The power of prevention, harm reduction in combating the fentanyl crisis

Part II in a series: How local organizations, leaders are working to increase access to resources like fentanyl test strips and Narcan

Increasing access to harm reduction tools and resources will play a large part in reducing opioid overdoses. This includes wider access to Nalxone, also referred to as Narcan, which many agencies, like the Eagle County Paramedics, now carry.
Eagle County Paramedic Services/Courtesy photo

While Eagle County has not seen the same scale of fentanyl overdoses as other counties across the state and country, the threat is still very real. Local leaders, as well as addiction and substance experts, are making moves to educate around fentanyl and prevent further community devastation by the substance.

“(The fentanyl crisis is) gaining momentum, and it’s going to catch us by surprise if we don’t start to address this rather aggressively,” said Amy Hermes, an Eagle County-based professional counselor and addiction counselor.

Similarly, Kala Bettis, the outreach operations manager at Eagle Valley Behavioral Health, called the current state of the opioid and fentanyl crisis in Eagle County “the tip of the iceberg.”

A three-part investigative series

Part I: Inside the new wave of the opioid crisis and how fentanyl is changing the drug landscape

Part II: How local organizations and community leaders are working to increase access to harm reduction and prevention resources

Part III: Educating youth about fentanyl and the danger it poses

“We are in a critical time to arm our community with prevention, intervention, treatment and recovery,” Bettis said.

Within Colorado’s mountain communities, Maggie Seldeen is one of the people leading the charge of prevention and harm reduction efforts with her organization, High Rockies Harm Reduction. While Seldeen only recently started the organization, its inception can be traced back to her own past with substance abuse and upbringing in Carbondale.

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“Growing up in a family full of substance abuse in a wealthy, rural community, my experiences were largely marginalized and ignored,” Seldeen said. “I was criminalized by the systems due to emotional problems clearly caused by my home life.”

While she was resistant to traditional recovery methods, such as Alcoholics Anonymous and therapy, Seldeen ultimately achieved recovery through support from her peers and nontraditional paths, she said.

Starting High Rockies Harm Reduction was her way to “offer this same recovery pathway to all those who have not been helped by the traditional options,” Seldeen said.

Maggie Seldeen poses for a portrait at Crown Mountain Park during the Overdose Awareness Day event in El Jebel on Tuesday, Aug. 31, 2021.
Kelsey Brunner/The Aspen Times

“I am particularly passionate about working with adolescents in the hopes that no one ever has to go it alone like I did, that no child ever need lose a parent to an overdose and vice versa,” said Seldeen, who speaks from personal experience. She lost her mother to an overdose when she was a teenager.

When she started High Rockies Harm Reduction, Seldeen began by filling certain areas of community need with the current opioid and fentanyl crisis.

“We saw a need for harm reduction programming and syringe services in our rural communities and we filled it,” Seldeen said. “High Rockies Harm Reduction seeks to create a space for those interested in recovery that are alienated from traditional options.”

While Seldeen started High Rockies Harm Reduction in her hometown of Carbondale and the organization’s services are primarily based in the Roaring Fork Valley, she has begun conversations to expand into neighboring counties, including Eagle County.

“Wherever we can be, we want to be,” Seldeen said, adding that High Rockies Harm Reduction has already begun partnering with Eagle County organizations such as Mind Springs, Eagle Valley Behavioral Health, Mountain Youth and the Eagle Valley Rural Communities Opioid Response Program group.

With Eagle Valley Behavioral Health, Bettis said the partnership will start with High Rockies Harm Reduction facilitating trainings on Naloxone utilization for its staff. This, she said is among other prevention and psychoeducation resources Eagle Valley Behavioral Health is working on.

These partnerships are just the start, Seldeen hopes. As a new organization, High Rockies Harm Reduction is working on funding and staffing to rapidly expand into its neighboring areas with a goal of recruiting someone to work locally in Eagle County by the end of the year.

A need for harm reduction

With regard to the fentanyl crisis, High Rockies Harm Reduction has three main service and programmatic areas: direct harm reduction services, pure recovery support services as well as education and advocacy.

Generally speaking, harm reduction refers to any actions that mitigate the risks of our everyday actions, Seldeen said, using seat belts as an example.

“Harm reduction is a concept that accepts the reality that some individuals will use drugs, and we want to give them the tools to stay safe,” she said.

