OWATONNA — Every day, according to the National Institute of Drug Abuse, more than 115 Americans die after overdosing on opioids.
The opioid family of drugs, which includes prescription medications such as OxyContin and Percocet as well as such illegal drugs as heroin and fentanyl, are a booming crisis around the country. President Trump declared them a public health emergency last year, and 2016 alone saw more than 42,000 overdose deaths tied to the drugs around the country.
Yet in Steele County, the opioid wave sweeping the country has been highly muted … so far.
“We have opioids here, heroin specifically,” said Andy Drenth, commander of the multi-agency South Central Drug Investigations Unit. “A very small group, I would say, though, and they’re usually going to the cities to get it, North Minneapolis and St. Paul, and they’re pooling their money as users to travel to the cities and get it back.”
In fact, Drenth said he’s not aware of deaths in the past year that can be directly attributed to opioid abuse. That sets Steele County apart, even from the rest of the state, where the Minnesota Department of Health reports that in 2016, the most recent year on record, 395 Minnesotans died due to opioid overdoses, and a further 2,047 were hospitalized. To address the growing wave of deaths, Gov. Mark Dayton last week announced a series of proposals to fight the crisis, including requiring opioid manufacturers to put money into a statewide treatment fund and expanding access to emergency drugs such as Naloxone, which can save patients in the midst of an overdose.
Dr. Tyler Oesterle, medical director for Mayo Clinic’s Fountain Centers treatment network, said there are a number of reasons parts southern Minnesota has so far been spared the brunt of the storm. But he worries that could be changing in the near future.
“Honestly, I think we’re headed in that direction,” he said. “We’ve seen an uptick, we’re just lagging behind.”
Opioids vs. meth
It’s not that there isn’t substance abuse happening in Steele County. But by far the most common drug Drenth’s team investigates is methamphetamine.
Unlike heroin and other opioids, meth is widely sold in Steele County, Drenth said, and his agents frequently conduct undercover buys and prolonged investigations to identify dealers and their sources in cooperation with other agencies.
In the case of heroin, the unit tends to act faster, he said, in some cases moving forward with a less serious charge rather than conduct the same degree of lengthy investigation.
“For heroin, we take a very proactive approach. If we hear of a heroin source, that someone is dealing here, we’ll move very quickly … just because of the higher risk for inconsistency in quality and or potency,” he said.
Unlike meth, which is often manufactured at major labs in other countries, heroin often is cut with other opioids of sometimes wildly different potency. That makes heroin much more dangerous to users than meth.
“It’s not as prevalent, but it is very possible [to fatally overdose on meth],” Drenth said. “We haven’t seen that to be as great a risk as the inconsistencies in heroin. … You can overdose on anything, it depends on how much you take, but the problem with heroin is you can take the same dose five times in a row and get five different potency levels. You don’t know what you’re getting, is the thing.”
While opioids, with their higher fatality rate, dominate news coverage, meth is making something of a comeback. One study in Wisconsin found meth use jumped 250 percent from 2011 to 2017, leading some in the treatment community to worry that meth is not getting the attention it deserves. Drenth said law enforcement must respond to each as separate problems.
“Right now there’s more push, there’s grant funding and overtime available if you’re working heroin source cases, but that doesn’t shadow any of the other work that we do,” he said. “We know there’s danger in all the drugs we investigate, and primarily we’re still investigating methamphetamine.”
That’s not due to any particular concentration of meth users in southern Minnesota, either.
“Our numbers are the same as everywhere,” Drenth said. “Statewide, we’re seeing the same as everyone else for our area or geography.”
So, why is opioid use so much less common here than in other parts of the state and nation? Oesterle said there’s probably a medical explanation, at least in part.
Many opioid abuse disorders start with legitimately prescribed painkillers. The Centers for Disease Control and Prevention have found that using prescription opioids for even seven to 10 days creates “a very high risk of addiction,” and Drenth said that many of the heroin users his agents interact with say their habits began with legal pills.
Oesterle said Mayo Clinic, the primary care provider for most of southern Minnesota, has traditionally been less liberal in prescribing opioids than many other providers, but even so, a 2017 report found that 80 percent of Mayo’s opioid prescriptions exceeded recommended guidelines. In the wake of that report, Mayo’s Opioid Stewardship Program announced a new set of guidelines meant to standardize the minimum possible dosage after different common surgeries at all Mayo’s operations.
“I think the conservative approach has served us well in kind of creating a buffer to what otherwise is really out of control in a lot of areas,” Oesterle said. “That does not mean we’ve been immune to the crisis, and we’ve certainly seen an uptick in opiate addiction in our programs, but talking to other programs at national meetings, it has in many cases completely taken over their programs, and that is not the case here.”
Fountain Centers, which has locations in Albert Lea, Owatonna, Mankato, Rochester and several other communities, specializes in patients with multiple substance disorders, and attracts a disproportionate share of opioid users because it is one of the few treatment providers in the region licensed to treat patients with Suboxone, a drug that can dull the physical cravings caused by opioid addiction. Even so, Oesterle said meth cases probably outnumber opioid cases two to one, with the centers seeing opioid and alcohol abuse in about equal measure.
Just in the past six to 12 months, though, Fountain Centers has seen a noticeable increase in opioid cases.
“We have meth, and quite a bit of meth, and it’s still the dominant player in our market, but it’s slowly being nudged out by opiates,” Oesterle said.
And in many of the communities served by Fountain Centers, Oesterle is now hearing from patients who began taking opioids not through a legal prescription, but to supplement other drugs, because opioids in recent years have become so much more affordable.
“It’s a kind of supply and demand, almost a twisted capitalism going on on the street,” he said. “If someone can’t find the meth they’re looking for, or the marijuana they’re looking for, there’s an opiate they can take.”
That flood of cheap (and dangerous) street opioids threatens to undo whatever progress physicians are making in reducing excessive prescriptions.
“I like to think we are catching it in time, I like to think the interventions we are doing will be sufficient, but there is such a street-level supply that’s out there, that the medical community can’t really address that piece,” he said. “We can only do what we can do.”
Not a healthy trend
Oesterle believes the uptick he’s seeing in patients seeking treatment for opioid addiction is a positive sign, because it means users are getting the message that opioids are dangerous and it’s time to change. But it also suggests that the region has yet to see the crest of the wave.
“People coming into treatment is usually the delayed signal,” he said. “The uptick has probably been happening for several years. We’re just seeing the folks saying, enough is enough, they want treatment.”
While opioids are uncommon still in Steele County, Drenth said they’re right on our doorstep, with growing problems as close as Mower and Faribault counties. In many jurisdictions, police now routinely carry Naloxone to intervene in overdoses. Currently, Drenth said, local police rely on Gold Cross Ambulance Service to administer the drug, but that could change in the future.
“We’re researching that for our officers right now,” he said. “I’ve seen that work. But Owatonna [police], we don’t carry it.”
In the meantime, police are pouncing quickly on every opioid dealer they can find, and playing the waiting game.
“It may just not be here yet,” Drenth said. “That’s what we’re hanging on to, and we’re prepared for it, but right now we’re just not seeing it as a major issue.”
Oesterle stressed that opioids have legitimate medical uses, and can and should be used responsibly where appropriate. But when it comes to staving off widespread opioid abuse, he isn’t optimistic either.
“I talk to the patients, and they have their own biases, but their sense is there’s more [opioids] in the region than there’s ever been,” he said. “We’ve been protected because of our conservative prescribing practices, but I think we’re getting swept up in a national trend, and it’s not a healthy trend.”