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.”
“Do you remember when COVID started happening? You saw the map, you saw where places were getting red, where hotspots were … Why would that not be available for this?”
Levi Wardell
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?”
“I know dozens of people who are in recovery from opioids, methamphetamine, alcohol, and leading really good, healthy lives. 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?”
Rodney Wambeam, WYSAC
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 madelyn@wyofile.com. 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.
This investigation was supported with funding from the Data-Driven Reporting Project. The Data-Driven Reporting Project is funded by the Google News Initiative in partnership with Northwestern University | Medill.
Data analysis and visualizations are by Jordan Wirfs-Brock, who you can follow on Mastodon @jordanwb@hci.social.
“Settling for the view that illnesses, mental or physical, are primarily genetic allows us to avoid disturbing questions about the nature of the society in which we live. If “science” enables us to ignore poverty or man-made toxins or a frenetic and stressful social culture as contributors to disease, we can look only to simple answers: pharmacological and biological.
The question is never “Why the addiction?” but “Why the pain?” The research literature is unequivocal: most hard-core substance abusers come from abusive homes.
The hardcore drug addicts that I treat, are, without exception, people who have had extraordinarily difficult lives. The commonality is childhood abuse. These people all enter life under extremely adverse circumstances. Not only did they not get what they need for healthy development; they actually got negative circumstances of neglect. I don’t have a single female patient in the Downtown Eastside of Vancouver who wasn’t sexually abused, for example, as were many of the men, or abused, neglected and abandoned serially, over and over again. That’s what sets up the brain biology of addiction. In other words, the addiction is related both psychologically, in terms of emotional pain relief, and neurobiological development to early adversity.
When I am sharply judgmental of any other person, it’s because I sense or see reflected in them some aspect of myself that I don’t want to acknowledge.
Shame is the deepest of the “negative emotions,” a feeling we will do almost anything to avoid. Unfortunately, our abiding fear of shame impairs our ability to see reality.
At the core of every addiction is an emptiness based in abject fear. The addict dreads and abhors the present moment; she bends feverishly only toward the next time, the moment when her brain, infused with her drug of choice, will briefly experience itself as liberated from the burden of the past and the fear of the future—the two elements that make the present intolerable.
Many of us resemble the drug addict in our ineffectual efforts to fill in the spiritual black hole, the void at the center, where we have lost touch with our souls, our spirit—with those sources of meaning and value that are not contingent or fleeting.
Our consumerist, acquisition-, action-, and image-mad culture only serves to deepen the hole, leaving us emptier than before. The constant, intrusive, and meaningless mind-whirl that characterizes the way so many of us experience our silent moments is, itself, a form of addiction—and it serves the same purpose.
Settling for the view that illnesses, mental or physical, are primarily genetic allows us to avoid disturbing questions about the nature of the society in which we live. If “science” enables us to ignore poverty or man-made toxins or a frenetic and stressful social culture as contributors to disease, we can look only to simple answers: pharmacological and biological.
All addictions—whether to drugs or to non-drug behaviors—share the same brain circuits and brain chemicals. On the biochemical level the purpose of all addictions is to create an altered physiological state in the brain. This can be achieved in many ways, drug taking being the most direct. So an addiction is never purely “psychological”; all addictions have a biological dimension.
One of the main tasks of the mind is to fight or remove the emotional pain, which is one of the reasons for its incessant activity, but all it can ever achieve is to cover it up temporarily. In fact, the harder the mind struggles to get rid of the pain, the greater the pain.” So writes Eckhart Tolle.
Even our 24/7 self-exposure to noise, e-mails, cell phones, TV, Internet chats, media outlets, music downloads, videogames, and nonstop internal and external chatter cannot succeed in drowning out the fearful voices within. Boredom, rooted in a fundamental discomfort with the self, is one of the least tolerable mental states.
We see that substance addictions are only one specific form of blind attachment to harmful ways of being, yet we condemn the addict’s stubborn refusal to give up something deleterious to his life or to the life of others. Why do we despise, ostracize and punish the drug addict, when as a social collective, we share the same blindness and engage in the same rationalizations?
No society can understand itself without looking at its shadow side. It is impossible to understand addiction without asking what relief the addict finds, or hopes to find, in the drug or the addictive behavior. Not why the addiction, but why the pain.
