Census: Rural Americans Have Higher Rates of Disabilities Than Urban Dwellers
U.S. Census numbers show that higher rates of rural Americans have a disability than urban Americans.
In 2021, nearly 15% of rural residents reported having a disability, compared to 12.6% of urban people, according to the U.S. Census.
“It really doesn’t surprise me,” said Dan Kessler, interim executive director of Association of Programs for Rural Independent Living, also known as APRIL. “When you look at rural areas, in terms of disability, there are many factors. I think one of those could very well be just access to health care…. Looking at primary care, where you may see a physician for a number of issues, for example, your diabetes or, or some other condition, which, if left untreated, could very well result in someone acquiring a long term disability.”
Kessler added that the digital divide also impacts access to medical care.
According to the Census numbers, in 2021, the South had the nation’s highest rates of disability at 13.8%. That was followed by the Midwest (13.1%), the Northeast (12.3%), and the West (12.1%).
“A lot of people age into a disability,” Mary WIllard, director of Training and Technical Assistance at APRIL told the Daily Yonder. “We talk about disability, it is really from that birth to dirt kind of a spectrum. And so I would say aging into disability, it’s a big thing in rural areas that’s been happening.”
She added that the surveys have also changed how they ask the questions, which may impact numbers.
“We’re starting to see a bigger breadth of people now disclosing on the Census, as well. So that’s … some of it’s just semantics, I think, disclosing I have a disability versus I might have difficulty walking,” Willard said.
Kessler told the Daily Yonder housing is another factor. “If you have affordable, accessible, safe housing, that can have a direct impact on your health care and your well being,” he said.
WIllard added that in many rural areas, the housing stock is older, making it harder to retrofit for people, especially with the increased costs for building materials associated with the pandemic.
Direct care workers also may not get paid for the travel time from rural client to rural client, making it less financially feasible, she added.
Still, there are positives, Willard said.
“I think rural America, especially post pandemic, has become more appealing to people with disabilities, especially if you’re immunocompromised,” she said.
Willard also mentioned the program AgrAbility, which works to enhance the quality of life for farmers, ranchers, and other agricultural workers with disabilities.
“I think more programs like that are helping people with disabilities to really live the rural agricultural life that they want to,” she said.
Facing high fertilizer costs, farmers still struggle to use less
This is the fifth and story in a series, “The Price of Plenty.”
As a young boy in the late 1950s, Frank Glenn knew the soft, freshly-tilled brown dirt lining his family’s fields signaled the start of another planting season.
“Back when we were young buckaroos, we would plow and disc and get a crop of weeds to come up [and then] knock them down,” Glenn said.
Frank and his younger brother John would hop on the tractor and start pulling their blue plow through the fields in February and March. Then they would go back with a tiller and turn over the topsoil before planting corn, soybeans, wheat and oats.
Today, the Glenns are still running their family farm in Columbia, growing corn, soybeans and hay. But about 25 years ago they transitioned to a majority no-till operation, no longer digging up the first few inches of soil before planting. Their fields are now filled with big clumps of dirt and old roots from previous harvests.
Rob Myers, director of the University of Missouri Center for Regenerative Agriculture, said less than half of Missouri farmers are using a regenerative method such as cover crops, no-till or integrating crops and livestock. Cost is one of the factors holding farmers back, Myers said.
Farmers use fertilizer to build their soil’s fertility and help increase crop yields. But less than half of the nitrogen fertilizer applied is taken up by the crops. These excess nutrients wash into the Gulf of Mexico, creating a dead zone where fish and shrimp cannot live. But nutrient pollution is not just an environmental problem – it’s a business one.
Farmers are responsible for the cost of implementing alternative practices, and they bear the risk if it doesn’t work. Bruce Shryock, a corn, soybean and wheat farmer in Auxvasse, said farmers are stuck between science and the economy.
“If you spend more and then don’t make any more, then you’re in trouble,” Shryock said.
Matthew Backer spreads anhydrous ammonia onto a field on April 4 at Wise Bros Inc. in Kingdom City, Mo. (Photo by Kate Cassady/Columbia Missourian)
Farmer finances on the line
A report from the University of Missouri found that net farm income in the state is projected to decrease by 14% this year, while the U.S. Department of Agriculture anticipates national farm income to fall by a fifth. Meanwhile, farmers’ input costs have increased 55% since 2020.
