On Wednesday, the Grand Forks Police Department sent out a warning: throw out your heroin.
Inherently, law enforcement wants everyone to throw out their heroin, or not buy it in the first place. But Wednesday's warning was specific. There's a bad batch going around Grand Forks; law enforcement believes a substance sold as heroin is laced with fentanyl, a much more powerful opioid that can turn deadly in small doses.
First responders were called to four overdoses in the same number of days, each requiring emergency medical attention and the administration of naloxone, a drug that opens up the respiratory system, which will begin to shut down if the body is overdosing on opioids.
A $180,000 grant Grand Forks received in August from the North Dakota Department of Human Services aims to inform the public on and expand access to drugs like naloxone, programs such as needle exchanges and medication-assisted addiction treatment.
The grant runs through April 2018, which Grand Forks Public Health Director Debbie Swanson says is not enough time to accomplish all the city wants to accomplish, but she hopes can help lay the groundwork to move forward.
"We'll be prioritizing things that are most important and the things that can save lives, and establishing some things in our community so that we can prevent overdoses and provide treatment," Swanson said.
State requirements call for Grand Forks and the four other cities that received the grants to use 80 percent of the funds on treatment and recovery and 20 percent on prevention.
The first goal is to increase evidence-based treatment and recovery services for people with opioid use disorder. This goal will focus on helping people transition back into society from the criminal justice system, including an attempt to implement medication-assisted treatment referrals for inmates at the Grand Forks County Correctional Center and the juvenile detention center.
There are no medication-assisted treatment programs currently available in Grand Forks. The city's goal is to have five certified facilities by April 2018. Providers issuing treatments with methadone or suboxone are required to get a certain waiver.
"Our goal as a public health department is to make sure that's integrated with primary care," Swanson said.
Another goal is to decrease the stigma surrounding opioid abuse and try to increase the public's acceptance for needle exchange programs, which have been shown to decrease the spread of Hepatitis C and HIV among intravenous drug users.
"Syringe service programs also provide a really good place to engage people in treatment," Swanson said. "So while some individuals in the community may feel this isn't an important thing to offer, what it can do is help people realize there are resources out there to help them and engage them in treatment long-term."
Installing a needle exchange is unlikely by April 2018, but Swanson hopes that educating the public and promoting the need is a step toward making the program a reality. There also will be a public class on accessing and administering naloxone.
"It's really important that the public understand that we have to save lives today in order for people to have a better future tomorrow," she said. "So naloxone will save a life and get people on the path to recovery."
The grant also will go toward prevention strategies, beginning with decreasing access to unneeded prescription opioid medication. This will include collaboration with Altru Health System physicians about adhering to Center for Disease Control guidelines for prescribing opioids and increasing promotion of the prescription drug takeback programs.
The plan also calls for collaboration with Inspire Pharmacy on a program to provide people in treatment programs, recently released inmates and people below the poverty line with access to naloxone for free or reduced costs.
Five pharmacies in Grand Forks can issue naloxone: Inspire, UND Student Health, Altru Pharmacy and both Thrifty White Drug stores.
A growing issue
Grand Forks Police have responded to 20 overdoses, including two fatalities, within city limits so far in 2017, according to Lt. Brett Johnson. In 2016, the department responded to 31 overdoses, four of which were fatal. They responded to 43 overdoses in 2015 and 39 in 2014.
Altru treated 498 cases of drug overdose in 2016, more than double the 226 treated in 2015, according to a report on drug usage in Grand Forks County by public health doctoral student Allie Canoy Illies. Of the 2016 overdoses, 319 were from street drugs, 124 were from prescription pills and 55 were classified as "other." Through April 2017, 129 overdose cases had been treated at Altru, more than were treated in all of 2010.
Grand Forks Police officers do not carry naloxone in their squad vehicles, according to patrol Lt. Bill Macki. Officers with the Grand Forks Narcotics Task Force carry the substance, and police keep it in their evidence processing areas.
The Grand Forks Fire Department and Altru EMTs do carry naloxone.
Overall, the city hopes the grant will help reduce the stigma around addiction and get the public to think of it like they would any other disease.
"We need to stop shaming people and instead inform them about resources we know will be helpful," Swanson said.