Congress boosted the budget for the battle against the opioid epidemic this year, and a chunk of it—$100 million—is slated for treatment and prevention in rural communities. But something about how lawmakers chose to prioritize that money caught a New Mexico health official by surprise: the funding is focused on counties that are mostly white.
For decades, Rio Arriba County has had one of the highest drug overdose death rates in the United States. It’s No. 2 over the last couple of years, according to recent data. Lauren Reichelt is the Health and Human Services director there. "Because we have been fighting it for so long, we have had access to resources—maybe not to the degree that we have a need," she said.
That’s why she was astonished, she said, to find out that Rio Arriba wasn’t on a list of 220 vulnerable counties that would be the focus of this new grant money under the Rural Communities Opioid Response initiative to the tune of $200,000 every year for three years. "One of the variables that they were looking for—and I quote this one—was persons who are not of Hispanic or Latino race but white race only," she said.
Rio Arriba County is 71 percent Hispanic and 20 percent Native American, according to the Census.
So what is this list that would prioritize white communities over places in New Mexico that have had such high overdose rates for so many decades? A former CDC scientist who was part of the team that created the list said it wasn’t meant to be used this way.
After a sudden HIV outbreak in an almost completely white county in Indiana, Jon Zibbell and other CDC researchers authored a study about where something similar could happen. "All modeling is wrong, but some is useful," he said. "You try to build a model, and you try to predict certain outcomes."
They used six factors, and one of them was non-Hispanic, white populations. Some of the 220 counties they put on that list don’t actually have much of a problem with HIV infections, he said, and other places left off the list are still at-risk, too. "This modeling study was not meant to identify all of the places that were at risk for the totality of harms from opioids," he added.
And yes, Zibbell said, because white populations were a factor, it could skew this new funding toward white communities.
Why didn’t Congress look at overdose death rates instead, which is how the opioid epidemic is usually measured? The CDC already has an online estimator for drug deaths in the U.S. Many rural counties that show up as high-risk there aren’t targeted for this funding.
David Montoya, who's in recovery, said you need treatment to quit. "Addicts out there know it isn't easy to just get up one day and shake it off, because it doesn't happen."
In Rio Arriba County in 2005, his brother died from an overdose on pills and alcohol. "I think if there would have been programs, it’s a good possibility he would have had a chance," Montoya said. "He would have had a place to go to."
David, though, has been clean for a year after spending 24 years addicted to opiates. "Because of the treatment, because of the program, because of my sobriety, because of suboxone, I am where I am today," he said. "Like I say, if it wasn’t for that, I wouldn’t have never pulled it off."
Rio Arriba is ground zero of this epidemic. And it’s always on everyone’s mind up here, he said. Most maps of the opioid crisis show the county turning a deep red first, before regions in the rest of the country flare up over the decades. "I guess it ran through generation after generation," Montoya said. "And it’s getting younger these days. But you know, if there’s no resources, I mean they don’t have nothing to run to but to the dealers themselves."
Since we started asking about the list, the feds removed it from the funding announcement. A spokesman at the federal agency handing out the grants said they did that to reduce the number of questions they were getting from rural counties. He also stressed that any rural county can apply and make a case for being considered high-risk.
Rio Arriba’s Lauren Reichelt said they will definitely try. "I do worry about the repercussions to my own ability to get my programs funded," she said. "But at some point, you just have to say, You know what? This is wrong."
There’s a difference, she said, between being a priority and simply being allowed to apply.
Three members of New Mexico’s congressional delegation—Sens. Martin Heinrich and Tom Udall, and Rep. Ben Ray Luján—signed a letter urging the feds to include Rio Arriba among the targeted counties.
Public Health New Mexico's Rashad Mahmood contributed extended data analysis and graphics work for this report.