From 2007 to 2016, the number of drug overdose deaths in Sawyer County reached 28.
As reported by the Opioid Community Assessment Tool, created by the National Opinion Research Center (NORC) at the University of Chicago, Sawyer County has one of the highest drug overdose mortality rates in the state — even higher than the national average:
• From 2007-2011 the rate was 19.2 deaths per 100,000 in Sawyer County, compared to 16.2 for the state and 17.7 for the nation.
• From 2012 to 2016, the county rate was 36.4 deaths per 100,000, compared to the state rate of 22.4 and the national rate of 22.5.
In Wisconsin, just two other counties have a higher drug overdose morality rate. They are the urban counties of Milwaukee, 37.7, and Kenosha, 37.1. Other rural counties with overdose rates similar to Sawyer County are Cass County in Minnesota and Iron County in Michigan.
This information was presented Tuesday, April 16, to the Sawyer County Board of Supervisors by Diane McNamer, the county's criminal justice coordinator. In early April, she and Sawyer County Circuit Judge John Yackel and Sheriff Doug Mrotek attended the Rural Judges and Sheriff Workshop in Columbus, Ohio, about the methamphetamine and opioid epidemic that is plaguing much of the country.
"At this conference, we were made aware that our county of less than 17,000 inhabitants is considered one of the worst counties, not only in our state but across many states, when it comes to the level of overdoses and deaths from drugs in our community," McNamer said.
From 2007 to 2011, the county saw 10 deaths from drug overdoses; from 2012 to 2016, that number increased to 18 such deaths.
And since 2016, the drug crisis in the county has only esca-
lated, McNamer said.
In 2018, the county experienced over 400 felony cases, a record (in 2016 there were fewer than 300). The increase is largely attributed to drug cases. The current rate of charges puts the county on the path to exceed 500 felony cases in 2019.
"I know if you speak to anyone in law enforcement or Judge Yackel, you are going hear the sheer number of cases involving drug abuse has only escalated since then," she said.
She added, "Make no mistake, we truly are in a crisis — a drug abuse crisis that no one ever saw forthcoming. The abuse of prescription pain killers, heroin, methamphetamine and other drugs has literally destroyed countless families."
She said it is obvious rural communities are not immune to the drug epidemic and that a different response is required.
Urgent action needed
"We are here tonight to say it is our duty to act with urgency to address the cycle of addiction and death that has taken hold on our community," McNamer said. "First of all, we need to understand that addiction is an illness. Although law enforcement is critical to an effective response to this epidemic, we simply cannot arrest or incarcerate our way out of the crisis of addiction. We can't change our past, but we can change our past response to drug addiction."
McNamer said there is a need for more diversion programs — programs that keep people out of jail but offer help with addiction or issues related to addiction — and offer more jail and treatment options.
Sheriff Mrotek said jails have gone from being facilities for short-term holds to performing long-term incarcerations because of the backup of processing court cases, many of which are drug related. He added that while inmates are held in jail they also have the opportunity to get clean and it is an ideal time for programming to help inmates. Unfortunately, the jail lacks facilities for such programing.
Mrotek recounted a recent incident to illustrate how the drug issue recoils within the county. On April 1 a state highway patrol trooper stopped a vehicle in Stone Lake and determined the woman driver had an outstanding warrant. While arrangements were being made to take the woman into custody and arrange care for her children, a male passenger showed overdose symptoms. The trooper administered Narcan, a drug to counteract the effect of opioids, and the man was taken by ambulance to the Hayward hospital, then flown to Duluth to an intensive care unit.
Later, when the woman was taken to jail, she was inspected and found to be carrying 17 grams of methamphetamine inside a body cavity.
Mrotek recounted another case of a woman inmate who overdosed because of drugs smuggled within body cavities. This woman had to be attended by a deputy at the hospital and at the intensive care unit in Duluth because she was in custody.
The sheriff expressed concerns about being unable to provide sufficient mental health counseling for inmates and concern about cutbacks to education and drug prevention programs in the community, programs such as DARE, which encourage youth not to use drugs.
Sawyer County Chief Deputy Craig Faulstich and Detective Brian Deyo displayed drugs confiscated in busts and discussed how the drugs are used and how much they are sold for on the street. Drugs shown included marijuana, meth, heroin and cocaine.
Faulstich said the drug trade is lucrative and as long as there is a demand there will be a supply.
