Theo Hoxie was 15 the first time he stole morphine from his cancer-stricken mother’s medicine cabinet. Using a syringe lifted from a friend’s father, he injected the drug into his veins and felt the weight of the world lift from his shoulders.
It was an act of desperation from a young man chasing a high he first experienced months earlier when he popped his first Vicodin pill for fun. The morphine and Vicodin — both belonging to a category of drugs known as opioids — offered a reprieve from a home he considered broken. Neither sealed the breach; instead, they provided a temporary escape from it all.
“It was like my soul had been awakened,” Hoxie said, nearly two decades later, of those initial euphoric experiences. “I thought to myself, ‘This is the feeling I have been missing my whole life.’”
And, for much of the rest of his life, Moxie chased that feeling. The pursuit led him down dark paths. He dropped out of high school and instead graduated to more potent opioids. Oxycontin. Methadone. Heroin. He spent much of the next decade-and-a-half living in vehicles and alleyways, serving jail time for possessing drug paraphernalia, befriending and falling in love with other opioid addicts, then watching many of them die. Hoxie, for a long time, accepted he would die from the affliction, too.
He isn’t waiting to die anymore.
His fortunes seemed to change the day he walked into The University Clinic, a Bay City-based primary care facility forged from a partnership between Saginaw Valley State University and Bay County Health Department. Over the years, he sought sobriety at 16 different residential treatment centers and five community health clinics, but at those places, Hoxie always fell off the wagon within weeks. Sometimes, days.
The Jackson native will turn 33 on July 6. When that date arrives, he will mark nearly two years of independence from opioids, by far his longest stretch since swallowing that first Vicodin. While associates credit Hoxie for the accomplishment, he is quick to share the triumph with those he said were instrumental in helping him achieve it.
“I’m alive today because of The University Clinic,” said Hoxie, now employed and living with his girlfriend and her daughter in Tawas.
“I truly believe that clinic saved my life.”
While the specter of relapse always looms over individuals with drug histories, Hoxie said the clinic’s interdisciplinary approach and dedicated staff — including SVSU faculty members with clinical experience and students training alongside them — provided his best chance ever at a healthy and happy existence. The office’s medical staff supervised his detox from opioids, its occupational therapists helped relieve the pains of his drug-abused body, and its social workers set him up for a sustainable lifestyle, free of drugs.
His ongoing recovery is a success story for The University Clinic, but it’s a rare bright spot in an otherwise dark narrative underway in the United States. Opioid addiction has surged nationally in recent years, prompting medical professionals and lawmakers alike to label the problem an “epidemic” — the same status applied to history’s deadliest outbreaks of smallpox, polio, typhus and the bubonic plague. In a 2016 report, the U.S. Centers for Disease Control (CDC) announced the rate of deaths related to opioids increased 200 percent between the years 2000 and 2014. In 2015, more than 33,000 people died from the epidemic.
No neighborhood is safe from the problem. Its reach extends from crime-laden streets, where Oxy is traded for unseemly acts … to doctor’s offices, where painkiller prescriptions sometimes are offered like candy. Its victims range from homeless people refusing food in favor of heroin … to parents passed out from overdosing in still-running vehicles, their infant children left unattended and strapped to safety seats in the back.
Bay City and its surrounding counties certainly aren’t safe from the opioid problem, as The University Clinic’s staff and associates discovered. And Hoxie is far from the first opioid addict — and likely far from the last — to seek help there.
“I never thought I’d see the day when more people were dying from overdoses than automobile accidents,” said Joel Strasz, who began his health care career in Bay County in the late 1990s. “That’s what’s happened, though. It’s happening here.”
Strasz four years ago was promoted to health officer — the top post — at the Bay County Health Department, where The University Clinic is housed in downtown Bay City. During his time there, he watched the opioid crisis develop both nationally and in his community’s backyard.
Nationally, the numbers alarmed Strasz.
The CDC in March 2016 issued recommendations to the nation’s doctors, urging caution when prescribing highly-addictive painkillers. Since 1999, the amount of prescription opioids sold in the nation quadrupled. Medical professionals had lowered the threshold for deciding when patients needed painkillers and how long they needed the medicine, experts argued, and those increasingly lax standards resulted in more Americans growing dependent on — and eventually abusing — the pharmaceuticals. In many cases, those pills served as gateway drugs to cheaper alternatives with more potency such as heroin.
Locally, the numbers alarmed Strasz.