Fertilizer accounts for about a third of these annual costs, and it now costs farmers nearly 73% more than it did in 2020. But farmers continue to buy it because it offers a good return on investment, said Ray Massey, a professor in MU’s College of Agriculture, Food and Natural Resources.
“The economics said that you can make more money if you have higher yields,” Massey said.
Farmers also must factor in other input costs like seed, pesticide, equipment and fuel. Crop revenue has increased but the prices for inputs have continued to rise, so their margins have stayed about the same, Frank Glenn said.
“It seems like they (the ag industry) don’t want farmers to make any money,” he said.
Some farmers coped with the price increases by cutting back on the amount of fertilizer they apply. Glenn said he and his brother went from applying 180 pounds an acre to 120 pounds last year. He said they were lucky crop prices were high or they might have not been able to survive the fertilizer price hike.
“Jesus, it makes you wanna puke,” his brother John Glenn said. “It’s so expensive.”
Frank Glenn plants corn in a minimum-till field on April 11, 2023 at Glendale Farm and Stables in Columbia, Mo. That day, Glenn had tuned into a country music station during his drive through the fields. (Photo by Maya Bell/Columbia Missourian)
Promoting intentional fertilizer use
Because fertilizer is expensive, farmers want to get the most bang for their buck, said Andrea Rice, director of research, education, and outreach at the Missouri Fertilizer Control Board.
The agency enforces Missouri fertilizer laws, conducts nutrient research and helps farms implement alternative farming methods.
Rice said high costs and current profit margins discourage farmers from applying more than the recommended amount, noting that farmers lose money if the fertilizer washes off their fields.
Heavy rain or snow melt washes fertilizer into waterways, polluting water and creating toxic algae blooms in lakes and rivers. Ultimately, some of this pollution travels downstream to the Gulf of Mexico and creates a hypoxic area called the dead zone at the mouth of the Mississippi River where water oxygen levels plummet. Any wildlife in these areas must move or suffocate.
“The Gulf hypoxia situation – that’s not something that any farmer would want to cause,” Rice said. But she said the problem did not appear overnight and is going to take time to solve.
Farmers have several ways of measuring how much fertilizer they need to apply to their fields. This includes soil testing and looking at past harvests to compare their yield to the amount of fertilizer they applied.
The Glenns use a satellite to create a grid of their fields and take samples from each block on the grid. They can see how their soil structure varies and pinpoint the exact nutrients each block needs.
Miscalculations such as applying too much fertilizer, applying it on frozen ground or overwatering fields will increase the runoff potential.
Sarah Carden, a senior policy advocate at Farm Action, an advocacy group opposing corporate influence in agriculture, said the industry is set up to support conventional farming, which disincentivizes alternative practices.
It’s easier for conventional farmers to qualify for crop insurance, Carden said, but it gets harder when a farmer wants to decrease the amount of fertilizer they use.
“It becomes a lot riskier for a farmer to participate in alternative forms of production,” Carden said.
Matthew Backer wears a gas mask as he spreads anhydrous ammonia onto a field on April 4 at Wise Bros Inc. in Kingdom City, Mo. (Photo by Kate Cassady/Columbia Missourian)
Making change happen
One method farmers can adopt to minimize the harmful effects of fertilizer is to plant cover crops, which help decrease erosion, hold moisture in the ground and reduce weeds.
Integrating cover crops was a learning experience for Shryock, the farmer from Auxvasse. In his first year planting cover crops, a wet spring spurred his rye to grow to about 8 feet tall. Getting that tall rye out of the field was a challenge, as it wrapped around his planter shaft and damaged the bearings on his equipment.
“I cussed it that first year,” he said.
Shryock has since learned to kill rye when it’s about 2 feet tall. He saw the benefits of cover crops after that first year as it helped his soil and decreased runoff.
Shryock also no-tills in addition to cover crops. These practices take more time, he said, but they’ve been worth it. He cut back on the amount of fuel he uses, but he still has to buy seed and pesticide and must spend time planting the cover crop. Shryock thinks more people would plant them if there was an incentive to help cover their costs.