He also reiterated McNamer's sentiment about the drug epidemic.
"We can't arrest our way out of this," he said. "Clearly it is not working because we have more stuff than we've ever had."
Faulstich said when the abuse of prescription opioids began to occur he predicted heroin, an illegal non-prescription opioid, would become more prevalent. Now it is one of the most widely confiscated illegal drugs in the county, along with meth.
Deyo displayed a bag of confiscated heroin with a "mix of color," indicating the presence of fentanyl, a highly dangerous drug often added to heroin. Faulstich said even a small dosage of fentanyl can kill.
Although law enforcement is critical to an effective response to this epidemic, we simply cannot arrest or incarcerate our way out of the crisis of addiction. We can't change our past, but we can change our response to drug addiction.
SAWYER COUNTY CRIMINAL JUSTICE COORDINATOR
Questions remain this week about the impact on the Hayward Community Schools after the Wisconsin Interscholastic Athletic Association (WIAA) Board of Control on April 16 voted 9-0 to approve a football conference realignment plan proposed by the Wisconsin Football Coaches Association starting in the fall of 2020.
Under the plan, the Hayward varsity football team will
play in the Great Northern Conference (GNC) instead of the Heart O' North Conference. The GNC includes schools in the Wausau area, with venues as far as 167 miles (Antigo) and 171 miles (Mosinee) from Hayward.
The Hayward School Board voted to appeal the proposal on the basis of the long travel times to games, student safety, impact on academic achievement, loss of traditional conference rivalries and potential decrease in student and family participation in football.
Hayward Community School District Supt. Craig Olson and Athletics/Activities Director Billy O'Brien traveled to Stevens Point on April 16 to present the district's objections to the plan. Olson said Monday there are still "a lot of what ifs" under the plan and he will know more later this week. The Hayward School Board did not address the topic at its reorganizational meeting Monday, April 22.
Olson said he has gotten multiple calls from parents following the WIAA decision. But "people took the right attitude, of 'Let's go down there and play (football) and kick their butts' rather than going into the tank. It wasn't 'The sky is falling.' They know we did our efforts, did our best.
"I can't give you (the school board) an educated thing as to what our options are, because they're changing for us," Olson added.
Only 13 representatives of petitioning schools attended the board of control meeting, including two from Hayward, Olson said. He was the only superintendent there.
"If there was a bunch of people displeased with it (the proposal), the room would have been filled," he added. "A lot of people thought it was a great thing for them. There was a lot of moving parts."
Olson added he does not think the realignment plan "will change for us." None of the petitioning schools received changes in the plan, he said. "It was a hands-down (decision). They (the board of control) felt really good about the decision they made, that it was really good for the state of Wisconsin."
O'Brien said that at the WIAA meeting, he and Olson "went through all items throughout the letters that the school district has sent them in regards to moving Hayward into the Greater Northern Conference. After the WIAA and Board of Control listened to the other six appeals in person and went through the nine other letters from schools who appealed just by a letter, it was a unanimous vote to move forward with the 2020 conference realignment.
"Although this is not what the Hayward Community School District was hoping for with the decision of the WIAA, the mission statement is to "ACHIEVE" and that is just what Hayward Football is going to do starting right now,"O'Brien added. "This has definitely been an obstacle that has been put in front of the football program, and we need to do whatever we can to make sure that our student-athletes are put in the best position to be compete."
O'Brien added that "There still isn't a great solution for the amount of travel (to and from football games). It will be interesting to see what the schedule will look like for Varsity. As far as sub-varsity games, I am still going to schedule a full schedule for JV and/or freshmen teams even if the GNC teams do not want to play due to the travel, I will make sure that we still have a full schedule to get all those student-athletes as much playing time as they can."
According to a WIAA news release, the plan "gives uniformity to the number of schools affiliated with a conference and makes certain programs have enough conference games for playoff qualification.
"As I indicated when the board gave its initial support of the plan, this was an enormous undertaking and a groundbreaking venture for the WIAA," Executive Director Dave Anderson said. "This was a good-faith effort, and there was openness to alternative ideas, 'big-picture' thinking, and widespread acceptance of the final decision. It's also important to convey that at any time there is 100 percent agreement of all impacted members, relief can be fast-tracked."
The realignment proposal was made to create conferences of the same size across the state, instead of the arrangements now that range from 10-school to five-school conferences. Teams must have a .500 conference record or better to qualify for post-season play. While making the changes, the committee also was able to entertain requests for alignment changes based on competitive balance.
