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Rehabbing the opioid addiction epidemic in the Steel City

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PUEBLO — Almost as troubling as the addiction problem itself is how communities are coping and working to solve the opioid epidemic. There are few places that’s more evident in Colorado than Pueblo, which continues to see a rise in use, arrests and overdose deaths related to opioid use.

Those working on the issue, locally and at the state level, say there are resources — which are mostly limited — but it’s up to communities to recognize what they need and treat the problem aggressively.

State of an Epidemic

The evolution of opioid addiction in Colorado, particularly in Southern Colorado, has been aggressive to say the least.

In April, a multi-agency report under the Colorado Consortium for Prescription Drug Abuse Prevention showcased a grave picture of the problem across the state: heroin-related deaths doubled from 2011 to 2015, heroin seizures by Colorado law enforcement increased 2,035 percent during the same time period and the number of people who were in treatment for heroin addiction increased 128 percent.

In each 2015 and 2016, Pueblo County saw 12 overdoses related to opioid use — the highest death count in the state, three times the state rate. And according to Dr. Michael Nerenberg, who runs the mobile needle exchange program in Pueblo, the problem isn’t getting better. It’s getting worse.

At a February Pueblo City Council work session Nerenberg said over the course of a year — June 2015 to June 2016 — the exchange had a reported 3,020 visits, which comes out to just over 250 visits per month. The needle exchange saw 420 total new clients and distributed nearly 200,000 needles. 118,000 were collected by the volunteers, which Nerenberg said is a conservative estimate.

Colorado Department of Public Health and Environment

The month prior to the city council work session was a record month, Nerenberg said. That came despite raised awareness, more meetings and more people working to implement programs and solutions.

For areas around Pueblo, rural and with few resources, the problem is as pressing. More often than not there are no detox beds available in Pueblo County, let alone the region. Treatment is limited. The Colorado state health department reported opioid overdose death rates tripling between 2001 and 2015.

Resources Local and State

“The plan is that the needle exchange gets them through the door,” said Margaret Redmond, executive director of the Pueblo Human Relations Commission.

The commission recently opened a stationary needle exchange in Pueblo’s Bessemer neighborhood — and while it’s a good start, Redmond says it’s hopefully just the beginning of a bigger solution to Pueblo’s heroin addiction problem. The exchange has so far been operating as a mobile unit in Bessemer Park — but Redmond and Nerenberg said the city asked that they operate somewhere else.

Funding from the city, $30,000, and county, $41,000, helped make the more permanent exchange possible. But help from like-minded people around the state has been invaluable.

The Colorado Consortium for Prescription Drug Abuse Prevention helps communities across the state get resources for battling the epidemic — which is just one of the major aspects of the group. The consortium also has working groups that focus on public awareness, research and affected family and friends.

“You tell us what you need and we’ll go try to get it,” said Robert Valuk, the consortium’s coordinator.

A snapshot at how the Colorado Consortium for Prescription Drug Abuse is structured. The group works in several different capacities to address the increasing problem.

A lot of federal funding for opioid addiction treatment can go to states, not local communities, Valuk said. So a big focus the consortium has is writing grants on behalf of communities across the state that are desperate, like Pueblo, for resources.

So far, Valuk said the group has been able to get over $33 million from the federal government. In March, Colorado’s Department of Human Services was awarded $7.8 million for opioid addiction.

Regularly a news release from U.S. Rep. Scott Tipton will outline what money federal money is available for opioid addiction. That’s the money the consortium is looking for.

Locally, Nerenberg, who has been substantially involved in helping get a handle on the epidemic, says there are resources available to Pueblo — local leaders just have to say yes. Nerenberg says they seem to still be hesitant.

This year the Colorado legislature included in its budget $7.5 million over the next three years for Law Enforcement Assisted Diversion programs, which aim to divert low-level drug and prostitution offenders to treatment instead of jail and prosecution.

“I’ve been talking to them (city council) for over a year and a half on this,” Nerenberg said.

At a city council work session, members told Nerenberg that the police department shies away from programs such as LEAD because possession of heroin is a federal felony.

If other communities have found a way around that concern, Nerenberg said he thinks Pueblo can too.

Other communities are interested in the available funding for LEAD programs, but Nerenberg fears Pueblo will see none of that specific aid because of reluctancy from the government.

