Rural Realities: Opioids on Main Street U.S.A.

Churches seek to become sources of hope

By Donna Frischknecht Jackson | Presbyterians Today

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Annalie Korengel wasn’t just having a bad week. She was having a horrific one. Five funerals in seven days can push any pastor to the brink of physical and spiritual exhaustion. But for the pastor of Unionville Presbyterian Church in Kennett Square, Pennsylvania, standing almost daily at the gravesides of young people who had overdosed on opioids pushed her into an indescribable hell.

When the last funeral had concluded, Korengel and the local funeral director, a good friend of hers, sat down to process what they had witnessed. They couldn’t. Nothing made sense. All they could agree on was that “we didn’t get into this business to bury kids,” Korengel said.

“There are just no words,” she added, her voice revealing a pastor’s frustration of not being able to take away the pain of loved ones, who also suffer from the guilt and stigma that accompany a drug death.

“No,” she said, “there isn’t anything to say except the God I know would say that these deaths are not OK.”

The new ‘inner city’

Used needles discarded in a park. A Narcotics Anonymous group renting space in a church. An increase in homes and cars being broken into as money for drugs is sought, leading many neighbors to start locking doors, some for the first time ever.

Welcome to life in rural America, where old-timers and newcomers alike are confronting a reality that neither of them expected. The old-timers were once stubbornly insistent that drugs were an inner-city problem. The newcomers wanted drug-free streets for their children. Now, however, both groups are slowly realizing that no one is exempt from the nation’s opioid crisis.

It’s a crisis that began in the late 1990s when health care providers, reassured by pharmaceutical companies that patients would not become addicted to prescription opioid pain relievers, began prescribing them more freely. The pain medications, though, were addictive, and opioid misuse increased. This trend has become especially prevalent in rural America, where farming accidents have provided a perfect entrée to opioid addiction.

In rural Washington County, N.Y., local organizations and area churches have teamed up to raise awareness of the opioid crisis. A drug forum was held recently in the Salem, New York, firehouse. “We can’t fight this alone. We need to work together,” said Charlie Perry, an elder at First United Presbyterian Church in Salem. Courtesy of the Salem Rotary Club

The American Farm Bureau Federation and National Farmers Union recently found that three in four farmers and farmworkers have been directly impacted by opioid abuse, either by knowing someone addicted, having a family member addicted, having taken an illegal opioid or having dealt with addiction themselves.

The increase in opioid abuse has led to an increase in accidental overdose deaths.

In 2015, the Centers for Disease Control and Prevention (CDC) reported more than 33,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin and illicitly manufactured fentanyl, a powerful synthetic opioid. In 2017, the number of opioid-related deaths in America totaled 47,600. That same year, the CDC reported another eye-opening finding: Drug overdose rates are rising in rural areas, surpassing rates in urban areas.

Health experts attribute the rising rates mainly to the lack of resources available to rural residents, with reliable transportation to drug treatment centers being a factor, along with the distance to a hospital or drug counselors. But this void in counseling facilities, drug prevention education and access to hospitals can present the rural church with ways to become a beacon of hope in the community, says Mary Ann Badenoch.

A rural revelation

Badenoch, a licensed counselor specializing in substance misuse, lives in Texas most of the year, where she worships at Trinity Presbyterian Church in Southlake. In the summer, she and her husband, Tom, spend time at their family cottage in Putnam, New York — a picturesque area in the Adirondacks surrounded by lakes and pine trees and not much else. On Sundays, they worship at Putnam United Presbyterian Church.

This past summer, Badenoch, who also works remotely for the Partnership for Drug-Free Kids in New York City, rented an office in the town of Ticonderoga, 11 miles from tiny Putnam, population just under 600. It was there, talking with Ticonderoga residents and business owners, that she had a rural revelation: While drug addiction is everywhere, for rural communities seeking to battle the epidemic and provide help for residents, “everything is harder,” she says.

What especially surprised Badenoch was the lack of recovery programs in the area.

Tom and Mary Ann Badenoch worship at Putnam United Presbyterian Church in Putnam, N.Y., in the summer. Mary Ann Badenoch was shocked at the lack of resources available to those addicted. Courtesy of Mary Ann Badenoch

“I figured it would be difficult to find local treatment programs, but I assumed that 12-step programs and other recovery meetings, that were basically free of charge for participants, would be more plentiful to make up for the lack of other substance abuse treatment options. Not so,” she said.

Badenoch also said medication-assisted treatment (MAT), which can incorporate methadone, naltrexone or buprenorphine, is “very important for the success in recovery from opioid use disorder, with studies showing that opioid deaths decrease some 60 percent when people receive medication-assisted treatment.”

“Finding treatment providers, though, that can prescribe MAT, paying for the treatment and having support to stay the course make this option nearly impossible for people in the Putnam/Ticonderoga area,” she said.

Badenoch says her summer office in Ticonderoga has given her a “deeper appreciation” for the struggles of those living in rural areas. She looks forward to this summer, when she not only plans to rent an office in Ticonderoga again, but also hopes to enlist local churches, like Putnam Presbyterian, to help in the opioid crisis.

“We can start by offering support groups,” she said. “People need support, encouragement and understanding from others.”

Badenoch envisions a cohort of local pastors collaborating to offer a regular schedule of recovery support meetings. She also would like to offer educational presentations for parents of children struggling with substance misuse.

“This is where the rural church can help,” Badenoch said. “There’s so much our churches can do.”

Working together

An hour south of Ticonderoga is another rural community working to raise awareness about how to help those addicted to opioids and prevent opioid addiction. There, as Badenoch noticed in her community, the most important thing is to bring much-needed resources to residents.

