After a young woman's death from a heroin overdose, an Alaska village looks inward

QUINHAGAK — That last time, that worst time, the high came on fast and strong.

They were inhaling smoke from cooked heroin — once, twice, then each did a bit more, "three little tiny specks" in all, said Shane Church, 20. Soon he and his girlfriend closed their eyes, relaxing, lying together close.

She never woke up.

Jamie Roberts was just 19 and, as her family tells it, a happy new graduate of Kuinerrarmiut Elitnaurviat, the just-remodeled school in the Southwest Alaska village of Quinhagak.

Her whole name was on the bulletin for her memorial service: Jamie Brenda Nekevvaq Nalugalria Roberts.

On Aug. 15, one after the other, four people overdosed on heroin in Quinhagak, a remote Bering Sea village of fewer than 700 people. It's a place where the city council is grappling with loose dogs and where piped water has finally reached almost every home in town.

Three men lived, including Church's older brother.

The heroin this time came mixed with the powerful painkiller fentanyl. For Roberts, the combination was deadly.

"I couldn't control it. It was too much," Church said, retelling in an interview a month later what happened. He thought Roberts was sleeping deeply then realized something was terribly wrong. "She didn't move."

The overdoses and death of a young woman just getting her start in life punched a village that had been seeing signs of heroin for months.

[Public health officials find steep rise in Alaska heroin deaths, overdoses]

This community in grief is fighting despair. Residents and leaders moved quickly: putting sharp focus on the problem, bringing in tools of old for children and parents to work on deep-rooted problems, and pushing out suspected dealers.

"The best medicine is to talk about it," Rose Domnick of Yukon-Kuskokwim Health Corp. told the village's middle and high schoolers on Thursday during a daylong assembly led by her Calricaraq program team.

That's Yup'ik for way of healthy living, a strategy that the Alaska Native-run health agency is using to address emotional crises and addictions.

Tribal control

Alaska State Troopers are investigating Roberts' death. No arrests have been made.

Phyllis Roberts, mother of Jamie Roberts, said she reported suspicions about dealers to the troopers' Western Alaska Alcohol and Narcotics Team in the months before the teen's death but no one flew to Quinhagak to investigate. Others said they reported drugs too.

"I called a few times. They never used to come," said Phyllis Roberts. "I didn't know it was going to happen to one of my kids."

After the death, troopers arrived.

They have been investigating the tips all along, said trooper Capt. Michael Duxbury, commander of drug enforcement statewide. By necessity they focus their efforts in supply lines and hubs like Bethel rather than in scattered villages.

"We're diligently working on it," he said.

Investigators need solid tips from people willing to give their names, yet in small tight-knit communities people don't want to look like snitches, he said. Troopers also must show cause before they can check suspicious passengers and luggage with drug-sniffing dogs, Duxbury said.

Warren Jones, president of Quinhagak's Qanirtuuq Inc., which runs the local grocery, has proposed the city levy a small sales tax to create a reward fund for solid tips.

People in the village noticed the homes with traffic at all hours and suspected dealing, tribal administrator Patrick Cleveland has said. After the overdoses, Quinhagak's Native Village of Kwinhagak tribal council and the tribal judge approved banishments of six individuals, most of them connected to drugs or alcohol.

[Western Alaska village banishes 6 after heroin overdoses]

None are tribal members, said Jerilyn Kelly, Quinhagak mayor and also tribal government environmental director, who was filling in for Cleveland at the end of last week.

Church, Jamie's boyfriend, said he hasn't tried to get any heroin since she died. He said he went clean on his own and wants the dealers gone.

The tribal council, police and court "have this great weight on their shoulders," Kelly said. She said she commended them for taking firm action, even if it divided the community.

The tribe is trying to take control and keep out troublemakers. It is looking into requiring outsiders to check in with the tribe and state their business, Kelly said.

The village corporation intends to transfer land to the tribe, a step toward tribal say on who lives in the village, Jones said.

Quinhagak used to have two village public safety officers, but hasn't had any since last summer. Residents began hearing about heroin about the same time the community lost the VPSOs, Kelly said. There was a misunderstanding over who had firing authority, she said.

She was hearing about "brown" but thought it was some kind of marijuana. Then she learned that's a slang name for heroin.

Now the only law enforcement in the village is through tribal police, who are unarmed and have limited powers, according to Patrick Cleveland.

The city and the Association of Village Council Presidents, the regional Alaska Native nonprofit headquartered in Bethel, have been talking about how to reinstate VPSOs, who get housing through the city, said Michelle "Misty" Matthew, city administrator.

A heavy backpack

Health officials said heroin only began showing up in the Yukon-Kuskokwim Delta in a big way within the past three to five years.

They estimate the region may be home to 500 addicts, including many in villages, said Teri Forst, a behavioral health clinician with Bethel Family Clinic who assesses patients for addiction and offers outpatient counseling.

Forst traveled to Quinhagak last week at the request of the school principal to offer information to students, their parents and the community.

[After a daughter's heroin overdose, a mother's grief]

Her presentations were part of a two-pronged strategy at Kuinerrarmiut Elitnaurviat, the Yup'ik name for Quinhagak school. Besides Forst's work on addiction and treatment, Yukon-Kuskokwim Health Corp. sent in a Calricaraq team from its healthy living program.

At the village school, children as young as fourth-graders already know about heroin paraphernalia, Forst said at a community meeting attended by only a few village residents.

