Articles, Blog

Opioids: Crisis in the Northland Episode 1 – Tracing an Epidemic: The Roots of Opioid Use and Abuse

December 14, 2019


[music playing] The purpose of this WDSE-WRPT
6 episode series “Opioids– A Crisis in the Northland”
is to start a conversation. Opioids have long
been a problem. It’s only recently it’s
been called a crisis. ANNOUNCER: In this series,
we will trace the epidemic, tell stories of addiction,
discuss treatment, assess law and addiction, seek
accountability for the crisis, and address solutions. We’d like to explore the roots
of use and abuse, especially in the Northland. My son, Ben, died of
an overdose in 2016. I would say probably
the first 15 years I worked here, we rarely– rarely saw opioid overdoses
that required naloxone. And now we see it regularly. Over, again, I would say
probably the past five years truly I believe this
is the public health crisis of my lifetime. Not just because
of Ben, but because of what we see day-to-day
in the emergency department or, you down the road at CADT. You know, that
sense of isolation in stoic, rural northern
Minnesota, the ability to be able to reach out
and to share or to say, I’m in trouble, or
I need some help. Like, that– that
is not something that has ever come easy. ANNOUNCER: There are many
reasons people misuse opioids. But Dr. Elizabeth Bilden,
an Essentia toxicologist, believes it isn’t
simply a choice. It’s an illness. [music playing] Why do people use drugs? Again, multiple reasons. For folks who have
a– so some folks use it from a
recreational standpoint and don’t have any trouble
with their job, their school, whatever is going on. So some people are using
it, again, recreational use. But folks with a substance
use disorder, the cause is the same here as it is
in other parts of the world. There’s an addiction. It’s an underlying illness. And who’s at risk for that? Trauma, young age of starting
some of those other substances that you talked about. Alcohol still being the
biggest problem in our country. So it’s an underlying
illness, again, that’s used despite the consequences. ANNOUNCER: Marcia Gurno is with
OARS, the Opioid Abuse Response Strategies work
group, whose mission is to create community-based
solutions for victims of substance abuse disorders. For opioids, the death
is directly related to the opioid overdose. And it’s taking young people
at a rate greater than alcohol, or any other substances killing
our young people, or motor vehicle accidents,
according to the CDC. So opioids are killing our sons,
daughters, mothers, fathers, brothers, sisters at a rate
totally never seen before. So at historical proportions. And St. Louis county’s
one of the highest in the state for overdose
deaths related to opioids. ANNOUNCER: Dr. Heather Blue
is an Assistant Professor of Clinical Pharmacy at UMB. We asked Dr. Blue why she
thinks the opioid epidemic is in the spotlight now when it
has been a longstanding problem. There have been
different groups that have been dealing with
addiction and mental health concerns for a long time. And then as it moves through
the socioeconomic classes, it’s getting more
awareness, which it should. It should have had
awareness the whole time. But we’re definitely
seeing as it’s affecting more
wealthy families, I think it’s also putting
a different face on drug misuse and the
fact that, you know, people have the stigma
that it’s someone– opioid use is someone sitting
in an alley injecting. And we know that’s not true. It probably has never been true. But now we’re seeing it more. It’s the professional that’s
slipping medications at work, and people that
are able to misuse their prescribed medications. And there are people that are
going to multiple physicians and getting prescriptions. They’re misusing it. And they have addiction. And they’re trying to
prevent withdrawal. So I think it’s showing us a
whole different view of what addiction is and really focusing
and hopefully really engaging people to look at
addiction as a disease that doesn’t have
socioeconomic classes or different ethnicities. It’s really just a disease
that can affect everyone. I went to school for
a chemical dependency and some of that stuff. So I did my internship at
Minnesota Teen Challenge. Back to 2009, ’10. And so I was doing my internship
in the outpatient program. Most of the people who
I worked with use pills. So it was oxys a lot, Lortabs,
so we heard a lot about that. I’m not sure when– within that time period probably
in between 2009 and 2011, ’12, if I can remember correctly, I
think the government came down on doctors. Like, do not prescribe
all these pills. Stop oxys and Lortabs
and all that stuff because people are
getting addicted to them. And so when that subsided,
the Opanas came on the scene like huge. In Duluth, I mean, they
were crushing them, they were smoking them,
injecting them, ingesting– I mean, anything that they could
do to get them in their system. And most of the people
who I worked with were addicted to the
Opana pills, the opioids. So soon after that that, there
