ROCK SPRINGS — On a wind-whistling afternoon in early April, Samantha Sanders and Camille Montoya huddle at the worn wooden table in Sanders’s tidy, sparsely decorated apartment. Munching on homemade sandwiches, they gather with fellow Wyoming Harm Reduction Collective members over Zoom. 

Sanders designed a handout explaining signs of drug overdose, she tells the group, and wants to distribute it in bars around town. Maybe it’s something they could get in local schools, Montoya chimes in.

The group contemplates legislative sponsorship, wondering if getting a bill on next session’s docket should be a priority, even if Wyoming may not be ready for more progressive drug policies.

Each member of the eight-person group, which is dispersed across the state, has been impacted by substance use in some way. 

Montoya’s husband suffered from severe opioid-use disorder, but got sober after moving to Rock Springs. Then a doctor prescribed her partner Adderall, which he began to abuse, she said. 

Resources were limited. “I was reaching out every day, all the time asking ‘where can I get him help?’” Montoya said. 

She was told to kick him out of the house, to force his rock bottom, she said. “I didn’t know what else to do.” Montoya’s husband stayed. Soon, however, he died by suicide, she said.

In the wake of her loss, Montoya threw herself into the work of harm reduction, which aims to “reduce the negative personal and public health impacts of behavior associated with alcohol and other substance use at both the individual and community levels,” according to the Substance Abuse and Mental Health Services Administration. 

Members of Wyoming’s collective hand out the overdose-reversing drug Narcan in strip clubs, bars and smoke shops. They are trained in rapid HIV and HCV testing. Alex Sessums, a Rock Springs member, gives out her phone number to any one who asks. “People will call me at any time day or night,” she said. 

The ambitions of the small, relatively nascent group are far-reaching: It wants to change state law and save lives of people who use drugs in Wyoming while contending with a culture that doesn’t always believe in the value of those efforts.

Rock Springs members of the Wyoming Harm Reduction Collective put together kits with naloxone, masks, toothpaste and informational fliers. (Sofia Jeremias/WyoFile)

It represents just one cog of a larger statewide system working to reduce drug overdoses and opioid impacts — other entities include Wyoming Department of Health, law enforcement agencies and nonprofits like Recover Wyoming. However, state laws, lapses of federal grants, geography and stigma stymie implementation of some of the tools addiction experts say are most effective — from syringe-exchange programs to methadone clinics.

The issue is made more complicated by the rise of fentanyl, which is helping drive an increase in overdose deaths in Wyoming and across the nation. 

“The numbers are increasing, and it’s very concerning,” said Casey Patterson, a Wyoming-based drug intelligence officer working with the federal government to monitor opioids across the Rocky Mountain region. Along with monitoring, Patterson works with a public health analyst to examine trends, track overdose death spikes and ultimately bring rates down. He also participates in various work groups like one focusing on naloxone distribution in jails.

“I can tell you meth is still probably one of the biggest threats, if not the biggest threat at the moment, but fentanyl is closing that gap in Wyoming,” he said.

Deadly fentanyl and ‘dark-age’ paraphernalia laws

“The opioid overdose deaths are really being driven by fentanyl,” said Rodney Wambeam, Wyoming Survey & Analysis Center senior research scientist and co-author of the “Telling the Story of Opioid Use in Wyoming” report

In 2019 there were 11 reported overdose deaths from fentanyl among Wyoming residents. In 2021 that number jumped more than 300% to 45, and seven deaths have been recorded in the first few months of 2022, per data requested from the Wyoming Department of Health. WDH has improved its ability to specify causes of overdose deaths over the years, a change that may be partially responsible for the increase in recorded fentanyl-related deaths.

Overall, Wyoming overdose deaths experienced an uptick from 2020-2021, from 90 to 95. 

Wyoming laws only stymie efforts to reduce drug-use impacts, many say, and are outdated compared to reforms passed in other Mountain West states. 

“We’re just in the dark ages in Wyoming,” noted Sessums with the Harm Reduction Collective.