Most heroin addicts need specialized intensive, inpatient treatment — which is not offered in Alaska villages and currently isn't in Bethel, either, she said.

Yukon-Kuskokwim Health Corp. is working to develop a Bethel inpatient program that will use medication to help addicts stave off cravings so that they can work on changing their behavior. It should be running this fall, YKHC spokeswoman Tiffany Zulkosky said.

Recognize that heroin isn't like other drugs, Forst urged the community. The craving can be overpowering and withdrawal can feel like the flu. If a loved one is addicted, a family member can help by refusing to talk unless the person is willing to get treatment. Give them food, but not money. Don't bail them out of jail. Many get well only after an arrest, she said.

Her tips were concrete and practical but the community also is looking to old ways and values. The Calricaraq team from Bethel told stories of their own traumas. Their parents who drank and their own drinking problems. A son who committed suicide. A loved one's drug addiction. Shame and guilt, anger and fear.

Willie John, a team member and son of the late, revered Toksook Bay elder Paul John, said even in his family there was trouble. His father drank as a younger man. His mother played bingo, its own addiction.

He has struggled too but is getting stronger, he said, the more he understands his life and his culture.

Without Calricaraq, "I would have been first in line at the liquor store," he said.

As the school assembly wound up, John illustrated the message. A student volunteer put on a backpack that was filled with balloons marked with good words. Love. Respect. Sharing. Caring. "All the good stuff from our ancestors," John said.

The backpack was light, easy to wear for walking.

Then the balloons came out. Rocks went in with other words. Hate. Disrespect. Loneliness. The backpack grew heavy. Others held onto it and the student couldn't walk at all.

Those feelings have to be processed so the weight can be lifted, the rocks removed, John said.

The city is acquiring existing buildings from other organizations, including the Lower Kuskokwim School District. Maybe one could be made into a new place for good health right in the village, said Matthew, the city administrator.

"We need an outlet for people to go."

Local leaders met last week on a community disaster plan that could kick in for a situation like the overdoses, Matthew said. They didn't get too far. Too many people were out moose hunting. They will regroup.

Counter-drug to heroin

Before the Quinhagak overdoses, the state crime lab had only confirmed fentanyl in trace amounts in a few Alaska heroin cases.

"This was the first with such a large amount in it," said Megan Peters, spokeswoman for troopers.

Fentanyl, a synthetic opioid, is so potent that experts say it is impossible to measure without advanced scientific equipment. Too much can stop someone from breathing. The National Institute on Drug Abuse says that an overdose should be treated immediately with an inexpensive drug called naloxone.

But that drug is only now making its way to Yukon-Kuskokwim village clinics, including the tribal clinic in Quinhagak.

[She died in the Anchorage jail detoxing from heroin. Her family wants answers]

It is not necessary for a doctor to be involved in administering the drug either through an injection or nasal spray. It is available over the counter at the Yukon-Kuskokwim Health Corp. pharmacy in Bethel, YKHC's Zulkosky said. Village residents who use heroin or their family members should call and ask for it to be sent to them, she said. Even if a health aide had it available, the time needed to respond in a village might be too long to help someone who had stopped breathing, she said.

The Native Village of Kwinhagak clinic did not have naloxone back in August, Kelly said. Now it has both the injectable and the nasal versions.

'She was not old'

The day she died started out a good one for Jamie Roberts, said her younger brother Robert, age 15. She had been living with her boyfriend but came over that morning to clean up the family home as she often did.

She told her mother she was at a loss.

"I miss school. I miss my friends," the new graduate said.

Jamie relished the traditional ways in Quinhagak, picking berries and gathering greens, preparing birds and fish, her family said. She loved four-wheeling and especially the game of New Year's Eve follow-the-leader in which kids took turns leading a long line of four-wheelers through town.

The whole family was proud of her graduation from high school. She was studious, determined and helpful, said principal Peggie Price of Kuinerrarmiut Elitnaurviat.

Roberts concentrated on the school's law enforcement track. She wanted to be a police officer, her brother said. She was on a waiting list for the Alaska Job Corps vocational program in Palmer.

She worked summers in the Coastal Villages Region Fund youth employment program and was assigned to the village corporation hardware store.

That day, she picked up her paycheck. Church, who dropped out of high school and worked as a laborer for Alaska Village Electric Cooperative, was paid too.

Church's older brother was another one of the overdose victims on Aug. 15. He was taken out of their home just as Church got home from work. Church said he didn't know why his brother was ill that day.

The young couple cashed their checks and bought heroin, he said. That's how it had gone for the last year. He had thought he would just try it once.

"Once was every day," Church said, at least until each paycheck ran out.

That day, he tried to kiss Roberts awake and got scared when she didn't respond.

"I tried screaming. I tried shaking her," Church said. He knew to call the village health aide but his hands were so stiff that he struggled to tap out the number. He tried over and over then finally got it right.

"I was just too slow," he said, breaking down in tears while sitting on the porch of his family's small blue home.

Robert Roberts, Jamie's brother, said the family was not prepared to lose her.

"She had no cancer. She wasn't old."

To turn the tragedy into good, the community organized a four-wheeler anti-drug rally through town. Her mother thought of it. People held signs to protest drugs and dealers and posted pictures on Facebook.

Church said he was second in line. He was crying too hard to hold a sign.