In 2015, rural Dixie County, Florida ranked among the highest in the state for opioid-related deaths. Now, less than one year after Gov. Rick Scott declared opioid addiction a statewide emergency in May, opioid deaths in the county have declined—but prevention efforts in children and teens persist.
For the last 15 years, Meridian Behavioral Healthcare has hosted prevention programs in the county’s only middle school, but community leaders want a bigger role in pinpointing the county’s substance abuse issues and deciding how healthcare conglomerates should address them.
Meridian received a grant for over half a million dollars in June after Scott signed the executive order and state departments launched projects aimed at combatting these deaths. The healthcare provider uses less than $70,000 of the funds to bolster programs at Ruth Rains Middle School to tackle and prevent childhood addiction.
Opioid addiction among youth in the county remains an important objective, said Carali McLean, senior vice president of clinical programs and business development at Meridian.
McLean said addiction rates are higher in places like Dixie County because rural areas have higher rates of environmental risk factors, like low income and employment rates, and higher levels of poverty, which increase the likelihood of drug use.
“When people don’t have resources, they’re at a lower ability and higher risk to manage or cope versus people that have a huge support system, transportation, insurance and financial needs,” she said.
Executive director of the Dixie County Anti-Drug Coalition Katrina Van Aernam disagrees.
“One of the arguments—and it’s not even a really good argument—is, ‘Ugh, those rural communities, they don’t have any resources,’” she said. “Well, that’s not true.”
The county, she said, offers plenty of resources for preventing and treating substance abuse. It’s just a matter of steering those resources to those who need it with the provider’s help.
Van Aernam, a Dixie County native, heads the coalition, a non-profit that collaborates with healthcare providers, lawmakers and law enforcement to identify the county’s needs and how to address them.
The county of 16,300 residents enrolls about 1,000 students combined at Ruth Rains Middle School and Dixie County High School. And while opioid abuse remains high among adults, rates of youth addiction inside the county aren’t as numerous since there’s fewer young people.
Still, opioid prevention among youth is one of the coalition’s main objectives—and a personal one for Van Aernam, a mother of five who in 2009 realized her son, then a junior in high school, was abusing prescription drugs.
The teen first smoked marijuana, she said, which led to using the “little white pills,” or prescription drugs found at pill mills around the county or sold illegally in schools.
She remembered sitting on a bench at her son’s baseball game with a handful of parents she’d known since her son was young. She didn’t know how to broach the subject with them.
“I’m thinking, ‘Is it possible that my son is the only one?’” she said. “But that wasn’t the truth.”
Her son refused to “snitch” on his supplier to avoid retribution, she said. She and her husband didn’t know where to go to find him help.
“Here, all of a sudden, he’s a full-blown addict, and we have no tools,” she said. “It was hard to find someone to walk us through it.”
The gap between consumers and service providers led Van Aernam to head the county’s first anti-drug coalition in 2011.
“I’m a momma who walked right out of my community into this position,” she said. “I work with Meridian, but until we’re able to get the truth as partners and collaborators, we’re not going to be able to make a difference.”
The coalition started hosting “Lunch and Learns” with the Gilchrist County Sheriff’s Office, Meridian and other community organizations to increase lines of communication between locals and service providers. The goal was to highlight issues and plans of attack, she said.
“The first thing we have to do is adequately assess our community,” she said. “We’ve got to know the truth about where the drugs are.”
Meridian hosts two programs at Ruth Rains Middle School in Cross City, the only middle school in the county. They include: “All Stars,” a character-based initiative that identifies high-risk behaviors that lead to substance abuse and tactics to avoid them, and “Life Skills,” an interactive course that teaches students about healthy decision-making and the resources available to prevent and treat drug use.
“Meridian’s been in our county for 15 years,” she said. “But I’ve had five children go through Ruth Rains Middle School. I knew Ms. Ruth Rains. Until I started doing this work, I didn’t know anything about ‘All-Stars.’”
Opioids are a class of pain-relieving narcotics that include legal prescription drugs like oxycodone, hydrocodone, codeine and morphine as well as illegal iterations heroin and fentanyl.
Because pain relievers like Oxycontin, Vicodin and cough syrup are regularly prescribed to adults, children can access the drugs through their parents’ medicine cabinets. Others buy from friends and classmates, McLean said.
Children and teens are particularly susceptible to opioid use in areas with high rates of opioid-related deaths among adults, like Dixie County. According to a 2016 drug report from the Florida Department of Law Enforcement, morphine caused over 25 deaths, the highest fatality count in the state. Fentanyl caused another five to 10.
“Kids learn based on what they see—they act, mimic,” McLean said. “If parents have an addiction or problematic use, that’s where they learn it from.”
McLean credits the rise in opioid abuse in the county to labor-intensive jobs in industries like agriculture, construction and manufacturing, which make up the bulk of the county’s economy. When parents are injured at work and prescribed a pain reliever, teens can easily access the drugs or buy from neighbors and friends, she said.
Others use the prescription drugs as currency. Some parents sell or trade opioids to afford school supplies and gas, Van Aernam said. And with an influx of disabled and retired populations in the county over the last 10 years, prescription pain relievers are more prevalent.
Joe Munson, vice president of prevention and community education for Meridian, said the developmental effects of opioid use are almost immediately apparent.
“Any time you’re talking about a child whose brain is constantly bringing in information like a sponge, you’re worried,” he said.
Repeated opioid use impacts brain receptors, impairing judgment as well as cognition, he said, as well as children’s ability to think and conceptualize abstract ideas.
Even after a few uses, sleep, energy level and mood are impacted and affect how students function in the classroom.
McLean said Meridian’s programs at Ruth Rains target prevention rather than treatment. For teens already using drugs, the healthcare provider offers outpatient counseling for substance abuse at Cross City and Trenton offices, as well as on-site counseling with consent from parents.
Counselors are also stationed at schools in the county, she said, to lift barriers for parents who work multiple jobs or don’t have the time or means of transportation to take their child to a treatment facility.
Because the coalition’s resources are state-funded, their actions are limited, so Meridian partners with them to expand community resources and address abuse of more substances.
McLean said Dixie County residents have called for more resources for opioid addiction. Prevention partnership grants are donated to healthcare non-profits across the state each year, but Dixie County was absent from its agency decisions from 2015 to 2018. While Meridian received a grant for over $500,000 to prevent and opioid abuse, only $70,000 went toward prevention services, and an even smaller fraction is used in Dixie County schools.
“People become outraged, people want answers, people want support,” she said. “They’re screaming from the rooftops of how this is a problem.”
But with help from other local agencies and law enforcement, areas like Gilchrist County are starting their own anti-drug coalitions to lobby for funding and create more prevention and treatment opportunities in the area.
Gilchrist County Sheriff’s Office Captain Sheryl Brown said while local law enforcement has a “zero tolerance” policy for drug use, the office is more interested in getting users help before it takes them to jail—prevention that will hopefully keep their children out of drug addiction, too.
“A lot of times, people don’t seek resources until they have legal issues,” she said. “Our goal is to cut that path.”
Dixie County’s anti-drug coalition and other service providers around the state have helped neighboring Gilchrist lay the foundation for its own coalition. The county was identified in the Florida Department of Children and Family’s Opioid State Targeted Response Project as a high-need rural county with marked nonmedical opioid use that didn’t receive the department’s grant for reducing prescription misuse.
“I wish there were more here,” she said, “But we do the best we can with the limited resources that we have.”