Opioid dependency can happen to anyone.
For so many, the path to addiction begins as an escape from pain or loneliness and escalates into a brutal cycle of dependence and withdrawal. If you use substances such as opioids, synthetics or heroin, recovery and healing are possible through treatment.
Learn the facts about opioids and how abuse and misuse is affecting our state. And remember, you are not alone. Help is available.
Get the Facts
“Opioid” is a word heard frequently these days. But do you really know what opioids are?
Opioids are effective pain relievers. They are also highly addictive drugs and can cause dependence even when taken periodically or recreationally. Opioids are also used by drug dealers as a mixing agent with drugs like cocaine and heroin to increase potency — often without the knowledge of users.
Hydrocodone (Hysingla, Zohydro ER)
Hydrocodone/Acetaminophen (Lorcet, Lortab, Norco, Vicodin)
Hydromorphone (Dilaudid, Exalgo)
Methadone (Dolophine, Methadose)
Morphine (Kadian, MC Contin, Morphabond)
Morphine (Kadian, MC Contin, Morphabond)
Buprenorphine (Buprenex, BUtrans, Probuphine)
Buprenorphine/Naloxone (Suboxone, Zubsolv, Bunavail)
Oxycodone (OxyContin, Oxaydo, Percocet, Roxicet)
Sources: hhs.gov (U.S. Department of Human Services), webmd.com, hopkinsmedicine.org (Johns Hopkins Medicine), drugabuse.gov (National Institute on Drug Abuse), cdc.gov (Centers for Disease Control and Prevention)
For a more extensive list with brand names and “street slang,” check out this resource from the American Society of Addiction Medicine.
According to the National Institute on Drug Abuse, synthetic drugs are substances that mimic the effects of illegal chemicals.
What Are Designer Drugs?
To understand what synthetic marijuana and bath salts are, and how they came to exist, you have to know what a “designer drug” is.
To understand what synthetic marijuana and bath salts are, and how they came to exist, you have to know what a “designer drug” is. A designer drug is a synthetic (chemically made) version of an illegal drug that was slightly altered to avoid having it classified as illegal. It is essentially an experiment by a chemist done to create a new drug that can be sold legally (on the Internet or in stores), allowing dealers to make money without breaking the law. As law enforcement catches up with new chemicals that are so created and makes them illegal, manufacturers devise altered versions to steer clear of the law. So, the cycle repeats. – DrugFreeWorld.org
Designer Drugs: Outpacing the Law
Sold in convenience stores, head shops and widely accessible online, these designer drugs are regarded as a legal high by buyers, sellers and users.
Frequent product name changes, indirect labeling and the use of untested, often undetectable chemicals make synthetics particularly dangerous. Every batch is different and presents its own set of side effects and risks. Continued alterations in the chemical compounds of synthetic drugs keeps manufacturers one step ahead of legal action.
Synthetic drugs are typically either synthetic cannabinoids, sometimes referred to as synthetic marijuana or “vaping,” or synthetic cathinones, more commonly known as bath salts.
Visit AmericanAddictionCenters.org for a more extensive list of synthetic drugs.
Addressing the Crisis
According to preliminary data from the Minnesota Department of Health, drug overdose deaths attributed to opioids are still at a critical high, with an estimated 331 opioid-involved deaths in 2018.
To address this critical issue, the Minnesota Department of Human Services, in coordination with the Health Care Administration and the Office of Indian Policy, was awarded State Opioid Response (SOR) funds through the Substance Abuse and Mental Health Services Administration (SAMHSA). The resulting initiative is designed to increase awareness and reduce deaths related to opioid overdose through prevention, treatment and recovery.
Numerous community agencies throughout the State of Minnesota are now participating in this effort.
The Opioid Crisis in Minnesota
The negative effects of prescription drug abuse have hit some Minnesotans harder than others. There are significant differences in drug overdose rates among racially and ethnically diverse populations in Minnesota as well as among the LGBTQ community.
Community and Race Disparities
While Minnesota has one of the lowest drug overdose mortality rates in the nation, Minnesota also has some of the worst race rate disparities in drug overdose mortality. African American Minnesotans were two times more likely to die from a drug overdose than white Minnesotans. Native American Minnesotans were six times more likely to die from a drug overdose.
