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While states nationwide have been scrambling to respond to the deadly opioid epidemic, New Mexico has been hard at work with an aggressive response for years. So why have its addiction rates remained stubbornly high? Hari Sreenivasan visits a state caught between two powerful forces: best-practice treatments and the international forces supplying American addictions.
We return to our series on the opioid epidemic, "America Addicted."
In a moment, William Brangham looks at how federal law enforcement was undermined when it came to stopping shipments of the drugs.
Let's begin with a report from the Southwest.
While states nationwide have been scrambling to tackle the crisis, New Mexico has been hard at work with an aggressive response for years. And yet its death rate from overdoses remains stubbornly high.
Hari Sreenivasan begins our report in northern New Mexico.
DR. GINA PEREZ-BARON, Las Clinicas del Norte: How'd your week go this week?
This is what progress against the opioid epidemic looks like.
ANTHONY OCANA, Patient:
I kind of messed up. I had a bunch of friends up there, and we started drinking and stuff. And a guy pulled out a baggie, and it was meth. And I kind of messed up, and I…
DR. GINA PEREZ-BARON:
Kind of relapsed with meth.
Relapsed with meth.
It's the latest relapse for Anthony Ocana. His doctor, Gina Perez-Baron at Las Clinicas del Norte, had already discovered it during a routine drug screen.
I'm glad you told me. Not happy, but glad you told me.
Then the surprise. Anthony's drug of choice is heroin.
Did they have heroin? Did they have — they did? No kidding. And you didn't use? All right.
A small success here in Rio Arriba County against a staggering problem that Perez-Baron says can only be won with a million small successes.
Yes, I may have relapsed, but this time I didn't do heroin, right? You know… or if I did heroin, I didn't inject it, you know? Those are all small recoveries. Those are all small victories.
The opioid epidemic struck this corner of New Mexico more than a decade before the rest of the nation, for reasons that aren't entirely clear.
Lieutenant Billy Merrifield of the sheriff's office:
LT. BILLY MERRIFIELD, Rio Arriba County Sheriff’s Office:
It's hard to say what actually fuels it, other than it's such — this drug, it just — once they use it once, it's like it takes control of them.
Some blame poverty and high unemployment. Others an aggressive overprescription of legal pills in the area. Others still the normalization of illegal drug use — so widespread now that multiple generations often use together.
Regardless, you can see the fallout almost everywhere. Needles scattered throughout the countryside…
LT. BILLY MERRIFIELD:
We could probably drive along this whole roadway, and we're going to find them.
And overdose rates five times the rest of the country. But this has also meant that New Mexico got a big head start on nearly every evidence-based strategy now being rolled out elsewhere.
That includes widespread harm reduction and needle exchange programs that are still extremely limited in many states.
PHILIP FIUTY, Santa Fe Mountain Center Outreach Worker:
You can just throw those right in here.
As long as the lids are tight.
There's a residential treatment center in a county facility on the banks of the Rio Grande.
And in the outpatient clinic where Perez-Baron works, there are even trauma-based group sessions for low-income Medicaid patients designed to get at the underlying emotional wounds that often fuel addictions.
EUTIMIA SANCHEZ, Las Clinicas del Norte Patient: I was molested when I was young. And I think that's what happened.
We don't have a single patient where trauma doesn't play a part in their addiction. What addiction is is really an effort to avoid pain.
Losing my son, it's taken lot out of me. I have relapsed over and over.
After more than a decade, these interventions have started paying off, says Lauren Reichelt, the county's health and human services director.
Overdose death rates fell here in 2015.
LAUREN REICHELT, Rio Arriba County Department of Health and Human Services: We brought it down by 30 percent, which I consider significant. And then it looks like, in 2016, we have held steady. And so that's at a time when everybody else's has been increasing.
At the state level, even bigger moves. As early as 2001, New Mexico became the first state to increase access to the overdose reversal drug naloxone, now in widespread use.
NURSE, Metropolitan Detention Center:
It reverses the heroin you just injected.
New Mexico is now a leader in training some at-risk populations on how to reverse an overdose, like inmates preparing to leave Albuquerque's Metropolitan Detention Center.
What I am hoping for is that even just one of you guys can reverse somebody to give that one person a chance to rethink what they're doing to their lives, what they're doing to themselves, what they're doing to their families.
And in Albuquerque Public Schools, one of the largest school districts in the United States, there is early opioid education, like this lesson by a substance abuse prevention counselor in a seventh-grade health class.
KIM CHAVEZ, Crossroads Counselor:
Metropolitan Detention Center: So, remember, opioids come in our painkillers and they come in heroin. So look at the difference in this brain.
Despite all those efforts — and the gains in hard-hit Rio Arriba County — the number of overdose deaths statewide is still staggeringly high. Around 500 per year, or 25 deaths per 100,000 residents. The national average is 16 overdose deaths per 100,000.
Many of those bodies show up here on a cold metal table.
