BRAINERD — Ask any medical or law enforcement expert and they’ll say it’s no surprise drug dealers found a way to turn the market failure of certain, hard to get drugs into an opioid epidemic.
Despite laws prohibiting them, law enforcement efforts to combat them and community awareness campaigns to educate, the sale and abuse of legal and illegal narcotics seems to always find a way to sustain itself, experts say.
Unfortunately, that cycle often leads to serious addiction and sometimes death.
“Anything that makes people think twice about lifesaving care is a detriment to our communities,” said Jessica Schwartz, substance use disorder program manager for Essentia Health. “There's no one immune from it. There's no family that this can't happen to. We have to stop making it a moral issue and take care of the people in our communities.”
Around four years ago, Schwartz was asked by Dr. Shiela Klemmetsen, a family medicine specialist at Essentia Health, to help lead a new substance use program at Essentia Health. Working at the Baxter clinic and seeing firsthand a need for a substance use disorder clinic in the Brainerd lakes area, she said yes and began seeing patients in December 2019.
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Treating about 200 patients a month for substance use out of the Baxter clinic, Schwartz also helps to support the Park Rapids and Walker clinics.
Methamphetamine, that's still the king. But at the end of the day, fentanyl is a drug that, once you're hooked on it, it’s next to impossible to ever get off of it.
Years ago, people may have bought one thing and received another when purchasing a drug, as there are no controls in the illegal drug market. That scenario has dangerously escalated in the past few years, bringing in a synthetic opioid — fentanyl — that would take hold in the country and not look back.
“The pandemic and a change in our prescribing policies and practices really dried up and ended the supply of legitimate opioid pills,” Schwartz said. “And so two years ago, people were buying what looked like real Percocet or they looked like real benzodiazepines, which is like Xanax. They didn't know they were getting fentanyl. Now, most young people who come to us are aware and were aware before they started using it.”
The first time Schwartz saw patients testing positive for fentanyl, it was a surprise. She said she had patients coming into the clinic for opioid use who were not testing positive for opioids because a traditional screen test would not detect fentanyl.
“Now, we don't have patients who test positive for anything but (fentanyl) if they're using an opioid,” Schwartz said, noting she has not had a patient test positive for an opiate which does not contain fentanyl in the past couple years.
And while methamphetamine remains popular in the area, law enforcement leaders in north central Minnesota agreed fentanyl is a drug that makes its mark all on its own.
“Methamphetamine, that's still the king,” Wadena County Sheriff Michael Carr said. “But at the end of the day, fentanyl is a drug that, once you're hooked on it, it’s next to impossible to ever get off of it.”
Cass County Sheriff Bryan Welk agreed with Carr, and said even with the high use of methamphetamine in his county, his biggest concern is fentanyl. Cass County had 113 overdoses in 2022 and, as of Feb. 15, had 15 overdoses in 2023.
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“We had an organizational meeting with Leech Lake (Band of Ojibwe) to address fentanyl and overdose issues, and how we can best work together in a collaborative effort to combat that poison that's being put into the streets,” Welk said. Cass County Sheriff’s deputies are issued Narcan, a medication used to reverse or reduce the effects of opioids, to administer to patients as needed.
In a February story in the Brainerd Dispatch, Capt. Joe Kleszyk, commander of the Paul Bunyan Drug Task Force, reported his department had 26 overdoses in 2019 and five deaths. In 2020, there were 88 overdoses and 15 deaths. In 2021, there were 158 overdoses and 24 deaths.
In 2022, the task force investigated 168 overdoses and 28 deaths. Not included in those totals, Kleszyk said, were another 14 overdose deaths on the Red Lake Indian Reservation. That’s 42 overdose deaths in the area in 2022.
People's dependence, physical dependence, happens a lot faster and their withdrawal is a lot worse.
The Paul Bunyan Drug Task Force is made up of law enforcement personnel from Beltrami, Cass, Hubbard, Koochiching and Mahnomen counties, Leech Lake Reservation, White Earth Reservation, International Falls, Park Rapids and Bemidji. The task force also has an agent assigned to them from the Bureau of Indian Affairs and an analyst from the Minnesota National Guard counter-drug team.
On Jan. 31, two Itasca County Jail staff were given Narcan after they were exposed to fentanyl while conducting a search of an inmate, said Joe Dasovich, Itasca County Sheriff.
“We had an inmate come in and he had illegal materials hidden in his person,” Dasovich said. “After he took it out from inside his person … jail staff were exposed. They did have PPE on but they were given one dose of Narcan each, monitored and they were able to go home without medical (treatment).”
Dasovich said the two staff members who were exposed were not tested for fentanyl after the incident and were given Narcan as a precautionary measure.
When asked what worries her most about fentanyl and what makes it scary, Schwartz said it was the quickness of the dependence on the drug.
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“People's dependence, physical dependence, happens a lot faster and their withdrawal is a lot worse,” Schwartz said.
With opiate addiction in the past, Schwartz said a person would need to go through 24 hours without use before they could start on a Suboxone treatment. Now, with the use of fentanyl, they require a patient to go through at least 72 hours of withdrawal before being able to start a treatment. Suboxone is a prescription medicine to treat opioid use disorder by relieving cravings and withdrawal symptoms.
Schwartz said she had a patient recently who used heroin in his past but hadn't used for a number of years. Recently that patient returned to the clinic after using fentanyl for a short period of time.
“He said, ‘Heroin withdrawal is not even comparable to this,” Schwartz said. “‘It's so terrible. It happens so quickly, that dependence.’
“There are so many young people who call us within a month of their initial use and say, ‘I really can't stop because the withdrawal is so terrible.’ And the sad thing is, those are the lucky kids because they haven't had an overdose.”
Addressing mental health and understanding substance use disorder is not a moral failing will go a long way to removing the stigma from substance use, Schwartz said.
“No one's ever been shamed into better health; we don't shame people for any other chronic condition and expect them to do better at managing that chronic condition,” Schwartz said. “We know that addressing mental health, removing stigma about substance use and making it easier to access care, are probably the three things that we can do most in our community to improve the trajectory of what's happening.”
Having four more positions similar to hers at Essentia Health now, Schwartz said they are doing all they can to educate people on how to care for patients who have a substance use disorder.
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“People with substance use disorder don't live in a vacuum,” Schwartz said. “They are seen in primary care, they're seen in emergency rooms, they're seen in podiatry, they're seen everywhere. And so we need to make sure that people are providing them with compassionate care.”
TIM SPEIER, staff writer, can be reached on Twitter @timmy2thyme , call 218-855-5859 or email tim.speier@brainerddispatch.com .
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