HAZEN, N.D. - Communities of all sizes need to have integrated plans in place for combating addiction if they want a chance at receiving federal dollars aimed at the opioid epidemic, U.S. Sen. Heidi Heitkamp told community members at a forum on Feb. 20.

The North Dakota Democrat had held six prior events to discuss opioid addiction across the state, but the Hazen event was the first to focus on the unique needs and problems for rural communities.

"We've got to address this as a public health crisis," Heitkamp said. "A lot of people think it's not in our community, that it's a big city problem ... I'm telling you, this is a problem every place in North Dakota."

Community leaders, law enforcement officials, attorneys, health care officials, school leaders and others from Hazen and surrounding communities attended and shared their views, problems and successes at the event at Hazen City Hall.

Heitkamp laid out some statistics on the nation's opioid problem at the beginning of the talk. Opioid addiction is estimated to have cost a half trillion dollars in 2015, or 2.8 percent of the gross domestic product. The "horrible, horrible statistics" represent loss of earnings and productivity and don't even take into account the social toll, she explained.

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Though North Dakota has not reached the same level of problems with opioids as other states, Heitkamp pointed out that the state does have one of the highest rates of increase of opioid-related deaths, indicating that the problem has arrived and expanded quickly. And opioids, though the drug of the moment for public conversation, is not the only problem. Law enforcement officials noted a resurgence of problems with methamphetamine and continuing problems with prescription drugs and alcohol, as well as stronger marijuana.

And while most people see and accept those problems in larger cities, rural areas are struggling, too, and often with fewer resources, the speakers said. Problems aired included difficulties in finding transportation to get people to larger cities for evaluations and treatment, inabilities to pay for treatment and increased related crimes to which small law enforcement departments must respond.

For people outside the towns and on farms in rural areas, there are even fewer resources.

"The isolation gets even worse when your closest neighbor is five miles away," Heitkamp said.

Heitkamp told the more than 35 attendees that the Hazen and Beulah areas have positioned themselves well to take on addiction, with community-focuses strategies, including resources from the Coal Country Community Health Center's addiction counseling services.

"I'm not just sucking up here," she said.

Aaron Garman, medical director at Coal Country, said the Beulah clinic's medication-supported treatment draws people from as far as Billings, Mont., and Grand Forks, and the health center continues to work on screening and treatment options for people struggling with addictions.

Mercer County Sheriff Dean Danzeisen and School Resource Officer Michelle Anderson addressed what they've seen: increases in drug use in youth and huge problems in getting people help. Sometimes, Danzeisen said, the only thing that helps is to keep people in jail where they can't use.

Transporting people to Bismarck or to Jamestown for evaluations is costly and time consuming and doesn't always end up with the result of someone getting committed for treatment, they said. And even when treatment is needed and wanted, the cost can be prohibitive for families.

Heitkamp said the best thing people can do to increase access to treatment is to support Medicaid expansion and get people who can't afford treatment screened to see if they qualify.

Heitkamp lauded federal legislation that had provided money to fight opioid addiction and its related problems, but she said it hasn't been enough. She talked about her new legislation, the LifeBOAT Act, which would put a one-cent-per-milligram tax on prescription opioids to fund community grants. Overprescription of opioids has been a big part of the problem, and it makes sense for the drug companies to pitch in to help find solutions, she explained.

She anticipates such funding won't go to specific programs but instead to whole-community plans that involve law enforcement, health care, social work, schools, faith groups and others.

"The only way you solve this problem is if it becomes a community issue, and the community works together," Heitkamp said.

Heitkamp said smaller towns have an advantage in their history of finding ways to solve problems.

"Once they decide to solve a problem they have a rich history of working together," she said.