Wyoming is one of just three states without a Good Samaritan Law providing some immunity for those who call 911 during an overdose. “People are dying because people are afraid to call 911,” Patterson said. He hopes to collect better data on just how many people in Wyoming are impacted by the policy. 

The state’s laws also outlaw delivery or possession of drug paraphernalia, making syringe exchange programs effectively illegal.

Idaho passed both Good Samaritan and needle exchange program laws, Montana amended its drug paraphernalia laws to exempt syringe exchange programs (which Utah legalized in 2016) and Colorado has eight public health harm reduction laws on the books. 

“There are some prevention things that really you can’t do in Wyoming,” Wambeam with WYSAC said.

The legality of fentanyl test strips is another source of confusion that some say further complicates efforts. 

The strips can detect the presence of fentanyl in other drugs, such as powdered cocaine or pills. Advocates point to studies showing the inexpensive strips can change the behavior of users, leading some to discard substances, use with a friend or keep naloxone on hand. 

State statute does not explicitly outlaw possession of them. The test strips, which cost roughly a dollar, can be purchased with federal funds from the Centers for Disease Control and SAMHSA, but they haven’t been widely distributed in Wyoming, and do remain illegal in many states.

In the meantime, law enforcement continues to seize illicit fentanyl. In 2019, Wyoming Highway Patrol made the biggest drug bust in two decades, which included a kilogram of synthetic fentanyl. 

The Naloxone problem

Access to the overdose-reversing drug naloxone is another challenge many harm-reduction groups face. 

In 2017 Wyoming passed Senate File 42 – Opiate overdose emergency treatment, allowing pharmacists to prescribe naloxone. Through a federal grant aimed at opioid overdose death prevention, WDH distributed Narcan, a brand of naloxone, mostly to law enforcement and EMS-related agencies. The department ultimately gave away over 8,000 doses, however, that grant ended in August 2021. 

Naloxone has become an important tool for police officers across the state.

Groups like the Wyoming Harm Reduction Collective fundraise or use their own money to purchase doses of the life-saving medication — a single dose of generic naloxone costs around $20-$60, while brand-name Narcan costs up to $140. The Rock Springs group recently ran out of naloxone completely and is searching for ways to purchase more.

“Naloxone is super hard to get here,” said Hailey Hayden, the project case manager for LEAD — a diversion program run out of the Cheyenne Police Department aimed at connecting individuals who commit low-level crimes with resources. Hayden implemented a program allowing LEAD participants to go to a local pharmacy and obtain two doses for free, but the grant supporting that program also ended.

“I was just kind of pulling my hair out trying to think of creative ways [to get naloxone],” said Patterson, who worked as a Cheyenne Police Department detective before retiring in June. “If I could order a truckload of this stuff, at least we would have it somewhere. I wasn’t able to figure out a way to get it.”

Recover Wyoming’s Cheyenne headquarters keeps Narcan behind the counter, handing it out to anyone at risk or related to someone at risk of overdosing. The nonprofit, which connects people with resources and peer-to-peer support, has a standing order through Cheyenne Regional Medical Center.

“I saw on Facebook today, someone else said that their good friend just died from a fentanyl overdose,” Recover Wyoming’s Executive Director Lana Mahoney said. “It continues to be a problem.”

WDH told WyoFile it still receives requests for Narcan and acknowledged state residents need the medication. The department is currently seeking new funding sources to support free statewide distribution.

The department also still provides funding to county prevention specialists through the Community Prevention Grant. These programs focus on a broad array of objectives from suicide prevention to tobacco cessation, and some ongoing programs include drug take-back days and awareness campaigns.

Syringe exchange programs are illegal in Wyoming. (Sofia Jeremias/WyoFile)

Legal prevention strategies also limited

Hayden’s work ranges from helping someone get a pair of glasses to in-patient substance abuse treatment center placement to applying for emergency rental assistance programs. Her cellphone’s ringer is turned up just loud enough to catch the 24/7 texts and phone calls.

Placing clients in Wyoming’s in-patient treatment centers is one of the most difficult parts of her job as the LEAD case project manager, she said. 

When LEAD’s efforts aren’t enough, the consequences can be devastating. 

