ST. PAUL — After two decades of struggling with opioids, Minnesota is seeing some signs that efforts to prevent drug dependence and treat addiction are paying off.
Overdose deaths, painkiller prescriptions and opioid-related emergency room visits have either declined or stabilized in the past two years, according to the most recent state data.
In May, lawmakers approved legislation making Minnesota the latest state to levy a fee on drugmakers and distributors to help cover costs of responding to the opioid crisis.
While that’s all good news, state leaders warn those successes are tenuous. Much of the recent data is preliminary and even if it holds true, health officials want to see several consecutive years of improvement before calling it a trend.
That’s because the opioid crisis is always evolving, according to Dana Farley, alcohol and drug prevention policy director for the state Department of Health.
“The opioid epidemic has been a crisis of gigantic proportions,” Farley said. “If we are going to have long-term success, we need to take a look at teaching (people) to manage the stresses of life … without having to use drugs.”
Doing that is an ongoing challenge. Here’s how Minnesota is doing with the most important opioid indicators the state measures:
Minnesota has lost more than 4,000 residents to opioid-related drug overdoses since 2000. That peaked in 2017 when 422 people died of overdoses related to the drug.
Last year, deaths fell nearly 22% to 322 people, but those numbers are preliminary and easily could rise. Determining what caused a drug overdose death is complicated and sometimes unclear because a person often has multiple drugs in their body when they die.
It’s hard to point to a specific reason why opioid deaths are down. Nearly everything the state is doing to combat the opioid addiction crisis — from education and prevention to making treatments more accessible — is aimed at saving lives.
Curbing the number of painkillers prescribed to patients obviously has an impact, but less than half of opioid overdoses are now due to prescription pills. The rest are caused by illicit drugs like heroin and synthetic opioids like fentanyl that are often used to make street drugs more potent.
National experts say four out of five opioid addictions begin with painkillers. But addicts often turn to street drugs that can be easier to obtain and more dangerous to feed their habits.
Fentanyl is increasingly responsible for overdoses deaths involving opioids in Minnesota and across the nation.
Doctors prescribed 3.5 million opioids in 2016, enough for about 63% of the state’s population to have a bottle of the powerful painkillers. Prescriptions dropped by about 11% to 3.1 million in 2017, the latest year for which data is available, and a further decline is expected.
Much of that decline is related to doctors learning more about the dangers prescription opioids pose. Patients now typically receive only a few days’ worth of painkillers at a time, if they are prescribed them at all, because of the drugs’ addictive nature.
It wasn’t always that way.
State lawsuits and other legal actions claim drugmakers knowingly misled doctors about the safety of longer-term opioid use. That misinformation is allegedly at the root of the opioid addiction crisis.
Minnesota also has implemented strict new guidelines for how many opioids doctors can prescribe. Those who fail to follow those new rules risk losing access to government reimbursements for patients on public health programs.
There are exceptions for treating conditions like chronic pain, but state health officials hope doctors will try harder to treat root causes of pain rather than relying on opioids long term.
“If we are going to change the curve of this epidemic … we are going to have to find other ways to treat pain,” Farley said.
That’s what Dr. Heather Bell and Dr. Kurt DeVine are doing at CHI St. Gabriel’s Health in Little Falls. Their goal isn’t to completely eliminate opioid use for chronic pain, but to use it more judiciously to ensure underlying causes are also addressed.
“We are looking for the appropriateness,” said Bell, who emphasized each patient’s medical history is closely reviewed. “Is there a legitimate reason and functional improvement (with opioids)?”
This approach has led to significantly lower opioid use among Bell and DeVine’s patients. The doctors are also using an e-learning tool to coach dozens of other medical providers in rural Minnesota on their methods.
A key tool in combating opioid overdoses is naloxone that acts as an antidote if administered in time. Naloxone works to reduce the depression of the central nervous and respiratory systems that occur during an opioid overdose.
While it is tough to gauge how often naloxone is used, changes in the number of fatal and nonfatal overdoses suggest medical interventions to counteract overdoses are saving lives.
For instance, emergency room visits for nonfatal opioid overdoses have nearly doubled from 1,078 in 2015 to 2,037 in 2017 before stabilizing in 2018.
Medication is not just being used in emergencies to stop overdoses. It is also increasingly relied upon to treat addictions.
Abstinence was once the preferred way to treat addictions to drugs and alcohol, including opioid dependence. Now, doctors and addiction specialists are increasingly using drugs like buprenorphine to ween opioid users off the drug.
Buprenorphine provides patients with a low dose of opioids that can help to taper their dependence on the drug. Unlike methadone, which requires strict oversight typically in a clinic setting, buprenorphine can be administered in a doctor’s office and by prescription so addicts can resume their lives.
“It is a game changer,” DeVine said.
He and Bell have about 100 patients using medicine to treat opioid addictions and are working with doctors in eight rural Minnesota communities to help treat about 150 more patients.
Minnesota law enforcement agencies continue to work to get illicit drugs, including multiple forms of opioids, off the streets. In 2017, there were 2,875 drug arrests by the state’s Violent Crime Enforcement Teams, down slightly from 2016.
Those teams of law enforcement seized 19,173 grams of heroin and 214,429 doses of prescription medications in 2017, the latest year state data is available. Police also confiscated 643 grams of fentanyl.
Fentanyl, a synthetic opioid that is 50 times more powerful than morphine, is increasingly responsible for opioid overdoses and deaths in Minnesota and across the nation.
After several years of debate, a bipartisan group of Minnesota lawmakers was able to win approval in May of a new fee imposed on drugmakers and distributors that will raise revenue to pay for opioid addiction and prevention efforts.
The law is similar to others passed by several states. The laws aim to hold drugmakers responsible for the crisis and raise new resources to fight it.
A new advisory council, set to meet for the first time this fall, will work to advise state officials on the best ways to use money from the fees to address the ever-changing epidemic.
Drugmakers opposed the fees, arguing they will make prescription drugs more expensive. They characterize the fees as a medicine tax.
“Unfortunately, what passed in Minnesota — a tax on legitimately prescribed medicines that patients rely on for legitimate medical needs to raise revenues for the state — ignores evidence-based solutions, sets a dangerous precedent and likely won’t help patients and families,” Nicholas McGee, a spokesman for the trade group PhRMA, said in a statement.