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On the front lines: How opioid use disorder affects Carlton County, and who's here to help

Etta Souder talks through the typical procedures Community Memorial Hospital emergency department nurses follow when treating someone who overdosed. Narcan is kept locked in the red drawers. (Jed Carlson / jcarlson@superiortelegram.com)

For more about this series, "Addiction: Everybody's Problem," go here.  

For information about where to get help with addiction, go here.  

On a Friday afternoon in December, police and paramedics responded to an unconscious woman in the driver seat of a car parked in a Cloquet yard. She was found with her head tilted back and her eyes rolled into her head, according to police reports.

The woman regained consciousness after two doses of Narcan — the opioid antagonist that can revive people who overdose — and was transported to Community Memorial Hospital.

She was just one of 67 people in 2018 who arrived at the CMH emergency department after an overdose, according to data collected by Etta Souder, director of emergency services.

Souder is passionate about filling in the cracks that people with opioid use disorder, and other substance use disorders, tend to fall through.

To understand the scope of the crisis as it affects the hospital, she reviewed every patient chart from 2018 to record the number of people whose chief complaint had been an overdose.

Opioids, she said, caused the vast majority of those overdoses.

As of last week, Souder had counted six overdose patients so far this year.

"And these are just the ones that show up at the door," Souder said. "How many more are going on outside of that?"

Probably many, Souder speculated, considering a common misconception she's aware of. People are often afraid to visit the hospital after an overdose for fear of having the cops called on them, which Souder said hospital staff wouldn't — even can't — do.

"That's not our goal — to get people in trouble. Absolutely not. We can't," Souder said. "Our goal is to treat our patients and make sure they stay alive."

A federal law restricting release of medical information means hospital staff can't talk to anyone other than the patient about their medical history and status, unless the patient grants permission, Souder said. She's not the only one working to grow awareness on matters related to public health.

For Carlton County public health educator Ali Mueller, that's her job. Every five years, she said, public health departments conduct a community health assessment to determine the area's top three health priorities.

In 2012, drug use was the second priority in Carlton County, Mueller said. Then in the 2017 assessment, drug use had risen to the No. 1 priority.

"That just reinforced to us that we still have a substance use problem in our community that we need to address in maybe a different way than what we've already been doing," Mueller said.

And that's what she, along with many others in the community, have been trying to do. From health care staff and law enforcement, both on and off the Fond du Lac Reservation, to the employees at the Carlton County Courthouse and more, there is a growing web of support for people with substance use disorder.

Paul Coughlin, Carlton County jail administrator and drug court representative, said that strong partnerships, like the one between the jail and Fond du Lac Band of Lake Superior Chippewa are invaluable, and something he doesn't take for granted.

"The amount of work that the tribe does to help their members in the area is far and above anywhere I've ever seen," Coughlin said. "They could say, 'Look, that's a county jail. That's not our issue,' but they don't come at it with that attitude. They come at it with, 'What can we do to help?'"

Still, there's a long way to go, and many cracks that have yet to be filled.

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For more, read "Overdoses: The Thin Line Between Euphoria and Oblivion."

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Souder wants to see more follow-up support for people who leave the emergency department after an overdose, knowing their chance of using again is very high if they don't get the proper help. Not everyone is in a place to accept that support, Souder said, but she wants patients to have access to those resources just in case.

"Patients that we've seen come in here, one day they're gone," Souder said. "We've seen it where they don't come back."

It's a fact Souder can't shake off.

"We've got to do something," she said. "It's just plain and simple."

Holly Compo, a public health nurse at the Carlton County Jail, wants to see more treatment beds and more housing so people with substance use disorders can re-establish themselves somewhere stable, as opposed to sleeping on someone else's couch.

"Until the community decides those barriers are important enough to help fix, we're going to keep seeing this revolving door in the jail," Compo said. "You can't go back to the same people that are enabling you. You need to have a better place to go."

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Etta Souder looks to a wall where she wants to hang a resource board at CMH on Feb. 27. (Jed Carlson / Superior Telegram)

On Halloween night last year, a 24-year-old woman went into the bathroom to make a phone call and when she came out a witness thought she appeared to be overdosing, according to a Carlton County Sheriff's Office report. She nodded off several times, but woke whenever officers nudged her or yelled her name, police wrote. The woman admitted that heroin caused the overdose.

In the vast majority of cases the victim of the opioid overdose was in their 20s, according to police reports since January 2017. The Fond du Lac Police Department did not respond to a record request for reports.

Of the four Carlton County victims who died of an opioid-involved overdose in 2017 and 2018, three of them were in their 40s, according to medical examiner reports.

"It really can be any walk of life," Coughlin said of people with opioid use disorder specifically. "It could be your neighbor; it could be your grandparent."

Between 2006 and 2015, the number of Carlton County residents admitted to treatment for opioids as the primary substance of abuse rose from 8 percent to 40 percent, according to local data shared by the Carlton County Drug Prevention Coalition.

And with every person affected by some sort of substance use disorder, there's also a family struggling, too.

"I think that people need to understand that while we may focus on the addict or the arrestee or the person in jail," Coughlin said, "there's a family and a community to whoever that person's attached to that suffers with them."

Souder understands that all too well. Addiction is not just something she's had to deal with at work — it has also been a part of her family.

"It went down a really bad road," Souder said, "and I'm happy to report they are now in recovery two years, almost three."

Andee Erickson

Andee Erickson has been a reporter with the Pine Journal since November 2018. She studied journalism and geography at the University of Wisconsin-Eau Claire, while working at the Leader-Telegram newspaper on weekends. She graduated in 2018. Erickson's from southern Minnesota, but started viewing the north as home after interning for the Duluth News Tribune in the summer of 2017. 

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