After managing to stay clean for a month on his own, one client gave up and started using again, she said. That same day he’d made the top of a waitlist for a facility in Sheridan, but changed his mind about going. 

“That is the worst part of my job,” Hayden said. 

Other aspects, like securing spots for out-patient treatment or accessing therapists or medication without health insurance, can also be painful. “I put myself in their shoes and I personally would not want to wait three months just to get medication,” she said. 

The state funds nine centers in Wyoming through the federal Opioid Response grant to provide buprenorphine and naltrexone, two medication-assisted treatments for opioid use disorders. However, there isn’t a single methadone clinic, meaning those who need that form of treatment must travel out of state. 

“In Wyoming, there’s not a ton of recovery support services across the state. Some communities have more than others,” said Mahoney of Recover Wyoming. The Legislature in 2021 slashed the budget for community health centers providing substance abuse treatment by $7.5 million. 

Finding residential treatment for women comes with another level of complication, Mahoney said. Only a handful of centers across the state accept kids, forcing mothers to decide between treatment or keeping their children settled in their community and school. 

Recover Wyoming launched a statewide telephone recovery support service funded by federal opioid response funds funneled through the state a year ago. The line provides free peer-to-peer support for the recently incarcerated, discharged in-patient clients and those far from in-person services. 

Roughly 30 people are utilizing the service currently, according to Recover Wyoming, but funding runs out in September. 

Stigma and criminalization add more barriers to getting help. Mahoney has struggled with alcohol and stimulants, and was addicted to meth, a drug that initially helped her pull all night study sessions. While alcohol abuse is somewhat normalized, meth addiction is not. “A lot of people are afraid to get help,” she said. “They don’t want to lose their jobs, or have their kids taken away.” 

Rock Springs members of the Wyoming Harm Reduction Collective put together kits with naloxone, masks, toothpaste and informational fliers. (Sofia Jeremias/WyoFile)

Opioid settlement funds to come

The OneWyo Opioid Settlement, the state’s share of a national agreement with opioid distributors, is being finalized — all the required subdivisions, cities, towns and counties have signed on to the agreement unlocking the full settlement amount, according to Wyoming deputy attorney general Misha Westby. Millions of dollars are on the line, with 35% going to the state

How those funds will be deployed remains a question. 

“Specific decisions and plans have not yet been made,” WDH spokesperson Kim Deti wrote in an email. “We would expect settlement funding received to likely be used to support existing programs for substance abuse treatment and prevention.”

Experts recommend using settlement funds to bulk-purchase naloxone, focus on community-based distribution and expand medication-assisted treatment options, according to a report from Harvard’s Health and Human Rights Center.

Reflecting on the federal grant used to purchase and distribute 8,000 doses of Narcan in Wyoming, WDH community prevention unit manager Rachel Nuss wrote in an email, “Although a lot of progress was made, due to low, widely dispersed population, infrastructure and capacity remain a challenge.” 

Data collection and infrastructure used to identify areas highly impacted by drug overdoses need additional improvement too, Nuss wrote, and are a top priority for the state’s overdose response strategy.  

“It takes a lot to build capacity in a frontier rural state,” Wambeam of WYSAC said.

A growing grass-roots movement

Last September, Tanagra Melgarejo of the National Harm Reduction Coalition helped organize the state’s first Harm Reduction Summit, which roughly 80 people across Wyoming attended. Sessums and Montoya of Rock Springs were among those present. 

Driven by the alienation and loneliness drug use spurs, they both know how small acts of care can add up, they said. These acts must suffice to fill gaps as statewide prevention efforts take shape. 

Camille Montoya writes a note of encouragement to include in a harm reduction kit. (Sofia Jeremias/WyoFile)

In Rock Springs, Montoya and Sanders sign off from the Wyoming Harm Reduction Collective’s bi-weekly Zoom meeting and start to assemble kits with masks, condoms and pamphlets containing safe injection information. They include hand-written notes of encouragement.

Gesturing toward a stick of chapstick destined for the bags they’re assembling, Montoya said, “When I was running the streets, something like this would have meant a lot to me. Just even the damn chapstick.”