Rice said education can help increase the adoption of cover crops, though some farmers are used to doing things the way they and their families always have.
She first advises new clients to do soil sampling. Then, she discusses the type of fertilizer they are using, the amount, application times and if they are using cover crops.
“If we take those things and we do a little bit at a time and we keep encouraging and keep educating over time, there will be a big impact,” Rice said.
The MU Center for Regenerative Agriculture has recently been awarded two grants: $25 million to offer financial incentives for farmers to implement regenerative practices and $10 million to research how to improve varieties of cover crops.
The grant will pay farmers to adopt grid sampling, cover crops and livestock grazing systems to decrease nitrogen runoff. It also will fund programs to help farmers learn about these methods and their benefits.
“It takes time to keep making changes and improvements in agriculture,” Myers said. “But I think we’re headed in the right direction with these practices.”
The former Rite Aid in The Plains now sits empty. Photo by Dani Kington.
THE PLAINS, Ohio — After operating for decades, the Rite Aid location in The Plains closed this summer. The closure has left residents without a local pharmacy and increased the distance between many neighboring communities and the nearest pharmacy option.
“This decision has been sprung on everyone (in) the Plains who used that pharmacy, completely without regard to how this would affect people who can’t easily travel to the next closest pharmacies in Athens or Nelsonville,” said The Plains resident Sam Jones in a Facebook message.
Jones has primarily used the Rite Aid pharmacy in The Plains since 1998.
Rite Aid press office representatives said, “A decision to close a store is one we take very seriously and is based on a variety of factors—not just one—including business strategy, lease and rent considerations, local business conditions and viability, and store performance.
“We review every neighborhood to ensure our customers will have access to health services, be it at Rite Aid or a nearby pharmacy, and we work to seamlessly transfer their prescriptions so there is no disruption of services. We also strive to transfer associates to other Rite Aid locations where possible.”
Press office representatives declined to provide more detailed information about The Plains closure.
Since 1998, the site of the former Rite Aid at 93 N. Plains Road has been owned by a Buffalo, New York-based company with the same address as national property management corporation Benderson Development. Company representatives did not respond to requests for comment.
The nearest pharmacies to the former Rite Aid include the Shrivers Pharmacy location on West Union Street 4.1 miles away and the CVS locations on East State Street and Court Street in Athens, each about five miles away. Existing Rite Aid prescriptions were automatically transferred to CVS, according to the store’s voicemail.
In addition to The Plains, the closure will also impact neighboring communities such as Chauncey and Millfield, which also lack a local pharmacy option.
“Late at night if a kid spiked a fever or needed allergy medicine I could run [to the Rite Aid] instead of Athens,” said The Plains resident Josie Dupler. “I used Rite Aid to get my flu shot every year, it was just convenient.”
For residents without reliable transportation, the increased distance to a pharmacy creates an added barrier to accessing healthcare.
Shrivers offers free prescription delivery. However, delivery is not an option for emergencies and some prescriptions.
In such cases, as The Plains resident Kit Seida said, those options “may as well be on the moon when you don’t drive.”
“No one wants to spend an hour on the bus when they’re sick just to go pick up something like cold and flu meds or an anti-diarrheal,” Seida said.
In addition to concerns regarding convenience and emergency pharmacy access, many residents expressed concern about losing the comfort of a local establishment.
The Plains resident Sue Estes has used the pharmacy for 25 years and will miss the comfort of a local store with familiar faces.
“The pharmacists always made me feel very comfortable when getting immunizations there and they always answered … questions I had regarding immunizations and medications with exceptional knowledge and patience,” Estes said. “It’s so sad that Rite Aid is no longer here.”
For Tammy Conner Hogsett, whose husband worked at Rite Aid in the late ‘80s and early ‘90s, the store “was not just another store, it was an opportunity creator for myself and my family.”
For others, the store’s disappearance is a troubling sign about the trajectory of their community.
“To lose Rite Aid feels disheartening,” Seida said. “Because all too often, all I hear is how The Plains has gone downhill, or how it isn’t what it used to be, or that it’s slowly ‘getting worse’. And the loss of an essential business, like the pharmacy, feels like proof-positive of those assertions.”
