PRICE — Jeff Wood had just won election as Carbon County sheriff when his friend died of an opioid overdose in December 2014.
As he walked into the funeral home for his friend's viewing, he noticed two other viewings underway.
"Two of the three were overdoses. It’s like, ‘Wow, this is unreal,’” Wood said.
Ask anyone in Carbon County about opioid overdoses or suicide, and odds are they have a personal story.
“Either you know someone, you’re related to somebody or you’re friends with somebody,” Wood said.
Statistics bear that out.
Carbon County has the highest rate of prescription overdose deaths in Utah, according to state health department data. It also has one of the highest rates of retail opioid prescriptions dispensed per 100 people nationwide, according to Centers for Disease Control and Prevention data.
In close-knit Carbon County, both are distressing distinctions, and their impacts deeply personal.
“In the cities, to hear about drug overdose and these other things, you may think it’s so foreign to you. In these small communities, every one of us knows somebody who is affected by it," Carbon County Commissioner Jake Mellor said. "Most everyone here in this small community also knows somebody who has committed suicide, mostly because it’s a smaller population and we mingle. We get to know our neighbors."
Mellor and other community leaders say that sense of community is key to turning the corner on the county’s high rates of overdose and deaths linked to misuse of prescribed and illicit opioids.
“I think we’re at a point we can keep pulling people out of the river or we can go way upstream and build a fence. The CARE Coalition, that’s exactly what it’s about,” said Karen Dolan, CEO of Four Corners Behavioral Health.
CARE stands for Carbon Addiction Reduction and Elimination, a diverse coalition of community leaders including law enforcement, human services agencies, clergy, prosecutors, health care providers and volunteers.
Four Corners Behavioral Health, a nonprofit service provider for people with mental illnesses, substance-use disorders and often co-occurring conditions, is reaching out to schoolchildren, jail inmates and community members to enhance existing prevention, education, treatment and support efforts.
“Our community just got fed up being top in the state for opioid abuse. There were a lot of different entities working toward a goal, and they realized that once we all work together, we can accomplish that goal faster," Wood said.
"The community’s been amazing. There’s every walk in life involved in this,” he said.
“I think turning the corner takes a little time for results to really show that we’ve turned the corner. But I can definitely say in the last two years we’re doing a lot of different things," he said.
Government, private industry, health care, nonprofit organizations, churches and volunteer mentors are coming together in a "combined front," Mellor said.
"That may just sound like common sense, but … historically, in other counties right now, that’s not what’s happening," he said.
One hub of activity is the county jail, where law enforcement teams work with Four Corners Behavioral Health to assess people arrested on drug-related charges.
The goal is to transition low-risk offenders to treatment and supervision in the community as soon as possible instead of lingering in jail with higher-risk offenders.
“We feel that’s the biggest bang for the buck,” Wood said.
People who abuse drugs are particularly vulnerable upon release from jail unless they’re connected to resources and people who can help them.
“With nothing, the risk for overdose is huge. They’re so vulnerable when they get out of jail because their tolerances have change," Wood said.
If they use the same dose after leaving jail, they can readily overdose and die, he said.
The jail’s health care provider prescribes naltrexone, a drug that blocks the high of opioids, according to the National Institute on Drug Abuse.
The drug is effective if used as prescribed, Wood said.
'A higher power'
A faith-based initiative formed under the CARE Coalition offers additional support, everything from picking up people from the jail upon release to helping place recovering addicts in sober living communities supported by faith organizations out of state.
Liz Ferguson, who worked many years in substance abuse prevention, said she believes the faith-based initiative provides a dimension of help and support that government resources such as drug court, incarceration and intensive treatment cannot.
“When I talk to them later, when some of them have become sober and they’re living a sober life, I’ve asked them, ‘What was it that finally made you step over to the sober living?'
“They said, ‘We had one thing missing, and that was God,'" she said.
Ferguson said her own faith teaches her that there is "a higher power that can give them hope and forgiveness for everything they’ve done and (for) living their lives.”
She calls it the “the missing piece of the puzzle.”
Mellor, 33, is the youngest county commissioner in the state. His portfolio of responsibilities includes mental health services and public health.
And while he is a full partner to the coalition — so much so he carries nasal and injectable Narcan in his pickup in the event he encounters someone who has overdosed on opioids — he and his fellow commissioners are also laboring to create new jobs.
The downturn in the coal industry and shuttering the coal-fired Carbon power plant that resulted in the loss of 70 high-paying jobs took a toll, both in terms of the economy and the community's psyche.
Mellor predicts there are better days ahead because the community has a strong collective work ethic, a branch campus of Utah State University, where custom-fit job training is offered, and infrastructure such as a regional airport and railways used to transport coal.
“We’re focusing heavily on what is known as stackable credentials. People no longer have to go through school and get a bachelor’s degree to start employment. We want them to have a certificate while still in high school and with that certificate be working while getting further education,” Mellor said.
“We want them to always be learning and to always be working. We’re designing a new way of career pathways.”
