and resources, and its opioid dashboard includes far more fatal and nonfatal overdose data — even in rural counties. Health department officials there said they haven’t heard any privacy concerns with the data they release.

Data isn’t enough

For Dr. David Martorano, director of adult psychiatry at Wyoming Behavioral Institute, overdose data needs expert context in order to be used to concentrate resources.

“Half the state is completely uneducated about mental illness and addiction,” he said. “And then you also have people who are influenced by the guy down the street.”

That is, if someone remembers a negative encounter with one person struggling with addiction, they may apply it to everyone else struggling with the same thing.

“People make terrible decisions that are not evidence-based, solely based on stuff they just heard or someone they know,” he said. 

Martorano would have preferred all the opioid settlement money going into one pot to make major, statewide improvements, he said. But even in rural counties that are getting a few hundred thousand dollars, Martorano recommends focusing on prevention and education in schools. 

“I was just out to lunch with a colleague, and she was talking about the fact that ‘you know, people have a really laissez faire attitude towards drug use in general at this point,’” he said. “And everybody thinks they won’t happen to me. I’m not going to be the one who overdoses. I’m not going to be the one who dies.” 

There needs to be an understanding of why people start using substances in that community in the first place and why they turn back to them, he said. 

Martorano is not the only one championing expertise in addition to overdose data. On a rainy night at the Comea Shelter in Cheyenne this spring, one man asked WyoFile to talk with local and state leaders and, “Tell them to come speak to us.”

The people there shared stories about abuse, childhood trauma, mental illness and military service. These factors, and being unhoused, make them particularly vulnerable to substance use disorders and illicit drug use.

Robin Bocanegra runs the facility and a “low-barrier” shelter in the winter to house those who haven’t entered recovery yet. She also intends to open a low-barrier shelter in a recently purchased motel to help shepherd residents into recovery. 

“We’ve seen, like most of you, that mental health and substance misuse are really the two driving forces behind homelessness; the things we can’t seem to get a handle on,” she told those who attended the governor’s 2023 mental health summit. “And so we’ve decided to make that our focus.”

WyoFile granted homeless individuals anonymity to discuss drug use in their community without fear of being identified. 

One man talked about ending up in an ambulance after using meth tainted with fentanyl. Through tears, a woman explained she had just lost a daughter to an overdose the month before. Another woman talked about relapsing and trying drugs that she could tell had fentanyl in them.

“I threw it away,” she said, adding it’s “why I haven’t done it since.”

One man talked about how a female friend was in rehab trying to recover from a fentanyl addiction, but that it was incredibly challenging, possibly even harder to get over than meth or heroin. 

The group also discussed ways the opioid settlement funds could help them.

One clear request was bolstered access to mental health resources, especially for people in their tenuous, homeless situation. Several people also specifically requested access to medically supervised withdrawal locations, which would involve medications to ease the often torturous and dangerous process.

A woman at Comea told WyoFile she brought her son to a facility providing that service in Nebraska, and he’s been sober for years since. 

Medical detox facilities, case managers and supportive housing for those with an opioid use disorder are all sanctioned uses for opioid settlement funds. 

People at Comea said transportation is important, too. Better transportation could mean a way to get to work, they said, but also a means of leaving a community where old friends and bad habits are easy to fall back into. 

Transportation can’t be directly funded by settlements, though, per the state agreement. 

Education

As Martorano mentioned, education is a key component of overdose prevention. 

Kota Babcock works with the Wyoming Harm Reduction Collective, and reiterated that it’s not just long-term users who are at risk of overdosing and dying. For some, it’s a lack of access to health care that spurs use, he said. For others, it’s youthful experimentation.  

“Teenagers have had overdose reversals in some of the school districts,” Babcock said. “That news doesn’t spread because people don’t want to talk about it, I feel like.”

Laramie County School District 1 now has Narcan in every school and extraneous buildings. So far, they’ve had to use the opioid reversal drug once, according to school nurse Janet Farmer, but would’ve used it once or twice more if they’d had Narcan access sooner.

One of Babcock’s friends in Colorado died of an overdose, spurring his decision to leave the Laramie Boomerang and work with the harm reduction group and Wyoming Equality. 

Babcock doesn’t know what his friend overdosed on or whether it was intentional because it was largely kept within the family, he said. That’s entirely understandable, Babcock added, but the stigma that pushes families to keep overdoses secret could contribute to fewer people knowing what’s going on.

Back at the Office of EMS, Director Aaron Koehler was clear: The state can and must do its best to get as much overdose information as possible to the public. 

“I think that it’s good business for us to do the best that we can to provide whatever information can be public,” he said. 

This comes at a time when EMS are often on the frontlines of opioid overdoses and mental health crises in Wyoming. This is also happening as EMS facilities are closing around the state and others are struggling to stay solvent.

Fentanyl and opioid overdoses are a priority, but they aren’t WDH’s main focus, according to Johansson.

“Especially over the last year, this has become a significant priority for us,” he said. “Does that make opioids and fentanyl our No. 1 issue in terms of the numbers with either overdoses or our substance use disorder issues in general? No, that has not played out yet. And that’s good.”

Overdoses are worth addressing

Convincing local residents that drug overdoses are a problem worth addressing also means convincing them that recovery is possible, Wambeam said. 

“I know dozens of people who are in recovery from opioids, methamphetamine, alcohol, and leading really good, healthy lives,” he said. “But if people aren’t convinced that that can happen, why would they care about Naloxone or medical-assisted treatment or any of these things?” 

Even after recognizing there’s a problem worth addressing, it’ll take caring, community-wide responses to spend the settlement money in the best way, Wambeam said. 

“Get a small group of caring people in each community, who will use the [settlement] money and have the connections to everyone from elected officials, to hospital staff, to prevention people, to mental health providers, to parents, to come together to make a plan that works locally,” he said. 

This is the last of a four-part series on overdoses in Wyoming. If you have more information to share with WyoFile about the opioid crisis, please email [email protected]. Also stay tuned for more reporting on the state’s EMS system and what’s being done to keep it afloat.

If you or someone you know is having suicidal thoughts, you can call or text the Suicide Prevention Lifeline at 988.

WyoFile is an independent nonprofit news organization focused on Wyoming people, places and policy.