Alaska Confronts the Opioid Epidemic in its Remote Communities

December 21, 2017|4:47 p.m.| Matthew Oglesby

In February 2017, Alaska Gov. Bill Walker issued a disaster declaration in response to the opioid epidemic. As part of an administrative order accompanying the governor’s declaration, Jay Butler, ASTHO immediate past-president and chief medical officer of the Alaska Department of Health and Social Services (AK DHSS), was appointed incident commander of a cabinet-level unifiedcommand response to implement the January 2017 recommendations from the Alaska Opioid Policy Task Force. The next phase of response planning involved travelling to some of the local communities that have been hit the hardest by the opioid crisis, including Prince of Wales Island, Ketchikan, and Petersberg, in southeastern Alaska, to convene a series of public meetings and strategic planning sessions with healthcare professionals, mental health and substance abuse treatment providers, and law enforcement, as well as representatives from the mayor’s office, local government, and the faith community. The response was astonishing, with community members pouring into town halls and meeting places to hear more about how the state, tribal, and local agencies can work together to address the opioid epidemic, or—as one elder from the Native Village of Klawock put it—the “sickness that has come to our land.”

Butler shared a few highlights from his trip with ASTHO. Below is a travelogue from communities that are hurting, but remain very much resilient and motivated in the fight against opioids.

Butler’s trip began in Ketchikan—the third largest island in the United States, after Hawaii and Kodiak. To reach this remote destination, Butler flew from Anchorage to Juneau, then to Sitka and on to Ketchikan (where a series of meetings took place), and from there took two ferry rides (totaling more than four hours) and drove another 40 minutes to Prince of Wales. Despite the isolated location, local police interdict at least a pound of heroin each month. Once on Prince of Wales Island, Butler and Andy Jones, director of AK DHSS’s new Office of Substance Misuse and Addiction Prevention, engaged in a two-hour session with the island’s opioid task force, led by the local public health nurse, Colleen Watson. An evening town hall followed, hosted in the auditorium of a local K-12 school, with representatives from the state legislature, as well as law enforcement and tribal elders from the village of Klawock in attendance.


During the meetings, Butler was surprised (and encouraged) to notice that these discussions emphasized multiple levels of prevention—at first by Watson and the local opioid task force, and then again later, during the town hall meeting, by one of the teachers, who described great success using this approach with her students. Butler and Jones then travelled to Petersburg, which included a similar itinerary: conversations with local stakeholders, government representatives, and police and EMS chiefs, followed by an open town hall at the Sons of Norway Hall.

Alaska High School Student

Jay ButlerFor his discussions, Butler provided background on the national opioid epidemic and how we got here, offering a brief presentation on the changes in prescription opioids that began about 20 years ago, leading to an influx of heroin and (more recently) fentanyl. Butler also talked broadly about solutions, which provided an opportunity to discuss the three levels of prevention—interventions to save lives, access to treatment, and sustaining recovery and primary prevention. Jones provided training in using naloxone rescue kits supplied by the state. However, Butler was quick to point out that he and his colleagues weren’t there to lecture. Instead, they came to listen. “We never had silence,” Butler says. “It was really wonderful and informative for all of us.” The main takeaway, Butler explains, is that addressing this epidemic is going to take the entire community. “This is the most constructive approach,” says Butler. “During the trip, no one asked, ‘What are you [the state] going to do? How are you going to solve this?’ Everyone was very open to our approach and looked forward to working together to solve this problem.”

For more information on Butler’s trip and to hear voices from the community, check out this recording from a local radio program that covered the meeting. Butler said that AK DHSS has an ambitious schedule including approximately 13 more of these events scheduled between now and March 2018.

Partnerships are critical to reducing the devastating impacts of this epidemic and our collective efforts will bring the nation closer to reducing or eliminating opioid misuse. Visit to view ASTHO’s opioid framework, access resources, and learn about promising practices that state and territorial health agencies are undertaking to end the opioid epidemic.