A review of the conferences is scheduled to be available every two years.
At Monday's meeting, the Hayward School Board unanimously re-elected officers for the coming year: Linda Plante, president; Derek Hand, vice-president; Dr. Harry Malcolm, treasurer; and Lynell Swenson, clerk.
By the time President Donald Trump declared the opioid crisis a public health emergency in 2017, abuse had gradually increased for two decades.
More than 47,600 Americans died from opioid-related overdoses in 2017 alone, according to the National Institute on Drug Abuse, bringing the total number of deaths to nearly 400,000 since 1999.
That number continues to climb.
While it took years for lawmakers, government officials and the media to truly grasp the scope of the problem, those on the front lines were seeing ramifications shortly after the introduction of a new wave of opioid painkillers in the late 1990s.
Melanie Brown-Woofter, president and CEO of the Florida Council for Community Mental Health, said the consequences were obvious early on, but were initially overlooked.
"There's always a canary in the coal mine," she said. "And our folks on the ground started expecting individuals with addictive behaviors and
seeing the overdoses in the hospitals much earlier than it was officially recognized by our state leaders. We had seen this years ago with cocaine, and we saw it with meth. And now we've moved into the opioid world."
Florida wasn't the only state to recognize and address the problem after it had spiraled.
As the number of deaths increased exponentially with prescription opioid overdoses into the late 2000s, state and local governments took notice and worked to identify solutions.
"When it started making the news, I think it shocked a lot of people, because it was under the radar for a period of time when it was first developing," said Ken Martin, chairman of Ohio State University Extension.
One of the most important steps, from both Martin and Brown-Woofter's perspective, was creating a coordinated response on the state level.
Coordinating efforts and resources
Martin said former Ohio attorney general and current Gov. Mike DeWine created a drug czar to help lead efforts to combat and treat addiction. And Brown-Woofter praised the efforts of Florida Gov. Ron DeSantis in reinstituting that state's drug czar, a post that had been cut eight years ago.
"We feel that a coordinated effort that's led centrally to be able to address this issue is so important," Brown-Woofter said. "Today, it's opioids. A few years from now, there may be another product out there. We see it morph over time."
That recognition prompted federal and state governments to allocate funding for prevention, treatment and recovery — highlighting why these efforts are so vital.
But there's still work to be done.
A recent Bipartisan Policy Center analysis revealed that increased congressional funding reached states with some of the highest number of opioid deaths, such as West Virginia, Pennsylvania, Ohio and Kentucky, but found that rural areas were largely underserved.
The report identified 57 federal grant programs providing $3.3 billion in opioid funding in 2017 and $7.4 billion in 2018 — a 124% increase in spending.
From 2017 to 2018, funding targeted to opioid use disorder treatment and recovery increased by $1.5 billion, according to the analysis.
In his role with the OSU Extension, Martin has used grant funding to help prevention efforts aimed at sixth-and seventh-graders in Ohio. The goal is to use evidence-based prevention programs to arm children with the tools they need to prevent substance abuse issues from taking root in the first place.
Martin said these resources connect mental health and substance abuse experts in multiple communities to establish a strong network of support and coordination.
"It's a community team that's built that rallied together to implement this program. If you can get that type of support committed, there's a real strong chance of it being sustainable over time," Martin said. "It's all about prevention education and getting it to young people."
New state and federal funding in Wisconsin, which saw more than 900 opioid overdose deaths in 2017, has encouraged health care officials to crack down on the crisis. U.S. Sen. Tammy Baldwin, D-Wisconsin, recently announced the state will receive an additional $6.25 million in federal grant funding for opioid abuse prevention, treatment and recovery.
Some recent initiatives include an addiction recovery helpline, funding for inmates leaving jail and public health alerts issued to areas with high numbers of opioid overdoses.
"We've continued to see a rise in opioid-related deaths since the early 2000s," said Paul Krupski, director of opioid initiatives for the Wisconsin Department of Health Services. "We have a three-pronged approach to address the crisis, which, I'd guess, is fairly similar to what a lot of other states are doing. We firmly believe we will eventually get ahead of this."
The department recently partnered with the University of Wisconsin School of Medicine and Public Health to launch an addiction consultation program, connecting providers in rural areas with addiction specialists for insight and resources.