Within both education and its direct services, the organization relies on two main harm reduction tools: fentanyl test strips to mitigate against the risk of fentanyl being in substances, and Naloxone, or Narcan, to mitigate the overdose risks associated with opioid use.

“Our goal is to get Narcan in as many American medicine cabinets as have opioids,” Seldeen said. “So, most of them.”

However, one of the biggest barriers to reaching this goal is the amount of misinformation around Narcan, she added.

Naloxone is a medicine that rapidly reduces an opioid overdose, by blocking the effects of the drugs. It can quickly restore normal breathing to a person if their breathing has slowed or stopped due to an overdose. There are two FDA-approved forms of the medicine — injections and the more commonly distributed nasal spray, of which the name brand is Narcan.

The laws around carrying Narcan in Colorado are purposely gray, Seldeen said.

Maggie Seldeen holds out a box containing two Narcan nasal spray doses while demonstrating how to utilize it at Crown Mountain Park during the Overdose Awareness Day event in El Jebel on Tuesday, Aug. 31, 2021.
Vail Daily archive

“Everyone can have Narcan, carry Narcan, distribute Narcan — there’s no language anywhere that defines age for that,” she added.

In recent years, more agencies and organizations have begun to have Narcan on hand. In Eagle County, this predominantly includes the local law enforcement agencies.

“We carry Narcan now in the hopes that we can save a life,” said Aaron Veldheer, a detective sergeant at the Eagle County Sheriff’s Office. “We never did that prior, it was always, in an overdose we would probably not get called until it was too late. I know that since we started carrying Narcan, that surrounding agencies in Eagle County, Garfield, Routt, have used Narcan to save several lives.”

With the extreme potency of fentanyl in many of the drugs seized, law enforcement agencies also keep Narcan on hand for their own protections. The GRANITE, or Gore Range Narcotics Interdiction Team, and Eagle County Sherriff’s Office have Narcan on site when handling any drugs seized now.

“We often carry Narcan with us, we’re always gloved up, some kind of eye and face protection,” said GRANITE detectives, who wished to remain anonymous due to the undercover nature of their jobs. “You can ingest (fentanyl) through the skin, any tear ducts, orally, if you inhale it — all of those are ways to get into your system so when we are handling narcotics, we do have Narcan on standby and somebody that is not handling the drugs on standby in case one of us goes down, they can use that Narcan spray.”

In 2021, Eagle County Paramedic Services deployed Narcan 11 times, four of which were for a suspected opioid overdose.

“There are a handful of mimics like strokes or altered mental status where we might trial a dose of it,” said Will Dunn, the senior manager of paramedics services for the organization.

Source: National Institute on Drug Abuse

Eagle County Paramedics not only carries Narcan in its ambulances, but started a program last year to help treat opioid overdoses at homes. David Miller, a community paramedic with Eagle County Paramedic Services, helped kick-start the program, which is appropriately called Narcan at Home.

Miller came to Eagle County from Pittsburgh where the emergency medicine providers helped launch harm reduction programs in response to the city’s mounting opioid problem. And while the opioid epidemic was not as severe in Eagle County, Miller still saw a need for this type of community service.

“We didn’t really have necessarily numbers, though, to say it was an epidemic in our community, but the concern was instead of being reactive, we needed to be proactive about that,” Miller said. “Opioid use in rural communities is well-documented, and we figured it was only a matter of time before we started seeing, not necessarily similar, but issues surrounding opioid use in the county or surrounding area here.”

So far, there have been two main applications for this Narcan at Home program in Eagle County.

The first is for individuals who are struggling with addiction and the paramedics have given the individual Narcan as well as have demonstrated to a family member how to use it. The second is for individuals who, after having a surgery or medical procedure, are sent home with opioid pain medication and are nervous about accidental overdoses. So far, the paramedics have distributed Narcan via this program to 11 Eagle County homes.

In the case of the former, Miller said it allows the paramedics to start having conversations around local treatment options.

“It shows that the community is supportive of people suffering from addiction, and it shows that the community, at many different levels, is genuinely interested and concerned and caring about helping folks with addiction,” Miller said. “It’s one simple measure of saying we recognize addiction is real, it’s a real problem that many people face, and we can offer a small piece of the solution puzzle to help people.”

