Orange County, Vermont, typifies many rural counties with its natural beauty and demographics. Located between Interstates 91 and 89 and just south of Montpelier, the state's capital, the heavily wooded county with beautiful lakes and state parks covers 692 square miles with a population of 30,000 people.

But what also lies in this county is the never-ending struggle to combat opioid abuse.

Orange County Sheriff William Bohnyak is no stranger to the opioid epidemic. He and his team have dealt with topioid infographiche plague that has infected not only his county but numerous other rural areas around the country.

“What I've found over the years … these drugs, especially the opiates, there's no discrimination. Doesn't matter what color your skin is, whether you are male or female, young or old, it doesn't matter ... there's a wide variety of people who are using these drugs.”

Over five years, Bohnyak has gone to many funerals of friends and members of the community who were overcome by opioid addiction.

One funeral was for the daughter of a family friend: a 26-year-old mother of four who became addicted to the painkiller, oxycodone. She sought out help and was on the way to overcoming her addiction, but when she became pregnant with her fifth child she relapsed and was found in a bathtub with a needle in her arm. She had overdosed by shooting up pure fentanyl.

Since the pandemic hit, Bohnyak said the drug problem has become more noticeable and prevalent in his community. Neighbors have noticed suspicious activities such as cars coming and going from certain houses, and even with people laid off from work, Bohnyak has found that they are still finding ways to pay and support their drug addiction.

According to a new report released by the Centers for Disease Control and Prevention (CDC), overdose deaths have accelerated during the COVID-19 pandemic with over 81,000 drug overdose deaths in the United States from May 2019 to May 2020.

According to the CDC, in 2018 alone 67,367 drug overdose deaths occurred in the United States, with 46,802 of those being directly related to opioids.

Synthetic opioids have driven much of the increase, the CDC noted. The impact of manufactured fentanyl was especially pronounced, causing an increase of 38.4% in overdose deaths between May 2019 and May 2020. CDC also noted a 26.5% increase in overdose deaths by cocaine and a 34.8% increase in overdose deaths involving psychostimulants, such as methamphetamine.

Across the nation's over 3,000 counties, opioid misuse continues to pose a challenge for county justice and health departments, with 130 Americans dying of an opioid overdose daily, according to the National Association of Counties. But the full extent of the rural drug problem doesn't stop there; it's impacting families as well as those who work in border control, health departments, sheriffs, and criminal justice systems.

On the Arizona border, Mark Napier, the outgoing sheriff of Pima County and soon-to-be chief of staff for the Cochise County Sheriff Department, has seen a different threat that he believes needs more attention than opioids.

“Interestingly enough, in Pima County, the number of overdose deaths from methamphetamine is actually higher than from opiates," he said. "Opiates get a lot of attention, and rightly so, but the real threat is methamphetamine. It’s coming up in enormous quantities from the border and I'm not saying that opiates are not a threat or not a public health problem but we often don't talk enough about methamphetamine.”

Napier and Lieutenant Samuel Pavlak of Yuma County, Arizona, both confirmed in interviews with Agri-Pulse that methamphetamine, heroin, and manufactured fentanyl are the three main drugs coming over the U.S.-Mexico border.

With medical marijuana becoming increasingly legal across the country, Pavlak said the border saw an increase in Opioid Umbrella Graphicsmuggling of harder drugs, especially methamphetamine. The glut of supply led to drastic cuts in costs, leading to meth being as cheap as $10/gram on the border. Pavlak also noted that the farther north the drugs go, the more expensive they become: That same gram of meth for $10 at the border could cost anywhere from $40-$80 in Ohio.

On top of the relative affordability of the drug, Napier said meth is also troubling due to the additional law enforcement needed to subdue a person who has overdosed.

“The violence that people engage in when intoxicated on methamphetamine is completely and totally different than the symptoms that somebody has when they're on opiates,” said Napier. “When somebody overdoses on opiates, they essentially go to sleep and they never wake up, they die. When somebody overdoses on methamphetamine, they engage in bizarre psychotic criminal behavior.”

Napier said resources are needed on the borders to prevent the drugs from coming in, since if the border can stop the drugs from entering the U.S., then the drugs will be stopped from moving farther into the country. But Napier also said more educational resources are needed to warn people about the effects of drug addiction, pointing to the educational prevention that has gone into drunken driving as an example.

“You know when I was a kid growing up, we didn't know what a DD was," he said. "Today, my kids definitely know what a DD is because we've done a good educational program with impaired driving.”

However, Bohnyak, the Vermont sheriff, says more resources and funding are needed in rural America. Most of the funding and resources are sent to urban areas for treatment and prevention, he said, since there is a higher concentration of drug use and distribution in those areas.