Source: MN Dept. of Health
Why Are There Disparities?
Risk factors for developing a substance use disorder add up over the lifetime starting with historical trauma, genetics, substance exposure during pregnancy, adverse childhood experiences, early exposure to drugs and social contexts where drugs are used, and early initiation to drug use.
Source: MN Dept. of Health
The Complexity Behind Disparities
According to the Minnesota Department of Health’s Federal Opioid Briefing, there are many reasons why African Americans and American Indians are dying from, and using prescription and illicit opioids to self-medicate, including, but not limited to:
Higher incidence of historical trauma
Higher incidence of adverse childhood experiences
Lack of access to medical care and/or non-opioid treatment options
Stigma in pursuing chemical health treatment and recovery supports
Lack of access to culturally responsive treatment programs
Lack of trust with Western medicine interventions
Failure to appropriately diagnose physical or mental health symptoms
Lack of research about the effectiveness of interventions within people of color and American Indian communities
Easier access to illicit drugs within the community
Racial bias on the part of providers who prematurely and/or abruptly discontinue opioids
Illicit drugs are currently addressing symptoms
Cultural acceptance of sharing prescription medications with loved ones
African Americans made up 5.8 percent of Minnesota’s population, and were 10.1 percent of the treatment population for opioid abuse in fiscal year 2015. The age-adjusted drug overdose mortality rate for African American/Blacks in Minnesota is the sixth highest in the U.S. (among the 38 states for which data are available). The same study found death due to drug poisoning or overdose is two times greater among African Americans than whites.
Although American Indians made up only an estimated 1.1 percent of the state’s population, they were 15.8 percent of those Minnesotans who received treatment for opioid abuse in 2015.
From 1999 to 2014, American Indian communities in Minnesota had drug overdose death rates nearly five times higher than white Minnesotans. American Indians were also 8.7 times more likely than whites to be diagnosed with maternal opioid dependency or abuse during pregnancy over the same period. American Indian infants are 7.4 times more likely to be born with neonatal abstinence syndrome (NAS).
See the full report from the Minnesota Department of Human Services:
Pregnant Women and Babies
From 2010 to 2014, rates of neonatal abstinence syndrome more than doubled in Minnesota. Babies born with NAS are more likely to be born preterm, have low birth weight and with inadequate or no prenatal care.
Every Situation is Unique
It is hard to get a clear picture of the drug dependency rate in pregnancies for a few reasons. There is no universal screening for substance use disorders in pregnancy. And it is important to remember that not all mothers of babies born with neonatal abstinence syndrome are diagnosed before birth as opioid dependent, and not all pregnant women dependent on opioids give birth to a baby in withdrawal. More information can be found here.
Source: Neonatal Abstinence Syndrome Data Brief from the Minnesota Department of Health
According to a 2015 National Survey on Drug Use and Health, LGBTQ men and women across all age brackets have almost three times greater risk of opioid use disorder compared to their heterosexual-identifying peers.
Opioid Use to Combat Discrimination
There is currently little research about the prevalence of opioid misuse among transgender people, but the use of illicit drugs is higher among the community. For LGBTQ-identifying Americans, the prevalence of all substance abuse disorders, including opioid use disorder, can often be attributed to stress and other social pressures.
Research from the National LGBTQ Health Education Center found that many LGBTQ Americans face marginalization and discrimination based on their sexual and/or gender identity. To escape these feelings, LGBTQ people often turn to opioids and other drugs that provide relief. CultureCareConnection.org from Stratis Health found that about four percent of Minnesotans are LGBTQ, with 45 percent living in the Twin Cities metropolitan area, 15 percent in other cities and 39 percent in smaller rural towns.
Minnesota is a large state with a significant rural population. The state recognizes that greater Minnesota and the Twin Cities metro area have different demographics related to opioid use and require different strategies to address service gaps.
Northern Counties Are at a Higher Risk
While the greatest number and rates of misuse and related deaths are in the seven-county metro area, multiple data sources point to high rates of misuse, treatment admissions and deaths in many northern Minnesota counties.
