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Officials work to combat rising opioid overdoses

Southwest Journal

Ian Selleck died in 2009 of an accidental heroin overdose at the home where he grew up in Edina.

“We were just an everyday, regular family,” said his mother, Star.

She said Ian was an athlete and wanted to experience everything exciting in life. He had tried heroin for a few weeks and then quit, she said. Then he got some birthday money, tried it again that night, and died.

“It was the day after he turned 19. Pretty young,” she said.

The Hennepin County Sheriff’s Office reports at least 144 opioid-related deaths in 2016 in Hennepin County. The office said the number is at a “crisis level,” a 31 percent increase from the prior year. Of nearly 600 opioid-related deaths since 2012, the youngest victim was 16, and the oldest age 98.

The Drug Enforcement Administration cites increasing addiction to prescription painkillers and a growing prevalence of drugs that contain concentrated and deadly narcotics like fentanyl.

“I don’t think people realize how many people are losing their lives to this, even in a very short time frame,” said Kenneth Solek, assistant special agent for the DEA in Minnesota. “We’re not talking hard-core addicts that have been doing this for years. The amount of people that are dying the first time or first couple of times they use this, we’ve never seen those kinds of statistics before.”

The issue has drawn the scrutiny of the Minnesota Attorney General, state legislators and the state Dept. of Human Services. Advocates rallied at the Capitol this week for new legislation to tackle the issue, including mandatory drug history checks for doctors prescribing controlled substances.

At Opioid Awareness Day on the Hill Feb. 21, people shared their stories with legislators.

Jake Blair’s brother Hunter died in December of a heroin overdose at age 24. Jake’s neighbor and friend overdosed three years ago. And six people from his graduating class in Hudson died of overdoses, he said.

“It affects everyone,” he said. “…It took somebody that I knew and basically turned him into a monster.”

Wayzata High School graduate Alex Milun died of a heroin overdose in 2015. His mother Kirsten said she wants to raise awareness of the issue, because she sees opioids everywhere: an oxycodone prescription for the flu, or a Vicodin prescription for a headache.

“This is a problem,” she said.

Minneapolis resident Judy Lee told of her son Dan, who fell and injured himself and received a prescription for oxycodone. She said he owned a house, worked a job, and was a “vibrant, capable, wonderful productive man.” Dan was also taking anti-anxiety medicine, and Judy said the combination became a prescription for death within weeks.

“He just stopped breathing in the middle of the night,” she said. “…These meds are just not appropriate for chronic pain.”

The Minnesota Attorney General’s office reports that U.S. sales of opioid painkillers have quadrupled since 1999, and fatal overdoses from prescription opioids have also quadrupled in that time. Unintentional poisoning surpassed traffic accidents in 2014 as the leading cause of deaths due to injury, according to the Centers for Disease Control and Prevention.

Drugs that fall under the opioid umbrella include heroin, hydrocodone (such as Vicodin), oxycodone (such as OxyContin), Percocet, hydromorphone (Dilaudid), meperidine (Demerol), fentanyl, methadone, morphine and codeine. The drugs cause a high release of dopamine, the same chemical triggered while eating, drinking, having sex and caring for babies.

Rebekah Forrest, a family nurse practitioner at the Native American Community Clinic on Franklin Avenue, said she’s talking to patients about opioids almost daily.

“People are scared,” she said.

Her patients typically first receive opioids from a family member or someone in the community. Some patients have told her if they can’t get a new prescription, they will buy opioids on the street if necessary.

“That puts the provider in a really challenging predicament,” she said.

Forrest is a member of the state Dept. of Human Services’ Opioid Prescribing Work Group, which is analyzing the appropriate size of an initial prescription and talking about how to help doctors feel comfortable saying no to requests for pain medicine. The group is also talking about support for patients who must cut back on pain medicine.

“The research really shows that to walk away from an opioid addiction is really hard,” Forrest said.

The clinic started prescribing buprenorphine in the fall, which some patients tolerate better than methadone, Forrest said. Long-term therapy and counseling is also proven effective, she said.

“It’s not a crime, it’s a chronic disease. It needs to be treated and recognized,” Forrest said.

Researchers can draw a line between overdoses and opioid prescriptions. According to the Attorney General’s office, the medical community started prioritizing pain treatment in the 1990s. Studies in the late 1970s and early 80s concluded that opioids were a safe treatment for chronic pain (some of those studies were eventually proven false), and pharmaceutical companies aggressively promoted their usage. New pain management standards implemented in 2000 led doctors to advocate for increased opioid use to treat what was considered a widespread problem of untreated pain, according to the Hazelden Betty Ford Foundation.

The CDC reports that up to 1 in 4 people in primary care who receive prescription opioids long-term for non-cancer pain struggles with addiction. When taken around the clock for long periods of time, patients can develop a tolerance that leads to higher doses, according to Hazelden. Marvin Seppala, chief medical officer at Hazelden, said that 10 years ago, 15 percent of youth at Hazelden were addicted to opioids, and now nearly 50 percent report an opioid use disorder.