The goal is to develop new industry or opportunities in Carbon County so people can earn a living wage at home. Presently, some 1,000 vehicles leave Carbon County each workday to travel to jobs outside the county, Mellor said. Most high school graduates leave the area to attend school or work.
Opioid deaths affect young, old
Whether pills or heroin, opioid-related death is no respecter of age or station in life.
Statewide, women ages 44 to 54 had the highest rate of death tied to prescription opioid use, according to Utah Department of Health data for 2013-15. Among deaths linked to heroin use, men ages 25-34 had the highest death rate per 100,000 people for the same time period.
In Carbon County, opiate overdoses affect a mix of people, some teens and young adults, as well as middle-age adults who have worked in dangerous, blue-collar jobs and were prescribed opioids after they were injured on the job, or after years of physical labor resulted in body-eroding injuries.
“You could come to my (LDS Church) ward and there are men who cannot stand up straight because of the damage they’ve done. It’s kind of the nature of the beast,” said Rep. Christine Watkins, R-Price.
“I know one family that their young son who was in his 20s died. I’m going to say it was two years later his mom died of the same thing. It’s not just a young person’s problem. If you have a back issue and you’ve been given those drugs and you get hooked, it will lead you down that road just as fast as young people,” Watkins said.
To enhance knowledge and encourage best practices, the community will hold an opioid summit in February for physicians and other health care providers who prescribe drugs, Mellor said.
Support for families
While there is growing understanding that addiction is a disease, many families struggle with feelings of shame and stigma tied to drug abuse.
“When my son died in 2012, no one talked about it,” said Darlene Schultz, a retired first-grade teacher on staff with Utah Support Advocates for Recovery Awareness.
“The stigma was so bad. It was like, ‘Oh, it’s another junkie off the street.’ That’s how your loved ones are looked at. They don’t look at it as somebody’s son or daughter, father, mother, husband, wife or sister or brother.”
This fall, Schultz started visiting Price to train facilitators who will run structured support groups for people who have loved ones who are addicts or have died from overdoses. Awareness about addiction is growing, but families struggling with the day-to-day reality need a safe place to talk and share their burdens, Schultz said.
“When your kid’s struggling with addiction, nobody brings you casseroles. They don’t come to your door and bring you dinner. They don’t help take care of you like as if someone was sick in another way, and that’s really hard,” she said.
In a small town where everyone knows one another, it can be especially difficult to overcome stigma and shame.
Obituaries of those who have died of opiate overdoses couch the details in phrases such as “died unexpectedly” or “returned to his Heavenly Father.”
For people in the prime of life, “you know it’s either an accident, an overdose or suicide,” said Dolan, a licensed clinical social worker.
Dolan said when she leads groups for women in the county jail facing drug charges, most are struggling with the reality of what addiction and conduct has cost them and their loved ones.
“Typically they’re detoxing and they’re grieving. Many of them, they’re sober for the first time in a really long time, and so there’s a ton of grief just realizing what’s become of their lives and all their losses," she said.
"A lot of it is grief work, a lot of loss, a lot of sadness.”
'An atomic bomb'
CJ McManus, 38, a former newspaper editor, is under drug court supervision in state court. This is his second time in the program, and this time he’s been clean for 20 months.
McManus grew up in East Carbon, a small town east of Price, and was a good student, popular and occasionally dabbled in pot and alcohol in high school.
Awhile after graduation, he tried OxyContin, which he said gave him a sense of euphoria he'd never experienced.
“The first time I took pills I had this conscious recognition, man. 'Man, this is how I want to feel. This is what I’ve been waiting for,'" McManus said.
But pills didn’t come cheap, and they weren’t readily available. In 2004, McManus picked up a felony charge for forging prescriptions, which led to his first placement in drug court.
At the height of his opioid addiction, McManus said he and his then-wife drove to Salt Lake City daily from Carbon County to buy heroin near Pioneer Park.
It's a four-hour drive round trip through a canyon that for many years was considered one of the most dangerous highways in Utah. That was the least of his concerns.
McManus has twice divorced, lost custody of his daughter, lost his home and other possessions. He's lost a number of jobs and admits that there were times he used drugs while working.
“Drugs will destroy. They burn everything to the ground. It was like an atomic bomb had gone off in the middle of my life. That’s what it felt like. That’s what it looked like. That’s what happened,” he said.
Dolan said she looks forward to a time when reporters come to Price to appreciate its rich diversity, history and community expectations that youths respecting their elders.
"It's a great place to live, but then we do have this other problem. But we're all working on it — together," she said.
Watkins, for one, says she is optimistic about the collective effort to address the issue.
"We have to be able to help (the frontline agencies) in helping our communities. We're a small community so we could probably do a lot better than the big communities," she said.
For McManus and others struggling with addiction, the stakes are high.
He is grateful for another chance at a sober life, and he wants his story to have a different ending.
McManus, who is college educated, lives in a small apartment near Price’s main street. He is working as an assistant manager at a fast-food restaurant and is on track to graduate from drug court.
In the past 18 months, “I’ve lost 17 people I knew and used with, all of them local. It’s crazy,” he said.
“Something’s got to change.”