Sofia Jeremias

Sofia Jeremias reports on healthcare, education and the economy in Wyoming. She received her master's degree from the Columbia Journalism School and previously reported on the West for Deseret News.

Join the Conversation

8 Comments

Want to join the discussion? Fantastic, here are the ground rules: * Provide your full name — no pseudonyms. WyoFile stands behind everything we publish and expects commenters to do the same. * No personal attacks, profanity, discriminatory language or threats. Keep it clean, civil and on topic. *WyoFile does not fact check every comment but, when noticed, submissions containing clear misinformation, demonstrably false statements of fact or links to sites trafficking in such will not be posted. *Individual commenters are limited to three comments per story, including replies.

Your email address will not be published.

  1. There is a hideous Wyoming connection to the nationwide Opioid Crisis beginning in Appalachia in the mid-1990’s and metastisizing to the rest of America in less than a decade. While the media eventually brought the hot lights onto Purdue Pharma and oxycontin and rightly traced the role of the Sackler family and the rest of Big Pharma selling billions of dollars worth of high profit opioids , mainly to the low income working class east of here, they missed Cody Labs in Cody Wyoming.
    A pharmaceutical startup in Cody possessed one of only three opium imporatation and processing licenses from the FDA and DEA in America. Cody Labs imported opium’ straw’ and converted it to oral ( liquid ) morphine sulfate by the barrel , which is the necessary active ingredient to further refine into Rx opioid drugs like Oxycontin . Cody Labs went on to manufacture is own Oxy , some generic oxycodone, and bulk morphine along with other pain meds. (They also produced mainstream products based on cocaine, but that is another story. )

    It is highly probable that Cody Labs in Cody Wyoming provided the feedstock for the other Big Pharma makers to produce opiods in the years from 2001 to 2007 when the opiod crisis peaked . Legally but also grey market. Until the cartels moved in and used Fentanyl and street Heroin to usurp it, black market. Cody Labs did it all legally at first but later got shut down for being not so legal. . They were always just one small step removed from the crisis in illegal usage that was killing people. Overprescriptions by country doctors and filled by unscrupulous pharmacists , and mom & pop drugstores becoming pill warehouses and Merchants of Death was how the Sacklers and others could make billions of bucks in bloody money. If you have the opportunity to watch the 8-part Hulu/FX docudrama on all this titled ” Dopesick” , I recommend it highly .

    The salient discussion points not aired out so far concerning Wyoming centers on Cody Labs applying for and wholeheartedly receiving literally millions of dollars directly from the State of Wyoming via the Business Council to expand their pharmaceutical operation in Cody. There was even legislation written specifically to grant them millions of economic development money , by name, sponsored by the late Senator Hank Coe of Cody. Blowback on that brandname insider patronage resulted in the legislation being reworded to not mention Cody Labs by name, but we all knew better. They got the sweetheart loans and grants anyway. Your State of Wyoming found itself bankrolling an opium mill in Cody to the tune of roughly $ 35 million of Wyoming taxpayer ” investment “. The opium kept being milled and sold out of Cody Labs by the truckload. The DEA had a fulltime compliance officer on site 24/7/365. ( I do miss her…).

    Cody labs not only manufactured Fentanyl legally , they were the very last legal manufacturer stateside of Carfentanyl, the plutonium of opioids. Carfentanyl is literally used to tranquilize 12-ton elephants and rhinos. It is maybe a hundred times more potent than ordinary fentanyl, which in turn is many times stronger than heroin , which is stronger than morphine. Cody Labs took raw opium vegetable matter in and sent Carfentanyl back out. It is no longer made in the USA by anyone.

    Then in a strange turn of events that even a Hollywood fictionwriter couldn’t easily dream up, Cody Labs was taken over by a much larger long established pharmaceutical maker based in Philadelphia named Lannett , who bought them out in 2007. The characters and narratives were a monumental Greek tragedy , but that is for another day . (the fabled Philadelphia lawyers are in fact real ). Truth be told the huge surge in demand for opioids thanks to the epidemic gave Lannett all the reason they needed to acquire Cody Labs… not for the manufacturing but moreso the precious opium importation license, since those were not being given out by the FDA any longer. They halted the available licenses at 12. Remember, Cody Labs was one of only three in the beginning. And at one time was shut down by the FDA for illegally making certain drugs outside of the regulation envelope ( insert sidebar here ). Lannett had no need of the Cody Labs factories and moved everything to Indiana, New York , and elsewhere. So they unloaded the real estate. The two factories in Cody were mothballed, one sold to Kanye West to make sneakers but now abandoned, and the other recently acquired by a gunmaker .

