Just days after the Buffalo Police Department received NARCAN — a medicine that rapidly reverses an opioid overdose — for the first time, officers rushed to a scene to use the overdose drug. 

A minor — thinking they were smoking marijuana — had ingested fentanyl and was overdosing. 

Weeks later, police officers again used NARCAN to resuscitate a man who had overdosed on fentanyl at a local hotel. 

“Within a minute, his breathing was back to normal, he was awake, his heart was back to normal,” Chief of Police Sean Bissett told City Council members after the event. “So much so that he woke up and was upset that we cut his shirt.”

Amid what law enforcement describes as an alarming increase in fentanyl use in Johnson County and Wyoming, local officials have taken steps to head off overdoses. This spring, both the police department and the sheriff’s office began carrying NARCAN and launched investigations into local fentanyl distribution. But prevention and treatment advocates say they need to develop long-term strategies to address opioid abuse.

County and Prosecuting Attorney Tucker Ruby said it was naive to think there had been no fentanyl in the community before the recent increase. There just hadn’t been enough to seriously concern law enforcement. That’s changed. 

“​​We’ve seen it. It’s here and it’s probably here to stay,” Ruby said. “So, it’s one of those things that we’re going to be combating and fighting against for the foreseeable future.”

 

A new threat

Fentanyl is a synthetic painkiller that is 50 to 100 times stronger than morphine. While it can be used safely in certain medical circumstances, just 2 milligrams is a potentially lethal dose, according to the U.S. Drug Enforcement Administration. 

The United States has dealt with fentanyl abuse for years, but it hasn’t been much of a problem in northeastern Wyoming. That’s beginning to change, law enforcement says, and because of its potency, fentanyl is a more dangerous drug than other drugs traditionally present in Johnson County, such as methamphetamine.

Haley Odenbach, emergency room manager at the Johnson County Healthcare Center, said that she has seen just a slight increase in overdose or drug ingestion incidences. In 2020 and 2021, the hospital saw eight and nine patients, respectively. This year, they’ve averaged about one a month so far, slightly more than they’ve seen before. 

But Bissett and Sheriff Rod Odenbach said they’ve been told that people have overdosed — but not died — without calling emergency services.

“We have to think how much of this is not being reported,” Bissett said.

Statewide, law enforcement seized 1.28 ounces of raw fentanyl in 2019 and 4.32 ounces in 2020, according to information collected by the Rocky Mountain High Intensity Drug Trafficking Area program. 

In 2021, law enforcement seized more than 64 pounds of fentanyl. 

In terms of separately seized dosage units — the pills collected by law enforcement — authorities seized 1,663 units in 2020. They seized 11,135 units in 2021.

“Fentanyl is the big thing right now,” said Casey Patterson, a drug intelligence officer with the HIDTA trafficking program and the Wyoming Division of Criminal Investigation. Patterson ranked fentanyl as his top concern among drugs in the state, in part because it is so deadly.

It can also be unpredictable, Patterson said. The amount of fentanyl in a given pill isn’t regulated and can vary widely, meaning even experienced users may not know what they’re ingesting. And some fentanyl pills are even labeled as oxycontin pills, Odenbach said.

Another problem, according to law enforcement, is that more common and less deadly drugs, such as methamphetamine and marijuana, are being laced with fentanyl.

“I think the danger to the public is fentanyl above everything,” Patterson said.

 

Almost inevitable

It’s unclear what prompted the recent rise in fentanyl, but local law enforcement said it was almost inevitable that the drug would make its way to Buffalo in some form, citing the community’s proximity to two interstates.

In November, the sheriff’s office and Wyoming Highway Patrol conducted a traffic stop on Interstate 90 outside of Buffalo and seized approximately 9,700 fentanyl pills. The stop was part of a yearlong investigation by the FBI and the Eastern Montana HIDTA Task Force, according to court documents. The investigation uncovered routine drug transports between Denver and Billings, prosecutors allege, and they have now charged Elizabeth Ronshaugen and Eric Swan, both of Billings, in Montana U.S. District Court.