On the other side of the problem is the lack of available healthcare providers who can administer and prescribe buprenorphine and other FDA-approved medications and therapies as part of providing medical assisted treatment to opioid-dependent patients.

But Pueblo legislators this session were successful in at least getting a pilot program off the ground to help resolve that issue. Successfully-passed Senate Bill 74, sponsored by Sen. Leroy Garcia and Rep. Daneya Esgar, designates $1 million from the marijuana tax cash fund go to assisting nurse practitioners and physician assistants obtain training that allows them to provide treatment to patients dependent on opioids.

The bill, which is only a pilot program for Pueblo and Routt counties, will have lasting impact, Garcia said. Once these healthcare professionals get training it stays with them.

This year, the legislature made a considerable amount of progress on the opioid epidemic, compared to years prior. Nerenberg believes it’s because opioid addiction now impacts so many the legislature has finally opened its eyes.

The Federal Angle: A Candidate’s Uncertain Promise

What happens next in fighting the opioid epidemic, at least in looking at resources and aid from the federal government, so far seems bleak.

In many cities on the 2016 campaign trail the topic of opioid addiction was front and center for Donald Trump. Many telling stories of a son or daughter overdosing on heroin or the long, grueling path that eventually led to rehab.

“I would dramatically expand access to treatment slots and end Medicaid policies that obstruct inpatient treatment. You’ve got to do this,” said candidate Trump at a New Hampshire campaign stop in October.

Paul Wright smokes a cigarette, Thursday, June 15, 2017, at the Neil Kennedy Recovery Clinic in Youngstown, Ohio. Republican efforts to roll back “Obamacare” are colliding with the opioid epidemic. Cutbacks would hit hard in states that are deeply affected by the addiction crisis and struggling to turn the corner. The issue is Medicaid, expanded under former President Barack Obama. Data show that Medicaid expansion is paying for a large share of treatment costs in hard hit states. (AP Photo/David Dermer)

But leaked documents from Trump’s budget proposal didn’t reflect the same sentiment in May and had many worried about future resources. Opposite of the campaign talk was a 94 percent decrease in funding to the White House Office of Drug Control Policy and the elimination of at least two drug-related grant programs. So far it’s still unclear what lasting impact Trump’s budget could have on areas hit hardest by the epidemic — rural and blue-collar cities that tended to vote for Trump.

The president still hasn’t nominated a ‘Drug Czar’, which would oversee the office of drug control policy.

Trump’s budget still maintains funds for the $1.85 billion block of grants that make treatment for 2.5 million Americans possible. But the budget also calls for a cut in addiction research funding and would completely eliminate federal dollars for the training of addiction professionals.

Anti-heroin task forces, such as the ones that operate across Colorado, are expected to suffer under Trump’s version of the budget as well.

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Middle schoolers have a plan to stop rock art tagging in Western Colorado

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Courtesy gjhikes.com

GRAND JUNCTION, Colo. (AP) — Arron Buehler’s day in a western Colorado canyon might not have had the Hollywood panache of Ferris Bueller’s day off, but something about seeing Buehler’s name scrawled on the sandstone escarpment gave Chris Joyner pause.

Joyner, spokesman for the Grand Junction Office of the Bureau of Land Management, looked at Buehler’s name — and those of many others emblazoned on rock in a canyon south of Grand Junction — and said that, paradoxically, there might be a reason for hope.

It was just last year that Buehler posted his name, next to Elizabeth, who left her mark in 2017.

Few of the names appeared to be more than a year or two old, and, “That tells me there’s opportunity here,” Joyner said.

The more recent the markings, the more likely the vandals are to be found, and the more likely it is that other methods might discourage younger people from following Arron Buehler’s lead, Joyner said.

Joyner and BLM archaeologist Alissa Leavitt-Reynolds are working in Grand Junction to deal with vandalism on federal lands, whether it be by graffiti artists such as Charley Humpy (who helpfully added, “Remember me” next to his name and yes, the BLM is doing all it can to achieve total recall), drug users ditching evidence in the desert, mayhem by “marksmen” and plain old dumping.

