Killer Crisis: Opioids Become Major Minnesota Killer

Opioid overdoses kill more Minnesotans than traffic accidents, and opioids are the leading drug killers.

Jason Roberts is lucky not be be counted in the death statistics.
A longtime heroin addict, Roberts overdosed twice on drugs laced with the manmade opioid fentanyl. He is convinced he would be dead if he hadn’t been arrested for robbery in 2015 and entered an addiction recovery program.

“It’s a plague,” Roberts said of fentanyl, a drug 50 times more powerful than other pharmaceutical opioids like morphine and is highly addictive.

“It’s going to be death, one way or another,” he said. “Either your soul or your body will die. It’s going to kill you.”

Jen Jensen said it was easy to get hooked.

“We were getting them from my folks,” she said. “If they were using them, it was OK for us.”

Eventually, like most addicts say, “I could not function without them.”
“At my lowest point I was broken and had no hope for a better life,” she said last month while touting a treatment program that finally helped her turn around.

Newly released state Health Department figures show opioid deaths rose at a slightly higher rate in 2016 than overall drug overdose deaths, with opioids blamed for 395 deaths (99 from synthetic opioids like fentanyl) and related heroin adding 150 to the toll. In comparison, 392 people died in traffic accidents last year.

Nationally, there were more than 63,600 drug overdose deaths during 2016, with about two-thirds of deaths opioid-related, according to data released by the Centers for Disease Control and Prevention. If current trends hold, the Trust for America’s Health projects the annual toll could reach 163,000 deaths by 2025.

One of the most striking CDC figures reports that the age-adjusted rate of drug overdose deaths involving synthetic opioids other than methadone doubled between 2015 and 2016.

And while Minnesota’s age-adjusted rate of drug overdoses is statistically lower than the U.S. rate, neighboring Iowa, North Dakota and South Dakota join Texas and Nebraska as the states with the lowest rates.

To combat the crisis, national, state and tribal leaders have declared opioid deaths a health emergency, with money and attention rapidly being focused on the issue.

“It is a complicated problem and it requires a multi-pronged approach,” Minnesota state epidemiologist Dr. Ruth Lynfield said, with programs needed to prevent people from becoming addicted but also treating them if they do.

Opioids were introduced decades ago as a way to ease serious pain when other medicines could not do the job.

Well-meaning family, friends and doctors often play a role in getting people hooked, even if unintentionally.

“They get them through family members and friends,” psychiatrist Dr. Sheila Specker of the University of Minnesota said as a common start for addicts.

In some cases, future addicts are handed prescription opioid medicine by loved ones who think they are helping control the person’s pain.

Other times people looking to get high, often young, take them from medicine cabinets and other unsecure locations where family and friends store them.

Doctors often provide the entry into addiction by prescribing opioids such as oxycodone and codeine. New state guidelines attempt to limit how much opioids doctors, dentists and others can prescribe.

Scientists say opioids may not lead to addiction if given for short periods of time, but the longer they are taken the more the risk of abuse.

Besides chronic pain, “despair” is a reason that drives people to opioids, Lynfield said. That could come from any of a number of personal problems.

More than 3.5 million opioid prescriptions were written in 2016 for Minnesota’s 5.5 million residents. That was down nearly 9 percent from a year earlier. On top of that, an unknown amount of opioids and related drugs are sold illegally, often in more powerful and dangerous forms than the legal variety.

Once hooked, an addict may “doctor shop” to get opioid prescriptions from as many health care professionals as possible or move on to drugs sold on the street, anything to avoid withdrawal symptoms.

The good news for Minnesota is that it has the fifth lowest rate of opioid prescriptions.

However, Dr. Rahul Koranne of the Minnesota Hospital Association said, there still are 47 prescriptions written for every 100 Minnesotans.

Greater Minnesota trends are different than found in the Twin Cities, the Health Department reports.

In the Twin Cities, opioid deaths have risen most years since 2000, soaring from 202 in 2015 to 256 in 2016.

Elsewhere in Minnesota, opioid deaths jumped in 2014, but the increase has been more gradual since then. There were 138 opioid-related greater Minnesota deaths last year, up five from a year earlier (officials did not know where one victim lived).

