More than 115 Americans are killed every day in a wave of fatal overdoses to substances like heroin, fentanyl, tramadol and other opioids. Medical professionals from the Mayo Clinic and Minnesota State University, Mankato now say that the only way to mitigate this epidemic across the country, and at home in southern Minnesota, is to approach those afflicted with addiction with compassion and care.
MNSU invited professionals with the Mayo Clinic and local law enforcement, including Minnesota River Valley Drug Task Force Commander Jeff Wersal, for a Wednesday panel discussion of "The Opioid Fix," a new three-part documentary created in a partnership between Twin Cities PBS and the Mayo Clinic.
The film talks about the origins and science behind the opioid epidemic and the strategies that doctors, families and communities can use to prevent addiction and help those suffering from a dependency on opioids. The panel was attended by medical students and public officials alike to learn more about this crisis sweeping the state.
Behind the epidemic
“The days of thinking a heroin addict is the homeless guy looking like a junkie is over,” said Wersal, whose task force investigates major drug activity in a a multi-county area that includes St. Peter and Mankato. “Anyone in this room could look like an opioid addict. I did presentations with a mother from Mankato who lost her son to a fentanyl overdose in high school. She had no clue he was on opioids. She didn’t even know what fentanyl was.”
According to many experts, the rise in opioid addiction over the past 30 years started, not in the streets, but in the doctor’s office.
Jason Dauffenbach, a consultant in the Division of Pain Medicine and assistant professor in the Department of Anesthesiology and Perioperative Medicine with Mayo Clinic Health Systems in Mankato explained that the first wave of the crisis began in the 1990s, when doctors began over-prescribing opioids to treat chronic pain following assurances from pharmaceutical companies that the medications were not highly addictive. In contrast with the companies’ claims, opioid addiction among patients spiked and in the 2010s many of those who became hooked began seeking illicit opioids like heroin and synthetic opioids like fentanyl.
Today, opioids account for an increasing number of overdose deaths. In 2016, 376 Minnesotans died from an opioid overdose, more than three times the number of overdoses in the year 2000. The rate of opioid addiction among people of color is even worse. In Minnesota, blacks are more than twice as likely to die from an opioid overdose than whites, and Native Americans are more than five times as likely to be killed.
“Locally we’re actually pretty lucky here in southern Minnesota, compared to Duluth, northern Minnesota, St. Louis County area and the metro in regard to opioids,” said Wersal. “When I talk about opioids, mostly what I deal with is the illegal stuff — heroin, fentanyl, things like that. When I look back to 2018-19, we had 20 heroin investigations compared to over 100 meth investigations.”
The panelists emphasized that to understand the opioid epidemic, people have to recognize addiction not as a moral failing, but as a disease.
“Most people who use these drugs don't get addicted, but an alarming number of people do, in part because of the drug and what the drug does,” said Thad Shunkwiler, assistant professor in the Department of Health Science at MNSU and licensed mental health professional. “It changes the body and we start to develop what’s called a physical dependence and that’s where you need that drug to function. So when you develop that physical dependence, the opioid addict is not trying to get high anymore. They’re not out there trying to have a good time and party, They’re simply looking to fill that need the body has because without it they go into withdrawal and opioid withdrawal is pretty miserable. Those people who become dependent will do anything to curb that withdrawal.”
Withdrawal can last for weeks and in severe cases even months and is often characterized by restlessness or anxiety, nausea, vomiting, fevers, pain and can sometimes lead to hallucinations or seizures. Shunkwiler explained that addicts will often go to great lengths to avoid withdrawal. In many cases, an addict will become more distant in their relationships with others and may engage in erratic behaviors like quitting their job to spend more time using the drug. Sometimes addicts will engage crime and theft just so they can afford to keep using.
One thing the panel recognized after the missteps of treating chronic pain is that there is no magic pill that will put a stop to the opioid epidemic, but they were optimistic that reforms could mitigate the crisis.
Dauffenbach pointed out that the medical community and state governments are already taking steps to move away from overprescribing opioids such as in 2017, when Minnesota began requiring all prescribers to enroll in the Minnesota Prescription Drug Monitoring Program which monitors prescription data on controlled substances including opioids.
Matthew Schumann, a pain psychologist with Mayo Clinic Health System in Mankato and Assistant Professor of Psychology with the Mayo Clinic College of Medicine and Science, also pointed out that incoming med students are beginning to be taught new ways to treat chronic pain instead of opioids.
These treatments include cognitive-behavioral therapy (CBT), physical therapy, occupational therapy as well as mindfulness strategies and activities such as yoga and tai chi to help patients manage their chronic pain.
“We focus on engaging in activity despite pain,” said Schumann. “Training the brain to understand that hurt doesn't equal harm and that increased physical activity can lead to a return to physical condition in the body and it changes how one thinks about their pain.”
Another potential method for treating chronic pain is medical marijuana. Sunkwiler is a member of the Governor’s Task Force on Therapeutic Cannabis Research and sees potential in the drug as an alternative to opioids, though he remains cautious about its usage.
“I’m not coming out as a marijuana proponent saying that is the answer,” said Sunkwiler, “But research is coming out that’s saying this may be an alternative and if we think about the long-term consequences of a drug like cannabis compared to a drug like opioids there are better outcomes when it comes to that.”
Overall, the panelists believed an “Opioid Fix” will require the prescribers to change their attitudes towards chronic pain from something to be cured to something to be managed. Schumann stated that the next generation of medical professionals will need to be trained to have different conversations with their patients, learn the signs of addiction, and learn when to prescribe physical, psychological and social treatments rather than medicinal.
“It starts with the next generation of medical providers and thinking about different ways to help manage pain and the keyword there is manage,” said Schumann. “Rather than trying to eliminate it or get rid of it, how are we going to find ways to manage pain that’s just going to stick.”