First an epidemic, then a pandemic

COVID-19 leaves Northeastern Minnesota drug users perilously isolated

Benton Graham

Ashlee Goodridge and Matthias Turbes III, prior to getting sober.

Ashlee Goodridge’s belly protruded from the front of her black hoodie. Brown eyes crinkled into a smile under her mask as she approached her drug counselor’s office, adding some warmth to an otherwise sterile, white-walled basement facility.

She brought good news – a welcome change after a difficult year. Yesterday, her doctor asked if she’d like to know the baby’s sex, but it was too late. She had already spotted the male genitalia on the sonogram.

The only person who might be happier than Goodridge, 33, is Matthias Turbes III, her boyfriend who is also 33.

At first glance, Turbes gives off a macho appearance with a leather jacket, stocky build and stud earrings. But appearances are misleading. Turbes broke down in tears when he learned they were having a boy.

The past year has challenged the couple in many ways, including a miscarriage, a fruitless attempt to get Goodridge’s three kids back from foster care, and a period of heavy drug use for both. It also left the couple cooped up in hotel rooms in Hermantown and St. Cloud, as they struggled to find a place to rent due to his criminal record and her rental debt.

Yet for now, at least, the couple maintains that the prospect of a child due in August, a commitment to their opioid treatment and the strength of relationship cuts through the hardships.

“I have a lot of mental health (issues) and she does, too, and a lot of it intertwines with each other,” Turbes said. “I can piggyback off of her with the things that I have troubles with, and she’s able to piggyback off of me with the trouble she has.”

Lots of others have been challenged by isolation too, especially in rural parts of northeastern Minnesota. Many in St. Louis County have a 10-mile commute to access public transportation.

As locals attempted to evade the virus, that remoteness became suffocating for some. The region made strides in tackling opioid and meth use in the past decade, but St. Louis County recorded 302 overdoses in 2020, the highest in the last four years. Thirty-one of those were fatal.

The ripple effects of COVID-19 compounded the opioid epidemic, as 2020 was the deadliest year for overdoses nationwide.

Social distancing forced many further into isolation, and the job market’s collapse left many without work. According to the Centers for Disease and Prevention’s most recent data, 2020 set a record with more than 93,000 overdose deaths.

Treatment facilities in St. Louis County are now struggling to handle a crush of patients that avoided seeking care at the outset of the pandemic.

Nationwide, experts are asking if the surge is a blip, or if the trend is likely to continue. The people on the frontlines face myriad issues, including how to quell the rise of synthetic opioids, the best approach to harm reduction and how to factor racial equity into these conversations.
And unlike the COVID-19 pandemic, a quick-fix vaccine doesn’t exist.

Isolation relapses

In northeastern Minnesota, safe drug-use advocates and county officials say that many of the people using opioids and meth used for the first time or relapsed after a period of sobriety due to the isolation.

Sue Purchase, Director of Harm Reduction Sisters, a nonprofit that provides clean syringes in rural Northland communities, said that she encountered a man who had had nine years of sobriety. And yet, the lockdown, cold weather and constant demand of caring for his child eventually became too much for him and his wife.

“They broke down and started using… that is such a familiar story,” Purchase said. Indeed, a recent CDC study that found that more than 13% of people surveyed began or increased substance use to cope with the stresses of COVID-19.

Purchase and the reporter never met in person, but the passion in her voice swells as she speaks about the hardships endured throughout the pandemic. She spends much of her week driving to far-flung towns in northeastern Minnesota, where she has slowly made inroads with tight-knit communities that often do not trust outsiders. Her strategy involves identifying more receptive community members who can serve as secondary service providers. She’ll give clean syringes to that person directly and have them handle distribution. Those inroads have allowed her to keep tabs on what she describes as a dire situation.

“Many people started using with COVID and using in isolation because of social distancing,” Purchase said. “Overdoses are just increasing every single day up here.”

For those who did seek out services, limited options became more so. The Center for Alcohol and Drug Treatment (CADT), a Duluth-based treatment facility, reduced its bed capacity by 10%. As uncertainty reigned last spring, many social-distanced in their homes and CADT saw reduced demand for its services.