Rural counties of Cass, Clearwater, and Mahnomen Counties have the highest rates of youth prescription drug misuse. The 2016 Minnesota Student Survey (MSS) revealed school district level data show particularly high rates in the Cass Lake-Bena District, the Waubun-Ogema White Earth District, and the Red Lake District. In addition,the CDC’s National Vital Statistics System (NVSS) found that Mahnomen and Cass Counties have the highest rates of drug poisoning deaths and Clearwater has the fifth highest rate. Similarly, Minnesota’s Drug and Alcohol Abuse Normative Evaluation System (DAANES) reported that Cass, Clearwater, and Mahnomen Counties are in the top ten highest counties for percentage of treatment admissions involving opioids as the primary substance of abuse.
According to the Centers for Disease Control and Prevention (CDC), while only 20 percent of all Americans live in classified rural areas, “Rural Americans are more vulnerable to prescription painkiller abuse and overdoses, and the rate of opioid-related overdose deaths in nonmetro counties is 45 percent higher than in metro counties.”
The disparity between rural and metro areas exists for a variety of reasons:
Increased unemployment rate
Greater rate of injuries that might require opioid medications
Less readily available access to hospitals and treatment for mental health and substance abuse
Misuse Continues to be a Known Issue
For all ages, the rate of opioid-related deaths in rural areas is 9.9 per 100,000 rural residents, and 43 percent of those deaths are adults 45+. Populations tend to skew older in rural areas, meaning there is likely a higher population of people living with chronic diseases and disabilities that might be treated with opioids.
According to the National Rural Health Association, as of March 2018, eighty-three rural hospitals have closed since 2010, leaving millions of rural Americans without local access to the care they require. Local hospitals in rural areas are an especially important resource since rural Americans are naturally further away from large care centers with emergency services and treatment options.
About half of rural Americans say they personally know someone who has struggled with opioid addiction.
The overall rate of babies being born with neonatal abstinence syndrome is steadily rising across the country, but a University of Michigan study found that these rates are rising much faster in rural communities. Another study by the CDC found similar patterns in the use of opioids in teens in rural communities.
In a recent “Life in Rural America” report conducted by the National Public Radio, the Robert Wood Johnson Foundation and the Harvard T.H Chan School of Public Health found that rural Americans identified drug addiction or abuse (including opioids) as a problem that has had a major impact on their communities. A majority of rural Americans said that “opioid addiction is serious problem in their community, and about half of rural Americans say they personally know someone who has struggled with opioid addiction.”
While rural Americans feel confident that their problems within their local communities can be solved in the next five years, a majority say that they’re going to need outside help to solve these problems.
And this makes sense. Because in the end, it’s about all of us.
Forty-three percent of opioid-related deaths from Americans 45+ came from rural areas, and because of the Baby Boomer generation, this age demographic will likely double by 2025.
We should also note that, in Minnesota, the only minority group that has a larger population in rural vs. urban areas is the American Indian community, which has been hit particularly hard by the opioid crisis.
Because access to proper medical care is less reliable in rural areas, government entities like emergency response teams and law enforcement become especially important.
According to the 2017 Ground Level Survey of Minnesotans by the APM Research Lab Minnesotans in rural areas tend to have less trust in the medical system, with 31 percent saying they sometimes or never trust their local medical system.
Social Stigma Plays a Part
Things like personal values also tend to differ between urban and rural areas. The “Life in Rural America” report found that rural Americans value a number of aspects of life in their communities. Most said that they have an attachment to their local community and “identify the closeness of their local community, life in a small town and being around good people as their community’s biggest strengths.”
In addition, when asked why they chose to live in their particular community, one-third of rural adults said it was because of their family. Because of the higher emphasis of family and close-knit communities in rural areas, the social stigma of having an opioid use disorder and needing treatment is more prevalent.
Source: Life in Rural America, report from NPR, Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health
Minnesota’s response to the opioid crisis includes a significant effort to increase access to medication-assisted treatment, reduce unmet treatment needs, and lower opioid overdose related deaths through the provision of prevention, treatment and recovery.
State Opioid Response-funded (SOR) initiatives have been awarded to 27 counties, tribes, health care providers and community agencies to expand services, address disparities and increase the availability of life-saving medications.
Current programs include the following.