Shame is the deepest of the “negative emotions,” a feeling we will do almost anything to avoid. Unfortunately, our abiding fear of shame impairs our ability to see reality. We may not be responsible for another’s addiction or the life history that preceded it, but many painful situations could be avoided if we recognized that we are responsible for the way we ourselves enter into the interaction. And that, to put it most simply, means dealing with our own stuff.
The very same brain centers that interpret and feel physical pain also become activated during experiences of emotional rejection. In brain scans, they light up in response to social ostracism, just as they would when triggered by physically harmful stimuli. When people speak of feeling hurt or of having emotional pain, they are not being abstract or poetic, but scientifically quite precise.
The hardcore drug addicts that I treat, are, without exception, people who have had extraordinarily difficult lives. The commonality is childhood abuse. These people all enter life under extremely adverse circumstances.
Not only did they not get what they need for healthy development; they actually got negative circumstances of neglect. I don’t have a single female patient in the Downtown Eastside of Vancouver who wasn’t sexually abused, for example, as were many of the men, or abused, neglected and abandoned serially, over and over again.
That’s what sets up the brain biology of addiction. In other words, the addiction is related both psychologically, in terms of emotional pain relief, and neurobiological development to early adversity.
Not all addictions are rooted in abuse or trauma, but I do believe they can all be traced to painful experience. A hurt is at the center of all addictive behaviors. It is present in the gambler, the Internet addict, the compulsive shopper and the workaholic.
The wound may not be as deep and the ache not as excruciating, and it may even be entirely hidden—but it’s there. As we’ll see, the effects of early stress or adverse experiences directly shape both the psychology and the neurobiology of addiction in the brain.
All of the diagnoses that you deal with – depression, anxiety, ADHD, bipolar illness, post traumatic stress disorder, even psychosis, are significantly rooted in trauma. They are manifestations of trauma. Therefore the diagnoses don’t explain anything.
The problem in the medical world is that we diagnose somebody and we think that is the explanation. He’s behaving that way because he is psychotic. She’s behaving that way because she has ADHD. Nobody has ADHD, nobody has psychosis – these are processes within the individual. It’s not a thing that you have. This is a process that expresses your life experience. It has meaning in every single case.
Medical thinking usually sees stress as highly disturbing but isolated events such as, for example, sudden unemployment, a marriage breakup, or the death of a loved one. These major events are potent sources of stress for many, but there are chronic daily stresses in people’s lives that are more insidious and more harmful in their long-term biological consequences. Internally generated stresses take their toll without in any way seeming out of the ordinary.
I was diagnosed with ADHD in my mid fifties and I was given Ritalin and Dexedrine. These are stimulant medications. They elevate the level of a chemical called dopamine in the brain. And dopamine is the motivation chemical, so when you are more motivated you pay attention. Your mind won’t be all over the place. So we elevate dopamine levels with stimulant drugs like Ritalin, Aderall, Dexedrine and so on.
But what else elevates Dopamine levels? Well, all other stimulants do. What other stimulants? Cocaine, crystal meth, caffeine, nicotine, which is to say that a significant minority of people that use stimulants, illicit stimulants, you know what they are actually doing? They’re self-medicating their ADHD or their depression or their anxiety. So on one level (and we have to go deeper that that), but on one level addictions are about self-medications.
If you look at alcoholics in one study, 40% of male adult alcoholics met the diagnostic criteria for ADHD? Why? Because alcohol soothes the hyperactive brain. Cannabis does the same thing. And in studies of stimulant addicts, about 30% had ADHD prior to their drug use. What else do people self-medicate? Someone mentioned depression. So, if you have been treated for depression, as I have been, and you were given a SSRI medication, these medications elevate the level of another brain chemical called serotonin, which is implicated in mood regulation. What else elevates serotonin levels temporarily in the brain? Cocaine does. People use cocaine to self-medicate depression. People use alcohol, cannabis and opiates to self-medicate anxiety.
Incidentally people also use gambling or shopping to self-medicate because these activities also elevate dopamine levels in the brain. There is no difference between one addiction and the other. They’re just different targets, but the brain systems that are involved and the target chemicals are the same, no matter what the addiction. So people self-medicate anxiety, depression. People self-medicate bipolar disorder with alcohol. People self-medicate Post-Traumatic-Stress-Disorder.
So, one way to understand addictions is that they’re self-medicating. And that’s important to understand because if you are working with people who are addicted it is really important to know what’s going on in their lives and why are they doing this. So apart from the level of comfort and pain relief, there’s usually something diagnosable that’s there at the same time. And you have to pay attention to that. At least you have to talk about it.
