Opioid recovery options available in rural areas like southwest Minnesota, but with 'big gaps'
"It's bad anywhere but it's really bad in rural areas," Alicia House, executive director with Steve Rummler Hope Network.
Editor's note: This is the fourth installment in a series about the opioid epidemic across the region. Watch for the fifth and final story in this series next Wednesday.
WORTHINGTON — While opioid use disorder is a condition that affects over 2.7 million people in the United States, access to recovery services can be hard to come by, especially in rural areas.
“Some of the biggest gaps for these individuals when they're trying to take the first steps into recovery — especially if they're coming from a rural community — is you don't have withdrawal management beds,” said Alicia House, executive director with the Steve Rummler Hope Network. “I still say getting into withdrawal management is like winning the lottery…It's bad anywhere but it's really bad in rural areas. You're going to have to travel hours and hours to find your closest withdrawal management, and then depending on the community you live in, once you get there, who even knows if there's going to be an opening? That's a big problem.”
Withdrawal management is the practice of offering specific medications to reduce the physical effects of detox, in order to transition a patient out of active use and into recovery.
While opioid withdrawal isn’t fatal, House noted it’s a severe and extremely difficult process, and not as easy as simply stopping use. The process typically lasts between three days and a week, with the intensity of withdrawal symptoms — which can include body tremors, insomnia and heightened cravings — peaking during days one to three.
“Usually they need some sort of medicated assistance to make it through that first seven or so days of not using,” House said of people with opioid use disorder. “Unfortunately, a lot of times people would say ‘I would rather die than withdraw on my own.’ And unfortunately, that's a decision I saw a number of them make.”
While residential treatment sites are places people can go during recovery, most often, in order to be admitted, they have to be medically stable — which people going through withdrawal are not. These types of treatment facilities aren’t set up for the type of round-the-clock monitoring necessary for an individual going through withdrawal, House added, but the difficulty of withdrawal and lack of access to withdrawal management and detox programs can make it difficult to get to that treatment step.
“We have all these things in place to help somebody make it from day seven to day 500,” she said. “What we lack is helping someone get from day one to day seven.”
There are no withdrawal management programs in southwest Minnesota, according to SRHF’s map of available detox programs. The New Life Treatment Center in Woodstock has seven detox beds and is the closest facility offering detox services to Nobles County. The next closest is in Marshall.
“It’s such a vital service,” said Cheryl Thacker, director of New Life. “We don’t have a lot of beds, but they’re pretty crucial…Ours is a clinically monitored detox, so we have 24/7 licensed nurses and a nurse practitioner who is on call. We make sure that we do everything we can to keep safe during the time that they’re with us, whether it’s two days or 10 days depending on the drug used and the level of use.”
Oftentimes, Thacker said, when people come in for detox, it’s the last place they want to be. They might be brought in by law enforcement, or want to go through inpatient treatment but need to be medically stable first.
“We have the opportunity to have a conversation with them,” said Thacker. “We do a detox assessment or full assessment, and have a conversation with them about their health, how their use is impacting their life, and talk with them about options to receive treatment, whether with us or with someone else.”
While the use of New Life’s detox beds comes in waves, Thacker said, on average they have three of their seven beds in use.
Established in 1977 primarily as a treatment facility for people struggling with alcohol misuse, the New Life Treatment Center has undergone expansions and updates over the years. Today, they have 21 inpatient treatment beds with their 12-step, faith-based residential program, as well as outpatient treatment programs in Woodstock in Worthington. Additionally, New Life provides treatment services to individuals incarcerated at the Prairie Justice Center in Worthington, after being approached by Nobles County in 2018.
“That kind of cleared the way for us to offer services down there,” said Thacker. “It’s been a phenomenal partnership.”
Primarily, New Life services southwest Minnesota, northwest Iowa and southeast South Dakota, but they draw people from all over the state and all over the country for a wide range of substance use treatments. Most commonly people seek treatment for alcohol and methamphetamine use, Thacker noted, but there has been a recent uptick in people seeking treatment for opioid use.
“There are two distinct places where we're seeing that growth and opioid use,” she said. “The first is with kind of a younger crowd using for recreational experiments. That’s also where we're seeing a lot of accidental overdoses, when people are getting stuff that’s laced with fentanyl. That’s a growing problem and we go to too many funerals.”
The second area where Thacker noticed an increase in opioid use is with older individuals, people who have had surgeries, or people dealing with chronic pain, who were prescribed opioids as a method of treatment. As the public became more aware of the addictive nature of prescription opioids, those prescriptions became harder to come by.
“You have these people who do desperately need that medication or have become dependent on it,” Thacker said. “I think there was somewhat of an overcorrection when it was realized that people were getting addicted at a much higher rate than what had been acknowledged previously, where doctors were really concerned about prescribing. That left these people in a very vulnerable spot.”
Moving forward, she said that making sure people are educated about the dangers of opioid use is important in addressing this problem, a sentiment echoed by the staff at Project Morning Star, a sober living home located in Worthington.
“There’s a big need for that, educating people about what opioid use disorder is and how quick an overdose can happen and how to stop it,” said Beth Hoekstra, director of operations at Project Morning Star. “When other people know more, I think that helps people trying to recover too.”
Hoekstra describes project Morning Star as a sort of transitional stepping stone for people who might be coming out of drug court or local outpatient treatment, and are in the process of recovery, but aren't quite ready to be on their own yet.
“We offer support and accountability. It's really that next step to them being on their own,” she said. “We don't want to see people stay stagnant. We want them to be working on things that are going to better their lives.”
That can mean a lot of different things. Sometimes Hoekstra says they're helping people get a driver’s license, filling out applications for medical services or food stamps, working on a resume or connecting people with additional resources. Residents will also have access to group counseling, life skills and job skills courses.
Set up to accommodate up to six men and five women, Project Morning Star follows a Christianity-based 12-step recovery program. Residents are expected to attend a church of their choosing, pay rent and cook their own meals as they work on being independent but in a supportive environment with individuals who share their experiences and goals.
“We want to set people up for success, and once they leave it's not like ‘all right, see you later,’” Hoekstra said. “We still want to be a part of their recoveries and in their lives.”
Recently, using funds from the Southwest Minnesota Opportunity Council, both Hoekstra and Assistant Director Lee Stewart attended training to become peer recovery specialists, a service they are eager to begin offering individuals leaving Project Morning Star, having both had their own journeys with recovery from substance use.
“It's a very different approach and very different from the kind of training I've received in the past. As a peer recovery specialist, you're really a cheerleader for that person. You want to be this positive uplifting person in their life and almost acting as a guide.”
While it's a conflict of interest to provide this service to people who are current residents at Project Morning Star, Hoekstra noted it will be another way to stay connected with residents who have moved on, should they choose to do so.
“It's so important to know that you're not alone in this and to have that support and accountability.” Hoekstra said. “There’s not as much available out here, but it’s something so needed in this community….We really want people to know that (Project Morning Star) is out here and we’ll help.”