Heather Menzel spent 312 mornings on a bus at daybreak, twisting through the Kern River Canyon out of Lake Isabella and into Bakersfield.
Her routine hardly changed.
Wake up at 5 a.m. Fight away the morning sickness. Board the bus by 5:45 a.m. Ask the bus driver to pull over so she could continue fighting off morning sickness. The then-32 year-old would squirm in her seat for 42 winding miles as the heroin cravings seized her again and again.
Then she’d hustle to Aegis Treatment Center, a Medication Assisted Treatment facility, where she got a dose of methadone, Buprenorphine or Suboxone – any variety of narcotic medications developed and administered under a physician’s supervision to help opioid users curb cravings and get sober with no high whatsoever. At least once a week, she would receive counseling.
She’d leave the treatment facility in a rush to catch the first bus back to the detached garage she called home. If she was quick, that bus would get her back to Lake Isabella by 10 a.m. If she missed it, however, she’d be stranded in Bakersfield until at least 2 p.m.
That daily five- to 10-hour ordeal was an outright necessity for Menzel, now 34, who decided to get sober about three years ago after more than 20 years of drug use – first with methamphetamine, starting when she was 13, then heroin in her 20s.
When she found out she was four and a half months pregnant, she knew she had to get sober. She just didn’t know how difficult it would be.
“It seems like a simple enough thing, but when you’re a homeless addict, getting to the bus everyday and getting down to Bakersfield is not as easy as it sounds,” Menzel said.
Kicking those addictions became a full-time job intensified by this obstacle: the Kern River Valley is a narcotics treatment desert – meaning that those suffering in this national opioid addiction epidemic and the public health emergency it has created – are left with little hope for recovery.
Menzel credits the Medication Assisted Treatment program for saving her life and the life of her daughter, Bella Sunshine.
“She’s the light to my darkness,” Menzel said. “Without the treatment, my daughter would not be here, and I’d either be using still or dead.”
‘Lifesaving’ treatment not available in Lake Isabella
The lack of opioid treatment programs could be why the 2016 opioid death rate in Lake Isabella and its surrounding communities of 65 per 100,000 residents is the highest in Kern County, and 21st highest statewide. It tops the 2015 opioid death rates of West Virginia, New Hampshire and Kentucky, the three states hit hardest by fatal overdoses. Their average death rates hovered between 30 and 42 per 100,000, according to the Centers for Disease Control and Prevention.
Kern County’s overall opioid death rate was 5.7 per 100,000, slightly higher than the state average of 4.6 per 100,000, according to data provided by the California Department of Public Health’s Office of Vital Statistics.
“What the rural areas of Kern County are facing is very similar to what we’re seeing nationwide,” said Javier Moreno, the regional manager of the southern Central Valley region for Aegis Treatment Centers, which operates more than 30 Medication Assisted Treatment facilities statewide.
Fewer than 20 people from the Kern River Valley are enrolled at Aegis’ Bakersfield treatment centers, but there are likely scores more from that area who need services, Moreno said.
A federal regulation that limits MAT clients from taking home medication before they can prove their sobriety, forcing them to travel to treatment centers at least six days a week, in most cases for the first six months, makes recovery all the more difficult for those living in far-removed places.
If Lake Isabella had a MAT facility, opioid overdoses would drop dramatically, he said.
“Medication Assisted Treatment is life-saving for those who are addicted to opioids. When those programs are available, the overdose rates reduce 50 percent,” Moreno said. “We know whenever treatment is not available, folks run the risk of overdosing.”
The 21 California zip codes with the highest opioid death rates had one thing in common: they had no state-licensed narcotics treatment programs within their boundaries, according to a Californian review of state MAT licensing records and overdose data.
Few had opioid treatment programs within 40 miles. Clinics in some of those counties have, however, begun providing waivers to physicians, allowing them to administer Buprenorphine to those in recovery through what the state refers to as an office based opioid treatment model. A similar "hub and spoke" system, developed in Vermont, is being rolled out in California, allowing physicians to dispense Buprenorphine through rural clinics or physician offices while working in collaboration with the nearest opioid treatment program.
Lake Isabella has none of those treatment options.
Methadone stigma unshakeable
Multiple substance abuse recovery officials in the public and private sector chalked it up to a few things: a lack of funding, a population too small to support the costs of a freestanding MAT, a lack of physicians in rural areas who can get waivers to administer narcotic medications under a hub and spoke system, and what seems to be an unshakeable stigma that such programs provide an avenue for people to get high legally, rather than a road to recovery.