Not every story has a happy ending, … but the discoveries of science, the teachings of the heart, and the revelations of the soul all assure us that no human being is ever beyond redemption. The possibility of renewal exists so long as life exists. How to support that possibility in others and in ourselves is the ultimate question.”
Gabor Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction
“The individual psychological stages in the lives of most people are:
1. To be hurt as a small child without anyone recognizing the situation as such
2. To fail to react to the resulting suffering with anger.
3. To show gratitude for what are supposed to be good intentions.
4. To forget everything.
5. To discharge the stored-up anger onto others in adulthood or to direct it against oneself.
We are still barely conscious of how harmful it is to treat children in a degrading manner. Treating them with respect and recognizing the consequences of their being humiliated are by no means intellectual matters; otherwise, their importance would long since have been generally recognized.
The abused child goes on living within those who have survived such torture, a torture that ended with total repression. They live with the darkness of fear, oppression, and threats. When all its attempts to move the adult to heed its story have failed, it resorts to the language of symptoms to make itself heard. Enter addiction, psychosis, criminality.
In the short term, corporal punishment may produce obedience. But it is a fact documented by research that in the long term the results are inability to learn, violence and rage, bullying, cruelty, inability to feel another’s pain, especially that of one’s own children, even drug addiction and suicide, unless there are enlightened or at least helping witnesses on hand to prevent that development.
The truth about childhood, as many of us have had to endure it, is inconceivable, scandalous, painful. Not uncommonly, it is monstrous. Invariably, it is repressed. To be confronted with this truth all at once and to try to integrate it into our consciousness, however ardently we may wish it, is clearly impossible.
Without realizing that the past is constantly determining their present actions, they avoid learning anything about their history. They continue to live in their repressed childhood situation, ignoring the fact that is no longer exists, continuing to fear and avoid dangers that, although once real, have not been real for a long time.
The results of any traumatic experience, such as abuse, can only be resolved by experiencing, articulating, and judging every facet of the original experience within a process of careful therapeutic disclosure.
For some years now, there has been proof that the devastating effects of the traumatization of children take their inevitable toll on society–a fact that we are still forbidden to recognize. This knowledge concerns every single one of us, and–if disseminated widely enough–should lead to fundamental changes in society; above all, to a halt in the blind escalation of violence.
The aim of therapy is not to correct the past, but to enable the patient to confront his own history, and to grieve over it.
It is not the trauma itself that is the source of illness but the unconscious, repressed, hopeless despair over not being allowed to give expression to what one has suffered and the fact that one is not allowed to show and is unable to experience feelings of rage, anger, humiliation, despair, helplessness, and sadness. This causes many people to commit suicide because life no longer seems worth living if they are totally unable to live out all these strong feelings that are part of their true self.”
Alice Miller, For Your Own Good: Hidden Cruelty in Child-Rearing and the Roots of Violence
I am a nurse with 27 years of experience administering opiates to patients. Thoughtful, controlled use of opiates is very beneficial for folks with pain, but it never makes them pain-free. The general public needs to know that opiates do not eliminate pain. No matter how much you take. Opiates are not the final answer to any pain issue. Too many opiates are in our communities. Our laws for opiate orders need to be changed, to allow a tapered release of the drugs from the pharmacy. Currently the provider writes one order for the maximum number of pills the patient will need. If the order is for 30 pills and the patient asks to start with just five, they will need to contact the doctor for an entirely new order if they discover that they need just a few more. We could reduce the amount of opiates in the community if patients only received the number of pills they needed. Instead of the order being for 30 pills, it could state “May have 10 tablets through June 12, then 5 more tablets through June 19”. This way patients would not find themselves with over 20 extra pills.
Larry, if you do some research, you will find Purdue had major skills to convince doctors that opioids were NOT addictive. Purdue has received some major ramifications. But even more, why do you want to throw away drug users???? It’s a disease. Shall we throw away cancer patients, even if they smoked? Or diabetics who might not take as good of care as they could have of their disease? Addiction is a disease according to the definition of diseases and it is treatable. It’s easy to be judgmental until you have a love one fall prey to this disease. I feel sorry for any family member (or anyone) that would fall prey to your judgement.
Wasted money/wasted efforts at salvation of drug users. My question has always been why did the doctors who prescribed the problem have gotten off Scott free?
Madelyn, Thank you for educating us about some of the biggest challenges and bringing such an important issue to the surface for much more conversation and action. A great and important series requiring a lot of research and depth-of-reporting! Again, Thank you.