As much as Arron Buehler and a multitude of companions — Brian, Charley, Dizz, Dominique, Kay, Megan, Elizabeth, Jon, Sam and Tosha all seem to be begging for court dates (and Tosha, did you know your name covered an ancient petroglyph?) — Joyner said prosecution ought not be the only response to a growing trend of vandalism and worse on western Colorado’s rocky outcrops and arid landscapes.

Citations for vandalism aren’t tracked by the Colorado U.S. Attorney’s Office, which prosecutes offenses on federal land, so no precise numbers are available.

An Army veteran, Joyner is using his post 9/11 GI Bill funds at Johns-Hopkins University to study ways to divert people from what he terms “dysfunctional visitor behavior.”

“Dysfunctional visitor behavior” has a more authoritative ring than “vandalism” and “littering” and Joyner said he hopes that a scholarly approach can help agencies fend off some of the destructive activity on federal lands before it takes place.

Some of his research suggests that “informed participation in nearby historic and cultural sites” can influence the way many residents perceive those sites, Joyner said.

The students in Ginger DeCavitch’s social studies classes at Mount Garfield Middle School experienced “informed participation” last summer.

DeCavitch took her students into Bangs Canyon to see the mica mine and found the defaced escarpment “as we were stepping over broken beer bottles and charcoal” from fires.

Vandals had used charcoal to scratch names and slogans on the rock, DeCavitch said.

“They call it tagging” and few participants see any issue with defacing the rock, taking selfies and posting them on social media, DeCavitch said.

She contacted the BLM soon afterward to see if her class could help clean up the mess they found.

“They all wanted to go back,” enough that some students hauled 40-pound containers of water down an occasionally difficult trail to help clean the site, DeCavitch said.

Her middle school students sat silent as members of the Southern Ute tribe described how they perceived the canyon and the ancient markings, many of which had been defaced, DeCavitch said.

Far from being discouraged, her students were enthused about tackling the enormity of the defacement, DeCavitch said.

“We have a plan that we’ll be back,” she said.

Introducing young people properly to wild lands is one way to discourage future vandals and dysfunctional visitors.

It’s one “foot-in-the-door” tactic that Joyner hopes land managers take up.

Visitors also can be endowed with a sense of ownership by agreeing with a simple proposition — the idea that one ought not litter on public lands, for instance — and then be brought along to agree with how to visit them appropriately, Joyner said.

It’s part of a human tendency to want to be consistent, he said. People who agree not to litter tend to want to build on that as opposed to act in contradictory fashion, he said.

Even providing a small gift or trinket can engender a sense of responsibility among potential vandals, Joyner said.

Other techniques include the “broken-window” approach — the idea that replacing broken glass as soon as it’s found and thus denying miscreants their moment of victory — isn’t as easy as it might be in other environments, Joyner said.

DeCavitch’s class, for instance, learned that while cleaning up a mess might eliminate an eyesore, it also could erase history.

Her eager middle-schoolers couldn’t go forward with the cleanup until members of the Southern Ute Tribe, headquartered in Duchesne, Utah, approved the plan, DeCavitch said.

While Joyner’s studies have suggested that males 16 to 25 who live within 60 miles of Grand Junction are the likely offenders, one look at the escarpment suggests that young women are more active participants than crime statistics might suggest, Joyner said.

One study suggests that younger people prefer non-coercive approaches, but Joyner said that doesn’t mean the BLM is losing interest in prosecuting vandals and others.

Far from it.

BLM officials routinely contact school officials and consult high school yearbooks to match the names they come across with people who could be prosecuted.

Some miscreants make it easier, posting selfies of themselves with their works. Some even lower the level of difficulty by including hashtags.

The criminal exposure can reach felony levels because of the difficulty and expense of dealing with cleaning up or restoring the markings that date back hundreds of years.

If the malefactors are found, Joyner said, “We don’t write warning tickets.”

___

Information from: The Daily Sentinel, http://www.gjsentinel.com

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The #WhatNow of #MeToo for the #COLeg

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AP Photo/David Zalubowski

When several lawmakers, lobbyists and staff at the state Legislature came forward this fall to allege they were victims of sexual harassment by lawmakers, two big questions followed: how often does this happen? What can be done to prevent more cases?

