Makenzie Huber/South Dakota Searchlight
Megan Cantone stumbled out of the hospital in tears from the pain.
She sought treatment for an infection from drug use. Medical professionals at the Denver hospital provided the treatment, but as Cantone recalls, it came with a heavy dose of judgment.
A doctor refused to numb her wound after recognizing it as being from illicit drug use, she said. The pain was supposed to convince her “never to shove a needle in your arm again,” Cantone said.
“I told my husband I feel like a complete failure, like a terrible person,” Cantone said. “That’s almost when a person could kill themselves because you’re at the lowest of your low and somebody treats you like that.”
Earlier that week, a nurse at a different hospital confronted her while treating another infection. The nurse told Cantone she’d end up killing herself and “pretty much told me I was disgusting,” Cantone remembers.
Cantone began experimenting with drugs in high school, but her opioid use started when she attended cosmetology and esthiology school in the Twin Cities. Her use escalated to meth and heroin over the years.
A doctor stepped in to defend Cantone, scolding the nurse. The doctor suggested medication to help her stop opioid use; he said she suffered from a medical disorder that could be treated.
As the opioid epidemic continues in South Dakota, physicians can offer medications for opioid use disorder. But the practice — made possible by a change to federal law in 2022 — is held back in South Dakota because of stigmas attached to it, advocates say. Stigmas like Cantone experienced, and what she still experiences in South Dakota today.
Cantone didn’t accept the medication from the emergency room doctor. She grappled with self-loathing. But the doctor’s kindness and offer stuck with her.
Months later, after near-death experiences and the realization she was pregnant, Cantone accepted a prescription and delivered a healthy baby girl. The medication straightened a winding path toward recovery.
The 35-year-old mother and wife, who lives in Sioux Falls, credits her Christian faith and the medication for her recovery. She will celebrate six years of sobriety in May.
Training providers to ‘recognize bravery’
Buprenorphine prescriptions in South Dakota tripled in the last five years, increasing from about 2,500 at the start of 2019 to around 7,500 at the end of 2024. The drug reduces opioid withdrawal symptoms and cravings.
Naloxone is available in some public spaces throughout South Dakota, especially in Sioux Falls and Rapid City. It prevents opioid overdoses by blocking receptor cells.
Cantone took a Suboxone prescription for years, which is a drug that contains both buprenorphine and naloxone to treat opioid use disorder. Now she takes buprenorphine.
The increased access to both medications is heartening for Craig Uthe, a family physician at Sanford and local spokesman for the national Opioid Response Network. The Mainstreaming Addiction Treatment Act eliminated a federal waiver requirement for prescribing buprenorphine. But physicians need more education on the prescriptions, he said.
“We didn’t have that many people prescribing buprenorphine before, and we still don’t,” Uthe said. “We have a lot of people still prescribing opioids but not prescribing buprenorphine.”
Opioids are prescribed for pain management but can be addictive, especially for patients with chronic pain, Uthe said. South Dakota opioid prescription counts in 2024 stood at 437,431.
Of the top 10 controlled substances prescribed to South Dakota patients in 2024, opioids claimed three spots, according to the state’s prescription drug monitoring program data. Two of the three drugs — methylphenidate and oxycodone — moved up in the rankings to fourth and sixth most prescribed controlled substances. Hydrocodone retained its number one spot.
The state and health systems are gathering data to measure how much buprenorphine is prescribed.
“If we see a county with high overdose numbers, we’d like to see a higher amount of buprenorphine prescribed,” Uthe said. “How can we, as the state Health Department or as health care systems, try to place a resource where there is the greatest need?”
South Dakota Health Department Secretary Melissa Magstadt said medical providers should make it a “prescribing habit” to prescribe naloxone for each opioid prescription they write. Overdose victims do not always suffer from opioid use disorder, she said.
“I’ve seen very well-meaning patients who took one too many doses or maybe forgot they took a dose or didn’t realize they had two different medications that had opioids in them,” Magstadt said.