In this way, harm reduction, Miller added, is beneficial to the entire community.

“The effects of addiction don’t just stick with the addicted folks, it spreads to families and friends and coworkers and everybody is affected and impacted by addiction,” he said. “Harm reduction measures, while certain parts of it might be specifically focused on reducing the harm associated with someone that is using, they ultimately benefit the entire community.”

In general, while the county has started to be more open about harm reduction and treatment for substance use, Miller said there is still an opportunity to encourage more dialogue and more access to harm reduction options, with specific reference to Narcan.

Laced and Lethal: A community conversation about fentanyl

Mountain Youth is hosting a free community event at Colorado Mountain College in Edwards on Thursday, April 14, starting with a dinner at 5:30 p.m. followed by a discussion at 6 p.m. featuring three community speakers. This forum seeks to destigmatize pill culture and fentanyl and address the “this doesn’t relate to me” attitude that exists.
 Attendees will also take away the best techniques for preventing drug misuse, overdose, and disease and learn how individuals at all levels can help combat our current public health crisis.

About the speakers

Amy Hermes is a licensed professional counselor and licensed addiction counselor who is trained to serve those struggling with both mental health and/or substance-related issues with a trauma informed approach.

Maggie Seldeen battled her own addictions for years and now wants to give back to the community that created her. Maggie combines her life experience and passion for social justice in dealing with persons who have a history of substance use.

Carole Bukovich lost her son to a pill laced with fentanyl in 2021. Carole is a beloved Eagle County resident who raised a family here and wants to share the message that the fentanyl crisis has reached our community. She wants to share her story so that no parent has to experience this loss.

“I view it very similarly to a public access defibrillator. They’re all over our community, if someone suffers a sudden cardiac arrest, bystander CPR and public access AED are the best chances for survival,” Miller said. “Similar to having Narcan out in the community, if someone suffers from an opioid overdose to the point where they are not breathing, rapid administration of Naloxone is going to be really the best chance of survival that person has.”

Overall, Miller said that even if access to Narcan saves only one person, “that’s well worth it being out in the community.”

“And if one person has that overdose reversed form Narcan, seeks treatment and gets better and is able to get out of that addiction cycle, that I think makes it absolutely worth it to have in the community,” he added.

Plus, Narcan — and other harm reduction measures — have a use outside of what Miller called the “addiction cycle.” With fentanyl’s ability to be laced and disguised in an array of drugs, Narcan can save lives of anyone who unintentionally takes a lethal, or close to lethal, dose of fentanyl.

“We want to create awareness of the real dangers that exist out there and the tools and resources that we provide for free to keep people safe,” Seldeen said of her organization’s harm reduction measures. “Ninety-five percent of Americans use some form of mind-altering substance. We believe that we need to take the stigma out of substance abuse to help people effectively.”

As the increased circulation and prevalence of fentanyl has escalated concerns for many institutions serving adolescents, a Colorado bill that passed in 2019 created the Naloxone Bulk Purchase Fund, among other things. The Colorado Department of Health and the Environment fund authorized school districts and nonpublic schools — among other entities like public health law enforcement agencies to obtain a supply of opiate antagonists.

Currently, only four public school districts in Colorado — Cherry Creek, Boulder Valley, Mountain Valley and Clear Creek school districts — have, or are, utilizing the fund to have Narcan on site.

According to Katie Jarnot, the assistant superintendent of curriculum and instruction at Eagle County Schools, the district previously discussed having health assistants and/or administrators trained to administer Narcan but decided against it. The reasoning, Jarnot said, was if there was a student suspected of overdose, the school would immediately contact law enforcement and EMS — both of which carry Narcan. Jarnot did add that school resource officers do carry Narcan.

Outside of Narcan, Seldeen said she’d love to see the “normalization of drug testing for both users and dealers.”

“Testing for the presence of fentanyl in recreational drugs like cocaine and MDMA can greatly reduce overdose risk, as you can find out if there is fentanyl in your drugs and make an educated decision on how to use or not use from there,” she added.

This is something that is gaining more traction and may be helping to save lives. The detectives from GRANITE said that people are becoming more cognizant about the risk of fentanyl being laced into other drugs. As such, detectives said that in “the majority of our local investigations, we’ve found at-home fentanyl test kits.”

