Over the last few years, Minnesota policymakers and medical providers ramped up the pressure to slow down the rate of overdoses and deaths caused by opioids. When you compare Minnesota to other states in the Upper Midwest, it is fairly similar in age-adjusted opioid and overall overdose death rates; despite having a relatively low mortality rate for opioid overdoses, 402 Minnesotans still died from opioid abuse in 2016, 58 more than who died in 2015 from opioids.
According to Kaiser, Minnesota had the 13th lowest age-adjusted opioid death rate in the US, and the 6th lowest age-adjusted drug overdose death rate in 2015. These rates were slightly higher than the rates in the Dakotas, on par with Iowa, and lower than Wisconsin and the rest of the U.S. The actual age-adjusted mortality rate for opioid overdose in Minnesota was 6.2 deaths per 100,000 people in 2015, while the national rate was 10.4 deaths per 100,000.
Age-adjusting mortality rates mean taking the observed death rates in a given area, stratified by age groups, and comparing them with the expected death rates of a “standard” population (e.g. the United States). Higher age-adjusted mortality rates indicate that more people in a population die than is expected, particularly at younger ages.
The types of opiates that are proliferating in Minnesota mean that the number of Minnesotans who die from opioid abuse will almost certainly continue to grow in 2017. Efforts to reduce the number of opioid prescriptions had mild success over the last couple years. According to FiveThirtyEight, most counties in Minnesota have fewer than 500 milligrams of morphine prescribed per capita (well below the median, with some counties in the US exceeding 3,000 mg per capita), and the rate of prescribing opioids is falling or holding steady, rather than increasing; however, when prescription opiates are unavailable, people addicted to opioids turn to other sources for their high, and that usually means shifting to heroin.
The Minnesota Health Department calculated that 453 Minnesotans died with heroin in their system from 2000 to 2015. The rates were much lower earlier in the century; no more than eight Minnesotans died from heroin in a year from 2000 to 2008. But from 2013 to 2015, the number of Minnesotans who died from heroin grew from 92 in a year, to 98, to 114 deaths in 2015. These deaths are depicted by year in the table below. Heroin is significantly cheaper than buying prescription opiates on the street, but the risks of overdose are much higher.
Source: Minnesota Dept. of Health Overdose Death Report
Additionally, a newer form of synthetic opioids has made Minnesota a much more dangerous place in terms of what is available on the market. Fentanyl, an opiate used only by severe cancer patients, is 100 times more potent than medical-grade morphine, and increasingly used as a supplement to heroin. The problem with using it to supplement to heroin is that it takes a much smaller dose to cause a lethal overdose.
A Minnesota woman was recently arrested for selling heroin laced with fentanyl that killed one of her buyers. This trend, along with illicit drug manufacturers who will dye and dilute fentanyl so they can press it into pills resembling Oxycontin or other prescription pills (which sell at higher prices than heroin), has led to a dramatic spike in deaths over the last five years. In 2011, there were 33 deaths related to fentanyl in Minnesota; in 2015, that number rose to 50 deaths, and in 2016, it was 101. As illegal substitutes replace pharmaceutical opioids more, Minnesotans can expect death rates to increase.
There are several avenues to combat this growing crisis in Minnesota, all of which should be considered. First, the state should continue the current practices of regulating prescriptions for drugs like Oxycontin and Vicodin. In 2015, Minnesota mandated that physicians recommending long-term opioid use for severe chronic pain must complete a comprehensive risk assessment for the patient. If the patient has characteristics that might lead to overdose, suicide, abuse, addiction, or holds jobs/participates in activities that are dangerous for someone on opioids, the doctor is forced to find an alternative.
A series of Minnesota laws regarding opioid use make it much harder for physicians to prescribe opioids and for patients to receive them. Physicians must reference a statewide database to determine if a patient has a history of opioid prescriptions. The law also authorized studies to determine the efficacy of acupuncture to control chronic pain, pilot programs to reduce opioid abuse across the state (including one on a Native American reservation), and a two-year grant to research chronic pain interventions in Minneapolis.
Second, Minnesota is expanding the availability of Narcan, also known as naloxone. Narcan works as a fast-acting antidote to an opioid overdose, and is now carried at most pharmacies and by emergency workers; however, the drug companies that carry the patent on this life-saving drug increased the price by 600%, causing some policymakers and law enforcement officials to limit Narcan purchases for first responders, or force survivors to pay for it. Working with Pfizer to purchase Narcan at reduced wholesale rates, as well as convince them to donate more Narcan to emergency workers and non-profit organizations, are vital steps to ensure Minnesota has enough life-saving medication for everybody across the state.
Finally, Minnesota should also expand the network of methadone and suboxone clinics that provide drugs to reduce cravings for the high heroin and prescription opioids provide. These clinics have been proven to help addicts get clean again, particularly for indigenous peoples. According to a 2017 strategic plan for opioids developed by the Minnesota Department of Human Services, a critical gap in Minnesota’s addiction treatment program is the number of physicians certified to treat addicted patients. Incentivizing physicians to gain certification, particularly in rural areas, would be helpful in reducing deaths and improving the lives of those addicted to opioids.
Minnesota needs a comprehensive plan to combat opioids at all levels of control and distribution. Addressing the over-prescription of opioids by physicians via education and legislation was a good start, and is vital for reducing opioid addiction in the long run. However, our state needs to dedicate more resources for methadone and suboxone clinics to provide the treatment heroin addicts need to become clean. Without these clinics, those addicted to heroin and prescription drugs will likely struggle to maintain sobriety at a moment when using heroin is more dangerous than ever with the prevalence of fentanyl on the illicit drug market.