Editor's note: This is the second story in a three-part series about a pending opioid-related settlement in Minnesota and how the opioid epidemic has impacted the Bemidji area.
BEMIDJI -- Opioids were deadlier than ever in Beltrami County in 2020.
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Fifty deaths were recorded by the Minnesota Department of Health as a direct result of opioid overdoses in the county from 2000 to 2020.
In the last several years, the number of deaths for Beltrami County has been:
Across the state as a whole, there were 1,008 deaths from overdoses in 2020, with 539 from fentanyl (a synthetic opioid), 207 from opioids and 117 from heroin. The number of deaths was above the total from 2019, where the state recorded 792 fatalities.
RELATED: Epidemic within a pandemic: Region sees uptick in drug overdoses
In addition to the deaths, there have been dozens of non-fatal overdoses, with 64 recorded in Beltrami County during 2020. In years before then, the number of overdoses included:
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According to Dana Farley, overdose prevention supervisor for MDH, the state began seeing the overdose increases starting in 2000, with many stemming from prescribed drugs.
“Early on, a lot of the overdoses were from prescription drugs,” he said. “We saw that as being a mismanagement of not only pain relievers, but a mismanagement of pain.”
Over the course of the pandemic, the number of opioid prescriptions dispensed has been gradually decreasing. In Beltrami County, since 2015, the number of prescriptions dispensed has been as follows:
- 21,703 in 2020
- 22,533 in 2019
- 25,073 in 2018
- 28,862 in 2017
- 34,338 in 2016
- 38,175 in 2015
Changes in prescribing
Farley said more responsible prescribing across the state has helped reduce the abuse of opioids given by doctors.
“Even when providing the appropriate amount of opioids, there are dangerous combinations that can happen,” Farley said. “That includes prescribing opioids with depressants. Requiring providers in Minnesota to check the prescription with the state’s drug monitoring program has enabled more people to avoid that type of prescribing practice.”
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“There’s a large number of people who develop an opioid use disorder who are given their first medication by a physician,” said Dr. Joseph Corser, the medical director for the medication-assisted therapy clinic for Sanford Health in Bemidji. “So who can prescribe has been cut way back over the years, and the number of opioids someone gets after surgery has also gone way down.
“Additionally, the number of people who get a refill of their medication has also gone way down. We’ve also advertised and talked about educating people more on the issue.”
Non-opioid-related therapies have also become more common following surgeries at Sanford Health, according to Corser.
As fewer opioids have been prescribed, though, more have been turning to other options, such as heroin and synthetics such as fentanyl.
“We've been seeing a lot more of an impact from the synthetics,” Farley said. “We saw that particularly in 2018, where synthetic opioids started to overtake the prescriptions in being represented in our overdoses. Other parts of the country had already experienced these types of overdoses.”
One aspect driving people who are addicted to opioids to continue seeking out such options is how severe the withdrawals can be.
Mindy Broden, the team lead for Sanford Health’s Chemical Dependency Program, said the withdrawals are “extremely painful and distressing.”
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“Essentially, our bodies produce natural opioids,” Broden said. “What happens when we start taking opioids is the body begins to stop its production of natural opioids. So when people go through withdrawals, there are no natural opioid reserves to help tend the body’s needs.
“It can look a lot like the flu,” Broden explained. “Extensive pain, body aches, sweating, nausea and gastrointestinal issues. It can also make a person either lethargic or give them heightened anxiety.”
Another factor causing an increase in the usage of heroin and synthetic opioids has been the cost of prescriptions on the street.
“The price of prescriptions has gone up, and it opened a door for the cheaper option, being heroin,” Broden said. “Then, in the last couple of years, we’ve seen a significant increase in fentanyl as well.”
Making the synthetics especially dangerous is what's unknown about them. Often, those who are purchasing the drugs won’t know what’s fully in them.
