‘They just were too afraid’: Health agencies confront stigma of addiction amid fentanyl epidemic

DAYTON — As local health agencies deploy various strategies to confront the fentanyl scourge, they face an ill that lacks an obvious remedy: the stigma of addiction.

Far from pressuring people struggling with substance abuse to change their behavior, this stigma can actually prevent them from getting help for it.

Consider the experience of Blue Mountain Heart to Heart’s mobile clinic.

In recent years, staff from Blue Mountain, a nonprofit that emphasizes advocacy and harm reduction, have driven the mobile clinic to outlying rural areas, such as Dayton and Starbuck in Columbia County and Waitsburg in Walla Walla County. This RV, named “Heals on Wheels,” is a place to get harm reduction supplies — from naloxone and fentanyl test strips, to clean syringes and safer-smoking kits — and medical care, such as testing and treatments for sexually transmitted infections.

Blue Mountain often goes out to those areas at the request of people who could use these services and who don’t have the time or ability to drive to Walla Walla.

And, not infrequently, the people don’t show up.

Later, the agency will get an apologetic phone call or learn by word of mouth that the individuals couldn’t risk being outed.

“They just were too afraid for anyone to see them come to get any help from us,” Everett Maroon, the agency’s executive director, said.

Studies of harm reduction programs, such as sterile syringe exchanges, show that people who rely on them are more likely to seek recovery in the future, and less likely to die of their drug use or suffer from related medical issues, including infections that require serious interventions.

Blue Mountain has given naloxone trainings in Dayton for social service organizations. At one point, the nonprofit was asked to train the drug-using community on how to administer the life-saving nasal spray.

“We had a really difficult time finding a location where a group of people could gather that they felt safe to learn about how to use naloxone to reverse opioid overdoses,” Melissa Cross, a registered nurse who works on the mobile clinic, recalled. “So it didn’t happen, unfortunately.”

Cross, who has shared her own recovery story, said, “Visibility and social stigma seem to be the two biggest themes that we see. Folks just generally aren’t willing to deal with the backlash from utilizing our services.”

It is a reasonable fear.

When Blue Mountain ran the syringe exchange in Pasco, a prominent local figure showed up with her smartphone to expose and harass the clientele. Shaming on social media and complaints at public meetings also take a toll.

All of this has a chilling effect, even in other towns.

Estasia Collins, a public health nurse with Columbia County Public Health, said, “Getting people in the community to seek out that help — I think people aren’t comfortable doing that, most likely because we are in such a small community.”

‘They just were too afraid’: Health agencies confront stigma of addiction amid fentanyl epidemic

‘Saving a life’

Columbia County Public Health is now looking to confront this problem head-on.

The agency recently got a $56,000 grant through the Washington State Department of Health to launch a campaign addressing both the stigma of addiction and of purchasing and providing naloxone.

Over the next few months, Collins and her colleague, registered nurse Madeline Jensen, plan to give presentations at community and civic groups about why it’s important to distribute naloxone and teach people how to use it.

“There can be a public perspective that that’s enabling, providing naloxone,” said Jan Strohbehn, the county’s public health director. In fact, she said, “it’s saving a life.”

The funds for the campaign, which also involves social media and local print materials, come from the state’s Opioid Abatement Settlement. The grant’s performance period ends June 30, but the department may seek additional funding to continue the campaign, she said.

Meanwhile, Columbia County is slated to get $290,746.91 in opioid settlement funds. So far, the county has received just over $81,000, none of which has been spent, according to county Auditor Will Hutchens.

Strohbehn and her colleagues hope to change the local conversation about fentanyl use, which Dale Slack, the Columbia County prosecuting attorney, believes has become “the new normal.”

“It’s like we thought about meth back in 2018,” Slack said. “It’s like, ‘Yep, that’s what people are doing.'”

Fentanyl — a potent synthetic opioid that the Centers for Disease Control and Prevention estimates at “up to 50 times stronger than heroin and 100 times stronger than morphine” — had been around for some years but didn’t usurp methamphetamine as the common drug of abuse in Columbia County until the coronavirus pandemic, said Slack, who until recently served as the county coroner.

“Meth was the king here for such a long time that I think most people were not interested in switching to a downer after that,” Slack said.

Then, in 2021, deaths from synthetic opioids began appearing in county statistics.

Between that year and 2023, the county saw between one and nine such deaths, according to the state health department, which for privacy reasons, suppresses fatality statistics under 10.

Slack investigated several of these deaths, he said.

In most cases, he said, the decedents had lived in poverty and poor health, their lives often ending in an unhygienic environment where drug use had become part of everyday life. When Slack arrived, they were often on the bed, or on the floor next to the bed, scattered scraps of tinfoil with burnt fentanyl residue and glass straws for smoking it lying around, along with, perhaps, Narcan wrappers, or the lead wires that EMS workers had used to try shock the person back to life.

“I think a lot of people dismiss people with drug problems as either weak or lacking in some sort of virtue,” Slack said, “but, seriously, how bad would your life have to get to use something that you have no clue where it came from or what’s in it just to escape from what’s going on around you?”

The OD fatality rate in Columbia County appears to be declining, even if fentanyl use is not, Slack said. He suspects that fewer people are dying now because of the naloxone that has reached the community.

“I think it’s solely attributable to a few groups that were trying to distribute it more widely around here,” he said.