Anxiety surrounding the virus was particularly pronounced for many struggling with opioid addiction.
Prescription pain medications can be a gateway for opioid use. In many cases, the original need for pain medication stemmed from a condition that made the person more vulnerable to COVID-19.

That was the case with “Sarah,” who asked that her real name not be used because of the stigma associated with methadone treatment. Suffering from lupus, the 43-year-old former movie rental store employee quickly realized that COVID-19 presented grave risks to her health.

Mask-wearing required no change to her routine, as she already navigated life with a face-covering, but the pandemic brought a heightened tension. She shied away from entering a grocery store, opting instead for curbside pickup at Wal-Mart.

As a patient at ClearPath Clinic, a methadone facility within CADT, she worried about balancing her treatment with social-distancing guidelines.

“Even though I only had to go to the clinic once a month,” Sarah said, “it was scary because a lot of people there… do high-risk things, so I was a little afraid. But I just wore my mask. I was wearing gloves. I had wet wipes, those antibacterial Clorox wipes. I’m just going crazy like wiping off the door handles in my car.”

COVID-19 made interviewing Sarah a challenge. After circling west Duluth for an open restaurant or café, the reporter and Sarah settled on a McDonald’s parking lot. They sat in the front seat of a grey SUV, windows cracked and masks on, as a chilly wind off Lake Superior buffeted the car making the 40-degree day feel colder and rustled Sarah’s rainbow hair.

That cold is part of what makes COVID-19 so isolating in this part of the world. Even for the heartiest Minnesotan, it’s not realistic for people to convene outdoors for much of the year.

Long waiting list

Once living in a pandemic became the norm, CADT saw demand surge and now has a long waitlist for its services. COVID-19 stymied recent progress in the region on two fronts: substance use organizations and officials needed to protect their staff from the deadly disease, and the isolation exacerbated mental health conditions that can lead to drug use.

St. Louis County officials noted that local groups that provided transportation to treatment pulled back on services. People seeking help struggled to find places to go, and virtual substance use treatment proved challenging.

“Initially, it was really difficult, especially in the rural areas,” said Amy Anderson, the corporate compliance officer at CADT. “We weren’t as set up for telehealth and we weren’t regulated to be able to provide telehealth in the substance use world.”

When the pandemic took hold in the United States, Goodridge and Turbes found shelter from a homeless agency. As fate would have it, the agency placed them both in a hotel in St. Cloud, a two-and-a-half-hour drive southeast of Duluth.

They don’t agree on the specific date they met, but it was near the beginning of the pandemic. The hotel turned out to be a hard place to stay sober, as they found themselves surrounded by others using heavily.

Goodridge gravitated to Turbes, as he was one of the few men at the hotel who treated her with respect. He quickly moved into her hotel room, as they fell into a routine of seeking out their next high and avoiding risky COVID behavior. In some respects, the couple was happy to take things slow. For instance, the two were not intimate for the first few months of their relationship.

Turbes started on prescription drugs at the age of five when doctors diagnosed him with ADHD. “I remember being locked in the University of Minnesota Children’s Unit, and they were like trying to diagnose me, and they started force-feeding me medication,” he said. “It was messed up.”
They put him on Ritalin and Dexedrine, two drugs that the U.S. Department of Justice says “have a high potential for abuse.”

As a teenager, he went to youth treatment facilities for his addiction to prescription medication. Instead of helping him kick the addiction, the facilities introduced him to stronger substances. He curiously watched others living in the facility using cocaine, and eventually curiosity became addiction.

He describes his childhood self as a “big issue.” The police brought him home for the first time when he was in the first grade for tossing chairs at a counselor’s office. Two years later, he tried to attack a police officer. They drew their guns on him. He lived with his mom and grandmother, but his mom had Crohn’s disease and was in and out of the hospital. To give his ailing mom respite, he spent time in foster homes as a kid.

Turbes emerged from his traumatic youth with social anxiety, which has made navigating the pandemic particularly challenging. He already dreaded simple errands like going to the grocery store. Knowing a deadly virus lurked only amplified that stress.