While the medically-prescribed path to opioid abuse was not the route taken by addicts introduced to opioids recreationally — as was the case for Hoxie — statistics indicate Bay County is home to others who fit the profile of the former. Michigan Department of Health and Human Services figures show medical professionals in Bay County wrote more opioid-prescriptions-per-person (1.9) than in any of the 82 other counties in the state in 2015. By comparison, Bay County’s 1.2 opioids-prescribed-per-person figure in 2009 landed the community at No. 6 on the statewide ranking.
The surging statistics seemed to coincide with other trends in the community. Overdose deaths in Bay County jumped from five people in 2005 to 25 people in 2012, Straus said. In 2015, 27 people died from overdoses.
Riverhaven Substance Abuse Services, a recently-defunct office within Bay-Arenac Behavioral Health, reported 15 percent of clients seeking treatment for substance abuse at the facility were seeking help for opioid abuse in 2005. That figure soared to 48 percent in 2014.
“The numbers don’t look good,” Strasz said. “We needed to do something.”
In May 2015, he issued a public health advisory for Bay County regarding the opioid epidemic. The advisory remains in effect today.
“I’m waiting for the problem to lessen significantly before ending the advisory,” Strasz said. “It doesn’t look like it’s going to do that anytime soon.”
Other experts share the skepticism. Barry Schmidt, project director of Bay City-based Neighborhood Resource Center — a community group that deals with social challenges including substance abuse — said the problem likely will persist in Bay County for years.
“You’ll have your ups and downs, but I don’t know when this is going to be over,” he said. “We have to keep it in the spotlight to keep people aware of it.”
Raising public awareness is one approach taken by The Bay County HOPE (Heroin Opioid Prevention and Elimination) Project, an organization Strasz assembled as part of the public health advisory. Its members include Schmidt, who discusses the problem at community forums as well as middle and high schools where opioid abuse also is on the rise in Bay County.
HOPE members also apply other strategies to curbing the epidemic, including referring addicts to treatment centers.
“That’s where The University Clinic has become so important in this fight,” Strasz said.
The clinic began as an experiment of sorts. No other county-run health department in the state housed primary care staff, which offer the sort of services patients often seek when visiting family doctors and physicians.
Funded by a $1.5 million U.S. Health and Human Services grant, SVSU and Bay County Health Department officials opened the clinic’s doors in January 2015, providing a variety of health care resources to clients who lacked resources and were less likely to seek primary care at traditional facilities.
“People suffering from chronic health conditions like hypertension and diabetes are who we targeted first,” said Kathleen Schachman, SVSU’s Randall Wickes Endowed Chair in Nursing and one of the clinic’s coordinators.
Clients trickled in at a slow pace for months. Early efforts at promoting public awareness for the facility attracted relatively few, Schachman said. There were days that featured a single appointment with a patient. Then the clinic redirected its outreach efforts and began seeing results within its first year.
“Things really started to pick up when our social workers and her student interns reached out to homeless shelters in the area,” she said. “This just happened to be a population who had nowhere else to go.”
Soon, positive word-of-mouth from clients attracted others. The office’s proximity to a bus station; the county jail and courthouse; and a park known as one where people abused drugs led growing numbers of individuals with limited resources to the clinic’s doors, Schachman said.
“In some cases, these are people who don’t usually get the care they need until they are in a crisis and don’t always show up for their appointments,” she said. “A lot of places don’t want these people as patients, but we are willing to take them on, and to treat them with respect.”
Serving the homeless, in particular, made Schachman acutely aware that more resources were necessary to aid the population’s mental health needs.
To meet those needs, Schachman applied for — and received — a trio of grants in 2016 worth a total of $2.9 million from both the U.S. Department of Health and Human Services as well as the Michigan Health Endowment Fund. The funds beefed up the clinic’s mental health resources, established a partnership with Wayne State University, secured a working alliance with Bay-Arenac Behavioral Health, and expanded the office’s three-days-a-week schedule to five.
As the clinic evolved during its second year of existence, the increased traffic revealed a growing community problem. Clients arrived with a variety of needs outside of mental health-related issues such as high blood pressure, lung disease, and diabetes, among others. Many of these problems, though, often were accompanied by another: opioid abuse.
Dorothy Lee, an SVSU associate professor of nursing and a nurse practitioner at the clinic, estimated about two-thirds of her clients suffered from opioid dependency.
“Some come in — their heart on their sleeve — and ask for help with it,” said Lee, who has 25 years of experience as a nurse in facilities across the state. “With others, they’re much more guarded, and say they’re here for something else.”
