“When it comes to addiction we still see it very much as a moral deficit and a character flaw, rather than an illness,” Esp said. “I read a lot of Gabor Mate’s work, and one of the things he says is, don’t ask why the addiction, ask why the pain. People use chemicals for a reason.”
As of 2022, the Idaho Department of Health and Welfare reported that fentanyl was involved in 49 percent of overdose-related deaths in the state of Idaho. That’s 270 Idahoans who died from opioid-related drugs. Not all organizations are responding to this crisis in the same way. While universities like Boise State are attempting to stimulate open dialogue around substance use disorder, new Idaho legislation seeks to increase prison sentences and fines for “traffickers” of the drug.
Addiction stigma
As of Aug. 7, 2024, Boise State in collaboration with Central District Health, has placed opioid overdose response kits in 40 on-campus locations. According to the Boise State website, these boxes will consist of “four doses of Narcan, a brand of naloxone nasal spray that rapidly reverses opioid overdoses … instructions, overdose information, a face shield for administering rescue breaths, gloves, alcohol wipes and a pulse oximeter.”
Naloxone can regulate someone’s breathing if they are experiencing slow breathing or apnea due to an overdose. This medication should be exclusively used in response to opioid overdoses and should not be utilized as a response to an overdose of alcohol or other drugs.
While addiction is often stigmatized, Boise State’s Wellness Center shared in an email with The Arbiter that individuals are not alone and that help is available. The Boise State Wellness Center described its mission to educate on harm reduction strategies and establish a supportive on-campus community.
“As a student, finding a sense of community can be challenging. Some students turn to substance use to cope with feelings of isolation. When substance use becomes repetitive or excessive, it can further exacerbate feelings of loneliness,” the Wellness Center said. “Our goal is to minimize the harmful effects by using harm reduction strategies. Ultimately, by normalizing conversations about substance use disorder and educating students about harm reduction strategies, we can cultivate a supportive community environment.”
The Wellness Center added that the September training will allow community members to learn how to “respond effectively to an opioid overdose.” At the training, individuals will be taught how to administer Narcan and be educated on the legal protections Idaho grants responders.
While these response boxes have the potential to save lives, Boise State’s Wellness Center is prioritizing substance use disorder prevention and mental health care.
“Boise State is prioritizing prevention over reaction in addressing the opioid overdose crisis. While emergency response boxes are being installed on campus, the university is also focused on addressing the root causes of substance misuse,” the Wellness Center said. “By providing wellness services that target stress, mental health, and academic pressures, Boise State aims to reduce the likelihood of overdoses occurring in the first place.”
The initiative was first voted on at an ASBSU meeting Feb. 1, 2024, and was introduced by Mia Hoetker, Assembly Leader; Bridget Gibson, First-Year Representative; Ethan LaHaug, Senate Leader; Ian Peña, AVP of Student Relations; Cayden Stone, Government Relations Officer; Jack Vuturo, First-Year Representative; Kalista Barkley, AVP of Academic Affairs; and Jason Holman, Student Body Vice President.
The bill’s purpose of intent was “to target student mental health needs, specifically regarding overdose prevention and naloxone availability on campus.” The bill was passed by the ASBSU General Assembly with 13 in favor, one abstaining and zero opposed and passed unanimously in the ASBSU Academic Senate.
Person first language
Central District Health staff members Jessica Harris and Courtney Boyce, a partner in the opioid overdose box collaboration, highlighted in an email to The Arbiter that a major component in the scrutiny around substance misuse is polarizing vocabulary.
“One way that anyone can contribute to reducing stigma and improving outcomes related to substance use disorders is by changing the words they use when discussing the topic,” Harris said. “Our ‘Language Matters’ document gives guidance on preferred language to use and can be found here. By using Person-First language, we encourage people to reframe ‘addiction’, which can be stigmatizing language and say ‘substance use disorder’ instead.”
Central District Health discussed the importance of supporting those struggling with substance use disorder by making options for treatment readily available in the community. Some of these resources include “Find Help Idaho, calling 2-1-1, or visiting Pathways Community Crisis Center during a crisis located at 7192 Potomac Dr, Boise, ID 83704.”
