Two-part series: Impacts of opioids felt throughout county
Editor’s note: This article is the first in a two-part series on the opioid crisis and its impacts on the area.
BEMIDJI -- In 2015, 12.5 million people misused prescription opioids and 828,000 individuals used heroin across the country. It’s an epidemic that’s become a serious public health issue nationwide, and here at home in Minnesota and more locally, in Beltrami County.
With the rise in people suffering from opioid addiction, county officials say it’s impacted numerous aspects of services, with a major example being foster care.
“About a year ago, opioids were a big problem for us, then about six months ago, heroin started becoming a problem and recently we’re also seeing meth,” said Jeff Lind, Beltrami County Social Services Director. “The larger issue is drug use in general, but opioids are a big part of it.”
According to the federal Center for Disease Control, there are four categories of opioids:
- Natural opioid analgesics, which can include morphine and codeine as well as semi-synesthetic such as oxycodone, hydrocodone, hydromorphone and oxymorphone.
- Synthetic opioid analgesics, such as tramadol and fentanyl.
“The number of kids going into placement is rising exponentially and a large reason is that drug use,” Lind said of foster care services. “In March 2017, we had 190 children in placement and 131 of them were in because of parental drug use being the primary issue. That is different than 2008, where we had about 56 kids in placement total.
“For the past 10 years, you can see the ups and downs, but in the last two-to-three years, it’s steadily increased.”
Amanda Longie, treatment director at Lake Region Chemical Dependency in Bemidji, which works with people addicted to alcohol and drugs, said her office has also seen an increase.
“I started practicing in Phoenix and was dealing with opioids and heroin down there and moved up here in 2014,” Longie said. “We do deal with quite a few people who are addicted to opioids and heroin. Maybe not as much as we’ve expected, but I would say that it has affected us personally and professionally, just watching the epidemic unfold.”
Becky Secore, Beltrami County Health and Human Services director, said the epidemic has impacted the county’s income maintenance and workforce programs, too.
“It’s a barrier for people trying to get work and it contributes to the number of people coming through the doors for things like food support, cash assistance and healthcare,” Secore said. “There’s not a program we have that’s not impacted by this issue.”
On the rise
Citing a report from the CDC, Cynthia Borgen, Beltrami County Public Health director, said nearly half of the opioid overdose deaths in the United States involve a prescription.
“That’s one of the things that’s different about this path, it’s that there’s a significant number of people who receive prescription opioids for pain,” Borgen said. “It can begin with a person getting a prescription and it can lead them to start taking drugs made much more dangerously.”
The dangers of opioid addiction is clear in the rise in overdose deaths. A report from the Minnesota Department of Health shows overdose deaths among Minnesotans increased 11 percent from 2014-15. The report, compiling data from 2000-2015, also showed there were 50 opioid-related overdose deaths in 2001 and 216 in 2015.
From 2000-15, Beltrami County had 21 deaths related to opioid overdoses; Cass County had 27; Hubbard County had six and Clearwater had two. In total, Greater Minnesota counties had 863 opioid-related deaths.
Yearly numbers from the state also show the rise:
- From 2000-07, Beltrami County had seven opioid-related deaths. For 2008-15, the county had 14.
- From 2000-07, Greater Minnesota had 229 opioid-related deaths. For 2008-15, Greater Minnesota had 634.
- From 2000-07, the state had 713 opioid-related deaths. For 2008-15, it had 1,560.
According to the Minnesota Department of Human Services, 6,852 people were admitted for treatment for heroin in 2016, and another 3,196 were admitted for opiates.
“We have had really significant growth in addiction to opiates in the state,” said Minnesota Department of Human Services Commissioner Emily Piper. “At the state level, we’ve been focused on trying to do broad-based solutions for the opioid epidemic while also doing targeted responses where we know the disparities and issues are the worst.”
The state has formed an opiate oversight project. Piper said the work includes improving prescribing practices, medication assisted recovery and improving the state’s prescription monitoring program. Additionally, Piper legislation proposed by Gov. Mark Dayton was passed this year to improve access to treatment and to ensure appropriate timing of treatment.
Needs of newborns
Another issued raised by increased opioid use is neonatal abstinence syndrome, which is the sudden discontinuation of fetal exposure to substances used by the mother during pregnancy.
“Basically, the infants go through withdrawals, with both physical and behavioral symptoms,” Secore said.
In response, a project called the First Steps to Healthy Babies was started.
“Over the past 10 years, Sanford Health personnel had become aware of the increase in the number of babies born with illicit substances in their body,” said Lisa Johnson, Director of Women’s and Children’s Health at Sanford. “During that time, we met regularly with law enforcement and child protection agencies to discuss the issue. We all said it would be good to have a program to handle this.”
Johnson said Sanford, along with Beltrami County and Red Lake Family Children Services, applied for a grant. Sanford used the $1.67 million to build the First Steps program.
“When a baby has been born with prenatal substance exposure, they can go through the withdrawal phase. So, we use a screening tool to determine the severity,” said Ali Bruning, program coordinator and nurse at Sanford. “If it does escalate, we start to look at some medication to help curb those withdrawals until they plateau, then we do a very slow decrease.”
“A big portion isn’t just treating physical dependencies, but also working with the families so they can take care of the baby when they get home, ensuring they know how to meet the need of the child and getting regular follow-ups,” Sanford Case Manager Kellie Monson said. “Some of the kids have to learn how to eat properly, so occupational therapy and physical therapy are also options.”
According to Johnson, after giving birth, mothers who are in medication-assisted therapy programs and are receiving services, are able to go home with the baby in their custody when the time comes. However, babies born to mothers who continue to illicitly use and aren’t involved in various programs often go into foster care services.
“Going forward in the long term, the key to bring down the trend lines we see is making sure people don’t become addicted in the beginning, that they’re properly prescribed opiates,” Piper said. “We’ve been working with prescribing guidelines in our state for doctors now, so they can understand what we know are the best practices.”