The new report indicates that nonopioid methamphetamine deaths soared 82 percent last year, mostly in greater Minnesota, where meth may be more readily available.

The state report shows a trend toward the use of more illegal heroin and synthetic opioids such as fentanyl and tramadol, often bought on the street and presenting more potency and a greater danger than government-controlled prescription drugs.

The Minnesota Human Services Department reports 10,599 opioid-related treatment program admissions last year.

Opioids produce highs, and users soon discover that crushing pills and then snorting or injecting the powder increases the euphoric effects over simply swallowing them.

Opioids reduces perception of pain, the original intent, but can produce a sense of well being and pleasure while also creating drowsiness, mental confusion, nausea and constipation.

Opioids are the current rage, Specker said, in part because they are easy to obtain from family and friends. Once those sources are not available, she said, “the switch happens to heroin.”

Eighty percent of heroin users first misused prescription medication, state health officials say. Often, heroin is mixed with other drugs to make for something more potent.

Terms related to opioids can be confusing, so the federal government’s Centers for Disease Control and Prevention compiled this list:

Acute Pain: Pain that usually starts suddenly and has a known cause, like an injury or surgery. It normally gets better as a body heals and lasts less than three months.

Benzodiazepines: Sometimes called “benzos,” these are sedatives often used to treat anxiety, insomnia and other conditions. Combining benzodiazepines with opioids increases a person’s risk of overdose and death.

Chronic pain: Pain that lasts three or more months and can be caused by a disease or condition, injury, medical treatment, inflammation or even an unknown reason.

Drug misuse: The use of prescription drugs without a prescription or in a manner other than as directed by a doctor.

Drug abuse or addiction: Dependence on a legal or illegal drug or medication. See opioid use disorder.

Fentanyl: Pharmaceutical fentanyl is a synthetic opioid pain medication, approved for treating severe pain, typically advanced cancer pain. It is 50 to 100 times more potent than morphine. However, illegally made fentanyl is sold for its heroin-like effect, and it is often mixed with heroin and-or cocaine as a combination product.

Heroin: An illegal, highly addictive opioid drug processed from morphine.

Naloxone: A prescription drug that can reverse the effects of opioid overdose and can be life-saving if administered in time. The drug is sold under the brand names Narcan and Evzio.

Non-opioid therapy: Methods of managing chronic pain that does not involve opioids. These methods can include, but are not limited to, acetaminophen (Tylenol) or ibuprofen (Advil), cognitive behavioral therapy, physical therapy and exercise, medications for depression or for seizures or interventional therapies (injections).

Non-pharmacologic therapy: Treatments that do not involve medications, including physical treatments (exercise therapy, weight loss) and behavioral treatments (cognitive behavioral therapy).

Opioid: Natural or synthetic chemicals that interact with opioid receptors on nerve cells in the body and brain, and reduce the intensity of pain signals and feelings of pain. This class of drugs included the illegal drug heroin, synthetic opioids such as fentanyl and pain medications available legally by prescription, such as oxycodone, hydrocodone, codeine, morphine and many others. Opioid pain medications are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused.

Opioid analgesics: Commonly referred to as prescription opioids, medications that have been used to treat moderate to severe pain in some patients. The include morphine, codeine, oxycodone, hydrocodone, hydromorphone, oxymorphone, methadone, a synthetic opioid, tramadol and fentanyl.

Opioid use disorder: A problematic pattern of opioid use that causes significant impairment or distress. A diagnosis is based on specific criteria such as unsuccessful efforts to cut down or control use, or use resulting in social problems and a failure to fulfill obligations at work, school or home. Opioid use disorder has also been referred to as opioid abuse or dependence or opioid addiction.

Overdose: Injury to the body (poisoning) that happens when a drug is taken in excessive amounts. An overdose can be fatal or nonfatal.

Physical dependence: Adaptation to a drug that produces symptoms of withdrawal when the drug is stopped.

Prescription drug monitoring programs: State-run electronic databases that track controlled substance prescriptions. The programs help providers identify patients at risk of opioid misuse and abuse due to overlapping prescriptions, high dosages or co-prescribing of opioids with benzodiazepines.

Tolerance: Reduced response to a drug with repeated use.