As the stresses over social distancing, mask wearing and vaccine supplies continue, a silent killer lurks in the shadows.
The opioid epidemic reaches far beyond local accessibility of both prescription drugs and street heroin. A quick look at local statistics from the Overdose Detection Mapping Application Program shows that from August 2019 to the end of 2020, law enforcement in southern Minnesota’s Steele and Rice counties know of 43 overdoses linked to opioid abuse — nine were fatal.
The bulk of the known overdoses have been concentrated in the area’s larger cities. Faribault has seen 14 of the 30 total overdoses in Rice County — two of which were fatal. Eleven of the 13 overdoses to take place in Steele County occurred in Owatonna, including all three of the fatalities. Despite the concentration in the larger cities, the epidemic is everywhere. Rural Rice County had a reported four overdoses, including one fatality, between September 2019 and August 2020, and in Steele County town of Medford, population roughly 1,266, was home to one opioid-related overdose in the last year.
“It’s here, it’s real and it’s affecting a lot of families and community members,” said Sgt. Paul LaRoche, commander of the Cannon River Drug and Violent Offender Task Force, which covers Rice and Le Sueur counties. “The presence has gone up — opioids in our area have been on the rise specifically with a lot more fentanyl-laced heroin. A lot of what our overdoses have been is that elevated presence of fentanyl.”
The Minnesota River Valley Drug Task Force is the lead agency in tracking and working opioid cases in St. Peter and the Mankato area. Jeff Wersal, MRVDTF commander, said the agency tries to track non-fatal overdoses, but that is difficult to hospital privacy laws. However, he did confirm a rise in fatal opioid overdoses in recent years.
In Nicollet County, there were zero fatal opioid overdoses in 2015-17, but in 2018-20, there have been two. In Blue Earth County, there were zero from 2015-18, but in 2019-20, there were five. Wersal noted that there were several more meth overdoses, but opioids are beginning to be more impactful in the area.
“I can’t give an accurate number, but I can tell you that drug overdose calls are almost a daily occurrence, especially in the Mankato area,” Wersal said about opioids.
“This is a huge jump from the past, even two or three years ago. Heroin and other opioids, like fentanyl, were hard to come by in our area as recent as three years ago — definitely not the case now.”
While Le Sueur County is smaller, with a total population that barely eclipses the city of Owatonna, opioids still present a real and devastating problem. Le Sueur County Sheriff Brett Mason said they know of five overdoses over the past year, two of which were fatal, but he emphasized that is only what law enforcement knows.
“I can tell you these numbers aren’t accurate, based on the fact that I know there are more overdoses going on, but they’re not being reported,” Mason said, adding that if an overdose victim is brought to the hospital before law enforcement can respond, the patient’s information is private unless a criminal investigation is initiated. “It’s tough and it’s running rampant — we see that through the national data and locally. The opioid epidemic is certainly thriving and that is unfortunate.”
Mason said similar to what other southern Minnesota counties have found, he has seen an obvious and concerning growth in the opioid trend over the last two years. In August 2019, Cannon River task force agents made a highly unusual drug bust in the Le Sueur County city of Montgomery. That bust alone netted nearly 1,000 pills of the prescription opioid oxycodone. The pills were tested for other potentially dangerous substances, task force Sgt. LaRoche said. Results showed them to be counterfeit, another cog in the ongoing list of problems in the war on opioids.
“People are confusing these with being oxycodone when, in reality, they are counterfeit ‘M30’ pills, something that is being seen all across Minnesota and the United States over the past year or so,” LaRoche said. “In reality, these are fentanyl.”
According to the Centers for Disease Control and Prevention, fentanyl is a synthetic opioid pain reliever, approved for treating severe pain, typically advanced cancer. The CDC says it is 50 times more potent than heroin and 100 times more potent than morphine, and is typically prescribed in the form of lozenges or transdermal patches applied to the skin, which are then diverted for misuse and abuse across the country.
However, as the opioid epidemic rages on, the CDC says most cases of fentanyl-related harm, overdose and death, have been linked to illegally made fentanyl that is sold through illegal drug markets for its heroin-like high. It is often mixed with heroin and/or cocaine as a combination product — with or without the user’s knowledge — to increase its euphoric effects. The United States Drug Enforcement Administration reports that fentanyl is often added to heroin to increase its potency or to be disguised as highly potent heroin. As a result, the DEA says many users believe they are purchasing heroin and are unaware they are purchasing fentanyl, often resulting in overdose deaths.
