Q&A: HMA consultant discusses Alaska’s substance addiction issues – State of Reform

Lindsey Kato is a Senior Consultant at Health Management Associates (HMA). Throughout her career, she has worked in the substance abuse, drug overdose, and suicide prevention fields. Most recently, she helped lead efforts to establish the National Overdose Response Strategy (ORS), a program funded by CDC and the Office of National Drug Control Policy.

Kato is an Alaskan native born and raised in Juneau, and has prior experience working to address suicide prevention and mental health across the state. She returned to HMA in late March, and will work on national objectives, as well as opioid treatment expansion and prevention efforts in Alaska. Her return to Alaska is timely, as the state has experienced a 71 percent increase in drug overdose deaths between 2020 (146 deaths) and 2021 (253 deaths), according to the Alaska Department of Health and Social Services.

In this Q&A, Kato discusses Alaska’s addiction issues and effective treatment/prevention tactics.

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State of Reform: What are some key contributors that lead to struggles with addiction in Alaska?

Lindsey Kato: “Alaska is unique in the sense that there’s significant isolation, in many ways. A lot of communities are isolated; often there are no road systems, and some places are only accessible by boat or plane. In the winter, I think it can feel especially hopeless.

Additionally, a lot of our resources are in larger communities, so smaller communities struggled considerably with access to services.

Our state has significant historical trauma that has created inequities. We have not had substance use treatment services historically, at least not compared to the need, and many people have to leave their communities to receive care. Alaska also has some of the highest suicide rates in the country, so when we’re talking about sadness and depression, those things are intertwined and make addiction more complicated.”

SOR: What have you found to be some effective methods in trying to help people with addiction issues?

LK: “Listening to people who are actively using substances, in recovery, or in treatment programs is one of the most effective methods for us to be engaging people with these issues. It would be remiss of us to try to provide support without listening to what they need. They need stable housing. They need to know they have a safe place to sleep. We know other effective methods; people are aware of best practice methods for using methadone, and other medications, and there’s a lot of evidence behind them. But meeting people where they’re at, hearing them, seeing them, and providing education and resources in safe places for them has been most effective.”

SOR: Do treatments vary significantly depending on which substance a patient is addicted to?

LK: “Yes. You can think of something like cognitive behavioral therapy or others as standard therapies you might see across different substances. Many times those are recommended across the board. But alcohol versus opioid versus methamphetamine versus benzodiazepines—all are different chemicals that act differently on the brain. They trigger different effects, so when you talk about treatment, that will vary.

When we think about that, we think about individualized treatment, which includes considerations of length of time using the substance, substance type, and mode of use. So even when considering an older adult or someone who has been injecting an opioid for a long period of time versus an 18-year-old who has been potentially smoking a prescription pill for several months, the type of treatment is going to be a little different.

Treatments can vary. Best practices vary as our knowledge base grows, and that makes it hard for providers. things will continue to change; Some of these treatments will grow, so it can be hard for our providers to keep up. The substances are changing as well, especially with the introduction of fentanyl into the market. That can impact the way we address some things, and the complexities at a treatment center. Maybe a patient reporting to a treatment facility for a methamphetamine issue is not aware they have been ingesting fentanyl as well, so that could change the course of detox and treatment.”

SOR: Is there a specific substance Alaska health officials should currently be focused on?

LK: “fentanyl; the alarm has been sounded on fentanyl. It’s not just in the opioid supply. It’s in counterfeit benzodiazepines pills and it can be found in methamphetamine. I would say fentanyl, methamphetamine, and alcohol are big. You can’t underemphasize alcohol and the way it contributes to negative impacts on communities. If we think about upstream primary risk factors, they’re similar across the board whether it’s methamphetamine, alcohol, or fentanyl.

So, I’m always asking, ‘How do we build healthy communities so the demand for substances is not there?’ We need to be strengthening our communities and building resilience. That takes time. It’s not something you wake up in the morning and do. We need to have a broader approach to health and safety in our communities to break the cycle of addiction and the demand for wanting to use those substances.”

SOR: What are some prevention outreach efforts Alaska health officials can take?

LK: “COVID hasn’t been helpful, but I think everybody is doing what they can. I think all of our agencies have some sort of priority around substance use and overdose, but that can be hard in the middle of a pandemic and with workforce shortages. I think we can do more aligned and coordinated efforts across the state, that will help, both in funding and resources. I think that’s where we are headed, in general, in the field of prevention.

I hope we’re headed toward a shared risk and protective factor approach. Everyone has a stake in it. With collective work and alignment, we’re headed in the right direction. And hopefully we can start to get our feet under us again. With COVID, we’ve seen increases in isolation, suicide, and violence. It’s not surprising we would see a correlation with overdoses and substance use. The past two years have been really difficult. When we’re thinking about addiction and substance abuse, we have to consider all the recovery, treatment, and counseling options we have, but now also how the system has been impacted with shutdowns and how that affects individuals.”

This interview was edited for clarity and length.

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