Battling the opioid epidemic in the Northland

By Celia Tarnowski

Whenyou first meet Etoile, which is French for star, her youthful looks, soft-spoken demeanor and a ready smile would lead you to believe she is much younger than 30. It’s likely you’d never guess what she has experienced in the past 10 years. Etoile’s life story includes experience with addiction and recovery, both chapters reframing outdated concepts on what the “face of addiction” looks like, and the process for withdrawal.

Etoile did not grow up in an environment that supported drug use; it was a strategy she discovered to escape painful experiences. When she was a teenager, her father became very sick and suffered from Post-Traumatic Stress Disorder. The illness took a toll on their finances, and she eventually lost her home, animals and possessions.

Etoile became her father’s caretaker until he died when she was 21. Wanting to start a new life, she moved away from home and enrolled in college. The summer before her first semester, Etoile began using drugs and alcohol to cope with the loss of her father.

“I was getting into anything I could,” she said. “I was very naive. Alcohol and cough syrup — I would use those to feel better.”

Plans for a degree fell by the wayside, as it was hard to concentrate and commit to school. She dropped out before the end of her first year. She moved in with her friend Ryan, who had a long history of drug use. Over the next few years, her occasional drug use became an everyday event, and the pills were replaced with heroin. Although using regularly, Etoile didn’t realize she had moved from choice to dependence. She described her first experience going through withdrawal: “I didn’t realize you could get physically addicted. I remember the first time I withdrew, I had no idea what was going on — I thought I had gotten the flu, a really painful and terrifying case of the flu. Ryan explained to me that I was going through withdrawal.”

As their use amped up, they spent most days trying to get their next fix; ultimately, it became the only thing that mattered.

“I don’t know how we did it,” Etoile said. “We somehow figured out how to get the money to buy from someone. Eventually, we stopped going outside and doing stuff. We just started smoking (heroin) all day, every day.”

The last year of their drug use, they became homeless and had to live in their car. Ryan and Etoile wanted to get clean, but their physical dependency on drugs and fear of the side effects of withdrawal resulted in many failed attempts. Knowing they couldn’t do it on their own, they sought help at the ClearPath Clinic in Duluth. Today, Ryan has been sober for two years, and

The Center for Alcohol & Drug Treatment helps women find hope at ClearPath clinic

Etoile is in the last stages of the process, tapering her medication to a very small amount. She said she hopes to be done by fall.

Treating the whole person

The Center for Alcohol & Drug Treatment opened the ClearPath clinic in 2015. It uses a multifaceted approach, which includes pharmacotherapies, case management and monitoring services, patient education, individual and group therapy, relapse prevention, motivational enhancement, 12-step facilitation and specialized chemical dependency programs. Some might be surprised to know that many of their clients hold down full-time jobs and run the gamut of standard careers, from teachers and business-owners to medical professionals. The face of addiction is diversified.

Etoile is one of the many ClearPath clients who depend on Medicated Assisted Treatment (MAT) to help them move toward recovery. Medications are used in combination with counseling and behavioral therapies, treating each person as an individual, said Tina Silverness, CEO of the treatment center.

“MAT for opioid addiction utilizes meds to stabilize brain chemistry, block the euphoric effect of opioids, relieve physiological and psychological cravings, and normalize body function,” she said.

Because the process uses medication to help patients move away from addiction, it is often misinterpreted as substituting one drug for another, Silverness said. She said there’s a difference between physical dependence and addiction.

“Physical dependence occurs when the brain adapts to the effects of a drug and develops tolerance. A person who is physically dependent on a prescribed opioid medication but is not addicted will not experience a loss of control, strong cravings, compulsive drug use, or a failure to meet work, social and family obligations. On the other hand, a person who has an addiction no longer takes a drug just to feel its effects, but rather to escape withdrawal and feel closer to normal. Addiction affects the parts of the brain responsible for decision-making and self-control, so a person … will continue to use the drug despite serious life consequences such as losing a job, getting arrested, or suffering an overdose,” Silverness said.

That is not to say that some don’t misuse the medication. However, the ClearPath clinic makes every effort to limit the opportunity for clients to resell or accumulate doses. There are cameras placed at every dosing station, and clients must take medication in the presence of staff members.

Changing patterns, finding balance

“Judi,” 55, has been in the ClearPath program for 10 years. She asked that her real name not be used for this report. Growing up, both her parents were alcoholics and used marijuana, a pattern she would follow. In her mid-30s, she met the man she would later marry. He introduced her to pills, which led to meth and finally heroin. Her addiction has caused turmoil in her family and the expected consequences, including a stint in jail. Feeding her habit became paramount to eating regularly or the right foods. She almost died when a

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Etoile is a ClearPath client who credits the clinic for her progress in recovery. She asked her last name not be used for this report.

Contact218-625-7822 stomach ulcer burst, the result of her poor diet. Her life turned around when she entered the ClearPath program. She credited the clinic with her ability to stay clean.

“Judi” is a ClearPath client who has been clean and in recovery for 10 years. She asked that her identity be protected for this report.

“I know I would have fallen back into where I was before because that’s all I knew,” she said.

Unlike Etoile, Judi doesn’t see herself tapering her MAT dosage with an end goal of leaving the program. She is at a steady dose and wants to continue with the additional supports she receives at the clinic. She has found a medication level that works, controlling the physiological and psychological cravings that drive opioid addiction. Judi considers her progress and future sobriety to be contingent on the clinic’s resources and the opportunity to surround herself with the supportive type of people that she finds at ClearPath.

“Right now, I’m happy with the way everything is going in my life,” she said. “This (program) keeps me involved with people that are clean and sober. There are so many positive things to keep me clean and focused. I think I would lose that insight if I didn’t come here.”

Changing perceptions

The CADT is working to move the public toward seeing substance-use disorders as any other chronic medical condition. Despite strong support from the medical community, it is difficult to change the long-held mindset that people battling drugs have a lack of moral conviction or character flaw. Silverness said this way of thinking hurts both the people who need help and the community they live in.

“This prevents many individuals from seeking out help and continues to perpetuate the cycle of addiction,” she said. “This is not only harmful to those needing treatment but also to our communities, becoming a public health and safety issue with increased rates of communicable diseases, crime, overdoses and deaths. All of which we are seeing with the current opiate epidemic.”

People who seek help know they’re seen as perpetual addicts rather than people on the journey to recovery. Judi was visibly upset when asked about other people’s perception.

“It’s hard to deal with the misconceptions,” she said. “You go to the clinic for help, but people view us as being bad people or drug addicts. They think we’re just trying to get high. I want to tell them, if you haven’t been there, you don’t know.”

Etoile said she wants people to look past patients’ exterior to get a better sense of who they are and what brought them to this point. She spoke with sincerity and concern, saying, “A lot of those people are beautiful inside; they’re kind, loving people who are just in so much pain.” D