“A lot of people are aware of what’s occurring and might be taking steps to try and prevent that,” they added.

The power of prevention

However, while these prevention methods are beginning to gain popularity in some circles, there is still a common stigma and misconception in other circles around increasing access and distribution of Narcan and other prevention efforts.

“There’s a huge disconnect and misconception that if you provide those types of prevention programs, it will lead to more use,” Hermes said. “We need to increase access to these preventative things.”

Prevention efforts, experts say, is much more effective than treatment after the fact, especially given the high risk of overdose with the presence of fentanyl.

“Evidence-based prevention programs have shown to dramatically reduce substance use, some over 50% in specific regions,” Bettis said. “Harm reduction provides our community members with understanding how infectious disease control and prevention education plays a main role in knowing risks of substance and alcohol use not just for the individual, but lasting impact on their community.”

Prevention, Bettis added, also starts with knowing, accepting and understanding that there are going to be people using substances like drugs and alcohol. From there, the community can put measures in place “before we need to focus on treatment and recovery.”

While Eagle County Public Health has not led any specific public health campaigns around the opioid and fentanyl crisis, it has been engaged in encouraging and financially supporting and assisting local organizations with their prevention efforts.

“Specifically for opioids and fentanyl, we have seen trends of increasing use throughout Colorado and the nation, so we will need to be proactive in our planning, prevention and intervention efforts,” said Heath Harmon, Eagle County’s public health director. “While access to treatment is still very important, prevention efforts are cheaper and more effective, and scalable to reach every community member. We need to support both approaches to be successful in the long term.”

Plus, Harmon added, with prevention, the earlier the efforts start — the better.

“Some of the most significant investments for preventing substance misuse are actually made in the earliest years of a person’s life,” Harmon said.

And although the county department has yet to engage in its own campaigns around the issue, it is aware of the challenge the fentanyl and opioid crisis presents. Harmon said the department is planning to convene a group of stakeholders in law enforcement to further discuss prevention and harm reduction efforts within Eagle County. These conversations will include discussions around opioids and fentanyl, he added.

Another one of the ways that local public health is engaging with community partners is in a regional planning effort to utilize the opioid settlement funds that will begin arriving into the state later this year.

The county will receive a portion of the approximately $400 million in settlement money Colorado will receive from national lawsuits filed against the largest opioid distributors and manufacturers in the country. How much, is yet to be determined, but Harmon said that public health is “deeply engaged” in the effort to distribute funds.

In these discussions, Harmon said that public health is working with this committee and harm reduction organizations to see how these funds can support a range of prevention, treatment, recovery and criminal justice programming.

“In general, benefits of these programs can range from education, to referrals to intervention or treatment services, to preventing the spread of communicable diseases, to preventing overdoses and death,” Harmon said.

For Harmon, however, the key around such prevention efforts is that “one message or a single approach won’t work.”

“It takes consistent messaging and support for our community in a holistic way to promote health throughout our life,” he said.

A whole-person approach to prevention

While some of these prevention efforts are thought of as only a way to prevent overdoses, preventing the cycle of addiction and opioid use, abuse can start much sooner and with a different set of prevention efforts. These efforts include having strong community mental and behavioral health care, systems of care and meeting people where they’re at.

In starting High Rockies Harm Reduction, Seldeen thought about the services needed in a similar way to how housing initiatives have the ideology of “housing first” — or the idea that housing, and having a stable living environment can serve as an access point to overcoming other challenges such as job stability and mental health.

“My ideology in doing all of this is that substance abuse is a mental health issue, and it’s usually a symptom of something else — that the substance use itself is not the root problem, that it’s a coping mechanism for problems beyond our control,” Seldeen said. “We believe that addiction and substance abuse are symptoms of mental health issues, not the cause.”

As such, High Rockies Harm Reduction offers peer recovery support services, connects individuals with behavioral health resources and works to address all these factors that may have led to substance use.

“The way I work with individuals is by really focusing on their mental health and bio-psychosocial influences: Other than getting individuals the supplies they need, I generally don’t even talk about substance abuse right away. Instead, I explore their hobbies, interests, social life, job, education, medical and behavioral health, etc., and work on getting the tangible aspects of their life together so they can begin to focus on their mental health,” Seldeen said.