She said it’ll likely take years for prescriber behaviors to change.
In 2023, South Dakota reported the second lowest overdose death rate in the nation at 11.2 deaths per 100,000 residents, according to the latest data available.
Ninety-five South Dakotans in 2023 died from drug overdoses, 47 of which were from opioids. In 2024, 90 South Dakotans died from drug overdoses, 36 of which were from opioids, according to the state Health Department.
Although most overdose deaths are among white residents, Native Americans are disproportionately affected. Native Americans die from overdoses at a rate of 26.6 per 100,000 — more than four times the rate among white South Dakotans, according to the State Unintentional Drug Overdose Reporting System.
Sioux Falls nonprofit Emily’s Hope partners with emergency departments. Physicians connect patients with the nonprofit, which works to connect them to medication and other treatment services, said Angela Kennecke, founder and CEO. Kennecke’s daughter, Emily, died of a fentanyl overdose, laced in heroin she injected. Her family was planning to enroll her into a treatment program when she died in May 2018.
Medication is the “gold star” for treatment, Kennecke said. Treating opioid use disorder without medication can be more harmful than no treatment, according to a Yale study published in the Drug and Alcohol Dependence journal in 2024.
“That is our first line of defense in getting people to feel better, to reduce cravings and get them the help they need,” Kennecke said.
Loretta Bryan, a registered nurse focused on clinical improvement within the South Dakota Association of Healthcare Organizations, educates medical providers on opioid use disorder, medications and how to engage with patients.
Her work includes “motivational interviewing techniques” to create authentic conversations with patients and improve screening.
“It takes a lot of bravery to walk through those doors and admit you’re struggling,” Bryan said. “Finding those words to recognize that bravery and having those in your back pocket is helpful.”
Expanding opioid use disorder treatment infrastructure
Access to medications for opioid use disorder is growing in clinics across the state, but not as fast as needed, Uthe said. The focus remains in emergency rooms and on harm reduction. Aside from clinics dedicated to behavioral health, Uthe said, family physicians and urgent care doctors should be comfortable prescribing the medications.
“We don’t have the infrastructure in place to address that need at the moment,” he said.
Lewis and Clark Behavioral Health Services in Yankton runs a telehealth behavioral health program focused on opioid use, with two outreach sites in Pierre and Huron. Rapid City-based Project Recovery is an addiction recovery clinic for opioids, alcohol and stimulant use with satellite clinics in Sioux Falls, Sisseton and Pine Ridge.
State funds to combat opioid use in the state support both programs.
Kendra Joswiak, clinical practice director at Project Recovery, said the organization treated 1,100 people for opioid use disorder in 2024. Of those treated without medication, about 90% will use again, she said, comparing medication for opioid use disorder to insulin for diabetes patients.
“If we had something as good for cancer as we do for opioid use disorder, we’d say we cured cancer,” Joswiak said.
Patients continue to face stigma after years of sobriety
Cantone continues to feel judged when she shares her history with medical professionals, pharmacists, friends and family.
She felt “icky” when she first ordered her prescription at a pharmacy when she moved back to South Dakota in 2020. Medication for opioid use disorder isn’t as common or well known in South Dakota as it is in Denver, she said.
“They looked at me like I was a drug addict or from Mars,” she recalled.
Friends and family have told her she’s switching one addiction for another. But medical professionals say the prescription drugs help restore balance to parts of the brain affected by addiction, allowing patients’ brains to heal without cravings or withdrawal symptoms.
The doubt and stigma undercut the pride and hard work it took to earn Cantone’s sobriety. But she knows people who struggle with substance use disorder are more than what others see.
“As much as we worry about what others think, what matters is you being healthy, getting your life together, staying alive and getting the help you need,” Cantone said. “Whether it’s medication or counseling or cutting cold turkey. You need to get yourself better and cancel out that noise.”