Reporters have asked state officials the first question repeatedly, returning to readers with little response from the state. The latter prompted a conversation from leadership, but as for what’s next—how the allegations, formal complaints, and legislature’s response—will impact politics under the gold dome and whether women will feel any safer is to be determined.

So far, top state lawmakers have decided to hire a human resources officer—who would be independent from the legislature—to be a contact person when incidents involving sexual harassment are brought forward. Now, leadership is tasked with handling and investigating such claims.

The group also decided to hire an independent consultant to review the legislature’s sexual harassment policy, and lawmakers, staff, and aides will undergo another round of sexual harassment training this year. Typically, those working at the Legislature are only required to go through training every two years.

Those changes are a good start, said Erin Hottenstein, executive director of Colorado 50/50, an organization that aims to get more women in public office. But the legislature stopped short of changing any current policies. And Colorado 50/50 called for an entire overhaul.

“I’m very pleased that there was a recognition that the policy needs to be improved,” Hottenstein said.

But there weren’t any specific recommendations regarding transparency, which Hottenstein said is significant in looking at what happens next.

Lawmakers and staff said they couldn’t disclose how many sexual harassment claims that leadership in each chamber have received because they were personnel issues.

“I think there’s a way to be transparent and safe,” Hottenstein said. “There should be a high- level summary document that shows on a certain date a sexual harassment complaint was made and who it was against and a date of a deposition and what the result was.”

Hottenstein said transparency becomes crucial in these cases because it leads to accountability and the public’s right to know what actions the people elected to office are taking.

In October, Pueblo Rep. Daneya Esgar broke her silence posting on Facebook that she was no stranger to sexual harassment and experienced it just a week earlier with a colleague she works with regularly as a lawmaker. The post was part of the #MeToo movement after a New York Times expose highlighted the stories of several women who said they’d been sexually harassed or assaulted by Hollywood producer Harvey Weinstein.

Then, a flood of other allegations were brought to the surface in Colorado politics. Rep. Faith Winter said fellow House member Steve Lebsock had harassed her at a legislative party in 2016. Winter and a lobbyist say they filed formal complaints against Lebsock.

An intern said Sen. Randy Baumgardner harassed her with sexually suggestive comments. The same went for Sen. Jack Tate of Centennial, who was accused of telling an intern that if she wanted to get ahead in her career, he could help.

Rep. Paul Rosenthal, who is openly gay, allegedly groped a man and used his seat to try and get a date with another.

But the case between Lebsock and Winter gained the most attention, even prompting Lebsock to take a polygraph test, which the administrator says he passed, to prove his innocence. Lebsock has hinted that the entire incident may be a case of dirty politics, alleging that Winter is the one lying.

When several lawmakers were asked if the case would mean a splintered Democratic party in the House, they were unsure, but optimistic about the session.

Still, there haven’t been any resignations over the allegations, though several, including leadership and editorial boards from across the state, said these legislators should step down from their seat. Some even called for House Speaker Crisanta Duran to step down from her position because she promoted Lebsock to a chairmanship despite knowing there was an incident between him and Winter.

The transparency piece has yet to be addressed by state lawmakers, and it’s unclear whether any policy or legislative changes will address that in the coming months. But for what it’s worth, the women who have broken their silence about sexual harassment in the Legislature are supportive of the changes leadership has discussed.

“I’m encouraged to see the direction leadership is taking when it comes to developing new and independent methods of dealing with complaints of sexual harassment at the Capitol,” said Esgar, who still hasn’t named the colleague she said grabbed her thigh at a legislative event earlier this year. “I’m hopeful that new ideas are still being formulated and considered, when it comes to ways to change the culture itself.”

The lawmaker added that a new session will certainly mean new ideas will come to light, “it’s our responsibility to lead the state in changing cultures to help make work environments safe and productive for all employees on every level.”

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Overdose overload: Addicts in distress put the strain on first responders

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The opioid and heroin epidemic has created a growing number of drug overdoses, which are taking their toll on first responders in southern Colorado’s urban and rural areas – first responders who are charged with administering initial treatment at the scene and transporting distressed addicts to hospitals.