This is similar to the way Vail Health and Eagle Valley Behavioral Health approaches addiction treatment and patient management, according to Bettis.

“We really want to combat the opioid crisis by having a stoic opioid prevention measure in place, knowing that addiction can be so fierce that it can create societal and cultural issues to present those barriers to behavioral health care interventions existing,” Bettis said. “There’s a lot of things that happen with addiction when it comes to job loss and homelessness and fear of that treatment, financial barriers; (Vail Health wants) to treat the whole patient in their whole system of care.”

Bettis referred to this approach as a “safety net of wraparound care.”

Not only does this type of system rely on collaboration between community partners to share resources and provide residents with the care and services they require, but it’s also something Vail Health builds into its patient care at many levels of care, she said.

“Substance can be part of our culture in many ways,” Bettis said. “So we want to set up within the health care system, treatment opportunities and that harm reduction forward piece, even when going to see our primary care physicians.”

Joe Drew is a pain and substance specialist at Colorado Mountain Medical. He represents one of the pieces of this system of wraparound care by helping patients manage chronic pain medication and manage pain after surgeries and in other scenarios. He also helps to facilitate and administer medical detox for individuals grappling with addiction.

In recent years, the increased awareness around the opioid crisis has led to an increased number of patients concerned about the prospect of becoming addicted to opioids, Drew said.

Not only that, but in his experience, the health care community has become more hesitant about prescribing opioids as the knowledge around the potential downsides of opioid prescriptions spreads.

“Education is where it starts when it comes to preventing a patient from misusing medications and having addiction struggles,” Drew said. “Spending the time to answer questions about opioid pain medications and how they should be used is an important part of reducing opioid misuse and abuse.”

Part of this education includes reframing how pain can be addressed.

“Pain lives in the brain, and getting the brain on board is vital to having effective pain management. I strongly encourage patients to engage with a counselor or therapist. I advocate for a holistic approach to pain management. The old mindset of just taking a pill to ‘kill the pain’ needs to change,” Drew said. “Incorporating the holistic approach to pain management ensures that we are doing what is best for patients.”

This holistic approach can include counseling as well as physical therapy, acupuncture, chiropractic services, meditation and more, he added.

Legal prevention, action

As prevention efforts work to overcome these barriers and stigmas on a local level, there has also been a recent rise in the number of statewide efforts to address and slow the fentanyl rise through the legal process.

In late March, a bipartisan bill was introduced in Colorado to increase the penalties for manufacturing and distributing fentanyl. This includes increasing penalties for dealers caught with fentanyl and in cases where the drugs dealt lead to death. It would also increase access to opioid antagonists, like Narcan, and fentanyl testing strips. It would not, as currently written, include harsher punishments for simple possession of fentanyl.

Locally, these types of legal action are something that Heidi McCollum, the district attorney for the 5th Judicial District, which spans Clear Creek, Eagle, Lake and Summit counties, fiercely believes in.

“We have to be tougher on fentanyl distribution — not just here, but across the state,” McCollum said. “I believe that illegal distribution of fentanyl is a serious crime, and should be prosecuted as a felony.”

McCollum said the local district attorney’s office looks at both possession and distribution cases as “very serious offenses in terms of prosecution.”

“While the possession cases typically have put the individual defendant at risk, the distribution cases put multiple people at risk of serious injury or death,” she said. “The lethality of fentanyl cannot be ignored as a factor when considering the direction that a criminal case should take.”

This “grave risk of severe harm including death from fentanyl,” McCollum added is what has led prosecutors to take a closer look at these cases and their potential impact on the community.

“Fentanyl, whether it has been produced illegally, or prescribed illegally by a medical professional, is still very dangerous when it is on the street,” she said. “Like other dangerous crimes or drugs, it is important to keep the safety of our community members at the forefront of our goals.”

McCollum said tackling the crisis through the criminal justice system is part of her elected duties — specifically her duty to keep the counties and communities her office serves, safe.

“If we can send a message that illicit fentanyl use and distribution will be met with severe penalties — and save just one person — then, our efforts are well worth it,” she said.

At the end of the day, all of the community members, experts and harm reduction leaders agree on this point: that if prevention efforts can save even just one life, they’re well worth it.

“For me, it’s all about providing the tools and resources for people who do chose to use so we don’t have to lose unnecessary life,” Seldeen said.

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