Bohnyak says urban areas may have more drugs, but people in rural areas are using them the most, and they do not have the proper access to treatment centers and resources to overcome their addiction.

Both sheriffs emphasized this is not an issue that can be solved through the criminal justice system. “We cannot arrest our way out of this,” Napier said. "As long as there are people in the U.S. demanding drugs, the drugs will continue to come across the U.S. border." 

Bohnyak noted the need for “a balance with the judicial system and the drug addicts."

"You can't just take a drug addict and put them in prison for 30 days without starting some sort of treatment program. We’re setting people up for failure,” said Bohnyak.

The National Association of Counties has conducted research on the opioid epidemic, specifically looking at the multistate area surrounding the Appalachian Mountains. Following its research, the organization suggested the best solutions for the issue would come through local leadership spearheading a movement of educating community members on the effects of drug addiction and providing local resources to combat the issue.

“We've talked about the need for local leadership to set the tone in these conversations around opioids ... we see that as the key starting point," said Johnathan Harris, NACo's research director.

Sheriff William Bohnyak

Sheriff William Bohnyak

NACo also recommended strengthening preventive educational initiatives, creating safe disposal sites or needle exchange programs, working with parents and families to talk with their children about the impact of drug addiction, and increasing access to telehealth services to help individuals in rural areas have greater access to mental health services.

“We definitely emphasize the mental health portion of this, and the need for mental health treatments alongside the addiction treatments,” Harris added.

In Erie County, New York, the first opioid crisis intervention court was established in 2017 to help drug addicts receive treatment and gain a support system to overcome their addiction. The special court is the only one of its kind in the U.S. and resides in a county with rural areas, but also suburban and urban areas surrounding Buffalo, N.Y., and its roughly 250,000 residents. 

“We should treat this as a health crisis, first and foremost, and not a criminal justice crisis,” said District Attorney John Flynn.

Sheriff Mark Napier

Sheriff Mark Napier

Under the court's operation, when an individual is arrested for possessing drugs, stealing, or any misdemeanor, they are evaluated by a medical provider to identify if they suffer from an opioid addiction. If so, their case is put on hold and they are sent to either an inpatient or outpatient treatment center. Each individual reports weekly to the judge to report on the status of their treatment. The judge then determines if the individual’s case is ready to be tried.

“And we either dismiss the charges, lower the charges, give them a plea deal or whatever it may be: depending on the facts of the case, the severity of the case, and depending on how well this person went through the treatment,” Flynn said.

In 2016, Erie County hit a peak of 301 overdose deaths followed by three successive years of decreasing opioid-related deaths, with 156 recorded in 2019. However, once the COVID-19 pandemic hit, the numbers began to skyrocket.

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In all of Erie County in 2019, there were 636 nonfatal overdoses to which police responded. In 2020, there were 929 nonfatal overdoses. 

In the rural areas of Erie County, there were 40 nonfatal overdoses in 2019 and in 2020 there were 65 nonfatal overdoses in the rural areas. Erie County has not been able to release the numbers of fatal overdoses due to the need for a finalized exam by the Erie County Medical Examiner’s Office.

Flynn attributes this increase to the increasing number of individuals working from home and struggling with mental health issues. But the coronavirus pandemic also shuttered courts and rehab facilities. The increase of COVID-19 patients in the hospitals has made it difficult for drug addicts to seek and receive any sort of treatment.

Flynn said he is working and advocating to start more opioid crisis courts around the country, especially in rural areas. 

District Attorney John Flynn

Erie County District Attorney John Flynn

“They need these opioid courts in counties that are in rural and suburban areas because, you know, this crisis is in the country and it’s hitting the Appalachian area hard, it’s hitting South Eastern Ohio, West Virginia, Kentucky … I mean it’s all over rural America,” Flynn said. “Every one of these places needs an opioid court. I'm telling you opioid courts, it saves lives.”

The opioid crisis court in Erie County applied and received a federal grant of $298,000 in 2016 that covered all its costs until 2019. Flynn said it costs about $100,000 per year to operate and supply resources for the opioid court to run efficiently. Since the federal grant ran out of money, Erie County has begun funding the program on its own through extra funds and sales tax revenue. 

“That's going to be a problem for rural communities where their local governments don't have the money. … These local communities, they need a strong partnership with federal and state governments to help them fund these kinds of programs,” said Flynn.

From the start of the program in May 2017 to July 1, 2019, the Erie County Opioid Crisis Intervention Court had a total of 486 people that went through the program with 310 people finishing. The program has had a total of four deaths: two were overdoses, one was by suicide, and one was a result of a medical condition not related to the individual's drug problem. There are currently 106 people in the program.

If you or someone you needs help for a substance use disorder, the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline is 1-800-662-HELP.

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