was a big drug bust in town here. It might have been like
4,000 or 5,000 pills maybe. But five or six
people were arrested and they might still
be in jail today. And that took most of the
Opanas off the street. And then when that
happened, heroin got introduced in
a very big way. I do know personally
about 20 people, kids under 18 years old, who
died in between 2010 and 2014. And you would not
read in the paper or hear anything about
that because they were under the age of 18. ANNOUNCER: Duluth Police
Lieutenant, Jeff Kazel, Commander of Lake Superior Drug
and Violent Crime Task Force, saw Duluth’s first sizable
heroin bust in the early 2000s. It was 2013 when we
seized our first big amount. It was 1,000 gram
amount, a kilo. So I would say 2013 would
be the big eye opening moment for around here. There are a lot of people
doing crack cocaine, as well. OK? And crack cocaine was a
major epidemic, especially in the African-American
community, in the marginalized communities. The epidemic of the
heroin came on the scene, a lot of rich kids were dying. And a lot of maybe
people who were– it had a great reputation on
the political scene or whatever. Now most of the kids are
just overdosing, dying. And then now it became a
public health and safety issue. It was let’s get help for people
who are addicted to opioids. And it’s needed, of course. It’s needed. But it was needed
a long time ago. ANNOUNCER: Representative
David Baker of the Minnesota House
of Representatives drove hundreds of
miles to Duluth to be part of this conversation. He lost his son, Daniel,
in 2011 to an overdose and works on legislation
to combat the epidemic. And the one
thing that I guess, if there’s going to
possibly be a good side to this opioid epidemic,
is it brought addiction to the forefront. And what in the
heck is addiction? And so this form of
addiction was then happening to a class
of people that it wasn’t supposed to happen to. And it made a lot of
us wake up finally and say, well,
this is a disease. This has to be
treated differently. This isn’t just
junkies or people that are always choosing
to look for the next high. Like my son, many
other people, he was injured in a
softball accident. And just a back pain. Doctor gave him pain pills. And my son, at about 20 years
old, found his first aha moment when he took the first pill. ANNOUNCER: Sue Purchase
grew up in Cloquet and is a harm
reduction consultant. She is a pioneer in the
needle exchange movement. We’re talking about
the mid-’90s on. And certainly that was
part of my experience. And what I saw running Women
With a Point-Access Works, the needle
exchange-harm reduction program in Minneapolis,
we started in 1996. And we didn’t start off
seeing pills immediately. But it wasn’t long before
they were part of the scene. You know, pill usage and
the opioid crisis as it related to prescription
drugs, how quickly Minnesota was to have more of a
problem related to pills. But, certainly, by
2000 without a doubt we were starting to hear and
see more related to pill use. And by 2007, 2006, when I
came back to Minneapolis after being in the
Northwest for a few years, I was absolutely stunned by– well, Access Works had
a lot of participants. The number had
certainly increased. And a lot of them
were young users coming from the
suburbs who had started in their parent’s medicine
cabinet and experimenting. And I don’t think with
any real knowledge about what they
were experimenting with other, than getting high. And then they would end
up at the needle exchange and looking for other sources. You know, whether
it was oftentimes heroin or some other access. So it really– I think that we watched it
unfold from the very beginning. It’s not a surprise. It isn’t the crisis
all of a sudden. People are dying. People close to them are dying. It’s not a random, strung out
junkie in South Minneapolis anymore. It’s happening in Cloquet. It’s happening in Duluth. It’s happening on
the Iron Range. And people can’t ignore it. ANNOUNCER: County
attorney Mark Rubin serves Minnesota’s
largest county in size, St. Louis
county, and reminds us how opioids have touched all of us. Actually a friend of mine who
was convicted and caught using. And it really does
jar one’s perception. ANNOUNCER: St. Lewis county
has the highest opioid overdose death rate in
Minnesota, according to the University of Minnesota. We asked why it is so
bad in the Northland. There are probably a number of
factors that contribute to it. One is St. Louis county is a
rather impoverished county. I think that we know
that the per capita death by overdose rate is much
higher in the Native American community. And many of our population
is Native American. So this is an
epidemic that has hit the Native American community
really, really hard. I think that those two factors
are probably part of it. I think it’s multifactorial. There’s lots of different
things going on. Maybe it is our prescribers. Maybe it’s our population. I don’t know. I don’t think anyone’s been
able to really say why here. We also know that prescribing
patterns affect opioid use, or at least they
