CUMBERLAND — It’s a convoluted problem, one with tentacles that span as far as any monster’s.
The overdose crisis that’s accompanying high levels of opioid use across the country, for many, isn’t a faceless nightmare creature. It’s something they’re intimately acquainted with, whether through first-hand use or through watching someone they love struggle with substance use disorder.
Allegany County and the surrounding areas, unfortunately, aren’t any exception. In fact, factors like the area’s relative geographic isolation may be keeping those affected from accessing the type of care they need to recover successfully.
And, then there’s the shame.
Many who are living with the disorder don’t seek treatment because they’re ashamed to even talk about it, employees of the nonprofit Maryland Area Health Education Center West shared with the Times-News during a recent interview. The stigma around drug use, they say, is one of the largest hindering factors that they uncovered during a yearlong series of focus groups held as part of a Rural Communities Opioid Response Program planning grant, or RCORP. The grant supports the “Healing Allegany: Pathway to Recovery” initiative.
Later this year, AHEC will apply for a three-year grant that, if awarded, will allow them to implement what they’ve discussed in the planning phase. The needs assessment focus groups were held over the course of the last year, and centered on getting input from groups ranging from homeless folks and those currently in recovery to first responders and members of the local faith community.
High OD rate
The statistics certainly indicate a need. Allegany County, with a population of around 71,500, suffered one of the highest drug overdose mortality rates in Western Maryland between 2013-2017, the most recent years for which information was available.
In that time frame, according to data from NORC at the University of Chicago’s Appalachian Overdose Mapping Tool, Allegany County had an overdose mortality rate of 57.2 per 100,000 people. In Garrett County and Washington County, the rates were 29 and 52.5, respectively.
Statistics from the Allegany County Health Department also show 22 drug- and alcohol-related deaths in 2019, though the counts for that year are not yet complete.
“To me it was just an eye-opening experience with the focus groups to sit and talk to folks who were affected by it personally,” AHEC’s grants manager and social media coordinator Richard Kerns said. “It’s something to look at the dry stats and another to sit down and talk to people and see what that ground-level experience is was just enlightening.”
The conversations in the focus groups, Kerns said, also ended up validating much of what they’ve seen when looking at the numbers. Stigma, he said, was the factor they found that “cut across all the different groups” and manifested in different ways.
“The first thing everyone thinks of is the stigma associated with people who use: You’re a bad person, you’re addicted, that kind of thing,” Kerns said. “That stigma also then extends to the folks who are called upon to provide the treatment for addiction. It’s burnout. … It was eye-opening for me to see just how pervasive it is.”
The implementation grant that they are applying for, Kerns said, would aid in forming and operating community programs intended to serve as a resource to combat the stigma.
‘No one is immune’
AHEC associate director Melissa Clark said she found talking to the focus group comprised of folks in recovery to be a particularly eye-opening experience.
“They shed a real light on the battles they went through,” Clark said. “They shed light on the struggles, the stigma, the using, getting clean, going back and getting clean again and what their final straw was. It’s so different for everyone. But they’re still viewed, even though they’re in recovery, with that stigma attached to them.”
Through the focus groups, Clark said, she also realized that some members of the community who haven’t had direct experience with substance abuse, whether through their own struggle or a loved one’s, may not realize the full breadth and scope of the problem.
“They just think ‘Oh, they’re a bunch of druggies’ … and don’t understand until it touches their own or friends,” Clark said. “And even then they don’t sometimes. I think it’s a lack of understanding the information. When you hear it all the time, see the billboards all the time you think ‘OK, well it’s not happening in my house or to my family, so it’s not a real thing or a huge deal.’ … It doesn’t discriminate.”
“I think about my mom up in Clarysville reading the paper, and when she reads about someone who’s died, it’s probably that same kind of perception,” Kerns added. “And there’s probably a lot of folks out there like her, older folks who just aren’t as plugged inside to the community outside the paper who’d have that perception. … They don’t appreciate how it does cut across all levels of society, how no one is immune. I think that’s where a stigma program could come in to provide that education … that this cuts across every societal level, and you’re not a bad person.”
To a similar end, Kerns said he was surprised to learn how many people in recovery cited a particularly supportive listening ear from a peer recovery specialist — often someone who is in recovery themselves — as helpful in their journey.
“Just about everybody that spoke to us talked about the difference one counselor made in their life,” Kerns said. “It was one counselor that really cared, and in most cases it had been … someone who’d been there, done that. There was a real value they saw, and it impacted their lives, just the insight they could give and commitment that they had.”
Peer recovery approach
Executive director Susan Stewart said that in the Garrett County focus group, she’d heard from the participants that it was “all about the peer” when it came to folks in recovery finding someone they could be comfortable sharing their struggles with.
“They trusted a peer in recovery the most, and felt the most supported and connected to those who’d walked through the same thing they’d walked through,” Stewart said.
Though the peer recovery approach seems to be the most effective, the region’s relative geographic isolation can make it difficult for folks in recovery to even access the support systems they need.
“There’s a lot of trainings available, but they’re down in Rockville,” Kerns said. “You’ve got to be able to get to Rockville, put yourself up for two or three nights. So one of the things we’re saying going forward is how can we make that happen back here and make it easier so we can have more peer recovery specialists?”
“It’s harder to get the services the further you get from the center of the state,” Stewart said.
As so-called “compassion fatigue” grows among first responders tasked with handling an increasing amount of drug-related calls, Clark said, they, too, may begin to internalize some of the stigmatic elements. Kerns noted that part of the training that would be made available to first responders would entail giving them tools to support their own mental and physical well-being so that they can continue helping patients.
“I had one (first responder]) say to me ‘At what point do you just not do it anymore? When you’ve been to one house four times in a week, Narcan’d this person six times, it’s frustrating,’” Clark recalled.
Although stigma isn’t the only factor that affects substance abuse, Clark said, it’s one of the most imperative to bust, as silence often is the root of many of the compounding problems.
“That’s what our community needs to understand, that this can happen to anyone,” Clark said. “So stop judging everyone that has an issue. We all have issues, just to different degrees.”
Follow staff writer Lindsay Renner-Wood on Twitter @LindsayRenWood.