There are also fentanyl analogs, such as acetylfentanyl, furanyfentanyl and carfentanil, which are similar in chemical structure to fentanyl but not routinely detected because specialized toxicology testing is required, according to the CDC. Estimates of their potency vary from less potent than fentanyl to much more potent than fentanyl, with carfentanil being estimated by the CDC as 10,000 times more potent than morphine.
Getting counterfeit pills, like M30, off the streets is a priority, and LaRoche said the investigation in the Montgomery bust is ongoing. Over a year later, the task force continues to try to find the main source of the pills made with a pill press.
“It’s rare to find someone in possession of that many [pills],” LaRoche said.
Wersal, of the Minnesota River Valley Task Force, noted that his task force focuses on the dealers, rather than the users.
“As a task force, we do our best to identify those who are distributing opioids,” he said. “Since there is an increase of opioid users in the area, drug dealers take advantage of that and go to where the customers are.”
He added, “The MRVDTF also focuses on identifying the supplier of the deadly opioids in the event of an overdose death. Our task force has had success and has gotten convictions or made arrests on most of the overdose deaths in the area.”
Sgt. Andy Drenth, commander of the South Central Drug Investigation Unit, which includes the counties of Steele, Waseca, Freeborn and Faribault, said it is just as difficult to find large amounts of heroin during busts and seizures, especially when compared to the other drug that continues to plague southern Minnesota: methamphetamine. In the valley — including Le Sueur, Nicollet and Blue Earth counties — meth remains the most impactful drug.
“You just don’t see (opioids) in large quantities like you would with meth,” Drenth said. “You can easily find a pound of meth, but it is extremely rare to find that amount of heroin.”
Drenth attributes this anomaly to both the cost and the potency of heroin and other opioids. Though these drugs decreased in price in recent years, heroin and opioids pills are double the price of meth. And, users simply don’t need as much to get what they’re looking for, according to Drenth.
“Heroin is so potent that you don’t need that much to get high; a small amount will last a longer time typically,” he said.
A crap shoot
Between the variety of elements that range from the potency to the proximity and the lacing and the counterfeiting, most law enforcement say the opioid epidemic is not only present in southern Minnesota, but it is getting worse.
“The MRVDTF and other law enforcement agencies recognize that it is a serious issue and are doing our best to keep it from becoming out of control,” Wersal said. “It is important to keep in mind that enforcement is only a part of the solution. Treatment is important, too, but I feel that prevention should be given more importance. Enforcement and treatment only come into play once someone has already become addicted to this poison. If we can prevent our family, friends, students and community members from using drugs in the first place, that will go a lot farther than the reactive actions of law enforcement and treatment courts.”
LaRoche agreed, adding that while the addiction can happen to anyone, local law enforcement is seeing a greater number of young adults fall prey to opioid addiction.
“It’s so highly addictive that I think sometimes younger adults don’t realize how quickly they could become addicted and the dangers that follow it,” LaRoche said. “They get the heroin, and they think it’s regular. Then we are being called.”
Drenth points to the two most recent overdose calls that have occurred in Steele County, one on Dec. 9, the other eight days later. In both cases, three doses of the anti-opioid naloxone being administered to each victim. The intensity of the overdose Drenth attributes to a common offender: fentanyl.
“When the potency is really unknown that is where the overdose happens,” Drenth said. “People may be use to using a certain amount of heroin, but this time it might be different and have fentanyl, then you don’t know how much you’re actually taking.”
Faribault Police Chief Andy Bohlen, in an October interview, said that the inconsistency is specifically what makes it so deadly.
“It’s not mixed in a pharmaceutical lab. One pill might have nothing, not fentanyl, and one will have a double dose,” Bohlen said, noting the Faribault Police Department is now administering naloxone on an almost weekly basis. “You have no idea what you’re sticking in your system.”
Without the availability of naloxone, Bohlen believes the number of overdoses in southern Minnesota would be “off the wall.” While first responders in southern Minnesota began carrying naloxone in the last two years, the life-saving drug also became available to the public without a prescription in southern Minnesota pharmacies in early 2018. The availability of the medication, while crucial, distorts law enforcement statistics on opioid overdoses.
As heroin and other opioids continue to rise in popularity, Drenth expects the overdoses to increase as well.
“This is a party drug. It is affecting our youth and that is the really dangerous part,” Drenth said. “The potency of heroin is so addicting and so powerful that just one dose could be your first and your last.”