Editor's Note: This is the first part in a series of upcoming stories on the opioid epidemic and its impact regionally.
WORTHINGTON — Since the 1990s, the use and spread of opioids throughout the United States has led to an epidemic of overdose deaths, with more than 564,000 people dying from an opioid-involved overdose between 1999 and 2020. Today, synthetic opioids such as Fentanyl, have contributed to an increase in opioid overdoses — a trend that has begun to show in Greater Minnesota.
A highly addictive man-made opioid, fentanyl is considered the primary drug threat in Minnesota by the Drug Enforcement Administration. Just two milligrams of fentanyl, enough to fit on the tip of a pencil, is considered a potentially deadly dose.
In 2021, there were over 80,000 fatal overdose deaths involving opioids, averaging roughly one person every seven minutes. Last year the DEA Omaha Division, which includes Nebraska, Iowa, Minnesota, North Dakota and South Dakota, reported seized nearly 4.7 million lethal doses of Fentanyl in both pill and powder form. Over 379 million potentially deadly doses of fentanyl were seized nationwide in the same timeframe.
“One of the big misconceptions of this crisis is that with overdose deaths being so much higher year over year, that people are equating that to a higher use (of opioids) when that isn't really the case,” said Alicia House, Executive Director of the Steve Rummler HOPE Network, an organization dedicated to addressing the opioid epidemic. “I think, statistically, it shows that our communities aren't necessarily using more than they ever have … It's just that our supply has become a lot more dangerous, and that's why we're seeing such an increase in deaths and substance use disorder.”
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Fentanyl has become increasingly common in recent years, not only in the form of counterfeit oxycodone pills like M30, but also as a filler in other street drugs that can result in dangerous and life-threatening reactions. The appearance of fentanyl in other substances has contributed to opioid overdoses, sometimes by people who would otherwise not have used opioids, House said.
“The current opioid crisis has occurred largely in three waves, the first of which started in the 1990s driven by the overprescription of medications … like OxyContin,” said Emma Lysne, a licensed alcohol and drug counselor from Luverne. “They were marketed as less addictive opioids, and the FDA label even said this. Then, over time, laws were cracked down upon and people no longer had access to those prescriptions — especially the people who developed opioid use patterns.”
This, Lysne said, led to a shift around 2010 toward heroin use, as a “cheaper and more readily available alternative” to prescription opioids. One 2013 study found that 80% of heroin users at that time reported starting with prescription opioids. In the years that followed, though, there began an increase in overdose deaths from man-made opioids. By 2020, 82% of all opioid-involved deaths involved synthetic opioids — more than 18 times higher than in 2013.
“Synthetic opioids are cheaper to produce and they're more potent than other opioids,” said Lysne. “They're increasingly used to lace other substances and are deadly in very small amounts.”
With 1,286 overdose deaths reported to the Minnesota Department of Health, the majority of which were associated with fentanyl, 2021 marked the first time since 2014 that Greater Minnesota saw a larger increase in opioid-related deaths than the metro area.
While Nobles County saw a decrease in drug overdose deaths, non-fatal overdoses, and opioid prescription dispensations overall in 2021, as did several surrounding counties, local law enforcement noted an increase in trafficking and use of synthetic opioids over the last several months.
“It seems like it's becoming more and more,” said Nobles County Sheriff Ryan Kruger. “I know that in the last couple of months, we've received a couple bigger traffic stops where we've seized stuff like M30 pills. It seems like what we're hearing is pretty much everything could have fentanyl in it.”
In addition to being cheaper and easier to produce, fentanyl is also lighter in weight and easier to transport, which has helped create a “perfect storm” for the spread and use of synthetic opioids, and the resulting increase in opioid overdoses, House explained.
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“It's important to remember that this crisis has affected everyone but it hasn't affected everyone equally. Minnesota has some of the worst disparities in drug overdose mortality in the country,” Lysne said, adding that African American Minnesotans and Indigenous Minnesotans face a much higher risk of drug overdose death than white Minnesotans. “This isn't a disparity in use rates. We actually see that people of all demographics use about the same amount in the same ways. It's just disparity in non-white communities overdosing and resulting in death.”
Similarly, House noted that health inequalities and lack of access to resources played a large part in the disparity of drug overdose deaths.
While recent years have marked a rise in opioid overdoses, it's also given way to increased efforts to address the opioid epidemic. Organizations like SRHN have created campaigns to help reduce the number of opioid overdose deaths through education on harm reduction and the use of the opioid reversal medication, Naloxone.
“In 2021, there were almost 5,500 ER visits for opioid-involved overdoses,” said House, “and those are instances where people were administered Naloxone and sought out continued medical care. Those just showcase all of the times lives were saved in Minnesota specifically.”
House said that in reality, the number of lives saved was likely much higher, but not everyone seeks medical treatment following an overdose where they were administered Naloxone.
Additionally, reducing stigma around substance use disorder, providing opportunities for recovery, and legislative action have all played a significant role in addressing the opioid epidemic House noted, and will continue to do so.
“We're doing the best we can to try and create marketing campaigns, resources, awareness, conversations, community forums — whatever it takes,” she said. “I think it’s going to need all hands on deck to get that education and that information out there to the people who need it.”
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