However, Seida added, “I — and plenty of others — are racking our brains to keep those assertions from being truth.”
After months of planning, the cities founded the Selkirk Pend Oreille Transit (SPOT) system, bringing the first fare-free bus to the area. Anyone 13 and up can ride alone with routes that span the entire county. Many riders are teens and tourists who rely on SPOT buses to get up to the ski resort as […]
For Decades, the Top Rural Health Issue Has Been Access to Basic Care; Now It’s Mental Health and Addiction
For the first time in 20 years, mental health and addiction are more pressing health concerns than getting access to basic healthcare, according to a survey of rural stakeholders.
Rural Healthy People 2030, released by the Southwest Rural Health Resource Center, surveyed a national sample of people “working to improve the lives and health of rural Americans,” to determine the most important issues facing rural residents. Participants included people working in health care, public administration, education, human services, and other fields.
In 2010 and 2020, the biggest issue in the survey was access to health care.
While access to health care remained one of the top five issues according to survey respondents, researchers said, the growing impact of mental health and addiction took the number one and two spots on the list regardless of age, race, region or occupation.
“For the past two decades, health-care access has been, far and away, the most important topic no matter how we cut the data,” said Timothy Callaghan, one of the survey authors. “The fact that mental health and addiction came out ahead of health-care access this time… certainly surprised us, but when you start thinking about the context of the past decade and the context of the pandemic in which you launched the survey, the findings are a bit less surprising.”
Callaghan said the rise of the opioid epidemic prior to the Covid-19 pandemic, and the growing recognition of the lack of mental health resources in rural America since the pandemic may be part of the reason. But changes in health care through the Affordable Care Act may have improved health-care access, bringing other issues to the top of the list, Callaghan said.
According to the U.S. Department of Health and Human Services, nearly 20 million people signed up for insurance as part of the Affordable Care Act during open enrollment this past year. During 2022, 35 million people signed up for insurance during the open enrollment period, 21 million of whom were part of Medicaid expansions.
Still the fact that mental health and addiction rose to the top across all categories was striking, he said.
“You’re going to see small changes in characteristics over the course of decades,” he said. “But the extent to which mental health and addiction have risen and were so consistently selected by stakeholders, demonstrates how big those issues really are.”
Stakeholders may have been focusing on what were the most pressing needs given the moment, Callaghan said. The survey was presented to stakeholders 2021. Partnering with rural health organizations like the National Rural Health Association, the Centers for Disease Control and Prevention, the American Hospital Association, and the National Association of Rural Health Clinics, the research center sent out links to the survey and asked stakeholders to comment. In addition, the center sent the survey to people who had filled out the survey in previous decades and asked stakeholders to identify others they felt may be able to provide insight.
According to the Pew Research Center, an estimated 40% of American adults suffered from increased mental health issues during the pandemic. A survey done by the Kaiser Family Foundation and CNN found that 90% of the American public felt the country was facing a mental health crisis. Adults across the country during the pandemic reported increased symptoms of anxiety, depression, hopelessness and sadness and suicidal ideation, as well as increased drug and alcohol use.
In all, 1,291 respondents answered at least one of the questions between July 2021 and February 14, 2022.
“I think part of (the rankings) could be that a lot of the rural stakeholders participating understood that we’re looking at 10 year trends,” he said. “Our data didn’t allow us to identify specifically why, for example, vaccination isn’t in the top 20 even though we might have expected it to be, due to the pandemic.”
Major concerns besides health-care access in previous surveys included heart disease and stroke, diabetes, and nutrition.
“We’ve seen some pretty considerable gains in heart disease deaths,” Callaghan said. “We still do have a gap between urban and rural America, but there have been some pretty considerable gains.”
Callaghan said it’s not clear if that is because rural health-care providers are better at managing the disease, or educating patients about the diseases, or if other topics have just become more important.
For now, Callaghan said, the study reveals where the focus of rural health systems should be, according to rural health stakeholders.
“We now have a better sense of the areas that are particularly in need of rural health investment,” he said. “We now know that addressing addiction and addressing mental health issues have become increasingly important to rural experts over the past decade and while health-care access remains important… we nonetheless have to start prioritizing the issues that are most important which are addiction and mental health.”
