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Searching for success: An inside look at Northland's Substance Use Response Team

As opioid overdoses continue to spike regionally and nationally, a team based within the Lake Superior Drug and Violent Task Force is paving its own path to get people into recovery.

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Tim Innis, right, a peer-recovery specialist with the Lake Superior Drug and Violent Crime Task Force's Substance Use Response Team, talks about the team’s work as counselor Jennifer Keuten and criminologist Jeff Maahs listen on Wednesday, Dec. 8, 2021. Steve Kuchera / Duluth News Tribune
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When Jennifer Keuten gets a call, she may be seen hurrying across town, quickly turning an emergency room, county jail, private residence or even a park bench into a makeshift office for a few hours.

Keuten is a counselor working for the Substance Use Response Team within the regionwide Lake Superior Drug and Violent Crime Task Force. It's her job to meet with clients who are struggling with addition issues, identify their needs and try to get them admitted into a treatment program as soon as possible.

"Something that I always try to do is to allow that individual to be proactive in their treatment and decision-making and what they want to see," Keuten explained. "Because it's really easy for me to say, 'Well, I think you need this, this and this,' but that might not be what they want. And I really try to get them to buy in and get some accountability and ownership."

Keuten, hired in April, brings a long-sought resource to local law enforcement agencies' efforts to tackle the root causes of substance use by means other than criminal enforcement. With a nearly $900,000 federal grant that took effect this year, the Substance Use Response Team has grown to six members, who provide a variety of outreach and support services to community members in need.

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Team member Jennifer Keuten talks about her work Wednesday, Dec. 8, 2021. Keuten is contracted through the Center for Alcohol and Drug Treatment to do comprehensive assessments on those struggling with substance-use disorders. Steve Kuchera / Duluth News Tribune

Officials said the grant, which also allowed for the hiring of two additional peer-recovery specialists, has drastically transformed their work by cutting down on bureaucratic challenges that prevented many clients from following through with treatment in the past.

"For so many of our people, you have this moment, and it's usually a very small window of time, that they're reaching their hand up for help, and you’ve got to grab onto it in that short time," said Tim Innis, one of the newly hired peers. "Decreasing that barrier with these assessments really makes a huge difference on what they're going to with the next step."

Working in the face of a troubling trend

The initiative started modestly in December 2018, but its staffing and scope have grown significantly over the past three years.

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Lead peer-recovery specialist Jess Nickila shares information with co-worker Tim Ausman during a meeting of the Substance Use Response Team on Wednesday, Dec 8, 2021. Steve Kuchera / Duluth News Tribune

Originally, the team included just one new hire: opioid technician Jess Nickila, who immediately got to work following up with overdose survivors and attempting to connect them with services such as treatment programs. But Nickila said it was clear from the start that a bigger team was needed to tackle the issue.

"We've been able to increase overdose outreach tremendously," said Nickila, now the lead peer-recovery specialist. "Previous to (the new hires) coming on, there was no way I would have been able to reach every person who had an overdose in the task force area. It was just impossible."

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Year after year, Northeastern Minnesota and Northwestern Wisconsin have continued to set morbid records for opioid-related overdoses and fatalities. Overdose rates are now seven times higher than 2013, when police started to identify heroin as a serious issue in the community.

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Gary Meader / Duluth News Tribune

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Gary Meader / Duluth News Tribune

In 2020, the task force area saw 382 overdoses and 41 deaths — a steady climb from the 245 overdoses and 12 fatalities reported just three years earlier. And the region has already blown past last year's records, seeing at least 429 overdoses and 46 deaths so far this year, according to preliminary numbers that are expected to increase.

PREVIOUSLY: 'It's a bad thing': Northland authorities fight deadly consequences of fentanyl

Nationally, the Centers for Disease Control and Prevention last month released a report showing that more than 100,000 people had died from opioid overdoses over a one-year period ending in April, with the effects of the COVID-19 pandemic likely contributing to the record number.

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Those are sobering statistics, local officials said, and they highlight the need for additional resources to be invested in breaking the cycle of addiction — particularly as the danger has been heightened with the emergence of counterfeit pills that are often laced with highly potent fentanyl.

"Those numbers could be significantly higher if this team didn't exist," said Duluth police Lt. Jeff Kazel, commander of the task force. " There are a lot of ways of solving problems. Demand drives the majority of the problem that we have. If these (peers) can pluck people out of the demand pool by getting them help, that’s a win for everybody."

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Gary Meader / Duluth News Tribune

Hundreds of clients served through expedited process

With Innis and fellow peer-recovery specialist Tim Ausman signing on this year, the response team had already made contact with 217 clients — 197 of them new to the program — through the first 11 months of 2021.

Nearly half those came through post-overdose outreach, while the remainder were referred by police officers, other agencies, friends, family, previous clients and via street outreach, according to data maintained by the team.

And more than 100 of those clients did end up following through with some form of clinical substance-use disorder treatment.

