Substance use disorder is a chronic brain disease.
“The important thing is that people can and do recover,” explained Kathy Nevins, an Essentia Health nurse practitioner. “It’s a treatable illness.”
She spoke about Minnesota’s opioid crisis at an Oct. 24 Headwaters Center for Lifelong Learning program.
Nevins said she struggles with the fact that 109,000 Americans died from opioid overdoses last year.
“It’s like a plane crash every single day for a treatable illness,” she said. “Brain sickness is not moral weakness.”
While introducing Nevins, Dr. Michele Thieman, an Essentia Health family medicine practitioner, said, “Kathy has literally been a lifesaver for a number of patients in the area. She’s helped us manage patients in the Brainerd area, Pine River, Walker, Park Rapids, Bagley, Fosston, Mahnomen, Detroit Lakes. She’s also worked to teach other providers how to help patients and recognize opioid disorder.”
Both work partially at Park Rapids and Walker clinics.
“We see patients from every walk of life,” Nevins said.
When asked how opioids are affecting Park Rapids, Nevins said to look at the in-custody roster for the Hubbard County Jail. Usually 90-92% are drug-related, she said.
Nevins said patients have called social services to find someone to care for their children because they know they aren’t capable. “They’ve been told there’s nobody who can take them.”
Why do people take opioids?
Life is stressful, Nevins said, and anxiety-ridden people try to escape it. It’s the major reason that people start taking drugs, she continued.
Both Nevins and Thieman urge compassion. Thieman said to ask people “tell me your story. Let me understand how you ended up where you are and how we can keep you from going back there.”
Six percent of adolescents who received an opioid during a dental procedure, such as having wisdom teeth pulled, were diagnosed with an opioid use disorder one year later.
One of every 550 patients started on opioid therapy died of opioid-related causes a median of 2.6 years later.
Fifty percent of opioid-related deaths are caused by opioids obtained from a medicine cabinet by a family member or friend.
“There’s not one reason in the world that you should keep that” unused opioid, Nevins said.
Opioid dependency can begin in only five days.
Nevins said the U.S. is 4.4% of the world’s population, yet consumes 80% of the world’s opioids.
She described three waves of opioid drug overdoses in the nation.
The first wave, from 1999 to 2010, was dominated by pharmaceutical opioids. They were being prescribed, Nevins said, “because we were told they would treat people’s pain.”
The number of opioids reported as dispensed in Minnesota has been steadily decreasing since 2017.
As physicians decreased those prescriptions, heroin-related deaths rose between 2010 and 2015.
Since 2015 to present day, synthetic opioid deaths have risen.
“The third wave shows how fentanyl has unbelievably taken off and definitely is the dominant opioid we worry about. It’s also the one that’s the deadliest,” Nevins said.
Nevins explained heroin is two to five times stronger than morphine. Fentanyl is 50 to 100 times stronger.
Most fentanyl is produced overseas. “The U.S. Coast Guard is our biggest barrier for fentanyl because it comes in on ships,” Nevins said.
The COVID pandemic and its resulting social isolation meant people were “self-treating” their behavioral health.
Nationally, drug-involved overdoses among all ages went from 70,630 deaths in 2019 to 109,680 in 2022.
Minnesota saw a similar rise in drug overdoses during the pandemic. In 2022, there were 860 deaths in a seven-county metro area and 470 in Greater Minnesota.
Emerging threat: Xylazine
“Here’s the one that keeps me up at night,” Nevins said of xylazine. It’s relatively new on the illicit drug market. It’s also called Tranq, Tranq Dope or Zombie Dope.
Xylazine is a sedative/pain reliever prescribed by veterinarians to put animals to sleep for surgical procedures. It is U.S. Food and Drug Administration (FDA)-approved for veterinary use only.
“It started as a contaminant, so something they were slicing into the drug supply so that they could stretch it out by increasing the bulk,” Nevins explained.
Drug users like it because “it gives fentanyl legs,” elongating and elevating the high.
“It’s super-addictive,” she said.
It’s also hard to recognize a xylazine overdose when someone arrives at the hospital.
In Minnesota, from January 2022 to July 2023, 8.1% of Minnesota Drug Overdose and Substance Use Surveillance Activity cases tested positive for fentanyl also had xylazine present.
“When it comes to xylazine in those cases, 5.1% were in the Twin Cities and 13.6% were in Greater Minnesota. In this case, primarily the Duluth area and St. Louis County,” Nevins said.
Beltrami and St. Louis counties were among 12 counties that had at least one xylazine-related overdose death between 2019 and 2022.
“It’s going to be here soon, if it isn’t already,” Nevins said.
Everyone should carry Narcan
There are four FDA-approved medications for treating substance abuse disorder: buprenorphine, naltrexone, methadone and naloxone.
“Six years ago, we weren’t treating it. I don’t really know that we had an idea how really big the problem was either,” Nevins said. “But now we have several providers in the Park Rapids clinic who treat this and use these medications.”
“Harm reduction” means keeping people alive and minimizing collateral damage until they are off opioids entirely. It’s a tough and controversial concept, Nevins said.
“But I now realize that there are people whose disease is winning and they are using drugs that they should not be using because they’re not ready to quit, for whatever reason. I believe we have a responsibility to keep them alive until that day comes.”
Examples of harm reduction include fentanyl test strips, drug deactivation charcoal pouches and needle exchanges. A needle, for instance, costs 40 cents versus $510,000 for a lifetime of HIV care.
Naloxone, also known as Narcan, is “the epi-pen” for overdoses. It’s easy to use, she said.
It’s widely available in the Twin CIties, but not in northern Minnesota.
“We all need to carry Narcan,” she said. Delivering it to someone in need is 100% covered by Good Samaritan Laws.
Nevins noted that Cass County has a drug treatment specialty court, but Hubbard County does not.
According to the Minnesota Judicial Branch website (mncourts.gov), “Treatment courts are the single most successful intervention in our nation’s history for leading people living with substance use and mental health disorders out of the justice system and into lives of recovery and stability.”
Opioid settlements to Hubbard County
In 2019, Minnesota was the first state to pass legislation establishing a licensing and fee structure for pharmacies wishing to sell pharmaceutical opioids.
It’s set to collect $20 million per year, she explained. Of that revenue, some goes to county social services and some to Opioid Epidemic Response Advisory Council (OERAC). Nevis is a member of OERAC.
In its first three years, OERAC has awarded $36,394,939 to 80 organizations.
This year, OERAC received 115 requests asking for $276,753,527. They only could fund 28 awards for $20,095,519.
In 2021, Minnesota joined historic, $26-billion, multi-state settlement agreements with pharmaceutical distributors McKesson, Cardinal Health and AmerisourceBergen, and opioid manufacturer Johnson & Johnson.
As part of the settlement, Minnesota expects to receive $296 million over 18 years.
Hubbard County should receive $1,716,234 total, Nevins said. The money can be used for any form of opioid abatement.
Nevins suggests using the funds locally to distribute Narcan for free, Narcan vending machines, LUCAS devices (for chest compressions), fentanyl test strips, halfway houses, hotel vouchers and gas cards.
Hubbard County is forming a task force to decide how to utilize the funds.