have in this crisis. And I think it is the case
that in St. Louis county we were prescribing
opioids at a much higher rate than other
counties in the state. I think that’s actually
also likely a contributor. And it’s unclear exactly why
there was that prescribing pattern. But I think it is the case
that we, as physicians, also in doing that– and again,
I’m talking several years ago– likely contributed to this
current crisis to some extent, as well. ANNOUNCER: Dr. Amanda Klein
is an Assistant Professor at UMD’s College of Pharmacy. Dr. Klein’s students, future
pharmacists and physicians, seek answers to
addiction, withdrawal, and the fundamentals of pain. There’s just a general
interest, general inquiry, that I get really fairly
regularly because somebody has known somebody that
has struggled with abuse or addiction, or has
had opiate overdose and it’s affected
them personally. And so they try to
I think seek out scientists for better answers. And, unfortunately, we don’t
have a lot of the answers right now. And that’s the reason why we
think that this research is important so that we can develop
these new therapies for people in the future. It’s a problem that needs to
be addressed at all levels. I mean, so I’m kind of– I call myself I’m down
here in the trenches, you know, trying to figure out
how the nervous system works and how it doesn’t
work after we’ve been taking these drugs for so long. And what happens when we
stop taking these drugs? And what’s the
consequences of that? And we spend a lot
of our time talking about opioids in our course. Because it is very,
very important. And because they will
run across individuals that are on these medications
and individuals that want to get off of
these medications. And so we feel like that’s
a very important topic that we need to discuss
and the students need to know by the time
they become pharmacists. Opiates, or opioids,
are actually naturally occurring compounds. They exist in
nature and they can be extracted from plants
like the poppy plant. And they have pain relieving
and euphoric properties. And so in your body
you have receptors that will recognize these molecules. And these receptors are
called opioid receptors. Many people are very familiar
with the new opiate receptor, or the morphine receptor. That’s how it got its name. The new opiate receptor in your
brain, is in your spinal cord, and it’s in your
peripheral nervous system. And so when you take morphine
or a related compound for pain relief, it will act all
over the nervous system to sort of dampen and quiet your
nervous system activity so you don’t feel the pain anymore. Opioids, as a medication,
are an important tool. And we use them every day. But they need to be used for
the right patient population. And for that patient population,
they’re the best medication. So people with painful cancers,
people with severe injuries, you know, they
still need an opioid and should have an opioid. But that’s not what
we were seeing. We were seeing this large
and increasing population of what appeared to be
young, healthy people with minimal injuries who
were back repetitively looking for specifically opioids. And that’s when we
knew we had a problem. ANNOUNCER: To understand this
epidemic across our nation and here in the Northland,
we must identify the roots of opioid use and abuse. I think that prescribing
pattern likely started to ramp up in the mid to late ’90s. And I think it got to a point
where it basically plateaued. And we were seeing kind
of the end of that. But, as we know, I
think our patients– many of whom developed
opioid use disorders– they needed more. And so came to the
emergency department more, came to the clinic more. And, again, physicians
I think in practice were seeing this as a
problem many years ago. Now at that time, it
was all prescriptions, meaning it was prescription
pills primarily that was being used. There was no heroin around. There was no fentanyl around. You got to go back
into like mid-1990s when the pharmaceutical companies
started introducing like OxyContin. It’s a synthetic opioid. And so when you
talk about opioids, you have naturally
occurring opioids, like yourself and myself,
we have opioids in our body right now, whether
you believe it or not. But endorphins are
opioids because they all attach to the opioid
receptors in your body. And that’s your
body’s way of dealing with pain and in
different situations and that it needs to do that. And then your body
does that for you. So you have all those receptors
naturally in your body. But when you start
introducing outside opioids, like the naturally occurring
ones from the poppy plant that produces opium, and
when it’s refined, it can be refined into morphine. And if it’s refined even more,
it can be refined into heroin. Then you get into like the
synthetics, like I was saying, it’s all made in a lab, in
a pharmaceutical lab, where they, again, they’re
built to attach themselves to their opioid receptor. And through chemicals,
they’re able to do that. So lots of different things. But heroin is an opioid. The pill that you get from– the pain pill that you get