Biden Officials Had To Charter A Plane So They Wouldn’t Get Stuck On Molokai
The group didn’t trust Mokulele Airlines’ scheduled flights, underscoring the difficulties island residents have accessing health care and other services.
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Maine homeschooling numbers remain high following a pandemic spike
In the fall of 2016, Jessica Coakley became increasingly concerned that her son, Braden, was falling behind in school. The fourth grader had an Individualized Education Program, requiring certain services for students like him with different learning needs.
But his mother worried it was not enough.
“I was feeling like the teachers and the principals and the people weren’t listening to me,” said Coakley, who lives in Bradley, just north of Bangor. “I would go to these IEP meetings and I’d be crying when I’d leave because I just felt so frustrated.”
When her son’s state test scores came back, they showed he was testing at a first-grade level — three years behind where he should have been, Coakley said. His self-esteem was suffering.
Left with dwindling options, Coakley, who had gone to school herself for a year and a half to become a teacher, decided to teach him at home. Although she was skeptical and scared, she remembers thinking to herself, “All right, well, I can’t do any worse.”
Thousands of families are making the same choice in Maine and around the country, leading to a sharp increase in homeschooling that skyrocketed during the pandemic and has remained a popular option.
In the 2019-20 school year, just under 6,800 students were homeschooled in Maine. The following year, that number almost doubled to 12,048.
While the population of homeschooled students has declined year-over-year since then, state records show that this past school year there were still about 10,100 students learning from home — a 50% increase from 2019-20. Because of a shift in the way this information is tracked, accurate data from before that year is not available.
In just under a quarter of districts across the state, there are now more students being homeschooled than there were in the 2020-21 year, during the height of the pandemic-era increase.
Experts, parents and advocates cite a number of reasons for the dramatic increase. Like the Coakleys, some families have pulled their kids with disabilities because they worry their needs aren’t being met. Others have religious or moral objections to material taught in public schools.
Maine’s rural landscape means that for some students, there isn’t a lot of choice: It’s the local public school or homeschool. For still others, in-person schooling feels untenable because of bullying or social anxiety.
State officials hope more students return to the classroom.
“Public schools are critical to our democracy,” said Marcus Mrowka, Director of Communications at the Maine DOE, “and a way that kids can come together and learn the skills that they need to thrive. So we would hope that more parents would choose to send their kids back to public schools in the years ahead, and we are providing those supports to schools and to educators in order to make Maine public schools the best places they can be for schools.”
Experts say for at least some families, the pandemic showed them for the first time that they could homeschool.
“In the nearer term, what we see are families who maybe never considered homeschooling in the past,” said Heath Brown, associate professor of public policy at City University of New York, John Jay College, and the CUNY Graduate Center, and author of Homeschooling the Right: How Conservative Education Activism Erodes the State. But, “because of the pandemic they were compelled to experience it, and some felt like it was an approach to education they preferred.”
Brown pointed to shifts in technology, such as the availability of online curriculum, that made homeschooling more accessible, academically and financially. Thus, today’s homeschooling population is far more diverse racially, ethnically, and along class lines than it was historically. He also noted changes in state laws that made it easier for families to pursue this option.
“Homeschooling organizations have been very effective, especially at the state level, for pushing for more lenient laws, laws that make it easier to homeschool,” he said. “As a result, homeschooling has become quite attractive to many families.”
He categorized Maine homeschooling laws as “middle of the pack,” neither the most lenient nor the most restrictive in the country.
Here’s how it works: Within 10 calendar days of beginning home instruction, Maine parents or guardians must provide the school system with a written notice of intent. They pledge to provide at least 175 days of instruction in specific subject areas, including English, social studies and library skills. And at the end of each school year, they choose from a list of assessments to demonstrate their child’s academic progress.
Jay Robinson, superintendent of MSAD 72, based in Fryeburg, said the vast majority of homeschooling parents in his district opt to have a certified teacher review a portfolio of their child’s work when the school year wraps up.
In November of 2016, Jessica Coakley pulled her son, Braden, from their local public school and began homeschooling him. The first year involved a lot of catch up, but with time, she said, he thrived. Courtesy photo.