Harris described Boise State as “excellent to work with” and emphasized the importance of this partnership.
“Boise State University is a vital partner in our community to reach college students, an important age group when it comes to overdose prevention,” Harris said. “College age young-adults are a high-risk group for overdoses. By partnering with the largest university in Idaho, we are able to familiarize a large number of students and staff with overdose prevention and response resources.”
Dr. Susan Esp, Coordinator of Addiction Studies and Associate Director for the Institute for the Study of Behavioral Health and Addiction at Boise State echoed the sentiment that vocabulary around substance use disorder is important in reframing how society views it.
“Recovering from substance use disorders does not require rehabilitation,” Esp said. “I actually really dislike that term, because when we have someone with a mental health issue, say depression, we don’t say they need to go to rehabilitation. We say it’d be helpful to gain support and potential treatment.”
Esp explained that one of the reasons she believes substance use disorder is stigmatized is that many people view it as a choice, as opposed to other mental illnesses.
After describing a PowerPoint presentation she created years ago, Esp discussed the connection between stigma and the policy that is created as a result of it.
“It [the presentation] also addresses stigma and the language we use when we talk about substance use disorders,” Esp said. “Which then continues the stigma, and it continues to inform policy which is then stigmatizing policy … Historically, our treatment of substance use disorder has messed up along a lot of racial lines, too, and one of the reasons we started paying so much attention to opioids is Caucasian middle-class people started dying, and that’s when we start[ed] to pay attention.”
Person first language such as “person with substance use disorder” instead of “addict” allows someone to be acknowledged as a human being — not just as their struggles.
“When it comes to addiction we still see it very much as a moral deficit and a character flaw, rather than an illness,” Esp said. “I read a lot of Gabor Mate’s work, and one of the things he says is, don’t ask why the addiction, ask why the pain. People use chemicals for a reason.”
Esp noted that while the opioid crisis is a prominent issue, it’s one piece of the puzzle.
“I’ve had people ask me, ‘what do you think of the opioid crisis? And I say, do you mean, what do I think of the addiction crisis?’” Esp said. “We have an opioid crisis, but it’s just part of a bigger picture of an addiction crisis in America.”
Understanding House Bill 406
As of July 1, 2024, House Bill 406 authored by Representative Ted Hill went into effect in Idaho. In its statement of purpose, it clarified that the bill is “not meant to capture the personal user. It is intended to make clear the punishment for those who choose to manufacture, deliver, or bring into the state amounts of fentanyl that meet the quantities listed in this bill.”
However, the bill text includes anyone “who is knowingly in actual or constructive possession of four grams or more of alfentanil.”
When asked about the concerns of placing individuals in one of Idaho’s for-profit prisons instead of treatment, Representative Hill said that he believes the bill isn’t targeting users — only traffickers.
“[The] pushback was, these guys are just users. Thresholds at 50 pills, 100 pills, 150 you know over 500 it goes higher and higher,” Hill said. “We talked to a lot of folks, when you get over 50, you’re not a user, you’re a trafficker. So we bought the threshold up to 100 …that is not a user amount. No one’s going to jail for having 10 fentanyl pills.”
As pointed out in a Capital Sun article, the bill’s definition of what it means to be a “trafficker” is unclear and is seemingly free of Good Samaritan incentives (legislative protection for individuals who call emergency services in the event of an overdose) or exceptions.
“When I talk to DEA, when they track, they go for the traffickers, they’re going for the dealers,” Hill said. “They’re not going for the kids who give it to each other … Now, if that kid had 100 pills and he is basically a dealer, absolutely. …He’s got 100 pills he’s distributed, you better believe it, he’s going down. But then they’re gonna find out who gave those pills to you, that’s the person they really want.”
Senator Phil Hart, the only Republican to vote against House Bill 406 explained that he took issue with the homicide charge. During a committee hearing, Hart said that while “we want to be tough on fentanyl,” he doesn’t “think this is the bill to do it.”
It is unclear whether House Bill 406 will decrease the amount of opioid-related deaths in the state of Idaho. However, Boise State, Central District Health and the faculty of The Institute for the Study of Behavioral Health and Addiction are providing education and resources to create a bigger and more inclusive conversation around substance use disorder.
