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.