CSU Extension agent Abby Weber covers a lot of wind-swept territory putting on workshops about rabbit and poultry care, sustainable living and cake decorating, and she also oversees shooting-safety classes, robotics challenges and dog-training courses for Bent County 4-H clubs.
And now Weber and other extension agents are moving to the front lines in the fight against opioid abuse in Eastern Plains towns and other rural corners of Colorado where drug-overdose deaths are on the rise.
Colorado State University is banking that extension agents, trusted and already well-known in their communities, can use their local star power to reach vulnerable families and counsel them about the dangers of opioids and how to prevent their misuse.
Weber is one of five CSU Extension agents so far enrolled in the $1.4 million program, partly funded by the U.S. Department of Agriculture. It calls for local health officials and others to join together to fight the misuse of painkillers and other addictive drugs in small, often isolated towns — the kind of places that typically have the least access to addiction treatment.
The CSU agents will be trained about the best strategies to head off drug and alcohol abuse. They will also be taught about running small groups and piecing together community alliances, and they will learn how to recruit families into family-based prevention programs.
They will also get specific training on implementing the Strengthening Families Program, a seven-week course that gets kids and their families together to build stronger ties and bolster refusal skills, said J. Douglas Coatsworth, director of CSU’s Prevention Research Center and and an overseer of the program.
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Meeting in churches, community centers
Extension agents are already meeting with families in local churches, schools and community centers in Fort Morgan and La Junta. The meetings will start in Bent County, Swink and Sterling in the fall. More groups are planned for southwest and northwest Colorado later this year, Coatsworth said.
The Strengthening Families arm of the project, in which participants meet weekly with the fully trained extension agents, is an evidence-based curriculum developed by Iowa State University that has proven effective at reducing risky behaviors, including opioid use, among youth, Coatsworth said.
Strengthening Families has been lauded by arms of the U.S. departments of Justice, Education and Health and Human Services.
A five-year longitudinal study of the program found “significant reductions in conduct problems and in the use of tobacco, alcohol and other substances,” according to the U.S. Department of Education. A followup look at 10th-graders found “significantly” lower usage of alcohol and tobacco use, the U.S. Education Department said.
But the key pieces in the whole program are local caregivers and experts, especially the extension agents, Coatsworth said. Locals wouldn’t give much credence to outsiders who roll into their towns and don’t know the families or local culture.
“I am an expert on this issue but who is going to listen to me if I parachute into a town and tell people I want to talk about drugs in their community? I am not going to get much of a positive response,” Coatsworth said. “But someone like Abby, or these other agents, are well-known and well-liked so they can be a lot more effective.”
The extension agents are seen nearly everyday on main streets, in coffee shops and in schools. They talk to young kids about good citizenship, healthy eating and their 4-H projects. They also jaw with weather-hardened farmers about their crops and livestock, even fraud protection, which gives them credibility, Coatsworth said.
The Strengthening Families Program is in broad use across the U.S., but only a few states, including Iowa, Ohio, Maryland, Pennsylvania and now Colorado, pair extension agents with existing local groups to lead drug abuse prevention efforts, Coatsworth said.
The program includes public health messages distributed through local and social media, Coatsworth said.
Weber has been an extension agent for two years, but she has lived and worked in southeast Colorado for 20 years as an educator and caseworker in child protective services for the 16th Judicial District.
Only about 7,000 people live in Bent County, and Weber is pretty sure she knows most of them. She has seen how opioids and drug abuse in general can rip apart otherwise stable and loving families.
“Some adults trade their food stamps for drugs, and that means they and their kids don’t eat,” Weber said. “If a parent is using drugs and the child knows, the roles reverse and the child becomes the caregiver. So you have the child trying to protect the parent and siblings, making sure they eat and that everyone is OK.
“The drugs hurt everyone in a family,” she said, “and, obviously, can be so dangerous.”
There were officially 543 overdose deaths related to opioids or heroin across Colorado last year, a decline from 2017 when there were 560, according to the Colorado Department of Public Health and Environment.
That drop — the first in a decade — is good news for those fighting the opioid epidemic in the state. But especially difficult challenges remain in rural Colorado, where the problem is often masked by CDPHE policies that prohibit the publishing of statistics about small numbers of people.
For instance, CDPHE doesn’t publish the stat for how many people died of opioid or heroin overdoses in Bent County for the years 2014-18 because the number is small enough that it could effectively identify those who died, in violation of privacy rules. But, for those years, six people died of any kind of drug overdose in the county, giving Bent a drug-overdose death rate 23% higher than the state’s as a whole.