Before the pandemic, Robinson said, about 75 students of the approximately 1,500 in his district were turning to home instruction. Once the pandemic hit, that almost doubled to about 130, where it’s hovered since.
As his district shifted back to in-person learning, Robinson heard from parents worried their kids would bring the virus home to at-risk family members. He believes this drove most of the homeschooling spike, although the numbers still haven’t returned to pre-pandemic levels. He also wonders if the rise of the culture wars and book bans might be playing a role in a parent’s choice to homeschool, although he had not heard that in his own district.
Angela Grimberg, executive director of Coalition for Responsible Home Education, said her organization has incorporated Maine’s annual review process into its model legislation, arguing that all states should have a similar one. Nationwide, she’s concerned there is not enough accountability surrounding homeschooling.
“We’re seeing that across the states, they are still trying to deregulate homeschooling,” Grimberg said, “even as prior policies weren’t enough to protect these children.”
The most severe cases, she said, can lead to severe abuse and neglect, and deregulation can also lead to an inadequate education. She noted this is not typical of most homeschool parents, but hopes to “protect what’s valuable about homeschooling while mitigating the risks for severe outcomes.”
When homeschooling is done responsibly, Grimberg said, it can be immensely beneficial, especially for students with disabilities and those facing discrimination.
Maine law dictates that home instruction students are eligible to receive special education and related services at their local public school. They may also enroll in and audit some public school classes as well as extracurricular activities. School districts are then eligible for funding to support students receiving on-site instruction.
Robinson, the superintendent, said educators in his district maintain relationships with families who don’t want to partake in the whole school program but still want their kids present for extracurricular activities and upper-level academic classes.
Trish Hutchins, regional representative for Homeschoolers of Maine, a statewide, ministry-based organization, said access to these supports varies by district. Largely it is “welcomed and encouraged.”
During the pandemic, Hutchins said, parents of students with special needs found themselves implementing their kids’ IEPs at home. While schools can be limited by staff and funding, she said, at home these students may receive closer attention and custom-designed curriculum.
Jake Langlais, the superintendent of Lewiston Public Schools, worries that academic needs are not always met in this context. He is concerned that there are a number of students being homeschooled who are “getting no education whatsoever.”
In the 2021-22 school year, there were 5,182 students in Lewiston public schools. That same year, around 220 students received home instruction, more than double the number in the 2019-20 year. By this past school year, about 170 students continued to learn from home.
While recognizing there’s “fantastic” homeschooling across the state, he also noted, “there are so many benefits — so, so many benefits — to public school (that you) can’t fabricate in a homeschool.” He pointed to unique skills and socialization students receive in a school building.
“There’s a lot of ways you can build up resiliency and routine in a school that are harder to create outside of school,” he said.
A rise in homeschooling can also impact school funding.
“If my enrollment is down 100 students — because of homeschooling or private schooling — that has serious impacts,” he said, especially in smaller districts.
The Covid Surge
When Jessica Coakley, the mom from Bradley, decided to shift her son to homeschooling in 2016, she scoured the internet for resources. She quickly realized they were spread out and challenging to aggregate. So she created a Facebook page, “Homeschooling in ME,” to help other parents and guardians.
“I started the page with the hope that we could start this small community,” Coakley said.
The group grew slowly to about 300 members. Coakley liked the sense of community it provided. Parents traded tips about science curriculum, the best resources from Khan Academy, which creates online educational tools, and where to locate textbooks on Ebay.
When the pandemic hit, the small community quickly grew. Coakley saw another uptick after the implementation of vaccine mandates. Now the page is home to over 3,000 members.
Hutchins, the Homeschoolers of Maine representative, saw a similar spike. Occasionally before the pandemic, she would receive calls from families in crisis who needed to abruptly shift to homeschooling. But when 2020 hit, she said, suddenly that was happening all the time. She was in constant crisis management.
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Coakley said today she hears from a whole range of parents who decided to homeschool their kids. A sizable minority of the posts she sees in her group are from parents of kids with special needs or facing discrimination.