"You’ve got to have that human, personal connection with people," Innis said. "And most of the time we don’t make that connection the first time we see someone, or even the fifth time we see them, but they know that we keep coming back and keep trying to reach our hand out, and eventually a lot of them will extend theirs."

This is where Keuten's role as the counselor becomes critical.

In the past, the peers would need to refer a client to a facility, where they would need to set up an appointment to undergo a comprehensive assessment. Also known as a Rule 25 or chemical dependency evaluation, the interview is necessary to screen people into treatment programs.

That process often used to take a week or two and involve a number of logistical hurdles for the client, often resulting in a missed opportunity to intervene. But now, under ideal circumstances, Keuten can go out in the field to meet a client, complete the assessment and get them approved for a program within 24 hours.

"The lens I look through is a holistic approach," said Keuten, who completed 72 assessments in her first eight months in the role. "There's just so many things when you think about in our lives. If one thing's not good, chances are something else isn't going to be good. We want to work on all of that. … And I try to throw in a little bit of education at same time. You just really want to get them to start thinking about what makes them happy in life. What would you enjoy doing if there were no barriers?"

'Defining and redefining what success means'

The SURT effort is a fairly unique program for a law enforcement agency, and without a model program to follow, the team members acknowledge they're sometimes forced to figure out best practices as they go.

"I think we're spending a lot of time as this team grows defining and redefining what success means for our client population," said Kerry Cronin, the Duluth Police Department's budgets and grants supervisor. "Success doesn't necessarily mean that when a peer makes contact that the client will go to treatment and maintain sobriety for the rest of their life. Sometimes a very small step can be a success."

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Gary Meader / Duluth News Tribune

The peers said they work with clients in setting smaller, achievable goals to carry them through the treatment and sobriety processes. And while the program initially was aimed at making contact immediately following an overdose, the team members are now trying to stay involved longer term.

Most treatment programs last just 30 days, and Nickila said it's not unusual for clients to have relapses and need to go through the process more than once.

"It's hard enough to stop chewing your fingernails in 30 days," she said. " Trying to stop use drugs and alcohol in 30 days, and then you're just done, is a near impossibility."

While initially pegged to opioid use, the team has received more flexibility in this year's federal grant funding to reach out to clients battling other addictions, including methamphetamine and alcohol

"It's not just an opioid epidemic," Nickila said. "Substance use in this country is a public health crisis."

PREVIOUSLY: Duluth police to expand opioid outreach as region sees record rates of overdoses, deaths

In an attempt to gauge the success of their efforts, the team has partnered with an independent evaluator, University of Minnesota Duluth criminologist Jeff Maahs.

Jeff Maahs, a criminologist at the University of Minnesota Duluth, provides independent evaluations of the Substance Use Response Team’s work. Steve Kuchera / Duluth News Tribune free card

Maahs initially looked at the use of Narcan, the "antidote" to opioids that can be administered to immediately reverse the effects of an overdose. He surveyed first responders and collected data on its use — more than 270 "saves" being reported by task force agencies in both 2020 and 2021.

Maahs also is tasked with recording accurate statistics on overdoses and fatalities, which officials said can help with grant applications. But the cumulative effect of the outreach program can be difficult to gauge.

"It's hard to figure out from a science standpoint," he said. " There’s no control group. So I mostly try to look at whether they’re meeting internal goals for the program, and give them a sense of what they've done and try to find ways to make the program more efficient."

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Gary Meader / Duluth News Tribune

More housing, treatment options needed

Asked about the biggest remaining challenges in addressing community addiction issues, the team responded with a resounding and unanimous answer: housing.

"Everything is for naught if nobody has a place to live," Nickila said. "Folks who go to treatment down in the Cities we encourage to stay there, because they come back here and there's no place to live, and it's impossible to stay sober outside. We have no place to house people, and it’s a real disservice to the community."

Keuten said more residential treatment beds are also needed in the Northland, as there are far more outpatient programs available. She said that sending clients out of town can be a good thing in that it "gets them out of their element," but many want to stay or return home and aren't able to find adequate living arrangements.

"We'd like to see the availability of some longer-term treatment, as well, because 30 days or 60 days is probably not enough," Kazel noted. "When you're looking at something that has taken over their system, a lot of studies are saying it's going to be a year or two years before they really get to a point where they're going to be 'normal.' Whatever 'normal' is."

The task force was still awaiting news on grant funding for 2022. The team is seeking to add another peer-recovery specialist and an analyst.

"We need more people to be able to add to a program that seems to be successful," Kazel said.

To get help

If you or someone you know is struggling with addiction, you can contact the Substance Use Response Team at 218-730-4009. The hotline is handled only by peer-recovery specialists and information is not shared with law enforcement officers.

Tom Olsen has covered crime and courts for the Duluth News Tribune since 2013. He is a graduate of the University of Minnesota Duluth and a lifelong resident of the city. Readers can contact Olsen at 218-723-5333 or tolsen@duluthnews.com.
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