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Project meetings for opioid and fentanyl awareness have been conducted across the region by Tribal Health and the Confederation of Salish and Kootenai Tribes. On August 28 the first Sanders County meeting was held in Dixon. It was conducted by James Steele, Jr, director of the Tribal Opioid Response (TOR) project, Kathy Ross, TOR project manager, and Amber Landowski from Arlee Tribal Public Health Clinic.

Ross, who has been an addiction counselor for 15 years, said that the goal is to present a positive outlook and to change people's biases regarding addiction. Rewording the terminology helps people who are dealing with these addictions. Ross said people often feel ashamed or embarrassed to admit they have a problem and worse yet, they often don't seek help. The organization has looked at the language which is often used that can interfere with those who are in need of getting help. Her job also looks into other factors of addictions such as triggers, neurobiology, cravings, coping with stress and other life issues.

"Changing how we refer to them can help ease their anxiety. Saying 'return to use' instead of 'relapse' can change our perceptions about persons suffering with addiction and how they see themselves," Ross added.

Drug abuse often starts with young people getting the drugs from a family member, which may or may not be accidental. Ross said that one in nine high school students in Montana have misused drugs. When used consistently, their tolerance levels go up. The brain adjusts up to a higher level of tolerance, resulting in higher doses and more frequent use. "Opioids are more addictive than methamphetamines. They are harder to recover from," Ross stated.

The naturally occurring opioid receptors in the brain are activated by a family of peptides such as endorphins and dynorphins that are released by neurons. These receptors can also be activated by synthetic or alkaloid opiates, the prototype being morphine, according to an October 15, 2007, report by the European College of Neuropsychopharmacology.

Statistics show that there are 89 opioid prescriptions for every 100 residents in Montana. Eighty six percent of those are from addiction consumption. OxyContin is not the miracle drug it was first presumed to be, according to Ross. "There have been 564,000 deaths nationwide from 1999 to 2020 from oxy use. There was a drop in usage of oxy, causing heroin to take over as the drug of choice." Ross said, and " Fentanyl started to become popular in 2013. It is 100 times stronger than morphine, and 50 times stronger than heroin." With knowledge of its harmful effects, people who are addicted to it primarily from injury and pain usage are often unable to recover. There is still a major problem with these drugs, Ross and her team agreed.

Opioids absorb quickly in the molecules through skin and in the brain. It takes seconds or minutes before death occurs from an overdose.

Ross said that the statistics may not be accurate with the fatality and poisoning results. "Because," she said, "there are those people who do not get medical attention and may take off after being given the Narcan recovery drug. So they are not reported."

According to a national survey by Health and Human Services completed in 2019, 1.6 million people had an opioid use disorder. In 2019, 70,630 people died from drug overdose and 10.1 million people misused prescription opioids.

Lake County had 52 poisoning deaths between 2011 and 2022. Eighteen of those deaths were opioid poisonings. "To make matters worse," Ross said, "there are counterfeit drugs that may contain lethal amounts of Fentanyl or methamphetamines and are extremely dangerous as they are disguised as a legal prescription pill. Users are often unaware of how lethal they are."

The Montana 2023 EMS Data Report and Suspected Opioid Overdose Related report from July 25, 2023, had seven 911 calls in Sanders County. Five of those had Naloxone administered and were accurately documented. This report is available in eMedications fields located on NEMSIS 3.4 data dictionary or EMSTS documentation guidelines on overdose-related EMS incidents.

Oxycodone M30, Adderall and Xanax are three prescription drugs that can be counterfeit with lethal Fentanyl, according to a Drug Enforcement Administration drug fact sheet. The street names for M30 are Mexican Blues, Blues and M-Boxes. These make up the majority of counterfeit pills. According to the DEA report, there are indications that drug trafficking organizations are targeting kids and teens with these pills that are made to look like candy in various shapes and bright colors. The best way to avoid counterfeit drugs is to only take prescribed medicines dispensed by a registered pharmacist, the report said.

Ross said that Fentanyl can be added to other drugs in what is known as the chocolate chip effect. In the candy-looking and flavored pills the dose is unknown. "One pill might have a deadly dose and another one may not," she said, "like a chocolate chip cookie. You don't know how many chips you will get in each cookie. You don't know how much Fentanyl will be in each pill or whatever it is added to. It can be found in Xanax, Meth, or marijuana."

"Naloxone or Narcan are nasal sprays used to reverse the effects of an opioid overdose and save a life," said Amber Landowski from the Arlee Tribal Health Clinic. Landowski offers training on usage and hands out free Narcan to anyone wanting to keep it on hand. "It is safe to use and attaches to the opioid receptors in the brain. It works on all opioid related drugs such as heroin, Vicodin, Codeine and Hydrocodone. Narcan and Naloxone do not work on Xylazine." That drug is used in veterinary practices for sedation and muscle relaxation. It has been added to illicitly made opioids, heroin and prescription painkillers. It is consumed, inhaled or injected. It has been detected in a growing number of overdose deaths nationwide, according to the Benton-Franklin Health District report. Narcan or Naloxone should still be used to reverse opioid effects. Street names for Xylazine are tranq, tranq dope and sleep cut.

Since overdoses can occur within minutes, Landowski suggests administering Narcan immediately. "Even if the person isn't actually having an overdose, it will not harm them, but if they are it could save their life."

"There is help out there," Ross added. Medically Assisted Treatment (MAT) is available for people wanting to recover from opioid addiction. Since withdrawal can be difficult, Suboxone may be used to help with the process. Methadone management has been around for 20 years. " It has been recognized by authorities as the best replacement therapy," Ross said.

"People have been known to die from withdrawals," Steele said. Though not very common, it can happen.

"Males in their 30s to mid-40s have the highest rate of drug use. Native Americans are four times more likely than any other group to suffer from drug addictions," Ross said.

Steele said anyone can get Narcan for free. You don't have to be a tribal member. "This program is for everyone, not just tribal people, but for all the people. We want the word to get out and let people know what we have to offer."

The Elmo meeting was not well attended nor was the one in Dixon, according to Ross and Steele. "We are really hoping to have a better turnout in Hot Springs. This problem is not going away. The more people are educated on opioids and Fentynal the better. If anyone wants to organize a meeting we would be happy to help," Ross said

The next drug awareness meeting is scheduled for 6 p.m. Wednesday, September 27, at the Indian Senior Center, 214 Spring Street, in Hot Springs. For more information, contact Steele at (406) 529-6443, Ross at (406) 745-3525 or (406) 239-9745, or Landowski at (406) 241-5768. Individuals seeking help can visit neverusealone.com or call (800) 484-3731.