“There are thousands of reasons why people homeschool in Maine,” Coakley said. “It’s incredible. I think that’s the craziest thing about this community is that we all homeschool our kids, but we all do it for entirely different reasons.”
She said the increase in homeschooling generally has helped shatter preconceived notions about who homeschools and why. Many of these stereotypes initially made her hesitant as well. “When I was mulling over my decision,” she said, “I was scared I was going to ruin his life.”
But instead, the time at home gave Coakley’s son an opportunity to catch up academically and build his confidence. He learned math skills through cooking classes and took piano lessons. It was a challenging first year, but by his fourth year at home he was doing well.
Before eighth grade, Coakley told his mother that he was ready to return to the traditional classroom. She was nervous but agreed. His initial transition back was an adjustment because he learned to take all of his classes on the computer. But his teachers were supportive and he loved being back in the classroom.
This fall, Coakley will enter his sophomore year of high school. Ultimately, his mother said, being at home and learning in a small environment gave him the tools to return and thrive.
“I’m super proud,” she said. “Look what we did. We did this together.”
Fentanyl use in Montana driving spike in overdose deaths
Deaths by drug overdose in Montana continue to rise.
Nearly 200 people in Montana died due to drug overdoses in 2021, the last year that comprehensive data is available, according to the state’s health department. That’s nearly 40 more lives lost than in 2020 and 80 more than in 2017.
Yellowstone County, the state’s most populous, had the highest number of fatal overdoses, followed by Missoula County.
Neither autopsies nor toxicological testing are performed on every person who dies from an overdose, according to Jon Ebelt, a spokesperson from the Montana Department Public Health and Human Services, so even those numbers could be an undercount.
Health care practitioners, law enforcement agencies and othersattribute the increase to the proliferation of fentanyl, a synthetic opioid that, according to the Centers for Disease Control and Prevention, can be up to 50 times more potent than heroin and 100 times stronger than morphine.
And there’s no sign of the trend slowing. During the first quarter of 2023 year, Yellowstone County reported 41 calls related to opioid overdoses, followed by Missoula County with 32 and Cascade County with 28, according to a report from the state’s emergency medical services. Across the state in 2022, there were 1,041 opioid overdose-related 911 responses by EMS agencies, an average of 87 per month, up from 76 per month the year prior.
“What’s happening right now is that people are literally walking down that path in the dark. They have no idea what is going to be laced, what is going to be a dose that could kill you.”
Nikki Russell, peer mentor, Montana Peer Network
And Narcan, an over-the-counter nasal spray that reverses overdose effects, has become a household name. Clinics and local health departments around Montana are training the public on its use, and advocates and officials are encouraging people to carry Narcan if they believe they might know someone using opioids.
For years in Montana, methamphetamine has been the drug most gravely impacting communities. A public health department report from August 2020 determined that the number of deaths, hospitalizations and emergency room visits related to methamphetamine had all increased substantially since 2015. Crime related to methamphetamine use also increased.
Montana also suffers from an alcohol-induced death rate far greater than the national average. The alcohol-induced death rate in 2019 for adults over the age of 25 was 30.9 per 1,000 residents, compared with 17.3 per 1,000 nationally, and 18% of high-school students in Montana reported engaging in binge drinking, 4% higher than their national peers.
But the arrival of fentanyl, a cheaper and more potent opioid, has created a new crisis. While methamphetamine and alcohol are still more prevalent, the rate of deaths from opioid-related drug overdoses in Montana nearly tripled between 2017-2018 and 2019-2020, according to the state Department of Public Health and Human Services. Nikki Russell, who struggled with substance abuse for nearly a decade and now serves as a peer mentor for Montana Peer Network — a statewide nonprofit that helps people struggling with addiction — said it felt like things changed overnight.
“It felt quick. I absolutely feel like I turned a corner and there [fentanyl] was,” Russell said. “I was hearing about one [overdose] after another after another.”
For example, the Northwest Montana Drug Task Force, responsible for covering six counties, including Lincoln, Lake and Flathead, equaling roughly 17,600 square miles, made 56 fentanyl-related arrests in 2022 and removed more than $2 million in illicit drugs from communities. Throughout Montana, there were 488 opioid seizures by law enforcement in 2021, nearly double the number in 2017, according to the Montana Board of Crime Control.