“In recent weeks, we’ve had people who maybe thought they were taking cocaine, but it actually had fentanyl in there,” Farley said. “So a lot of drugs are labeled one thing but they’re cut with opioids or fentanyl. People don’t know what they’re taking.”
Treating the issue
The epidemic has resulted in a gradual increase in treatment in the last decade. Over the past nine years, the number of people seeking treatment in Beltrami County for opioid addiction has been as follows:
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Because the withdrawals can be so severe, medicated assisted treatment has become more common to help people stabilize their lives.
“In the last five to 10 years, there’s been quite the advancement in several medication-assisted therapies to help people,” Farley said. “Not only have there been additional kinds of medication, but the requirements for providers have also changed. Before, there was a limit on how many patients they could have. That has changed to allow a more relaxed approach to providing medication-assisted therapy.”
“It’s a daily dosing program,” Broden said. “The medication helps with cravings and guards against overdoses. It sort of puts a cap on the addiction.”
Corser said one of the effective medications has been suboxone.
“Even though they know, in a cognitive sense, that it’s not what they want to do, they can have an overwhelming urge to return to use,” Corser said. “It’s because the brain has changed, especially if they started using before they’re 25. Medication like suboxone is very useful for patients to prevent those cravings. It can help restore that balance to the brain.”
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Another effective medical treatment, often used in emergency situations, has been naloxone, commonly called NARCAN.
“One of the success stories we’re having is the distribution of naloxone,” Farley said. “Even though drug overdoses have increased, so have the number of non-fatal overdoses.”
Withdrawals in newborns
Those needing treatment haven’t been exclusively people who have taken opioids, either. Another issue caused by the epidemic was infants who were born showing withdrawal symptoms because their mothers used opioids.
“We were seeing more and more babies born with withdrawals,” Corser said. “Subsequently, the number of children being placed into foster care because mothers had positive urine tests for opioids also went up."
In response, Sanford Health, in working with Beltrami County Health and Human Services Department, started the First Steps to Healthy Babies program. The program provides treatment and support to mothers throughout their pregnancy so they’re in recovery by the time of birth, as well as in-home postnatal care.
RELATED: First Steps to Healthy Babies program extended
“It’s so when the time comes to deliver the baby, the child can stay home with the mother,” Corser said. “It’s really important for an infant’s development.”
Corser also said because both the mother and their partner are so integral to a child’s development, the name of the program was changed to First Steps to Healthy Families, as treatment is now provided to the mother’s partner as well.
Closing gaps in treatment
While advances have been made in treatment and new programs have been established by providers such as Sanford, some parts of the state remain lacking in care.
“When you look at variations in different areas, you have to always consider if there’s access to naloxone if there’s access to drug treatment and what the assistance is for first responders,” Farley said. “It can be a variety of things. We also know we have people from rural areas sometimes come down to the metro area for treatment.
“There are counties where residents don’t have quick access to treatment. We also see some other spots where there’s a disparity of resources that can contribute to drug use. Poverty and unemployment, those can play a factor.”
Homelessness is another factor that can impact the amount of drug use, according to Farley.
“It’s not just a metro area issue, it’s a statewide issue, and those are hard-to-reach populations,” he said. “So reaching out to these hard-to-reach populations is important to help getting them stabilized, as is housing. Those are some things MDH is interested in.”
He said one initiative to reach other populations, including those in rural parts of the state, is the Tackling Opioids with Networks, or TOWNS program. TOWNS is now in 11 communities and uses a community clinic approach.
Farley said the number of patients has increased because the program is meeting them where they are. Moving forward, Farley said potential funds from any future settlements will likely be going toward these treatments, which will continue to be needed.
“Unfortunately, the epidemic continues to impact the state at a huge level,” Farley said. “It’s not just the overdose deaths. It’s the non-fatal overdoses. It’s the ongoing misery that not only impacts the individuals but also the families and loved ones. There’s recognition at the state and federal level that an ongoing need exists and I think there will be funds dedicated to that.”