“Here we are, wedged between two major interstates. That’s never going to change,” Bissett said. 

A portion of fentanyl is seized on its way through Wyoming, in particular along Interstate 80, Patterson said, calling the interstate “the new Silk Road.” But at least some of it is being distributed in communities and being seized in small amounts by local law enforcement. Fentanyl that is intended for local distribution often travels along Interstate 25, according to Patterson. 

Local officials say they believe fentanyl is being brought in from surrounding counties.

Patterson suggested that, as authorities have cracked down on physicians overprescribing opioids, those who are addicted turn to illicit fentanyl, prompting those dealing drugs to distribute a higher volume of fentanyl. 

The illicit fentanyl industry is also extremely profitable, according to Ruby — too profitable to ignore. 

“There’s too much money, right? There’s too much money in fentanyl. And there’s too much money in meth for them to not show up here,” Ruby said. 

Odenbach and Bissett said that they have coordinated their investigations, which has been helpful, especially as those investigations consume a large amount of financial and physical resources. They have also partnered with the Wyoming Department of Criminal Investigation. 

“​​The best thing that could come out of this is the fact that, basically, it’s one police department working together to put an end to it if we can, or put a dent in it at least,” Bissett said.

 

Looking for a solution

While law enforcement agencies work to disrupt the distribution of fentanyl, they have limited options to help those who are addicted to the drug. 

“Law enforcement can’t arrest our way out of this. If we could arrest our way out of this, we would have solved the problem 20 years ago,” Patterson said. “People are addicted. There’s a lot of people who are just addicted.”

Many of the people who enter Johnson County’s criminal justice system for drug offenses are referred to Northern Wyoming Mental Health’s center for treatment. Tyler Broderick, counselor at NWMH, said he has also seen a recent increase in fentanyl abuse. 

Broderick has a range of tools to help people through drug addiction treatment, from weekly outpatient groups and medicated assisted treatment to, in more serious cases, inpatient treatment. While many of NWMH’s patients who suffer from opioid addiction come through the criminal justice system, Broderick said, plenty of patients come independently. Broderick said he keeps those interactions confidential. 

But the organization is hamstrung by a lack of funding, especially when it comes to staffing, Broderick said. Like many entities, the center has been affected by statewide budget cuts. 

“We do what we can with who we have right now,” he said.

Nationally, advocates say more can be done to reform drug laws. The Office of National Drug Control Policy — which oversees the HIDTA program — recommends that states adopt laws that provide immunity to those who call emergency services in overdose situations and improve access to naloxone (the generic version of NARCAN).

Laws that provide immunity — so called “Good Samaritan” laws — have grown in popularity in the past 10 years, but Wyoming is one of just three states without one. The U.S. Government Accountability Office reports that states with Good Samaritan laws tend to have lower rates of opioid overdose deaths, though the office noted the research is limited.

But Bissett and Odenbach said they don’t believe the lack of a Good Samaritan law prevents people from calling authorities in overdose situations. Those involved in the two reported overdose cases were charged, they said. 

The public distribution of naloxone has gained traction in Wyoming. In 2017, the Legislature passed a bill permitting pharmacists to prescribe the drug. 

Justin Waterson, pharmacist at Buffalo Prescription Shop, said the shop prescribes naloxone about five to 10 times a year. In many instances, they prescribe naloxone to people who have been prescribed opioids by their doctors but may be at risk of overdosing if it isn’t used correctly. In other instances, though, they prescribe naloxone to people who may be abusing drugs or who know of someone who is abusing drugs. 

“It’s one of those better safe than sorry medications,” Waterson said, adding that he will generally prescribe the medication to anyone who asks for it. 

Patterson said he hopes to convene stakeholders in the state and use the data collected by the trafficking program to craft new solutions that suit Wyoming — solutions that rely on not just the public safety system but also the public health system. The ultimate goal, he said, is not just to break linkages to drugs, but also to build linkages to care.

 

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