Consultants urge more action on opiate issues

By Kevin O’Brien

In order to better combat opioid addiction and other substance use disorders, a consulting firm hired by Marathon County is recommending that the county increase accessibility to treatment programs, create a new public health position, and focus on underlying issues such as housing insecurity and the lack of trained counselors.

These ideas were among the six short-term recommendations and two longterm goals presented by Third Horizon Strategies to the county board at its Oct. 17 educational meeting. A similar presentation was given to a joint meeting of the Board of Health and the Health and Human Services (H& HS) Committee on Oct. 9.

Earlier this year, the county voted to spend $50,000 from an opioid legal settlement on an independent gap analysis of the county’s existing drug treatment programs. That number was later increased to $70,000 before the county decided to hire Chicago-based Third Horizon.

Eric Bailly, senior director of Third Horizon, said his firm spent the last four months analyzing publicly available data on substance use disorder (SUD) in the county, along with interviewing 14 people involved with the issue, from substance abuse counselors to law enforcement to someone with “lived experience” as an addict.

On the national level, nearly 18 percent of adults report having a substance abuse problem, and of those roughly 40 million people, 77 percent have not received any treatment, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). At the same time, the number of drug overdose deaths jumped by 130 percent between 2018 and 2022.

“That really has heavily affected rural communities, especially during the opioid crisis,” he said.

Bailly said his team did a “quantitative analysis” of risk factors and substance abuse rates, comparing Marathon County to Wis-

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consin and the nation at large. While the county has lower rates of people who admit to smoking marijuana and using prescription drugs without a prescription, the percentage of binge drinking and alcohol-related mortalities is higher than both Wisconsin and United States, according to statistics from 2021.

“Alcohol is a slow burn,” Bailly told the board. “It has a significant impact on the body over an extended period of time.”

In response, supervisor Ann Lemmer asked Bailly if there’s any way the county can use any of the opiate settlement funds to address the county’s alcohol problem. Bailly said not directly, but he noted that the issues of opiate addiction and alcohol abuse are often “intertwined” among those with multiple SUDs.

When it comes to opioid overdose deaths, Marathon County saw an alarming 214 percent increase from 2018 to 2022. The overall number of overdose deaths per capita remained below the state and national rates, but higher than those in neighboring counties.

Based on conversations with local treatment counselors, police officers and others involved in SUDs, Third Horizon pointed out the success of the county’s existing programs such as the Crisis Assessment and Response Team (CART), which pairs behavioral health specialists with police officers when responding to mental health-related calls.

Even with the resources currently available, however, Bailly said Third Horizon found that the different services did not always collaborate well, and access isn’t always easy for those in need of treatment, especially in non-English speaking communities.

Third Horizon came up with six near term recommendations:

■ ■ Increase the availability of non-medical detox services outside hospital settings

■■ Increase the availability of medicationassisted treatment services

■ Provide more targeted resources for those who speak English as a second language

■ ■ Promote school-based prevention programs

■ ■ Form a countywide SUDs response advisory committee, made up of people with experience in the field

■ ■ Create a public health position focused solely on SUDs issues As longterm goals, the consultants suggested efforts to increase the amount of housing available for those in recovery and recruiting more substance abuse professionals.

Bailly and public health officer Laura Scudiere faced several questions from H& HS members, including supervisor Stacey Morache, who wondered what the county obtained from the $70,000 it spent on Third Horizon’s study. She noted that the county’s Criminal Justice Coordinating Committee (CJCC), which includes representatives from law enforcement, the courts, socials services and other departments, already came up with similar findings.

“What did we find out from this analysis that we didn’t know already?” she asked.

Scudiere said Third Horizon was able to do a more formal assessment of the county’s substance abuse treatment needs using “a comprehensive data analysis.” In response to a follow-up question about a possible public health position, Scudiere said her department has hired limited-term employees before with measurable goals to meet.

“That would be expected of this position,” she said. “There would be established data points that we would need to see improvement on to understand whether or not we are making a difference.”

At the Oct. 17 board meeting, in response to a question from supervisor Chris Dickinson, Bailly acknowledged that Third Horizon had not reached out to the Veteran Services office as part of its analysis.

“That was definitely a gap on our part,” he admitted.

Dickinson said it seemed to him as if the study had gone beyond what the settlement funds were supposed to be used for.

“I have a concern that this analysis went very deep into a lot of other areas that aren’t really opiate-related,” he said, pointing to data about lack of childcare, housing, health insurance, and food. Bailly said those are factors affecting why people with opiate addictions don’t seek help or find it difficult to maintain sobriety.

“Readiness to change is definitely a component,” he said at one point.

When asked what the next steps were, county administrator Lance Leonhard said the board has the sole authority on how to spend the rest of the $3.5 million in settlement money the county is set to receive from pharmaceutical companies involved in a class-action lawsuit.

The CJCC, which was tasked with developing proposals for spending the settlement money, included the independent gap analysis as its top priority out of nine recommendations. Some of the group’s other recommendations included expanding the county’s deflection programs to get more low-level drug offenders into treatment and creating a full-time case manager at the Marathon County Jail to cover medication-assisted treatment for inmates.

Leonhard noted that he has not allocated any of the settlement money in the 2025 budget at this point, but the board can always make amendments. He recommended that supervisors consider forming a working group to focus on spending strategies going forward.

“The short answer is: it’s ultimately the board’s call,” he said.

MORE THAN TRIPLED- The data collected by Third Horizon Strategies shows a dramatic increase in opiate overdose deaths between 2018 and 2022, an over 200 percent spike that outpaced both the state and surrounding (contiguous) counties.

GRAPHIC BY THIRD HORIZON STRATEGIES