    The State of Wyoming bankrolled Cody Labs then Lannett to make opioids and eventually Carfentanyl was on the menu. The Washington Post investigative team that drilled down into the supply side of the opioid crisis by getting the FDA to reveal the opium supply chain from poppy to pill only went back to the year 2007. We need to get those same opium logs and supply chain records for Cody Labs going back to the year 2001 , pre-Lannett , and see where all that imported opium straw made into morphine sulfate was shipped.

    I feel absolutely certain that Cody Laboratories using State of Wyoming money significantly fueled the American opioid epidemic in the earliest phases that led directly to the Fentanyl scourge today.

    Dopesick, indeed. Wyoming seems more like West Appalchia to me every passing day. Opium, coal mining …pick your poison.

    1. Thank you for this comment, Dewey. Great work! Your research is appreciated. Most of us have lost someone because legal opium manufacture in this country was approved by criminals in suits. They feign surprise well, but no one at the top is innocent. There were many players in this dirty game, including many members of the HW Bush and Clinton and baby Bush administrations. Your research indicates we have foxes in the Wyoming hen house as well. This could have been stopped anywhere along the line, but it is always the same story. Follow the money.
      The Solari Report, at http://www.solari.com has substantial background on “The Great Poisoning” of America. She was in HUD under HW Bush at the time and blew the whistle on many bad actors. There are also stories from the time of how you can lay a map of HUD foreclosures over a map of L.A. crack house busts and it is a spot-on match. Once you go down the rabbit hole you realize that there is always more to the story. Thanks again.

  2. It can’t hurt. What being done isn’t working. It’s a dance with death the way it is now. Royal family of England made part of its fortune on control of Opium in 1800-1900’s. Open it up. Sell it with out the poison it cut with and see what happens. Sell it Cheap. So it undercuts the black market. But drugs have been scourge of mankind for ever and will continue to be. My thoughts are we have a generation that does not know how to cope on their own with the issues in today’s life. They have lost the American “Dream”. But the ones willing to cross into America have the dream and the fire to go get it. Not all are bad folks. Have bad situation and willing to go change it. Folks if the market didn’t exsist here in USA the Cartels would not be feeding the market. It that simple.

  3. I just keep wondering how many more people will die before America decides that waging the war on drugs has caused more deaths and ruined more lives than it saved? My best friend died of a heroin overdose in 1999 and I realized then that making things illegal does not save lives and in fact costs lives and taxpayers a great deal of money.

    America is uniquely qualified to realize that banning substances doesn’t work and in fact has far larger social consequences than acceptance of drug use with taxation, regulation and compassion replacing incarceration and death. America once thought that banning alcohol would solve a multitude of societal problems but Prohibition started the largest crime wave in American History, so instead of learning from that lesson, the USA took that idea Worldwide by waging the Drug War.

    I am convinced that had we not destroyed opium dens 140 years ago, like Wyoming did in Newcastle, then we would not have the problems of Opioids which lead to Heroin of unknown strengths and then Fentanyl, which increases the likelihood of death.

    To be honest I have inhaled and I have experimented with a fair amount of recreational drugs. Based on my experience it is evident, at least to me, that the USA made a sane decision we would have NEVER made naturally occurring plants illegal.

    I realize most people do not have experience with spotting the differences between Meth and Cocaine, but if you look closely it will become evident that Meth use drives far more violent crime and murder than those choosing Cocaine. I have been appalled that American society has basically prescribed Meth in the form of Adderall to its children and then this same society is completely miffed when Meth use explodes. I could draw the same line with Opioid prescriptions, which occurred AFTER my friend’s death, to the rise in Fentanyl in America.