“Something else” often involves a desire for the staff to write a prescription for opioid-based painkillers. While Lee and others at the clinic are authorized to order such medicine, education and experience help them identify individuals genuinely in need of pain relief as well as those seeking a high. The staff does not write prescriptions for those in search of the latter. Instead, the clinic offers them help in achieving sobriety. Sometimes the patient welcomes the extended hand. Sometimes not.
“There is the attitude of, ‘It’s OK, because at least you came to us for help, and we want to help,’” Lee said. “They might leave frustrated when they didn’t get what they wanted, but sometimes those same people will come back later when they realize we can help them and that we aren’t going to judge them.”
Lee said University Clinic staff recognize people addicted to opioids are suffering from a disease, not a weakness, as some in the public — and even some in medical care circles —perceive the problem.
“No one becomes an addict by going into a situation saying, ‘I’m going to make a bad decision today,’” Lee said. “They start off thinking they can control themselves, but that’s not the case. There’s so much that gets broken and hurt when you become addicted to a drug.”
The staff’s empathetic approach was what distinguished The University Clinic from all the other facilities Theo Hoxie visited while trying to kick his opioid habit.
“I thought it might be one of those community clinics you had to call for an appointment at 8 in the morning and wait in a line,” he said. “That was not the case at all. They took me in with hugs and smiles. They listened to my story. I’ve never had that before.”
Hoxie, as was the case of many others arriving at the clinic with similar issues, was initially evaluated by Lee.
“I told her I was an addict, but she didn’t treat me like I was an addict,” Hoxie said. “Most doctors treat addicts like crap. University Clinic staff wanted to understand me, and then they wanted to help me.”
Lee connected Hoxie with the clinic’s social work supervisor, Sherry LaMere, an SVSU adjunct social work instructor with 34 years of clinical experience in Bay County. LaMere and her master’s degree-level student interns assisted Hoxie in securing a variety of resources, allowing him to purchase his first phone. He was provided with ongoing therapy from the social work staff, who helped him craft a résumé that landed him a job as a therapist technologist working with autistic children.
Hoxie continues to visit the clinic, nearly two years after staff there helped him go clean. Lee continues to treat him for the Hepatitis C he developed from injecting himself with an infected needle. The social work staff checks in to ensure he remains connected to ongoing support systems in the community. He also visits the clinic to receive a healthy dose of something else:
“Love,” he said. “This place has shown me so much love.”
Hoxie so far has proven to be a success story for the clinic. There are others. But rebounding from opioid abuse is no guarantee, and not everyone who visits the clinic will recover.
“It’s heartbreaking, some of the stories you hear,” Lee said. “I asked this girl who came here once — she was 20 and had been on heroin since 11 or 12 — ‘How do you define health for you?’ She said, ‘Health, to me, is not trying to kill myself every time I try to get off this stuff.’”
The best chance many addicts may have for recovery, though, lay in the sort of interdisciplinary approach adopted by The University Clinic, staff say. The office also has close ties with Bay Health Plan, which aids visitors lacking health insurance coverage.
“The more we look at our parents’ lives in a comprehensive way, the more we can help them,” LaMere said.
“The less often we have to refer a patient to an outside service, the more likely it is that we can keep them engaged, helping them immediately and over a sustained period. Otherwise, people can get lost in the transition of care.”
Offering a “one-stop shop” for health care needs help staff build a rapport with patients. With rapport comes trust, she said.
“It’s all about trust,” LaMere said. “Frequently, that means interdisciplinary staff connect with patients at the emotional, physical and mental level. This builds trust and rapport to assist them in moving forward with their overall health and life or, in laymen’s terms, ‘Meeting them where they are.’”
Sometimes that means literally meeting them where they are. LaMere, for instance, has traveled throughout the city to reconnect with University Clinic patients who missed appointments. She and her student interns make home visits, seek out patients in local parks and on the streets in order to encourage them to return to the clinic’s care. High-risk patients — which includes opioid addicts — often benefit from this aggressive approach, LaMere said.
Officials hope the clinic’s reach outside of the region will grow stronger. Schachman plans to apply for grants aimed at establishing satellite clinics north of Bay City and securing partnerships with ambulance agencies that would allow University Clinic staff to visit 9-1-1 callers experiencing something less than a health emergency. She said it’s likely both scenarios would connect staff with those suffering from opioid addiction.
In the meantime, the clinic in downtown Bay City will serve as a center for healing in a community — and country — embattled by an epidemic.
“These are people who have been exposed to war,” Lee said of Hoxie and other opioid addicts. “It’s a different kind of war, but that’s what it is. That’s what we’re faced with here.”