In January, Terry Mann stood in front of the Dillingham City Council and told the story of his daughter, Dellana, who died from an overdose last May.
“I don’t want this thing to happen to anyone else. It’s the toughest thing I’ve ever – I continue to go through in my life – to lose a child,” he said.
In the meeting, he said the community desperately needs more behavioral health services, more education about the dangers of drug use, and easier access to care. Mann asked the city to support a group he and a few other community members have formed. It does not have an official name yet, but it’s a place where people can tell their stories and organize to advocate for a cohesive community response to fight overdose and drug misuse.
Mann said he was blindsided by what happened to his daughter. Dellana had just graduated with honors from Dillingham High School and would have studied at the University of Hawaii that fall.
The night she died, she went for a drive, Mann said. When she didn’t return or respond to his messages, he went looking for her. He said he thought the car may have broken down somewhere without a phone signal.
He said when he found her, he administered the medicine naloxone, because he kept it on hand, and started CPR.
“By then, she had probably already passed. I did try to save her life,” he said. “I found her with tin foil.”
Mann said his goal now is to reach and help other families and community members so they don’t have to live through something similar.
“I want to honor my daughter and I don’t want her death to be in vain,” he said.
There are reminders of the drug risk everywhere in Dillingham. A poster at the post office warns of fentanyl trafficking in Alaska; naloxone kits sit in the corners of offices and stores; memorial announcements appear on the community’s Facebook page. There are signs of resilience too – fliers advertise talking circles and crisis hotline phone numbers.
But Mann said the community needs to do more to address widespread drug use in the area. He said that since his daughter’s death last May, three other 18-year-olds with ties to Dillingham have fatally overdosed, and that the risk is real for everyone.
“We’re not immune to these sort of things,” he said. “The common things I felt when I assumed people that I knew used drugs – I kind of threw them in a box. We all live in that box.”
Longtime Dillingham EMT Malcolm Wright said that death from substance abuse is nothing new in Dillingham. He said the synthetic opioid fentanyl, however, has caused a spike in overdose deaths in recent years. Wright said that the highly potent drug is fairly inexpensive and easy to access.
“What’s available, even though it looks like a commercial pill, is at varying doses and it’s very hard to know how much one is taking. And it’s mixed with other things,” he said.
After losing a loved one or community member to overdose, people may react differently, said Dillingham-based AJ Knittel, a licensed professional counselor specializing in grief. He said some people may feel anger toward people selling drugs. Others, he said, may feel a call toward making change. He said others still may feel a sense of apathy which is sometimes used as a personal protection mechanism. Knittel said continued exposure to situations like overdoses could lead to feeling numb.
“It could lead to being desensitized to it,” he said. “It creates an expectation for the future where this is just normalized in our society. We don’t want to normalize overdose loss whatsoever.”
Tiffany Webb is another member of the new community support and advocacy group. She said that stigma – judgment and shame toward those using drugs – is one of the reasons people would rather die than ask for help. Webb has spent five years as the opioid overdose prevention coordinator at Kanakanak Hospital. She said she works with the group as a citizen, not in an official role.
Webb said that a person can’t shame someone into getting better.
“How we respond to our pain gets vilified a lot. We do it in our own families to each other but we also give labels to people,” she said.
Holding a boundary, she said, while still communicating with a loved one is hard. But she said that that is a healthier way to maintain a relationship with someone using drugs.
Webb said the current medical system is centered on billing – that means people need a diagnosis or label to get a treatment that insurance will pay for. That diagnosis focus can be a roadblock for people who need help.
“People don’t want to be disordered or dependent on things. We don’t like the way that sounds,” she said.
She said in the medical community, people conduct research to create ‘best practices’ to address an issue. Webb said, however, that there is no focused research on what techniques work best for opioid addiction prevention in Southwest Alaska’s Native communities.
“There’s nothing that could be called the best practice for us that is a medical intervention or treatment intervention,” she said. “But what we do have is thousands of years of a best practice that is well established by all the people we came from.”
As the overdose prevention program’s coordinator, Webb helped lead a program at Dillingham’s Kanakanak Hospital that centered on teaching Yup’ik cultural practices and traditional structure as a means of preventing both overdose and opioid misuse in general. She hosted talking circles to help community members heal and get support, with folks around town attending regularly. The program, Webb said, came from funding from a tribal opioid overdose prevention initiative from the Centers for Disease Control and Prevention.
She said the community, however, has lost so many people, in that time, to drug use.
Webb said she knows many individuals are working hard to make a difference but that the wider system needs to change.
Webb and her fellow group member Terry Mann said they want to see a united effort to address the opioid epidemic from organizations in the area, like the city, schools, tribes, the Bristol Bay Area Health Corporation and other organizations like the Bristol Bay Economic Development Corporation and the Bristol Bay Native Association.
Webb said the effort will take involvement from everyone – especially considering the scale and economic incentive behind selling opioids.
“There’s a lot of money behind opiates and fentanyl,” she said. “Even with the recent lawsuits that have been won by the government, I think there’s not a lot of teeth to that. It doesn’t really impact the pharmaceutical companies.”
Opioids are the most abused prescription drug, according to the National Center for Drug Abuse Statistics. The center reports about four out of five pharmacy-filled prescriptions are opioids.
In Alaska, opioid manufacturers and pharmacies alike have settled with the state for their role in the opioid epidemic. Between 2010 and 2017, enough retail doses of prescription opioid painkillers were distributed in the state to give every Alaskan more than 400 doses, according to a press release from the state’s Department of Law. Payouts from these settlements will total nearly $100 million in the next 15 years. The Alaska Mental Health Trust Authority, a state corporation, said in a report that drug misuse in Alaska, generally, had an economic cost to the state and local governments of more than $1 billion in 2018 alone.
Webb said she wants to make the risk of drug use common household knowledge – and that will take a united effort. Recovery services need to be as easy to access as the drugs themselves, she said, and she said that with potent drugs like fentanyl, the community can’t risk alienating anyone.
“I know it’s hard to hear about. I know it’s hard to talk about. But we have to talk about [this] stuff through the tears and through the hurt because if we don’t, nothing is going to change,” she said.
The group’s next steps, Webb and Mann said, involve creating a working definition of what prevention means across the board, not just for specific organizations, so that everyone can have a common understanding.
