Editor’s note: This is the second of three parts of a nationwide series by Adams Publishing Group newspapers about the nation’s ongoing and evolving opioid crisis, and how it affects local communities.

Addiction is a real and present problem in Mille Lacs County.

Many unwanted and illegal behaviors have addiction as their root cause. Last July, County Attorney Joe Walsh addressed the topic in a quarterly newsletter column distributed to residents.

“I have a front-row seat to a variety of unwanted and illegal behaviors that all have addiction as their root cause,” Walsh wrote, adding sometimes the behavior he witnesses becomes violent, resulting in assaults and injuries. Walsh said other times, such behavior results in burglaries, break-ins, and thefts that are the result of desperate people looking for their next high.

“Parents lose their children because they can no longer manage their drug habit,” Walsh added. “Opiates are sometimes the cause, but it could just as easily be methamphetamine or even alcohol. Sometimes it is all of the above, mixing alcohol with pills and other drugs.”

And while overdose deaths due to opioid use are at alarming levels, deaths due to meth use are on the rise, states a report from the Center for Rural Policy and Development.

A June 2018 analysis by the Mankato-based, not-for-profit research organization focused on the state’s addiction crisis and the impact opioids and methamphetamines is having on individuals, families and society.

While counties struggle to keep up with services and control their budgets, law enforcement is seizing record amounts of illegal substances, and the cost is mounting at hospitals around the state.

The opioid crisis continues to dominate headlines for good reason. According to the Center for Rural Policy and Development’s June 2018 report, in 2015, Minnesota ranked near the bottom (45th out of 50) in overdose deaths compared to other states.

However, in 2016, Minnesota stood out as one of several states that had a statistically significant increase in drug overdose deaths (17.9%) between 2015 and 2016, according to additional drug overdose death data supplied by the Centers for Disease Control and Prevention. And according to additional data from the Minnesota Department of Health, between 2000 and 2016, deaths from opioids (which in this case includes prescription opioids but not heroin), increased 631% statewide.

In Minnesota, the disparity in overdose deaths based on race is among the worst in the nation.

According to the Minnesota Department of Health, while the overdose mortality rate in the white population went from 10.1 per 100,000 white residents to 11.7 between 2015 and 2016, the mortality rate among Native

Americans went from 47.3 to 64.6 per 100,000 Native American residents.

Policymakers have been cracking down on access to the supply of prescription opioids.

As they do so, users have been turning to illegal alternatives, including heroin and the extremely powerful synthetic opioids fentanyl and carfentanil.

Particularly deadly is carfentanil. It’s 100 times more potent than fentanyl and 10,000 times more potent than morphine; it was invented to be used as a tranquilizer for very large animals, such as elephants.

But while society has been mobilizing against opioids over the last couple years, in rural areas of Minnesota, especially in northern Minnesota, methamphetamines have come surging back.

Meth was a growing cottage industry in the early 2000s, mostly rural and mostly small time, with home brewers cooking up the drug in basements and abandoned farm houses across the state.

After legislation was passed to put its key ingredient, pseudoephedrine, behind the pharmacy counter, methamphetamine production—and use—tumbled.

Glenn Anderson, a board member of the Center for Alcohol and Drug Treatment in Duluth and recently retired director of the Northern Pines Mental Health Center in Brainerd, stated in last June’s Center for Rural Policy Development report that the national focus on opioids is understandable: meth doesn’t kill people like opioids can.

The lethality just isn’t there, Anderson stated, but combined, the opioid and meth epidemic is having a ripple effect. And, the impact of substance abuse goes beyond the individual with the addiction.

Substance abuse is in fact the most common reason for out-of-home placements for children, a 2017 Minnesota Department of Human Services report stated.

This trend can create surprisingly complex situations, and that complexity adds cost for counties and trauma and upheaval for the individuals involved, especially kids.

An analysis of Minnesota Hospital Association data shows that over a 10-year period between January 2008 and September 2017, individuals with some variety of health problem related to meth and/or opioids visited Minnesota’s hospital emergency departments 161,197 times.

Of that number, 82,509 were outpatient visits while another 78,688 resulted in admissions.

The charges resulting from outpatient emergency department visits involving meth and opioids represented only a small fraction of total charges over those 117 months — less than 1% — but the dollar amount they represent is substantial: $232.5 million.

Over the same time period, hospital admissions resulting from emergency department visits came to $2.4 billion, while total inpatient charges for admissions related to meth or opioids statewide came to a whopping $4.1 billion dollars over that time span.

And, as the number of meth and/or opioid-related emergency department visits mushroomed, so did the dollars spent on them.

Emergency department visits involving meth and/or opioids, however, increased 337%, while charges were projected to increase 665%, from $6.2 million in 2008 to $47.6 million in 2017.

In the Center for Rural Policy & Development’s June 2018 report, the Minnesota Hospital Association acknowledged its Greater Minnesota members were seeing an increase in the use of meth among patients in their emergency departments.

“Hospitals and health systems across Minnesota are seeing an increasing and concerning trend in substance abuse emergency visits across Minnesota,” said Dr. Rahul Koranne, the association’s chief medical officer.

To respond to the opioid epidemic, Koranne said Minnesota physicians are decreasing the number of opioids they are prescribing in clinics and emergency rooms, but have more work to do with community partners, the state, counties, social service agencies, law enforcement, and recovery advocates.

In 2017, the Minnesota legislature passed the Substance Use Disorder Reform Act, or SUD Reform. A key component of this act includes streamlining the process of getting people into treatment.

Under the traditional “Rule 25” system, a person seeking out treatment that would be paid for with public assistance must go through several assessment and approval gates, starting at the county, before getting into a treatment program.

The delay between the first assessment and finally entering treatment, often up to a month or two, provides many opportunities for a person to drop out of the process:

The new system, which went into effect July 1, 2018, allows individuals on public assistance to go directly to a qualified provider for assessment and start a course of treatment right away, skipping several steps, although counties will still determine an individual’s financial eligibility for services.

And while the death count from opioids is much higher and is indeed an emergency right now, the number of lives blighted and the dollars spent in dealing with the fallout from addictions to other substances are still adding up.

While recent policy changes may have helped boost the stats of people accessing treatment, the growth in overdoses, overdose deaths, hospitalizations, emergency room visits and county social service budgets indicates a broad problem of addiction that won’t end when the opioid crisis ends.

The Center for Rural Policy & Development report concludes with the following:

“The difficult truth about the drug epidemic in Minnesota is that once the problem of prescription opioids is addressed with special policies and targeted programs, the more difficult nut to crack—endemic substance use disorder and its embedded, long-term causes—is still out there.”

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