"It's creating a high level of patient care locally," Krupski said.
Because Wisconsin is largely rural, counties are often the first line of defense when addressing substance abuse. The health department has awarded grant funding to more than 25 counties and tribal nations through its Unmet Opioid Treatment Needs program. In the first half of the program's second year, more than 1,000 residents have received treatment or recovery support services.
As the crisis continues to evolve, states must evolve with it, Krupski said, especially as states see a rise in fentanyl and illicit opioid use.
The department contracted with the AIDS Resource Center of Wisconsin to pilot a program using fentanyl testing strips.
"When individuals come in for syringe exchange, the staff is giving them the strips with direction," Krupski said. "Our hope is it will help active drug users change their behavior; they're testing the drugs beforehand and deciding not to use if fentanyl is detected. It's, in essence, saving lives."
Tackling the evolving epidemic
Most states implemented prescription drug monitoring programs (PDMPs) after realizing how significant the problem was.
PDMPs are designed to crack down on two major contributing factors to the opioid crisis — patients collecting opioid prescriptions from multiple doctors and unscrupulous doctors who operate "pill mills," prescribing as many pain pills as possible.
While there is no federal standard for how PDMPs operate, they act as a way to ensure patients can't receive multiple prescriptions for the same physical ailment, and that authorities can easily identify doctors who are overprescribing pain pills.
In Wyoming, experts point to the state's creation of its own PDMP in 2003 as a major factor in the state being spared the worst of the opioid crisis. Lauren Gilbert, an assistant research scientist with the University of Wyoming's Survey and Analysis Center, said the Wyoming Online Prescription Database being in place before the height of the opioid epidemic meant the state was well-positioned to get out in front of the problem.
It helped Wyoming identify several pill mills, including a Casper physician charged in a federal case that alleges he improperly distributed prescription drugs.
Many states also have limited the amount of opioid-based medication a patient can be prescribed. Wyoming's Legislature earlier this year limited the amount of opioids for first-time patients to a seven-day supply. Florida insurance companies put a cap on opioid prescriptions, as well, Brown-Woofter said.
Federal prosecutors are also threatening criminal action against those prescribing more pills than average. Wisconsin's drug monitoring system revealed a 29% decrease in the number of prescriptions dispensed from 2015 to 2018.
Some of the country's largest drug distributors continue to face civil lawsuits in several states, which could lead to billions of dollars in damages. Governments want companies such as Purdue Pharma and Walmart to reimburse them for the cost of combating the epidemic, arguing these companies misled communities about the risks.
In March, owners of Purdue Pharma, maker of Oxycontin, agreed to pay Oklahoma $270 million for the company's role in the crisis. Oklahoma Attorney General Mike Hunter said the settlement would help establish a national addiction research center at Oklahoma State University and support local efforts.
Minnesota communities are hiring coaches for recovering addicts, decriminalizing drug testing strips and treating inmates jailed for drug crimes. Minneapolis recently equipped police officers with Narcan, too.
Access to opioid-overdose drugs like Narcan is a vital component in keeping people alive and giving them the chance to seek recovery. But with increased access a willingness to increase its usage has not always followed.
Martin said too often law enforcement officers were reluctant to use drugs to help bring people out of an overdose because "they'll keep coming back for more." It was a prevalent sentiment throughout the country as the crisis grew. To combat it, experts say it will take serious conversations and culture change to understand not only this crisis, but addiction as a whole.
A survey released by integrated health company Vizient last year reveals what changes hospitals, in particular, have undertaken to reduce the opioid toll on human life.
The survey found that 64% of hospitals recently made new investments in opioid medication management recently. Most common programs included prescriber education, prescription monitoring, pain management alternatives and safe disposal of old medications.
But because drug problems can start and end in a medical facility, hospitals are now implementing emergency department intervention programs.
Last year, University of Colorado Hospital and St. Anthony North Health Campus each received $400,000 to expand treatment for opioid addiction in emergency rooms.
In hundreds of emergency departments throughout the country, staff are trained to release overdose patients following detox, rather than providing treatment or clinical care. In Colorado, UCHealth now offers medication-assisted treatment to these individuals, a move that will likely reduce the mortality rate among addicts.
Another major step in helping save lives is making sure those seeking treatment are being served well. Brown-Woofter said Florida recently cracked down on some providers who ran "sober homes," which provided those with opioid addiction places to recover. She said there were multiple cases of providers setting up shop to make a profit off of the crisis without producing any supports for those in recovery. Sometimes heroin dealers would wait outside the homes to try to entice people into relapse.
