Drug overdose deaths in Minnesota increased sharply in the first half of 2020, going up 30% compared with the same period last year, according to state health officials.
Overdose fatalities began to rise in March, just as the COVID-19 pandemic was taking hold in the state, and were primarily driven by deaths from synthetic opioids such as the powerful pain medication fentanyl.
"I am, sadly, not surprised," said Dr. Emily Brunner, who specializes in addiction treatment at the Sage Prairie Addiction Medicine Clinic in Eagan. COVID-19 has upended lives, leading to social isolation, job loss, salary cuts, loss of health insurance or homelessness.
"I have been concerned about it because stress tends to trigger relapses," she said. "There's been really a continuous flood of people both using after a long period of time sober, and relapsing after being stabilized on [treatment] medication."
The pandemic also has changed health care, with some clinics closing or doing most visits electronically. Some fear catching the coronavirus in a health care or treatment facility.
"A lot of people are scared," said Dr. Joseph Lee, medical director for youth services at Hazelden Betty Ford. "They don't know where in the current paradigm to ask for help."
Altogether, 490 Minnesotans lost their lives to opioids and other drugs in the first six months of 2020, compared with 373 deaths in the same period in 2019, according to the report released Thursday by the Minnesota Department of Health.
While most overdose deaths in the first half of 2020 involved opioids, deaths from other drug types were also up substantially, though at lower numbers, Health Department officials said.
Psychostimulant deaths, which include methamphetamine, increased 55%. Benzodiazepine, or sedative, fatalities were up by 85%, and cocaine deaths rose 67%.
Drug overdose deaths rose by 29% in the Twin Cities metro area and by 36% outside the metro. Young adults from ages 25 to 34 saw the largest increase, with overdose deaths going up 58%.
"Deaths due to overdoses are preventable even amid all the troubles we've had this year," Health Commissioner Jan Malcolm said.
"We need to work together to find ways to better support those suffering from substance use disorders, but it is important to know that there are resources available and those resources can still be accessed safely even with COVID-19 restrictions in place."
Fentanyl driving overdoses
Counterfeit drugs posing as standard pain pills or anti-anxiety medications are cheap and easily available. But many of them contain fentanyl, which is 50 to 100 times more powerful than morphine.
"It is pretty dangerous if you are expecting to take a Xanax but are really taking a fentanyl pill," said Brunner.
"That nationally is driving a lot of the overdoses," she said. "It is also driving our local numbers, and it does seem like the problem has been getting worse from what I've seen."
Fentanyl and other synthetic opioids also make it more difficult for doctors to prescribe the correct dose of Suboxone, a medication used to help people recover from substance use disorder.
"Even though fentanyl wears off quickly, it builds up in our body so a dose of Suboxone for someone using fentanyl frequently may be challenging," said Dr. Ryan Kelly, an assistant professor of medicine at the University of Minnesota and an internal medicine hospitalist at the Community and University Health Care Center in south Minneapolis.
Suboxone helps moderate powerful opioid withdrawal effects, but the dosing issues for fentanyl users can lead to the false perception that the treatment drug is ineffective.
"There is growing apathy to Suboxone" among some patients, Kelly said.
Additionally, many clinics shut down completely when COVID-19 first appeared in the state in March, making access to treatment medications more difficult. "Face-to-face clinic visits are decreasing across the board," Kelly said.
State and federal governments have made it easier for doctors to consult with patients over video or telephone calls, and there are more phone visits, he said.
"But if you don't have a phone it is difficult to do those appointments," Kelly said. "Telemedicine in general has worked well. When it is the only option, that is not a good thing."
As with the rest of the health care system, the pandemic is causing a rethinking of how to best provide addiction treatment.
"The narrative of a few years ago was, we have to reduce stigma by using medication. Taking medicine for opioid use disorder is a good foundation for treatment," said Lee. "We are now finding that the system is so stressed it is not that simple. There are access issues of many kinds."