Brandon Costerison, who is a spokesman for the National Council on Alcoholism and Drug Abuse and based out of the St. Louis area, says there are two trends coming out of the opioid and heroin epidemic. The first is positive: Hospitals, once overdosed addicts are brought to their facilities for initial treatment, have been more and more able to put those addicts into long-term treatment programs with the help of community support. Costerison likens overdoses to heart attacks in that essential follow-up treatments concentrating on “high blood pressure and all the other things that caused the heart attack” are needed for preventing heart failures in the future. He adds that not all communities, particularly those in rural areas, can offer follow-up treatments for addicts who overdosed and who often leave the hospitals and/or incarceration without getting the treatment they need to get off drugs and prevent future overdoses.

The second trend, though, is most disparaging: the high number of overdosing addicts has put a strain on first responders to get overdose patients through emergency room doors. Costerison says that emergency medical technicians have about two to three hours to get opioid addicts who overdose to the hospital. He adds that he has relatives in the Pueblo area and wonders about the toll put on EMTs in southeast Colorado’s rural areas, where the nearest medical facility could be as far as 45 miles away or even greater.

Third strike, and done?

As for the toll overdoses take on a community in terms of dollars and cents, Costerison refers to a June 28th story appearing on the USA Today website about an Ohio town that has suffered such financial losses from repeat opioid overdose calls that its city council morbidly discussed a three-strikes rule. Middletown, Ohio, which has less than half the population of Pueblo, actually ruminated over leaving a distressed opioid addict for dead if that person was treated and taken to the hospital by the city’s EMTs for an overdose two times prior.

The city council cited, among other things, the high cost of Narcan, the drug used to counter the effects of an opioid overdose. “That somebody’s life is only worth a few bucks is really disconcerting,” Costerison says.

A call last month to Middletown city media representative Shelby Quinlivan humanely revealed that the three-strikes discussion “went nowhere” and the councilman who brought up the idea did not get re-elected and will leave his post this month.

Thankfully, a discussion like the one had by the Middleton City Council would be highly improbable in Pueblo.

Pueblo Fire Chief Shawn Shelton explains that, although his firefighters are also trained as EMTs, they don’t take anyone to the hospital and in at least some cases don’t administer Narcan. He says the City of Pueblo contracts with a Greenwood Village-based national company called American Medical Response or AMR for those services. (AMR has a similar contract with Canon City.)

In AMR’s hands

In regards to opioid and heroin overdoses, Pueblo firefighters and police officers usually arrive at the scene first, then call AMR, which sends EMTs and an ambulance. The AMR EMTs in many cases administer the Narcan and then transport the overdose patient to the hospital. AMR then bills the patient or the patient’s insurance provider for the Narcan and services rendered. The only expense for the city is for the firefighters to call and observe the AMR EMTs, and those firefighters would be on duty anyway.

Also Shelton’s firefighters have observed that, like in Middletown, there have been a number of addicts in Pueblo who repeatedly overdose, but figures on just how many were not readily available.

As an aside, the fire chief says Narcan, which is also known by the generic name naloxone, is only a temporary fix that lasts a relatively short time before the negative symptoms of the overdose – vomiting, dizziness, seizures, etc. – return. Shelton says addicts often get angry after the Narcan is administered (to help save their lives) because it interrupts or ruins the heroin high for which they paid a lot of money to buy on the street.

Mike Lening is operations manager for AMR’s South Region, which serves Pueblo, most of Pueblo County (except for Rye and Beulah), and Fremont County. He says an increase in opioid overdoses across his region “makes it tougher” on his company’s resources (EMTs and equipment). As for the cost of treating overdosing addicts, who most often cannot pay for AMR’s services, Lening says his EMTs do not curtail their services based on someone’s perceived inability to pay for them. He adds that sometimes in rural areas his EMTs have to transport patients to hospitals that are “up to 45 minutes to an hour away.”

As for the urban area, Lening says AMR has seen “a little bit of a spike” in opioid overdose calls in the city of Pueblo recently.

