How Nikki King Is Innovating Treatment For Opioid Addiction

CHRISTIANE AMANPOUR: Nicky King was born in Kentucky where she saw firsthand the devastating impact of the opioid crisis. She then moved to Indiana where she established an innovative addiction program, which was focused on treatment and support rather than instead jail. It’s offered through the community hospital, Margaret Mary Health. And it could serve as model for other parts of rural America. And here she is discussing it with our Hari Sreenivasan.

HARI SREENIVASAN: Christiane, thanks. Nikki King, thanks for joining us. Nicky, I want to ask a little bit about your story. You didn’t grow up in Indiana but yes, in Appalachia. And you came of age during this opioid crisis. Tell me a little bit about what it was like witnessing this happening around you?

NIKKI KING, MANAGER OF BEHAVIORAL HEALTH AND ADDICTION SERVICES, MARGARET MARY HEALTH: So, I grew up in Southeastern Kentucky. I remember when oxycontin first came to the area. I remember everyone talking about this medication for the first time. And, you know, when it really rolled in, the big reaction that people had was, is it possible to be addicted or abusing a medication that came from your doctor? Because up until then, crack was something that happened in the cities. You know, people have some sort of vague knowledge of what crack-cocaine was, but nobody had ever really seen it or anything like that. You know, the big bad at that time was pot, and that was like the worst drug possibly imaginable. And so, you know, the thought that you could have something so much worse that comes through and it came from your doctor was unheard of. Doctors helps people, they didn’t addict people. And so, when people started get this medication, you know, you started to see people that just started acting funny. Suddenly they were like really fixated on this medication. When was their next refill? Could they get a higher dose? You know, different things like that. It started to dominate the conversations. And then you would start to have people who, you know, have these various memories of people who were clearly in the early stages of the addiction. And, you know, when they would walk away from a conversation, you kind of see people looking at each other like, that is weird. Because literally all they talk about is their medication now. And then before you know it, you’ve got people breaking into the houses trying to steal other people’s medications or people trying to break into the doctor’s office and steal their medication. And it came on slow but fast at the same time, because, you know, it just felt like isolate incidents. And I’d honestly compare it a lot to the pandemic. Now, I think that a lot of people ask, you know, about the people that I saw, you know, who had suffered from drug addiction when I growing up and it was in every single family who had someone who was struggling and, you know, some people were open about it. They talked about it. They saw it for what it was. But honestly, even up to the point I was in high school, some families still didn’t know exactly how to account for the behaviors that they were seeing, which now in retrospect, clearly people who were struggling with a hidden addiction.

SREENIVASAN: Was this just normal for a kid going to school to know people or to see people who had overdosed?

KING: You know, the first time I saw an overdose, I already knew what to do, because we had talked about it so much at school with my friends, and I was 13. At the time, I was proud of myself for knowing what to do and for listening to those conversations. And I look back and I thought, why did a 13-year-old know how to wake somebody up from an opioid overdose? Like that should not ever happen, yet that was just part of our normal day-to-day conversation. There were just friends that you know you couldn’t go to their house, because their parents weren’t safe and it was just given that they would come to your house. And nobody ever said anything that loud, it was just sort of the social structure that kind of came up around, you know, this. And I remember the big thing to me was, you know, I could have sat down and I could have told you everyone who would have been dead of an opioid overdose and I would have been right 9 of 10 times.

SREENIVASAN: How many people do you think you know that have died because of this?

KING: Hundreds probably. At one point, I sit down. I actually tried to name them. I thought of 20 without having to actually look at Facebook. So, I think that — the thing that really stuck with me is if as a child, I can look around and I can see who the at-risk people are, how did we let them fall through the cracks? How did we let them get that far? Because if I’m picking up on it as a child, a professional would have picked up on it a long time before that. But there weren’t any. You know what I mean? There was no intervention, not really. I mean, there were some treatment programs here and there, there’s a lot of really successful drug courts that are going on in Eastern Kentucky and places like that. But by and large, their treatment interventions for people who have already developed the problem. There was nothing that was addressing the underlying issues, the underlying mental illness which, you know, Appalachian counties have a much higher rate of mental illness than the rest of the country. There was nothing addressing the childhood trauma. Kentucky is like I believe the worst state in the union for child abuse. For kids in the foster systems, you know, just this really anemic services to kind of head this stuff off. And I was really frustrated because if me and my friends could sit down and have a conversation while we were in high school about everything that would need to change to stop the drug epidemic, which we would do. You know, we would go to these really campy education things and we laugh about how dumb they were. And we would talk about what we would do if we were in charge. And if we could figure out as children, how was everybody else not seeing this? To me it was so obvious. And every time — you know, by the time I got old enough for people to start taking me seriously on this, all I ever heard is, we can’t do it. There’s not enough resources. Can’t do it in a rural community. There is not enough people. There’s not enough trained staff. There’s not — you know, it’s too expensive. It won’t be very good program. Maybe you will have a program, but it won’t be like what, you know, the rich people can afford to send their kids to. It won’t have that success rate. That was all I ever heard. And so, to me, like I said, the solution was right there. So, I put my money where my mouth is and five years of my life and a lot of my sleep.

