Because of rural Mon-tana’s small population, fully understanding the scope of opioid abuse is difficult.
For example, because the number of overdose occurrence is too small for statisticians to get reliable conclusions, several counties in the state are clustered together. Region 2 includes Blaine, Cascade, Chouteau, Glacier, Hill, Judith Basin, Pondera Teton and Toole.
While the data is not specific by county, Toole County Health Nurse Kristi Aklestad explained that valuable information can still be gleaned.
“What they find is the overall admission rate for overdose in our region from 2012 to 2014 was slightly higher than the statewide total, so it was 167.1 per 100,000 [in Region 2], and the state was 115.4 per 100,000,” Aklestad said.
Anecdotally, providers and other officials have seen an uptick in opioid abuse in the area.
According to Brooke Rogers, treatment coordinator for the Ninth Judicial District Drug Treatment Court, which encompasses Glacier, Teton, Pondera and Toole counties, abuse of opioids is a concern in the drug court.
“We’ve had a lot of people who have abused Suboxone when they’re coming here. Opioids are also an issue,” said Rogers.
Cut Bank Police Chief Michael Schultz said that illegal possession of Suboxone has declined since the Ideal Option clinic opened in Cut Bank last year.
Before the clinic opened, Schultz said, “People were having to travel lengths to get Suboxone, so we were seeing a lot of Suboxone-related activity.”
Since the clinic has opened, that illegal activity has shifted and “people have been getting it legally.”
Dr. Debra Guinn, director of the Montana Perinatal Center and Director for Maternal Fetal Medicine at Kalispell Regional Medical Center, noted that evidence of opioid use disorder in newborns has jumped significantly in the last decade or so.
Guinn said that, according to Medicaid data, between 2008 and 2015, about 1.5 percent of all newborns covered by Medicaid showed evidence of opioid use disorder. Currently, about 8.3 percent of newborns on Medicaid show evidence of opioid use disorder.
The fact that many communities are very rural – 45 of Montana’s 56 counties are classified as “frontier” – make providing care even more challenging, Guinn said.
“It’s not the issue that you see as much on the east coast and this point in time,” said Dr. Greg Holzman, Montana DPHHS state medical officer, “but we’ve seen a significant increase in opioid use and prescribing and overdoses.”
Overdoses peaked in 2009 and have fallen since then. Between 2000 and 2015, 44 percent of all drug overdose deaths are attributable to opioids, according to Montana DPHHS. While the number of prescriptions for opioid painkillers has dropped recently, there were still 70 prescriptions written for every 100 residents in Montana in 2016, according to the Centers for Disease Control and Prevention.