Other research has also laid the problem bare.
A 2018 report from the Colorado Health Institute found that Bent County was one of 16 Eastern Plains counties — Sedgwick, Phillips, Yuma, Logan, Washington, Morgan, Kit Carson, Cheyenne, Lincoln, Kiowa, Powers, Otero, Crowley, Baca and Las Animas — that collectively had an overdose death rate of 20.6 per 100,000 residents between 2014 and 2016, higher than the 15.8 statewide death rate for the same three-year period.
Numbers from the state Health Department show that there were at least three rural counties — Las Animas, Huerfano and Conejos — with death rates from opioid or heroin overdoses that were at least double the statewide average for the years 2014-18. In some spots the problem is only getting worse. The death rate from an opioid or heroin overdose in Las Animas County was 21.3 per 100,000 residents in 2016, according to CDPHE. In 2018, it was 41.3, more than four times greater than the state’s as a whole.
And rural Colorado also has the least amount of resources to deal with the opioid crisis. A 2017 report by the Colorado Health Institute found that 31 of the state’s 64 counties don’t have a clinic that can provide opioid-addiction-treatment medication like methadone or buprenorphine.
“Many treatment centers are 20 to 30 miles away in parts of Colorado and some people don’t have cars to get them there and mass transit is pretty rare in many parts of the state,” said Andres Guerroro, manager of the opioid prevention program for the state health department. “And don’t forget the embarrassment factor as well. People don’t want their neighbors to see them walking to a treatment center or to even see their car parked outside the building.”
Substance abuse is community’s top public health concern
Bent County residents know they face a big problem with substance abuse, said Omer Tamir, executive director of Bent County Public Health. In a 2018 community health survey, 1 out of 3 residents said alcohol and substance abuse was their top public health concern.
But, true to the Colorado Health Institute’s research, many residents feel they are cut off from treatment for drug abuse problems, Tamir said. “There is no hospital in Bent County, no mental health centers and staff turnover for those services in town is very high,” he said.
The county seat is in the town of Las Animas, which is 20 miles from La Junta and 40 miles from Lamar (and which is different from Las Animas County, to the south). Many Las Animas residents can’t afford cars and other means to get to those larger towns for help, Tamir said. There is a bus system, but many residents aren’t aware it exists.
High unemployment also plagues the county, and there are not enough industry in the area to support growth, he said.
“For many people here, it is a struggle,” Tamir said. “These are good people here, but like in a lot of rural towns in Colorado, they are finding it tough going.”
Self-medicating to fill a void
Meanwhile, opioids, other drugs and alcohol fill a void in many people’s lives, Weber said.
Adults usually start using painkillers for relief from an injury. Kids see their parents misuse the drugs and don’t see them as dangerous because they are prescribed by a doctor.
Methamphetamines, marijuana vaping among youths and alcohol abuse are also part of the CSU effort.
“I think if we can sit down and talk to these families about what is going on with them, and with the help from our community partners in the local community, could make a difference,” Weber said.
In the past, most extension agents have been focused on the newest trends in livestock feeding and teaching farm families how to manage finances. But by the 1980s, a lot of those old ideas about what extension agents should take on changed as outside forces, like economic woes, pressured farmers.
“Programs were developed to help families manage stress and deal with the growing problem of alcohol and tobacco and other drug use,” Coatsworth said. “This is a natural extension of that work.”
The extension agents, including Weber, will also add a needed perspective to drug abuse education, Kristin Carpenter said. Carpenter is the Communities That Care program director for the Otero-Crowley Public Health Department. Communities That Care, run through the state Health Department, is also aimed at substance abuse prevention.
“She works with people with a farming, conservative background and many of those folks think drug problems don’t exist around them, it’s always problems associated with cities,” Carpenter said. “Their (extension agents’) work could change that perception.”
The meetings will be held close to homes for families who can’t or won’t go to area treatment centers.
The two-year project has received more than $320,000 from the USDA and nearly $1.1 million from the federal Substance Abuse and Mental Health Services Administration. The CSU team will collaborate with the Colorado Consortium for Prescription Drug Abuse Prevention and Rise Above Colorado during the effort.
Funding will run out by late 2020, but organizers hope the community partners will have a strong infrastructure in shape to keep the program going.
“We want to build something here that will last for good,” Weber said. “It’s something so worthwhile for the people who live out here.”