“Our aim is to bring training and counseling services to our rural community,” said Charlie Duveen, a member of Hebron United Presbyterian Church in West Hebron, New York.

Hebron is just one of many hamlets connected to one another by county routes and farms. Along with the communities of Shushan, Salem, Cambridge and Greenwich, the residents of Hebron do not have quick and easy access to medical care, let alone drug treatment facilities and drug counseling.

In 2003, the closest hospital — in Cambridge, New York — closed, leaving residents with an hour-plus drive to the nearest hospital. In late 2018, Salem residents learned that the medical office on Main Street, where many elderly residents go for blood tests and prescriptions, was in danger of closing as well. The disappearance of medical care in rural America is a trend not only in upstate New York, but nationwide, and only exacerbates the opioid problem. A U.S. Government Accountability Office analysis found that between 2013 and 2017, 64 rural hospitals closed due to financial distress and changing health care dynamics, more than twice the number in the previous five years.

With resources evaporating around them, residents like Charlie Perry, a member of First United Presbyterian Church in Salem, have stepped up recruitment for a grassroots opioid-awareness group that began a little more than 1½ years ago, reaching out to school officials and youth in organizations such as Future Farmers of America.

It was in 2017 that Duveen, president of the Salem Rotary Club in Salem, New York, broached the subject of raising opioid awareness among the rural communities. Others agreed that something needed to be done, and so early Monday meetings began with a core group of retirees, Duveen said. That group soon expanded and welcomed members of Hebron United Presbyterian, Shushan United Presbyterian and First United Presbyterian, as well as members of local Methodist and Catholic churches. The group was soon named the Salem Opioid Recovery Task Force.

Last April, the task force held its first event, the Opioid Awareness Forum, at a local firehouse. More than 70 people from neighboring towns attended. Among those attending were people in recovery and those looking for help. After the forum, 15 people stayed for a Narcan training session.

“Narcan is medication than can save the life of a person experiencing an opioid overdose,” Duveen explained, adding that the medication is “now easy to administer with a nose spray applicator.”

Later in the year, First United Presbyterian Church in Salem was the site for a mental health training program that focused on depression and suicide among youth, as well as opioid addiction. According to Badenoch, the drug addiction and mental health connection is an important one.

“About 50 to 75 percent of patients receiving treatment for a substance- use disorder also have another diagnosable mental health disorder,” she said. “Undiagnosed and untreated mental health disorders lead to more frequent relapse. A good treatment plan for co-occurring disorders includes possible pharmacological treatment for both the substance-use disorder and the mental health disorder, as well as ongoing counseling and support.”

But again, these services are often difficult to obtain in rural areas, Badenoch says.

To encourage more involvement from his church family, Perry proposed to First United Presbyterian’s session that a speaker on the opioid crisis be invited to give a presentation at one of the church’s fifth Sunday programs. For the past several years, First United Presbyterian has used the fifth Sunday in a month to offer a new worship experience or a special speaker. The congregation usually gathers around a meal on this Sunday. Perry said the fifth Sunday presentation on opioid addiction was a wonderful opportunity to connect the congregation with what is happening in their community.

While progress has been made raising awareness about the opioid crisis in the small community, Duveen says there is more to be done. And admittedly, he says, it has “taken our task force about a year to get our heads wrapped around the problem of addiction and death from opioids.”

Admitting the truth

As Duveen, Perry and other members of the Salem Opioid Recovery Task Force get a handle on the opioid crisis in their backyards, a survey conducted by the American Farm Bureau Federation and National Farmers Union indicates that 31 percent of rural adults are “largely unaware” that rural communities are impacted more than urban communities by the opioid crisis.

The Rev. Annalie Korengel says she didn’t get into ministry “to bury kids.” Courtesy of Annalie Korengel

At first, it is hard to believe that drugs have come to rural America, especially when rural America has long been depicted as a picturesque refuge from the scourges of city living.

Take, for instance, Korengel’s church. Located in Pennsylvania’s southern Chester County, Unionville Presbyterian seems deceptively “wholesome,” sandwiched between open fields where horses graze peacefully. And yet that pastoral setting is marred by troubling statistics. In 2017, there were 141 accidental drug overdoses in Chester County.

“We all want to think the opioid crisis is in the cities, but it is here. We can’t pretend anymore,” Korengel said.

Korengel’s “aha” moment came in the summer of 2017, when she was invited by the Southern Chester County police department to deliver the opening and closing prayers at a vigil held to raise awareness of the drug crisis. Until then, the pastor had known there was a problem, but she wasn’t really involved. A self-proclaimed “avid people watcher,” Korengel took note not only of those speaking at the vigil, but also of those gathered, those comforting one another and those sharing their tears — and stories — freely. After delivering the benediction, Korengel remained at the vigil. She stayed and listened more to the stories of addiction and loss.

“I thought, ‘If I can do anything, I can listen,’ ” she said.

Today, the pastor is doing more than listening to individual stories. She has started a parent bereavement group, providing a space for parents to talk freely about losing a child to a drug overdose. The group meets weekly at the church and draws parents not just from Kennett Square, but also from neighboring towns. Korengel says it has become a place where parents can realize that they are not alone, that there are others like them “who have slept with car keys under their pillows” to keep their children from sneaking out to meet up with their drug dealers.

“Parents need a place where the shame can be taken off the table,” she said.

Korengel also provides a presence of spiritual comfort for the local police. Serving as their chaplain, Korengel can be found on the scene of a drug overdose, praying for the deceased and for the family and first responders.

It’s a call that never is easy, Korengel says, but hopefully one day, with churches stepping up, helping and educating, praying and listening, the opioid crisis will be a crisis no more.

Donna Frischknecht Jackson is editor of Presbyterians Today.

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