“Euphoria is the effect that most opioid users seek, but it’s also the effect most likely to diminish with regular use,” states a Hazelden report.

Hazelden cites multiple studies that say nearly 80 percent of new heroin users previously used prescription opioids.

Monique Bourgeois, community relations director at the nonprofit NuWay, said the scariest time for opioid users comes after they have quit. The body loses its tolerance for the drug, she said, and if people resume using the same amount, they can easily overdose. Seppala said the body’s tolerance drops substantially within weeks, and the tolerance is almost gone after a month.

The drug also has a high relapse rate, as anxiety, depression and drug cravings can linger for months or years, according to Hazelden.

“It’s like the worst flu you ever had, only you know you can relieve that within minutes,” Seppala said. “They feel so bad they think they are going to die.”

The DEA increasingly sees opioids mixed with other narcotics like fentanyl, making the drugs cheaper and more deadly. Fentanyl is a synthetic opioid similar to morphine but 50-100 times more potent. Prince died of fentanyl toxicity, according to the Midwest Medical Examiner’s Office.

Jaime Edward McClellan of Brooklyn Park was recently sentenced to 15 years in prison for conspiring to distribute the heroin mixed with fentanyl that killed Alex Milun. The case marked the first time U.S. Attorney Andrew Luger’s office charged a defendant with distributing heroin resulting in death.

“Heroin right now is costing more than fentanyl,” said Solek, adding that the potency of fentanyl makes it attractive to traffickers. “You can make a lot more profit on a kilo of fentanyl than you can with a kilo of heroin.”

He said the toxicity makes it harder for victims to survive a careless choice.

“You never know what you’re getting on the street,” he said. “They’re buying something they think is looking the same as a legal prescription, when in fact it’s made in somebody’s basement or somebody’s garage. And they’re putting together whatever they want in that pill. All they’re doing is forming it into a pill which gives people a false sense of security.”

Almost all of the significant illegal narcotics here come from Mexican cartels, Solek said.

Hennepin County became a “High Intensity Drug Trafficking Area” last fall, a federal designation that triggers the allocation of federal resources. The Hennepin County Sheriff’s Office is planning a year-long drug prevention campaign, seeking to partner with school districts and other groups to educate parents and youth.

In Minneapolis, reported narcotics offenses dropped 32 percent citywide from 2016 to 2015, according to Uniform Crime Reports.

Shari Lisell said her boyfriend’s vehicle was stolen on a brutally cold night in January from the Kingfield neighborhood near 39th Street & 1stAvenue South. Police recovered the vehicle six days later. Police said they arrested a 40-year-old driver who was addicted to heroin, and the vehicle was littered with used needles.

“It was trashed inside and looked as though the fellow had been living in it,” Lisell said. “Our hope is that his experience of being caught and jailed can create a different circumstance for him, namely sobriety. Addiction sucks, but the cure is so worth it.”

The Minneapolis Fire Department started using naloxone last year to reverse overdoses from heroin and opioids. Fire Dept. staff said they saved seven lives in the first week alone.

Naloxone is available to community members as well. The Steve Rummler Hope Foundation provides regular training sessions at venues like Lunds & Byerly’s in Uptown and Northeast.

“Anyone and everyone is welcome, whether you’re a medical professional or an 18-year-old kid,” Foundation Director Lexi Reed Holtum said.

The foundation started the program after passing “Steve’s Law.” The bill allows law enforcement officials and the public to access and administer naloxone, and it provides immunity to those who call 911 to report an overdose.

Reed Holtum said anywhere between two and 50 people show up for naloxone training. Family and friends are often the first ones at the scene of an overdose, and people repeatedly tell her that naloxone saved a loved one’s life.

“We’ve got to stop treating it as a moral failing and treat it as the disease that it is,” she said. “This is not a heroin epidemic, this is a prescription pain pill epidemic.”

Dr. Charles Reznikoff of the Hennepin County Medical Center said the public often expresses either sympathy for people in pain or disdain for people who are addicted,  but it’s not that simple.

“The reality is there is a lot of overlap,” he said. “Not all addicts are bad people and not all pain patients are sympathetic people. Moreover, a lot of people have both pain and addiction together in one human being. … Many people with addictions suffer incredible amounts of pain.”

Reznikoff, a member of the Opioid Prescribing Work Group, has prescribed Suboxone to help treat opioid dependence for eight years, and he said it’s effective in recovery.

“The reason I’m in this is to help try to promote more doctors out there in the community to take on buprenorphine prescribing. It’s straightforward, it’s incredibly helpful, it’s a wonderful treatment, and we just need more doctors to get that license and help dig us out of this epidemic,” he said.

Bourgeois of NuWay said 23 million Americans say they’re in long-term recovery from drug and alcohol abuse.

“People do find recovery and get well and lead really productive lives,” Bourgeois said. “There is help out there, and there are ways to combat this.”

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