Experts disagree about how best to limit deaths caused by drug use. Look no further than the spirited debate surrounding drug use instigated by Carl Hart, a professor of psychology at Columbia University who regularly uses heroin. He advocates for a wider acceptance of drug use, including opioids, to create a safer environment.

A wide range of critics have said that he avoids discussing the negative consequences. In particular, they contend that marketing opioids as safe is what led to the crisis in the first place, as doctors broadly prescribed painkillers such as OxyContin starting in the late ‘90s.

One thing that most experts, including Hart, agree on is that tainted opioids have had dire consequences for the epidemic.

Specifically, the presence of fentanyl in overdose deaths has spiked dramatically since 2014, according to the CDC. Fentanyl is a synthetic opioid that is extremely powerful and addictive. It enables drug dealers to produce lower quantities and sell them for a similar price, increasing their profit margins.

Northeastern Minnesota is not immune to synthetic opioids, as St. Louis County officials and ClearPath staff said they began to see fentanyl more regularly in the mid-2010s.
Started with prescription

While academic debate rages, Turbes’ experience represents a fairly common path. Many of the people who wind up addicted, started using prescription drugs under recommendation from a medical expert with limited warning about the potential for addiction. There are also plenty of children prescribed Ritalin who do not wind up heavily using more potent substances.

Sarah describes her childhood as nearly the opposite of Turbes. She had a horse, pigs, cows and a deer that lived in the house. However, her path to substance abuse mirrors that of Turbes. Doctors diagnosed her with Lupus SLE at the age of 14. At that time, her chest pains were excruciating. When the ibuprofen didn’t cut it, they tried her on stronger pain killers, first Lortabs, then Vicodin and, finally, OxyContin.

She spent the next seven years heavily using the pain medication to assuage her various illnesses. When she turned 21, she started a job for a local phone company. To set herself up for success in the new role, she stopped taking the medication. She started to feel sick and couldn’t figure out why. “I take a pill, I feel better,” Sarah said. “I’m like ‘Oh no. Oh no’.”

Both Sarah and Turbes said they received no warning that their medications were highly addictive.
Jane Maxwell, a research professor at the University of Texas at Austin who focuses on patterns of heroin abuse, said health officials didn’t understand the potency of OxyContin when it first became available.

“I think we didn’t realize that when I get you OxyContin, I’m really giving you a nice pill that is cleaned up and better-looking heroin,” Maxwell said.

The past year’s spike in overdoses has also raised questions about health outcomes for the state’s American Indian population. While St. Louis County is 90% white, it has a sizeable American Indian population and abuts Fond du Lac, an Ojibwe reservation. According to the Minnesota Health Department, American Indians are seven times more likely to die of an overdose death in Minnesota.

Shayna Clark is one of Harm Reduction Sisters secondary service providers. Clark grew up on the Red Lake reservation, about three-and-a-half hours northeast of Duluth.

As a former opioid user and member of the Chippewa tribe, she lends credibility to the Harm Reduction Sisters operation. Recently, a friend reached out to her for help. His brother died a year earlier from an overdose, and after a year of heavily using meth, he was ready to seek out treatment.

She hopes she can be a guiding light when people in her life experience traumatic events related to drugs or are simply looking for someone to speak with about their addiction. Her eldest son is 17 and lives on the Red Lake reservation. He witnessed a family member overdose and had to call for an ambulance earlier this year. The relative survived, but Clark has worried about her son’s mental health since. He agreed to go to therapy, but she fears the traumatic event could have a long-term emotional impact.

Clark said it’s important to know someone who can lend a hand when seeking out help. She never had that person in her life. Her low point came when she got in trouble with the Duluth police for drug possession, which led to her losing her house and children in the same day.

“When you find yourself walking around the city at 3, 4 in the morning, feeling lonely, sad, tired,” Clark said. “No place to go.”

Eventually, she wound up at Mash-Ka-Wisen Treatment Center, a culturally based facility that caters to the American Indian community. Since then, she hasn’t used drugs.
“It’s rewarding to remain sober,” Clark said.