Medical investigator Dr. Hannah Kastenbaum:
DR. HANNAH KASTENBAUM, New Mexico Office of the Medical Investigator: Several in a day are concerning for drug deaths, for overdose deaths. Every day, we're here at one of these tables examining some young person who shouldn't otherwise be dead. Every day.
New Mexico seems to be doing everything. They have aggressive treatment. They have harm reduction. They have early education. They even track every opioid being prescribed.
So why is it so bad? Part of the answer is the freeway we're driving on. Two national highways cross New Mexico — I-40 east to west, I-25 north to south. They meet in Albuquerque.
RUDY MORA, Undersheriff, Bernalillo County:
We're jumping on here onto I-40 westbound. This road is literally the pipeline of America.
A pipeline that keeps drugs from Mexico pulsing through the state, says Rudy Mora, the Bernalillo County undersheriff.
Mora says he's been involved in close to a thousand large-scale drug seizures over the course of his career. Hidden cargo, including heroin, meth, pills, marijuana, frequently travel on from Albuquerque in concealed compartments in tractor-trailers, discovered during routine stops and planned raids along this highway.
Illegal activity and busts are frequent here because New Mexico serves as a Walmart style distribution center in the international drug trade, he says.
And once they can get those drugs across the international border, then they can start breaking their drugs apart and distributing them from there.
MIKE GALLAGHER, Investigative Reporter, Albuquerque Journal:
They're looking to see if there's dope hidden, stuck in there and hidden, covered up by the fruit. And so he's going to be shining his light and digging through the fruit.
Mike Gallagher, an investigative reporter for The Albuquerque Journal, says Mexican cartels have streamlined the entire process. They now operate deep within the U.S. and control every piece of the pipeline.
From the point of origin, where the poppies are grown, to the lab, to the smuggling organizations to the delivery points in Albuquerque and the Northeast Heights.
One example of many: this now closed auto body shop in Southwest Albuquerque, tied in a federal investigation to the Juarez cartel. In an auto body shop in Mexico, they'd open vehicles up, create secret compartments, and stash drugs inside to get it across the border.
Then they'd come to an auto body shop here in Albuquerque, where those vehicles would be opened up, the drugs would be taken out, money would be put back in, and then the vehicles would go back across.
But the drugs, Gallagher says, continue on.
Oklahoma City, Tulsa, Saint Louis, Memphis, Atlanta, Charleston, into New Jersey, Ohio, and as far north as Massachusetts.
WILL GLASPY, Special Agent in Charge, Drug Enforcement Administration: The Mexican criminal organizations understand that some of their loads are going to be seized. That's a cost of doing business to them.
Will Glaspy is a special agent in charge with the Drug Enforcement Administration. Until recently, he oversaw the El Paso division, which includes New Mexico.
The cartels, Glaspy says, play a numbers game that will continue to be in their favor, unless the U.S. wants to drastically reduce commerce with Mexico. Last year alone, roughly 5.8 million trucks legally dove over the border at points of entry, along with 75 million personal vehicles. More than 42 million pedestrians crossed by foot.
For us, it's a game of cat and mouse. We're always looking for the avenues or the cover that the criminal organizations are using to smuggle the drugs. Once we find that, then we can focus on that until the traffickers move to something else.
Confiscated drugs from the nearby border crossings are stored in a drug vault near Glaspy's old office. Tens of thousands of pounds often line the shelves. But no matter how much is seized, Glaspy says, it's just a small fraction of what flows in — a sign of a bigger problem.
They have realized that they have got this huge market in the United States, so they have ramped up production of heroin and really flooded the streets of the United States with this deadly poison.
It just blocks the pain is what it does, you know? Numbs it.
Back in Rio Arriba County, stories like Eutimia Sanchez's help explain why the national opioid epidemic has been so hard to beat back.
In recent years, she turned to pills and cocaine to block her pain — the physical pain from a fall, she says, and the anxiety of everyday life. For long stretches of time, she fights for sobriety. But they're always interrupted by moments like this:
I relapsed this weekend, before my dad and everybody showed up. The pain is so bad that I just — I can't. So, you know, I go self-medicate with drugs, you know?
Addiction continues to rage in Rio Arriba County, despite the small band of health providers and their many efforts. Despite aggressive law-enforcement action and the county's recent drop in death rates.
Dr. Leslie Hayes says treatment can work wonders for individual payments, but this county is still filled with poverty, unemployment, and trauma… pain in search of a painkiller.
DR. LESLIE HAYES, El Centro Family Health:
I have heard law enforcement say we're not going to arrest our way out of this problem. The same is also true for medicine. We're not going to treat our way out of this problem. We want to stop it earlier. Stop it by not prescribing inappropriately, and by getting other things in their lives that are meaningful.
The nature of addiction means that most solutions and victories here will continue being small and incremental.
There are times when Sanchez still reaches for drugs. But more often now, times when she reaches for helps.
I will have cravings. And there's times I have stopped. Because I will call somebody up and take a walk or do something else. They will remind me of the things that we have been working on.
Working to cope … a work in progress.
For the PBS NewsHour, I'm Hari Sreenivasan in New Mexico.
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