from a doctor’s prescription, opioid. Same thing. ANNOUNCER: In 1910,
“The Flexner Report” was published, laying out
a medical education manual and standardizing
ethical responsibility. Chinese laborers brought
opium over in the 1850s. They were morphine
and opium that was contained in
tonics and elixirs and available in drug stores
throughout the 19th century. And that’s really during a
time when there was no FDA. There was no standardized
testing for drugs. You know, we were using
opioids for lots of things. Some of the antique and I think
the coolest bottles to find, an advertisement was to
give opium to infants. So colicky baby, to help them. To help soothe them. Which now I think in the
face of this epidemic it’s crazy to think about. But we didn’t know. And it does do that. It mellows. You know, it can calm them down. They won’t cry as
much, unfortunately. There can be severe
problems with using it. But opioids have been
used for a long time in lots of different ways. We’re just now starting to
realize their full impact. ANNOUNCER: Opioid experts
say over-prescribing led to dependency and misuse. Subsequent prescription
restrictions spiked illicit drug
use and caused a surge in synthetics, like fentanyl,
causing increased overdoses. This is a multifactorial
sort of the perfect storm. Folks have addiction. Initially increased–
well, going way back there was a problem. That’s why we have
a law in 1914 that limited the distribution,
who could prescribe opioids. It’s been a problem
for a long time. And decreasing distribution is
what the health care systems are doing. The number of prescriptions
in the United States– and we follow here in Duluth– follow, I can speak to
Essentia, the same trend. The number of prescriptions have
actually decreased since 2010, even before the CDC
guidelines came out. So folks are trying. But then you have, again,
adding this increase– the responsibility
to treat pain. ANNOUNCER: According to the
DEA, fentanyl is 80 to 100 times stronger than morphine. Fentanyl has become
a lethal problem for emergency rooms
and law enforcement. So what what seems to
happen is there will be kind of– it’ll be quiet for a while. And then there’ll be
a new batch in town. And there has been kind of
this recent change from heroin to fentanyl. So there’s way more
fentanyl in the community. And fentanyl is just a very,
very, very potent opioid. And so people who are used to
using one from one supplier, then they used the same
dose the next time. And if it’s contaminated with
fentanyl, it it’s way too much. And so then they– and that’s what– opioid
overdose, what it does is it– it shuts off your breathing. You stop breathing. And there are not that many
medicines that do that. It’s potentiated by
taking benzodiazepines, like Valium or alcohol. ANNOUNCER: According
to the CDC, in 2016, the number of overdose
deaths involving opioids was five times higher than 1999. On average, 115
Americans die every day from an opioid overdose. And from 1999 to 2016, we have
lost more than 350,000 lives. We only have about 3.6%
of the state’s population. And we have over 5% of
the opioid-related deaths. So it’s a lot statistically. It didn’t have to
happen to our family. And it didn’t have to happen
to 1,000 other families right here in Minnesota. I miss Ben every day. And yet, you know,
this is my, you know, attempting to make his
life mean something. [music playing] In the next episode, we’ll
be discussing addiction– or substance use disorder, as
we’ve come to understand it. Stories of loved ones,
those who have been lost, and what we can do. I’ve been an addict
most of my adult life. I guess how I became
addicted to them, I never really cared
for pills or anything. And that’s kind of how
everybody builds up to it. I got a prescription
for oxys when I was– I want to say 23,
after a car accident. And I learned that
you could smoke them. I never knew that was a thing. And I tried it and I liked it. And opioid addiction is so much
different than other addictions I’ve had in my life. It was, you know, I
dabbled with stuff and then became a meth
addict and stuck with that. That was easy to walk away from. The first time I
tried an opiate, I wanted to do it every day
for the rest of my life. And just– then you’re
physically addicted to it. And the withdrawal
is so horrible that you just
don’t want to stop. And if you want to know what
resources are available to you, out of St. Louis County, there’s
the Opioid Abuse Response Strategies team, OARS. We’ll be sharing more about them
throughout this documentary. [music playing]

2 Comments

  • Reply GEORGIA MAN December 28, 2018 at 1:00 pm

    To the white race will y'all stop blaming the Mexicans, the doctors and the drug dealers for y'all drug problem. It's your fault if you do drugs and you die. White people is junkies the end. Start looking in the mirror and quit drugs and stop blaming somebody else.

  • Reply RICK Killmonger December 5, 2019 at 7:13 am

    Heroin is awesome

  • Leave a Reply