State Opioid Response Current Grantee Programs
Medication Assisted Treatment (MAT) Expansion and Recovery Resources
CHI St. Gabriel's Health
CHI St. Gabriel’s Family Medical Center offers training on evidence-based assessment and management of patients with opioid use disorders, thus spreading knowledge between rural clinics.
Crown Medical Support Services Clinic
Crown Medical Support Services, a culturally specific nonprofit community clinic in the inner city of Minneapolis, works to bridge the gap in healthcare disparities, particularly for individuals who are minorities and uninsured. The clinic offers office-based buprenorphine treatment and substance misuse counseling programs among other behavioral health services.
Broadway Family Medicine (University of Minnesota)
Broadway Family Medicine, a University of Minnesota Department of Family Medicine and Community Health training clinic located in North Minneapolis, offers an integrated medication-assisted treatment (MAT) and addiction medicine training program.
Hennepin County provides medication-assisted treatment and transition services for 480 justice-involved individuals with opioid use disorder. Hennepin County provides services at three sites serving justice-involved populations: the Adult Detention Center in Minneapolis, the Adult Corrections Facility in Plymouth, and the Behavioral Health Care Center. The program also supports opioid-specific transitional services linking people exiting services at these sites to ongoing MAT and additional community-based treatment, rehabilitative services, and wraparound supports.
Hennepin Healthcare operates an Extension for Community Health Outcomes (ECHO) hub, a series of learning collaboratives focused on evidence-based assessment and management of patients with opioid use disorder. The ECHO hub focuses on diagnosis and office-based treatment and care for specific populations, including pregnant and postpartum women, individuals involved in the criminal justice system, and cultural minorities.
Hennepin Healthcare (Partnership with Native American Community Clinic)
Hennepin Healthcare, in partnership with the Native American Community Clinic (NACC), provides a multidisciplinary Native American Extension for Community Health Outcomes (ECHO) hub, which support health care and other service providers with tele-training and mentoring. Together, Hennepin Healthcare and the Native American Community Clinic addresses prevention and treatment of opioid use, disorders, pain management, and/or mental health conditions among American Indians in Minnesota.
Hennepin Healthcare System: Hennepin County Drug Court
Hennepin Healthcare System helps Hennepin County residents access treatment medications and services while they remain involved in the criminal justice system. The Hennepin Healthcare Addiction Medicine Program collaborates with the judge, administrator, community corrections staff and public defenders to increase the likelihood that individuals start and remain in treatment as they complete their court obligations.
Leech Lake Band of Ojibwe
Leech Lake Band of Ojibwe focuses on the needs of pregnant women, justice involved populations, and families affected by or suffering from opioid use disorder. Using a multidisciplinary team approach, treatment plans emphasize culture through a partnership with the BaMeNim Anishinaabeg program, an entity under Leech Lake Tribal Courts that aims to prevent crime and delinquency through the promotion of healing of mind, body and spirit with a strong cultural component in program design.
Mille Lacs Band of Ojibwe
The Mille Lacs Band of Ojibwe enhances treatment by expanding navigation and access to medication-assisted treatment for Mille Lacs Band members who are pregnant, women with children, or are reentering the community from a secure facility. Naloxone training is also be provided.
Northwest Indian Community Development Center
The Northwest Indian Community Development Center offers services for justice involved and pregnant and parenting community members in Beltrami County. The center uses community-based services that focus on both prevention and reunification for American Indian families. The center provides parenting supports, education, life skills and self-management of the recovery process after inpatient treatment and during Medication-Assisted Treatment outpatient services.
Red Lake Chemical Health Programs: Mother's Sacred Gift
Mother’s Sacred Gifts Program focuses on the treatment, prevention and recovery for pregnant women who are dependent on opiates during pregnancy and early parenting. The program offers high quality pre-natal and post-natal medical and behavioral health care, collaboration with child welfare agencies to prevent out of home placements, case management including a peer recovery specialist, assistance with transportation and housing, and linkages with other services within Red Lake reservation.
Rice County Integrated Opioid Response Project
The Rice County Integrated Opioid Response Project focuses on improving systems and services through interdisciplinary collaboration and reducing barriers. The project creates an Integrated Opioid Response Council that works to increase partnerships across disciplines and streamline access to services, while a multidisciplinary team works with opiate users to connect them to whatever services are needed in order to move to recovery.