    Ending the Drug War on naturally occurring plants would not only save lives in America as well as a great deal of money it would lessen world wide crime, narco-terrorism and illegal immigration, especially at our southern border.

    PS I am advocating for the legalization of Coca Leaves and Poppies which like Marijuana in Colorado, could be processed here in America into the products consumers want. Most users of drugs will self select for less concentrated forms of product use.

    For instance, just like alcohol, most do not choose 200 proof booze, but choose wine or beer. I would posit more people will choose to chew coca leaves or make tea than those that choose Cocaine. Either way we will collect tax revenue and reduce deaths while also having the resources and compassion to treat and care for those that cannot manage appropriately.

    The Pope drinks coca tea, why can’t we?

    1. I agree with you on most points here. But. We lost a son to prescription Opioid pills he could get in 10 minutes with cash and a cell phone. This is very different from the fun stuff kids think they are getting. They don’t know it when they get a different batch with additives like fentanyl. They drop a few pills just like they did 2 days ago and they are dead. Heroin can also be too strong or laced.
      Recreational drugs should be available but the opioids and their variants are an odd category and an exception in many cases. They may serve a special purpose and do well at that, but the person on the street is too naive to see the danger of experimenting with man-made crap. The open borders are a huge problem and China is using the same tactics on us that Britain used on them with Opium dens.
      Meth is very dangerous as well. It is cheap and addictive and leads to violent criminal activity. I lived in some bad areas and saw the way people changed. These two categories are feeding the mental health problems suicide/death rates and we are losing good people. They either die physically or in spirit.
      The conversation must move forward and we must engage each other in a way that promotes legal natural drug use and teaches against lethal man-made chemicals that cannot be trusted. I appreciate your position. The recent increase in busts of people running drugs in our state tells us there is demand and we should make legal drugs that are safe to ingest available ASAP to stop the flow of uncontrolled poison.
      My 2 cents.

      1. Bob,

        It probably matters nothing to you, but I’ll give credit where it is due. I agree with your post. There was no partisan blaming, was reasonable, succinct, and rational. I hope to agree more with the reasonable Bob posts.

        Cheers

      2. Bob I am sorry for the loss of your son as it is horrible to watch families lose their loved ones to a problem that our American politicians refuse to admit are caused by US policies. I have watched addiction to alcohol kill people and destroy lives, but drugs, especially powerful, concentrated doses leave little room for mistakes.

        My proposal seems to mitigate that risk as most people will be informed about the power of the product they are procuring. I would also contend most will choose the less powerful alternatives like smoking or eating opium rather than interjecting heroin or taking an opioid pill that would be made locally by someone that is known. In addition, it would be apparent that more powerful concentrations should be taxed a little harder to defray the costs for those that cannot control their impulses. The taxation should be much like cigarettes where those taxes eventually covered the costs of the detriment to society, but not more so the black market is not encouraged.

        I would also ask all citizens to recognize that both political parties as well as the media are so entrenched with money from Big Pharma that our Federal Legislature will never entertain the idea of trusting the public with managing naturally occurring plants. Just watch the nightly news and the advertising for a pill for everything, so there is no large push to self medicate and in fact the media pushes scare tactics about drugs, which I have found to be lies, just like the lies I was told about drugs in my youth. I would also argue that the USA lost in Afghanistan due to its Drug War and I have been backed on this premise by Sebastian Junger.

        One of the greatest things a State ever did was defy the Federal Government and make Marijuana legal, so kudos for Colorado. This process needs to occur for all naturally occurring plants across all of our States in order for the US to make a world where people have a chance to live and possibly use these products responsibly as some of our brain chemistry probably requires these products for a healthy life. Wyoming voters should make legalizing naturally occurring plants a priority, no matter the party of the candidate.

        1. Chuck and Greg, Thank You. It is important that we found common ground. Baby steps, right? I will, for my part, try to focus more on solutions than blame. But as we know, both parties have created this situation. Nixon outlawed natural drugs, and I am betting Big Pharma and the Rockefellers were right there writing checks. Kudos to you both. Let’s keep this trend.