By the numbers

Although Lening says he cannot come up with the total number overdoses his EMTs treat during any given time frame, the Pueblo Fire Department was able to come up with statistics relating to the number of times Narcan has been administered in the presence the city’s firefighters during their calls. Pueblo Fire Inspector Erik Duran, who is also the fire department’s information officer, provided a chart that shows in 2014 either firefighters, AMR EMTs or Pueblo police officers administered Narcan during calls labeled as drug overdoses and alcohol and other poisonings 69 times. Duran explains that roughly 95 percent of those calls are in fact overdoses. That number increases dramatically in 2015 to 92 calls, then goes down to 73 calls in 2016, and back up again to 84 calls from January 1st to mid-December of last year. Other calls during which Narcan was administered, which might have been overdoses, are those in which the victim was unconscious or near unconscious at the scene and there was no telltale paraphernalia when first responders arrived, so the victim’s medical condition could not be immediately ascertained. In those calls, AMR EMTs took over treatment. Those numbers are 32 such calls in 2014, also 32 in 2015, 48 in 2016 and 37 during most of last year. And yet during other city fire department calls, which again might have been overdoses, the victim received Narcan during treatment and died at the scene. The numbers for those calls are two in 2014, one in 2015, six in 2016 and five for most of 2017.

Rural areas not immune

EMT resources in rural areas are being stretched, to say the least. Alamosa Police Department Capt. Samuel Maestas says that the cost of opioid overdose calls for his city had been steadily on the rise until they “flat-lined” recently when the city took advantage of a state grant giving rural areas the funds to purchase Narcan. The move also allows Alamosa police officers, who are usually the first to arrive at the scene of an overdose, to administer the drug before EMTs from San Luis Valley Health arrive to transport addicts to the hospital thereby taking fire department personnel out of the picture in most instances. San Luis Valley Health provides emergency medical response, through its Alamosa Ambulance Service, for the city of Alamosa and all of Alamosa County.

Ted Andersen is the director of the Alamosa Ambulance Service and he estimates that his company’s emergency call volumes for overdoses have increased by roughly 24 percent from the start of 2015 to the beginning of last month. Andersen says, “We almost don’t have enough ambulances to handle all the overdose calls,” adding that the cost of keeping those ambulances stocked with Narcan is astronomical. Also, Andersen says he needs more EMTs because of the heroin and opioid crisis, and EMTs are in short supply mainly because they require four years of training – much like registered nurses do.

Andersen explains that most of the distressed addicts his EMTs encounter are transients (homeless and from out of state). He adds that many of them are repeat, to coin a phrase, overdosers, who­ – once they are hospitalized – refuse the long-term treatment that would get them off heroin and opioids for good.

Andersen theorizes that addicts come to Colorado without jobs because they know marijuana is legal here and surmise local officials are lenient when it comes to other drugs. He says he has heard that Pueblo, Colorado Springs, and even Denver are dealing with the same issue.

At the scene of the overdose, the EMTs usually encounter an addict who is either not breathing or having seizures. Andersen says EMTs are putting their lives at risk because, once the Narcan is administered, the addict becomes hostile. “It’s like they’re saying, ‘Hey, man, you just ruined my $200 high. Thank you very much!’” he says. Then the punching and kicking begins.

Andersen says his EMTs now wear protective vests to counter these violent reactions. To avoid conflict at the scene in the first place, the EMTs, if possible, try to clear the patient’s airway and get him or her stabilized without using Narcan. Andersen says they save the Narcan treatment for the emergency room, where the environment is more controlled.

What to do?

Southeast Colorado’s first responders are seeing their resources being stretched to the limit when it comes to handling overdose patients – many of whom are repeatedly coming into contact with EMTs because they refuse long-term treatment. The National Council on Alcoholism and Drug Abuse’s Costerison says in St. Louis the opposite is true. They have overdose patients who want treatment and can’t get it largely because Missouri, unlike Colorado, has not expanded its Medicaid program making long-term treatment unaffordable to most addicts. Yet Costerison says St. Louis has instituted a peer program whereby addicts, once they are done with initial overdose treatments and are in recovery, receive bedside counseling from former addicts who also have been through overdoses. Costerison says the peer program has been more effective at urging distressed addicts into long-term treatment than suggestions that they should get help by medical professionals who have not been through the addicts’ ordeals.

However, St. Louis has a population of almost three times that of Pueblo, so it might be difficult for Pueblo and particularly the smaller communities in southeast Colorado to find enough recovered addicts to be on call whenever an overdose occurs. So a solution to the problem of overdosing addicts may remain elusive for some time. Meanwhile, first responders are risking life and limb and taxing their resources to save opioid addicts from themselves.

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