St. Louis County Public Health and Human Services Department
The St. Louis County Public Health and Human Services (SLC PHHS) Department offers a multi-disciplinary, holistic approach to address the problem of opioid abuse, overdose, and death within the four treatment courts in northeastern Minnesota. This project will provide opioid stabilization services and clinical case management services to participants who identify as having or are at risk for an opioid use disorder.
Sanford Health of Northern Minnesota
Sanford Health in Bemidji provides recovery services for pregnant women in collaboration with the Bemidji Women’s Clinic, Bemidji Medication Assisted Therapy Clinic, and community partners. Recovery Services for Pregnant Women works to reduce unmet opiate treatment needs for pregnant women, increase community awareness about opiate risk during pregnancy, and provide supportive services to pregnant women and mothers in recovery to prevent relapse.
Wayside Recovery Center
Wayside Recovery Center is a women’s behavioral health ECHO Hub that for connects providers and clinicians while strengthening care for women statewide. Wayside serves as a “super” ECHO Hub by supporting and partnering with the American Indian Family Center, Minnesota Indian Women’s Resource Center, Minnesota Recovery Connection, and Ecumen, focusing on American Indian pregnant, postpartum and parenting mothers, aging adults/seniors with opioid use disorder and peer recovery and care coordination services.
Located in Mankato, WEcovery is a Recovery Community Organization (RCO) dedicated to helping individuals maintain long-term recovery. WEcovery provides recovery group meetings in schools and at central locations, as well as supports student recovery with Certified Peer Recovery Specialist Services.
Increasing the Treatment Workforce
Career Pathways Collaborative: Life House/SOAR Career Solutions
Life House, Northeastern Minnesota’s largest provider of supportive housing and services to homeless youth, and SOAR Career Solutions, a career and re-entry services agency, have joined forces to create Opportunity Youth of Duluth (OYOD), a Career Pathways Collaborative serving young people ages 16-24 who are disconnected from school and work. OYOD enables youth to obtain in-demand living-wage occupations, provide supported transitional employment paired with stabilization and mental health supports, and supply individualized career coaching and facilitates apprenticeships and specialized job skills training.
Mesabi Range College
Mesabi Range College offers training on comprehensive opioid assessments for those seeking to work in underserved areas. The college trains individuals in rural areas in addiction counseling, targeting county social workers along with other individuals who work with those from underrepresented communities and/or are low-income. The training helps prepare individuals for successful licensure to care for individuals with opioid and substance use disorder.
Integrations Wellness & Recovery Center
Integrations Wellness and Recovery Center addresses the shortage of licensed alcohol and drug counselors (LADCs) in rural Minnesota. The center offers an internship program focused on training in co-occurring mental health and substance use disorder treatment, opioid comprehensive assessments, and evidenced based standards of practice.
To better equip behavioral health providers in recognizing and responding to the cultural needs of the Southeast Asian community, the Amherst H. Wilder Foundation is creating a series of trainings and a treatment curriculum. The curriculum will be developed in-house by a multilingual, multicultural team of mental health and substance use providers, with strong consumer input from outpatient treatment clients. The content will include videos of bilingual, bicultural providers introducing important topics or difficult activities; a facilitator’s manual explaining not only steps but also cultural context; and client-facing worksheets and activities translated into common Southeast Asian languages such as Hmong and Karen.
Naloxone Training and Distribution
Hennepin County Public Health's Red Door Clinic
The Naloxone training and distribution service within Hennepin County Public Health’s Red Door Clinic provides targeted opioid overdose prevention and recovery services to isolated and vulnerable communities in the Twin Cities metropolitan area. The Red Door has been providing Naloxone training and distribution as well as syringe exchange since 2015 in response to the rapidly increasing rate of opioid deaths within Hennepin County.
Indigenous Peoples Task Force
The Indigenous Peoples Task Force provides basic naloxone education, training and distribution to Native American-based organizations, service providers, community members, and to people who inject drugs.