SREENIVASAN: So, you grew in a place where you saw what the opioid crisis was doing, you’re in a position where you can figure out how to help people. Tell me a little bit about the specifics of the program that you’ve built.

KING: So, our program is basically a full-service mental health and substance abuse clinic, as well as medication assisted treatment. We have several rural clinic locations, health center location in the rural Midwest. We generally consider our patient population to include 65,000 people in Southeastern Indiana.

SREENIVASAN: What do they get there? Just the fact that there is a center, that’s the big difference?

KING: So, in our rural area, there really aren’t any other comprehensive treatment programs. You might have a little bit of the individual therapy or something like that here or there from federal centers but there’s nothing like a real comprehensive treatment program. Those are usually — and especially when you talk about a program that addresses all the social determinants of health and all the different aspects of population health, so primary health, psychiatry, substance abuse counseling, job counseling, resume training, child care waver training, stipends for work clothing, et cetera. I have lived my whole life in a rural community. Other than a few years of going to school, I have never lived anywhere but rural. And all I’ve ever heard from our hospital is, you know, maybe we don’t have this amazing super qualified brain — neuro brain surgeon that Harvard has, right? But what we do have is community. That is our strength. We have a population that is ours. They go to church with us or they go to church with their doctor. They see each other at Kroger. And so, because we have a dedicated population, we can really leverage those relationships and they are genuine. You know, you really do want to see somebody get better from substance use or really want to do — you do want to take care of them because you went to school with parent or you know, and you know how distraught their mom is. Every Sunday at church she is praying. Every Sunday at church she prays that, you know, this isn’t the week that her child overdoses. How can you not help? You know, how can you standby? You can’t. You see them every week. They are your neighbors. They are us. They are our community. And so, that is all we’ve ever said. That’s been our battle standard of rural health. This is what we do better than urban.

SREENIVASAN: Has the pandemic made it worse for the people that are getting these services?

KING: Oh, absolutely. So, when you have got folks who are already dealing with the stigma who many of them have already burnt every bridge that they had in their life throughout their addiction, you know, they have alienated family members and friends and things like that. And then you lock them inside in social isolation during a pandemic, that becomes really difficult reengage them. In fact, you know, I know before I got into the mental health profession, I would have told you thought I thought that individual psychotherapy was probably the gold standard and people who did not do individual psychotherapy and the group psychotherapy, so like group therapy appointments, was because group therapy appointments were more resource efficient, not because they were better. You know, you got one therapist, you got 20 people who needed this, you know, so just put them in a group, that’s better. But actually, what we know is that group psychotherapy is the most effective form of addiction treatment. And a significant part of that is because it helps to reintegrate people back into a supportive community of people who have similar experiences. And so, for people who really crave that social interaction and they really get a boost from that supportive community, locking them inside during a pandemic has been horrific. And that is even besides the collective mental trauma of surviving the pandemic, being afraid for your life, being afraid for your loved ones, not being able to visit the family members who are possibly at the end of their life, financial concerns. I mean, all of those things, compacting with — you know, trying to treat somebody who is suffering with mental illness beforehand, a significant mental illness is really difficult. That said, Telehealth also helped to overcome a lot of barriers that have been traditionally really difficult to overcome in rural communities.

SREENIVASAN: So, here you now with professional skills able to help people who probably remind you of people that you knew growing up. Tell me if you can, do these leave an impact on you? What — the ones that maybe did make it or even the ones that didn’t?

KING: Oh, yeah. I remember them all. I know their names. I know their faces. I know where they work. It’s really creepy but sometimes I’d go in to where they work and I just watched them for a while and I think about how different they are. You know, they smile now, their faces aren’t hallowed out and gray and, you know, they play with the kids, they have a laugh again. I know all of them. They all leave an impact. Honestly, I think the bigger ones that stand out to me, were the ones I weren’t able to help. Before we started the program, there was a girl who is already dealing with substance use disorders and she was a teenager. And I remember working for 16 straight hours with her to try to find some sort of mental health treatment. And she had come in as a suicide attempt. And I remember every hospital that I called arguing with me that it was not a serious enough attempt. And I remember thinking that this is where we are. You know what I mean? When we are faced down with, you know, a person who is in that deep of despair that whether or not they are so serious or not that they can’t cope with their lives. And we come back to this place of arguing with them that they could just do better or maybe it wasn’t that serious or, you know what I mean? That one sticks with me a little.

