RICHMOND, Ind. — The COVID-19 pandemic not only sickens and kills Wayne County residents, it causes isolation that creates disconnect and loneliness.
That exacerbates an epidemic that struck the county long before COVID’s March 2020 arrival: substance misuse.
Christine Stinson, executive director of the Wayne County Health Department, said she thinks there is a link between COVID and local drug overdose deaths. There have been 29 confirmed overdose deaths with 11 more deaths pending toxicology confirmation they occurred because of overdoses, she said Tuesday during a roundtable discussion with Gov. Eric Holcomb’s top substance use policy adviser.
“During COVID, we are seeing an increase in overdose deaths in Wayne County right now,” Stinson said.
State Rep. Brad Barrett, a Richmond Republican who represents District 56, said while COVID draws the attention at the macro level, Tuesday’s discussion involved those paying attention to substance use at the micro level. He said Douglas Huntsinger, the state’s executive director for drug prevention, treatment and enforcement and chairman of the Indiana Commission to Combat Drug Abuse, asked Barrett to host the roundtable.
Barrett said that he has worked closely with Huntsinger’s team on substance-related issues. Huntsinger, despite an arrival delayed by an Interstate 70 accident, met with Barrett, State Sen. Jeff Raatz and 10 people involved in combating substance use locally.
“Over the last four years, we spent a lot of time building a statewide infrastructure that really focuses on the whole person, that works to ensure that we’re moving people through the full continuum not just with treatment but ensuring that we’re looking at moving individuals into recovery and how we support them in that recovery,” Huntsinger said. “if we’re not helping them sustain their recovery, all we’re doing is just continuing to create that treatment churn.”
He noted that Richmond was one of the largest cities in the state where he had yet to build relationships with the local stakeholders. Those relationships help the state assist communities, because programs are of no use if they don’t work in the communities that need them.
“We know there’s no one-size-fits-all approach,” Huntsinger said. “We know that we have to work community by community to help implement things that are community-based.”
Some OD deaths, some saves
Wayne County’s 40 deaths so far are not as many as the 52 residents who have died this year from COVID complications; however, many overdoses do not end in deaths. Some of that’s because first responders employ Narcan to counteract overdoses.
Sheriff Randy Retter said his agency’s officers routinely administer Narcan before medical assistance arrives.
“We do have a lot of overdose deaths, but we are saving a lot of people on a daily basis,” Retter said.
Huntsinger said Indiana’s statewide overdose death total increased 33% during 2020.
Stinson said she noticed when she arrived in Wayne County from Marshall County in February 2020 was that Narcan was not readily available. She said the health department has since distributed more than 1,000 Narcan kits to try to save lives.
“It was one of the first things I saw; why don’t we have Narcan in this community?” she said. “It’s very needed in this community.”
The health department also tries to meet those addicted to substances where they are, Stinson said. The county’s three-day-a-week harm-reduction program provides clean syringes, wound care, substance abuse counseling, testing and immunizations. The first question asked of participants is if they want addiction treatment.
Despite that, the program’s primary goal is to stop transmission of diseases such as hepatitis and HIV, not stop drug abuse.
“If that happens from our program, great,” Stinson said. “We would love that. We would love for people to stop using drugs. We would love that, but that’s not our main goal.”
It is, however, the main goal of others.
“It would be great if everybody with a substance disorder wanted treatment,” said Gerald Cyranowski, the regional vice president for Meridian Health Services.
That’s not the case. Cyranowski said you would expect people faced with losing their families or referred by a court to embrace treatment, but because of addiction’s heavy grip, that’s not always the case.
Treating the root of the problem
Kory George, the county’s chief probation officer, said 318 individuals have gone through the diversion program implemented five years ago by Prosecutor Mike Shipman and the probation department. The program dismisses low-level felony and misdemeanor criminal charges if addiction treatment is successfully completed.
George said probation had traditionally served offenders when they were on probation or parole after completing their incarceration. The diversion program moves that service to when an offender might avoid incarceration.
“We realized we’re going to serve them at the back end or at the front end, so why not try to catch them when their motivation will be higher,” George said.