Rural AIDS Action Network
Rural AIDS Action Network (RAAN) increases access to medication-assisted treatment (MAT) for patients diagnosed with opioid use disorder (OUD) as well as to help improve systems of care for patients diagnosed with co-occurring disorders. This project is designed to create a culturally responsive MAT program to support women at risk for OUD; create a medical dimension of care and improve client care coordination for the Red Lake Family Healing to Wellness Court (Mino-misko-miikanaakedaa); and improve coordination of post-overdose treatment, increase access to withdrawal support, and increase availability of MAT for difficult to reach populations.
Steve Rummler HOPE Network
Steve Rummler HOPE Network distributes naloxone kits and provides training throughout the Minnesota. In addition, the network expands naloxone distribution through strategic partnerships targeting 30 counties and embeds naloxone pick-up points and community overdose prevention trainers across the state.
The StreetWorks Collaborative (Lutheran Social Service)
A program of Lutheran Social Service of Minnesota’s Metro Homeless Youth Services, StreetWorks Collaborative works with youth experiencing homelessness and/or at risk of homelessness, ages 13 to 24 in the Twin Cities metropolitan area. The project, through youth-specific training and distribution of Narcan nasal spray, helps prevent young people experiencing or at risk of homelessness from dying of an opioid overdose.
Expanding the Availability of Medication Assisted Treatment
Avivo provides outreach to individuals struggling with opioid use through mobile assessments and immediate, direct connections to chemical and mental health services. A care coordination team helps individuals access benefits and services, such as food assistance, employment or expunging a criminal record. The program also leverages strong relationships with community partners, the Native American Community Clinic, and Minnesota’s Red Lake Band of Chippewa Indians (Red Lake Nation) to ensure client needs are met quickly.
Mille Lacs Band of Ojibwe
The Mille Lacs Band of Ojibwe provides an integrated community response to opioids, including enhancing treatment for opioid use disorder for Mille Lacs Band members who are reentering the community from a secure facility, for pregnant women, and for women with children.
Valhalla Place provides navigation and access to medication-assisted treatment through street and community outreach, offering needs and substance use disorder assessments, referrals to medication-assisted treatment programs and services, and naloxone training and distribution.
Innovative Response to Minnesota’s Opioid Epidemic
Minnesota Indian Women's Resource Center
Minnesota Indian Women’s Resource Center operates a native-specific drop-in center to support urban Native women and Two Spirit/Native LGBTQ relatives. The center is grounded in indigenous healing philosophies to help those struggling with the combined challenges of substance/opioid use disorder, mental health/trauma conditions, homelessness and/or commercial exploitation/sex trafficking. The facility also provides respite in a welcoming and safe environment; immediate-needs services such as a safe sleeping area, shower and basic hygiene supplies; connection to harm reduction services, assessment, medical and mental health care; and the full range of treatment options, including Medication-Assisted Treatment.
NorthPoint Health & Wellness Center
NorthPoint Health and Wellness Center offers an innovative project called Healing Opioid Addiction through Whole Person Support (HOAWPS), serving residents of North Minneapolis struggling with opioid addiction – particularly African American men, who are overserved by the criminal justice system and underserved by the human services system. HOAWPS conducts outreach, helps clients stabilize prior to entering treatment, continues to access needed services during treatment, and helps those in need achieve personally identified goals related to their health and well-being. The program provides culturally responsive, whole-person care including access to housing, food, employment, legal and other services as needed to help clients achieve and maintain stability and sobriety.
Northwest Indian Community Development Center
The Northwest Indian Community Development Center in Bemidji offers an Anishinaabe Care Coordination model to deliver and enhance opioid use disorder prevention, treatment and recovery supports through an integrated community response. The center advances a tribally-driven approach to optimal chronic pain management grounded in culturally relevant practices, provides access high quality prenatal care and family support and reunification, and increases access to healing-centered environments for those returning home from incarceration or court ordered inpatient treatment, with special prioritization for prenatal/postnatal care.
PHS Indian Hospital Collaborative
The PHS Indian Hospital, also known as the Red Lake Hospital, works within the Red Lake Helping Hands Collaborative to expand access to medication-assisted treatment (MAT) services, reduce assessment wait times, facilitate MAT induction for pregnant women, expand access to withdrawal management services, and improve care coordination for clients with opioid use disorder. The Red Lake Helping Hands Collaborative includes the Chemical Health Program, Red Lake Courts, and Family and Children’s Services.