Those Medication Assisted Treatment facilities, however, are so critical in suppressing opioid death rates that President Donald J. Trump’s Commission on Combating Drug Addiction and the Opioid Crisis described them as “essential” to stymying the nation’s epidemic and recommended that the government “immediately establish and fund a federal incentive to enhance access” to such programs, according to an interim draft report.
“MAT has proven to reduce overdose deaths, retain persons in treatment, decrease use of heroin, reduce relapse and prevent spread of infectious disease,” the report states.
Trump’s October declaration of the opioid crisis as a public health emergency, however, has so far allocated no funding to establish new MAT facilities.
The California Department of Health Care Services launched an effort last spring, fueled by a $90 million federal grant, to provide more opioid treatment services in areas with the highest overdose and death rates.
Lake Isabella didn’t make the cut.
Despite that, Kern Behavioral Health and Recovery officials say they’re working through plans to get some sort of substance recovery program in the area in the next two to four years.
“One of our efforts for the future is to really expand that service to the eastern Kern area,” said Anna Olvera, a behavioral health and recovery system administrator for the substance use disorder division. She acknowledged that it’s “unrealistic” to expect those living in the Kern River Valley to drive daily to Bakersfield for treatment.
Stop-gap systems may lower human toll
In the meantime, Lake Isabella will continue relying on stop-gap measures for its residents who may have the will to recover, but not the time or means to travel to Bakersfield daily.
There are Alcoholics Anonymous and Narcotics Anonymous group sessions, a faith-based support group called Joe’s House that’s currently closed as it restructures, and an Alano Club that provides a meeting place for recovery groups two or three times a day.
Aegis and Kern Behavioral Health & Recovery Services teamed up with Kern Stop Meth Now to purchase safe boxes where unwanted pharmaceuticals, including opioids, could be disposed of in communities around Kern County, with sites expected in Lake Isabella.
“It doesn’t stop the problem of folks being addicted to opioids, but at least it’s a preventative stop,” Moreno said.
The Kern Valley Healthcare District received grant of roughly $15,000 from Kaiser Permanente to launch a community engagement program that puts substance abuse counselors and educators into classrooms from kindergarten through high school graduation to teach kids about safe medication practices, said Lisa Wyly, a project manager and substance abuse counselor for the healthcare district.
Eventually, substance abuse counselors like Wyly will step into emergency rooms when patients present addiction issues, she said, describing a new initiative that hasn’t yet been implemented.
“We’ll link them with services,” Wyly said. “Right now, people present in the emergency department, then off they go. Soon, there will be more of a focus on whole person care and trying to reduce emergency room visits.”
Still, however helpful those services may be, Wyly knows that a MAT would offer a substantial advantage to those in recovery, especially when traveling to Bakersfield “seems unreachable.”
“It may give them a sense of hope that they can get support right here in our community,” Wyly said.
‘Stuck with no way to get sober’
Menzel knows the power of combining narcotic medication treatment with group support recovery services. One doesn’t work without the other, she said.
She now works at Joe’s House, helping others recover, is enrolled in college and hopes to return to Aegis Treatment Center as the first client to ever become a substance abuse counselor.
People know her around the lake – and her story – so it’s not uncommon for others facing substance abuse issues to ask how she got sober. How did she get her life back?
“I tell people that methadone worked for me,” Menzel said, adding, though, that she knows the challenges of the program. If you miss an appointment you can be cut, as Menzel was in what she considers one of the most frightening moments of her life. She found herself in the freezing cold garage where she lived, pregnant and without a treatment program, because she missed her bus. She cried out to God for an answer. Then her mother called her before 6 a.m. saying she would take a leave of absence from work to drive her to Bakersfield every day for treatment. Menzel managed to re-enroll in the program.
“You’re not going to lose this baby,” her mother told her.
There was hope.
But Menzel knows that’s not the case for everyone, especially those living in Lake Isabella. She can count almost a dozen people she knows personally who have tried to obtain treatment in Bakersfield but had to drop out. The distance was too great a barrier.
“Lots of people don’t have that support. It’s nearly impossible, and it’s heartbreaking,” Menzel said. “They’re just stuck with no way to get sober.”