Ka Mua, a nurse practitioner at Ideal Option, which operates nine clinics across Montana that provide medication-assisted treatment to treat opioid dependence, said she has seen a significant rise in the use of fentanyl among patients in the last 18 months.
Among the many risks posed by fentanyl, according to Mua, is that the symptoms of withdrawal — intense nausea, fever or debilitating muscle aches — can start much quicker and be much more intense than with other opioids.
More than half of patients at Ideal Option clinics across the state test positive for at least two substances, and 24% test positive for three or more. That circumstance, called polysubstance use, often reveals that people don’t know how their drugs are getting cut or mixed. It’s not uncommon, then, for people to think they are taking one drug but to learn later that it was laced by illegal manufacturers with fentanyl, which is partly why the overdose risk is so high, Mua said.
There’s “no way to measure the correct dose of fentanyl as a street drug,” Russell said.
“At the time when I was using substances, it was a dangerous road, but I could kind of see where I was going, even though I was, so to speak, lost,” Russell said. “What’s happening right now is that people are literally walking down that path in the dark. They have no idea what is going to be laced, what is going to be a dose that could kill you.”
THE ROLE OF LAW ENFORCEMENT
Steve Holton has worked for the Ravalli County Sheriff’s Office for more than 25 years, and he’s been the sheriff for six. While substance use is nothing new in the Bitterroot Valley, he said, the pervasiveness of drugs and the impact substance use is having on the community is notably different.
“Fentantyl is definitely on the rise, even down here,” Holton said. “We’re seeing a lot of distribution. It’s super easy to get. It’s super pure. There was a time when our problem was methamphetamine labs, and that is simply not the case anymore.”
Although the number of fatal overdoses in Ravalli County is low — according to the public health department, six people died in 2021 — Holton said those numbers don’t adequately reflect the threat of the drug crisis in the community.
All deputies in the sheriff’s office carry Narcan, and Holton said access to naloxone — the generic name for the medication — has prevented many overdoses from resulting in death. But he cautions that people shouldn’t assume that low fatalities means overdoses are uncommon.
“People tend to have a that-can’t-happen-here attitude,” Holton said. “I don’t think people understand just how prevalent the dangerous drugs are in Ravalli County.”
That’s a lot of area to cover with few people. Such remoteness makes responding to possible overdoses or investigating the origin of drugs in the community difficult, Holton said. Emergency calls “are a long ways away from each other, so to get people the help they need, law enforcement is often the answer,” he said.
REDUCING STIGMA
A compelling and growing body of research, including from the National Institute of Health, shows that criminalization of drug use prevents people from seeking treatment, which can push people struggling with addiction even further to the margins of society.
As a result, there has been an increasing effort nationally to reduce the prominence of traditional law enforcement in moments of mental health crises, including for people who may be using drugs. Missoula and Flathead counties, for example, have both created programs within their police departments that pair mental health counselors with law enforcement officers.
Community organizations are stepping up across the state, too. Safe syringe exchanges, like those offered by Missoula’s Open Aid Alliance, and medication-assisted treatment clinics are becoming more common. Those interventions are considered part of harm-reduction practices, a school of thought that aims to reduce the stigma around drug use.
“People tend to have a that-can’t-happen-here attitude. I don’t think people understand just how prevalent the dangerous drugs are in Ravalli County.”
Ravalli County Sheriff Steve Holton
Advocates say public health interventions such as needle exchanges reduce some of the potential harm that drug use can cause. People struggling with addiction, they maintain, should feel comfortable seeking treatment and support. Russell added that the stigma around substance abuse, especially in rural communities, often discourages the people she works with from joining support groups, seeking help or taking advantage of existing resources.
The Montana State Legislature is doing work of its own to reduce the number of opioid-related drug overdoses in the state. A bill signed into law in May exempts fentanyl testing strips from the list of illegal drug paraphernalia so that people can better avoid unknowingly consuming the powerful opiate when they are using other substances.
Fentanyl’s hold on communities in Montana, experts agree, has forced something of a reckoning in how society can best help drug users prevent overdoses.
“If somebody’s not alive, how can they recover?” Russell said.
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