Clark and Purchase are highly concerned about the drug use in the American Indian community, which they say has also led to other health problems. In the past few months, cases of HIV have increased among American Indians.

Goodridge’s identity as an American Indian has also been important in her battle with addiction. She noted that some drug users assume American Indian women are more likely to provide sexual favors in exchange for drugs.

Like Clark, Goodridge spent time in a culturally based facility in northern Minnesota designed specifically for American Indian women. Goodridge valued the spiritual component of her treatment and would like to run sweat lodges and spiritual ceremonies one day. To perform those ceremonies, she’ll need to earn six degrees passing from infant to elder and ultimately to death.

“It’s the steps you got to take in life,” Goodridge said. “And you have to pass so many of them degrees, and it just gets harder and harder as you go up, so it’s kind of like the circle of life.”

For Goodridge and Turbes, the triggers are everywhere. A sunny day reminds them of a time they were high. A rainy day elicits the same nostalgia. Both have spent time in various treatment facilities, but they’re confident this time is different.

Ashlee and Matthias after becoming sober.

A sense of hope

The combination of ClearPath’s methadone services and their supportive relationship gives them a sense of hope. It’s Turbes’ second time trying methadone treatment, and Goodridge’s first.

Turbes says he’s actually trying to implement his counselor’s advice this time. They both had previously tried suboxone, a more widely available substance abuse medication, but it didn’t work.

Goodridge spent time in Duluth previously and felt that moving north would help the pair achieve sobriety. They have access to the services they need, without the same bustle of a city.

“It’s better scenery all around compared to the shit you see in the cities,” Goodridge said.

The couple started methadone at the end of 2020 after a period of heavy drug use at the start of the pandemic while living in the hotel in St. Cloud. Now, they say that they’re making more progress than most do.

“We’ve achieved a lot more than most people in our first 90 days,” Goodridge said.

Goodridge and Turbes’ case isn’t the norm, said Jennifer Villa, the clinical supervisor at ClearPath. While people who have been in the program long term seem to be improving as pandemic restrictions lift, the volume of newly admitted patients is overwhelming.

“People outside of the program aren’t doing well. That has a lot to do with the opioid epidemic and all of the fentanyl coming into the area where we live,” Villa said.

The clinic now has around 100 more patients than it did last year.

Sarah has inched her way down from a high dosage and has been on methadone for 15 years. Part of her reticence to scale back her dosage stems from a traumatic experience with a previous doctor who decreased her dosage by 100 milligrams in one day, a massive shift.

She is also hyper aware of the stigmatization of methadone, as it took her years to even tell her parents. When she started treatment, she took out a student loan to pay for it.

She aims to be done with treatment by the age of 48 and wants to put her social services degree to use by helping teenagers struggling with addiction. She also wants to dispel the negative stereotypes around the treatment.

“People that are on methadone aren’t bad people,” Sarah said. “They just made some wrong choices.”

ClearPath plays a huge role in helping the community with treatment services. It is the only facility licensed to provide methadone treatment in St. Louis County. The next closest location is two-and-a-half hours away.

While located in one of the denser parts of Duluth, it’s a critical resource for people seeking help in more rural parts of the community.

The opioid epidemic has long been a health crisis associated with rural America. As vaccines become more readily available, public health officials will try to put back in place programs that helped slow the epidemic.

However, the post-COVID-19 reality remains unclear.

“I don’t think we’ve really begun to see the impact that COVID had on substance-use treatment,” Maxwell said. “How many people go to treatment? How many people should have gone to treatment, and instead self-treated themselves and ends up dead or overdosing?”

As experts sort through the broader implications of COVID-19, northeastern Minnesota watched gains in its decade-long battle against opioid use disappear. The carnage laid bare a system that was not equipped to handle two public health crises and magnified health disparities along racial lines. Clinics are having to take in patients at enormous volume.

However, figures like Turbes, Goodridge, Clark and Sarah offer hope. They form a community of recovered and recovering addicts who want to be a guiding light for folks in need. With enough torches, there might be an opportunity to stem the powerful tide of substance abuse that took shape during the pandemic.

Benton Graham is a journalist from Minnesota.