SREENIVASAN: I just want to ask a little bit about kind of the wrap that Appalachia gets when you go could back as far as that image of war on poverty and Lyndon Johnson. And it seems that the region has become almost a caricature. And here we are at a time when movies like “Hillbilly Elegy” based on the book by J.D. Vance are really popular. What does that do to you?

KING: This is the hardest question I think I’ll never an answer to. I have had to do a lot of soul-searching that there will never be enough studying, that there will never be enough things that I know that I actually have the answer to this because maybe there is not one. Yes, to your point, the war on poverty started for about an hour from where I grew up. And the biggest thing that has always hit me is one picture. One picture hit the TV and suddenly everybody knew everything they needed to know about Eastern Kentucky. I really attribute this a lot to what Americans think about work ethic. You know, from the minute that we grow up in this country, we are fed this line about the American dream. We are fed this idea that if you work hard and you are a good person that good things will happen to you and then you’ll get a two-story house with a white picket fence and a golden retriever, and we cannot in our soul come to terms with the fact that that is not true for some people. Because if it’s not true for some people, it cannot be not true for us. And we really cannot — as a culture, we can’t deal with it. There’s this level of cognizant dissonance where we need to believe that everybody has the option to succeed, to grow up and to work hard and succeed. But the truth is, if that was really how it worked, every coal miner in the world would be a millionaire right now, because they work harder than anybody, but they are not. They are struggling. And I think that when they saw those pictures from the war on poverty, they needed to believe that there was a reason, that there was something wrong with the American people because they can’t come to terms with the fact that there is something wrong with the American society and that the American dream does not exist. And I think that we have to call attention to that. You know, for the few of us like me and, you know, say J.D. Vance who get out, and for people to listen to us and to put us on TV shows like you and, you know, different things like that and ask us what we think, we’ve got a microphone and we have to use that to elevate the voices of the people in our community and talk about the systemic struggles that they have and a deck that’s been largely stacked against them. And I really get annoyed when people use that platform to espouse how special they are. If everybody would just be like them and just work harder like them, because plays right into the, you know, perception box that everybody has, everybody wants to believe. Everybody wants to believe there is something wrong with the mountain people, and that is why they are not successful because that is easier to stomach than some people in this country are not born in a position to succeed no matter what they do. I will tell you I am not special. I am here because I got lucky time and time again. If I have said it once, I’ve said it a thousand times, if I have seen further in my life, if I have accomplished one thing that was worthy, it is because I have stood on the shoulders of giants. But you have to take a step back and look at a system where you have entire (INAUDIBLE) of people who were dying of unprecedented rates of diseases of despair, of chronic health conditions, of poverty, just really intense poverty and all the historical factors that led up to those situations before you can even begin to understand that one person’s story.

SREENIVASAN: How did you escape being one of those statistics? How did you get out?

KING: My grandma and my mom beat me over the head from the time I was little with, get out, you know, see the world. Do what you want to do. Get an education and then come back to live the kind of life that you want, you know. And it’s OK if you want to, you know, be a wife and a mother and things like that, but don’t get yourself in a position where that is the only option that you have. Because, you know, my mama (ph), for example, well, she married young. She never had a chance to go off to college, and she used to tell me that that was always her dream and that, you know, she felt like she waited her whole life to get that opportunity and it just never came. And she used — you know, our — the way we would bond at our playtime was going over multiplication tables. She made me learn Latin because she thought the kids in the city were learning Latin and they would make fun of me one day when I go to college if I didn’t know Latin, which in retrospect is really hilarious, all the things that she thought that they were learning in city schools. But, you know, I had her and I always felt like I owed it to her. It was her dream that I had to live the life that she wanted, that she had given that gift to me when she passed and that it was my job to carry that baton. And so, I mean, that helped. And honestly, I got lucky time after time. I had teachers who would go out of their way to, you know, foster something in me, to grow something in me. I won the lottery 1,000 times over and it should not be that hard. It should not require that. But I am glad that it was me. And I feel like I have a responsibility to pay it forward.

SREENIVASAN: Nikki King, thank you. Thanks for joining us.

KING: Thank you.