There were even cases where providers would kick people out when their insurance money ran out, connect them with drug dealers to get them to relapse, then readmit them in order to receive a new round of insurance dollars.
"There were some bad apples taking advantage of the system," Brown-Woofter said.
Experts in the mental health and substance abuse treatment fields believe there are immediate steps that can help keep more on the path to recovery. More funding for substance abuse treatment, increases in the mental health workforce, and increasing the time government and private insurance will fund rehabilitation stays are all on the wish list.
"Addiction is a brain disorder. And once you enter into addiction recovery, you're in recovery for the rest of your life," Brown-Woofter said. "People don't choose this. Anything we can do to enhance service provision and increase capacity so anyone who needs it can seek services and keep them in recovery is what we're interested in."
Another approach could have a significant impact on improving the odds of a sustained recovery for those with an opioid addiction.
"Expanding access to medication-assisted treatment is the most effective way to reduce overdose deaths and curb the opioid crisis," said Beth Connolly, project director of the substance use prevention and treatment initiative at The Pew Charitable Trusts.
Connolly believes policymakers should focus on how treatment is delivered and build up the capacity of the mental health sector to deal with an increased need.
"(They should) support coverage and reimbursement policies that ensure access to care, and help underserved populations – such as pregnant women or individuals involved with the criminal justice system — access effective care," Connolly said.
But there are other underlying factors that prompted the opioid epidemic, too. One of the biggest factors in the Appalachian region, and across the country, is social isolation, said Katie Cahill, associate director of the Howard H. Baker Jr. Center for Public Policy at the University of Tennessee.
"I think the addiction issue, in regard to opioids, is really a symptom of a broader illness that's plagued the region, which is really dealing with social isolation, struggling economies and dying towns," Cahill said. "I think addiction issues generally, and opioid addiction specifically, come out from disconnected communities."
While her research is based in Appalachia, Cahill said social isolation and economic insecurity isn't a problem specific to that region. Those issues can be found in the former steel towns of the Rust Belt, the cities that never recovered from the real estate collapse that started the Great Recession, and in the middleclass suburbs where isolation from neighbors helps fuel issues like depression.
"It's important to think about the addiction crisis in the broader context of what our society is going through," Cahill said.
Editor's note: This is the third of three parts in a series by Adams Publishing Group newspapers about the nation's ongoing and evolving opioid crisis.
Today, Part 3 assesses policies state and local governments are pursuing to stem the epidemic.
Our top story reveals the depth and cost of the addiction crisis here in Sawyer County.
The American Birkebeiner Ski Foundation (ABSF) is working on a proposed pedestrian bridge which would allow skiers, cyclists and runners/walkers on the Birkebeiner Trail to cross over State Highway 77 approximately 700 feet east of Hatchery Road.
ABSF Executive Director Ben Popp told the Town of Hayward Board April 9 that he and Sawyer County Highway Commissioner Gary Gedart met with the Wisconsin Department of Transportation (WisDOT) regarding the Birkie Foundation's original proposal to construct a recreational underpass of Highway 77 just east of the Hatchery Road Intersection.
The underpass project would have cost more than $500,000 and "went by the wayside at this point," Popp said. One problem with an underpass would be safety, because it would be on a curve and cold air passing beneath the highway could create a slippery surface, he indicated.
"So now we're looking at a second option," a recreational overpass for skiers, cyclists and hikers on Highway 77 — similar to the Key Log Crossing of Highway 00 that was constructed and placed last year as part of the Birkie Trail.
"We got approval for the DOT to go with an overpass as opposed to an underpass," Popp said.
Northern Wisconsin Based Engineers is working on draw-
ings and site work for the overpass, a steel span that would be 19 feet high and 136 feet long, Popp said. It will go out for bids, for a cost "which should be significantly less" than an underpass, he said.
Birkie Foundation Membership and Development Director Audun Mikkelson is working on an application for a Department of Natural Resources state trails grant to help fund the project, Popp added.
WisDOT would work out a maintenance agreement with the Town of Hayward and a financial agreement with the ABSF.
"Depending on what Spooner Machine (construction company) and site work comes back with, we're optimistic of trying to get it done yet this fall," Popp said. "We're working on access easements" with two landowners at the site, he added.