The front end work also extends to juveniles. The probation department has spent resources training on adolescent brain science and looks for alternatives to incarceration, such as connecting the youths to proper services that will provide better outcomes than incarceration.
“What we do know is that incarceration does not generally result in improvement in folks,” George said.
He added that Judge Darrin Dolehanty has implemented a family recovery court that works with families struggling with addiction. The justice system, including police agencies participating in the Handle With Care program, try to recognize trauma’s impact on youths, something that cuts across all sections of society.
Richmond Mayor Dave Snow said recognizing when trauma impacts a child is important because trauma can impact their education and their future.
“Find ways to treat this at the root rather than 15 or 20 years too late,” Snow said. “Way too often, we are treating the issue 15 or 20 years down the road.”
Drug issues drive crime
Retter’s agency is among those participating in the Handle With Care program where law enforcement alerts schools when trauma impacts a student. That gives the school additional information for why a student might be struggling in class or acting out. The sheriff’s department also reaches out to fifth- and sixth-graders with its DARE program and has expanded its drug-education effort with a Too Good for Drugs program through 12th grade.
Unfortunately, drug issues continue to drive crime. Richmond Police Chief Mike Britt estimated about 80% of crime is drug-related and said the drug problems exist across society. He said his department has made 800 to 1,000 drug arrests a year and yet not put a dent in the problem.
Heroin had been the primary drug, but now methamphetamine is No. 1. Britt said, though, that almost all drugs are now a combination that can include fentanyl, which is more dangerous than heroin.
Those using methamphetamine tend to be more aggressive and combative and they often suffer from psychosis. Retter told about a melee inside a residence when officers attempted to serve a warrant. An officer and a K-9 fell through the ceiling virtually on top of another officer, resulting in two officers being taken to the hospital.
If someone does end up in jail, Retter said treatment programs are available and the jail attempts to connect the person with resources.
“It’s important to be able to make sure that we provide them with every opportunity possible,” Retter said.
Issues of access and stigma
Tim Pierson, the executive director of the Drug Free Wayne County Partnership, said Richmond and Wayne County are rich with those resources. When he first learned about the area’s drug problem, Pierson said he was “in complete disbelief.” Then, he became involved.
“I discovered that part of the issue is just access,” he said. “People fall into these traps. There is one thing they all have in common, generally speaking, which is they don’t have healthy support.”
Amanda Light, the program director at Richmond Comprehensive Treatment Center, was one of several roundtable participants who mentioned the stigma associated with addiction and treatment as a problem. She said her patients, 70% of whom receive methadone, are often stigmatized because of that medically assisted treatment path, but overall, the population of people struggling with addiction feels stigmatized and judged.
Those seeking treatment often face barriers such as insufficient finances or transportation to visit counselors, Light said. Face-to-face meetings are important, she said, because those connections lead to relationships that can then have an impact.
Amanda Mullins, the manager for adult services at Centerstone, also said those receiving treatment often struggle to keep appointments because “their lives are in such disarray.”
She said COVID-19 impacted treatments because more appointments were conducted by virtual means and often led to less progress.
“People not having to leave their environment often are not prioritizing that hour of therapy,” Mullins said.
Staffing shortage in treatment now ‘critical’
Pierson said listening to the perspective of those receiving services is eye-opening, and those people should have a voice about what they need. He also said youth prevention efforts, neighborhood programs and increased community engagement are needed.
There also are more people needed in the work force that serves those who are addicted. Cyranowski called the shortage in work force “critical.” Others agreed, including Huntsinger, who said that’s a statewide issue.
He said the state has a lot of work to do in that area, but issues such as licensing and funding for internships are being considered to help move workers through training.
“We’ve got potential, but we’ve got a lot of struggles and hardships to overcome,” Huntsinger said.
Staffing shortages just add to the overwhelming task those providing substance misuse services face. Raatz, a Richmond Republican representing District 27, said he appreciates the efforts of those workers who see “small wins and big losses.”
Mullins said she wonders if the efforts with bare-bones staffing are even scratching the problem’s surface.
“I feel like we need a mental health and addictions national guard called in,” she said.