Opioid community forums have been popping up in many locations around the country and more recently in the Midwest. Pine County held its own opioid and heroin community forum and free community meal in response to the recent epidemic of opioid abuse in the form of prescription abuse-related deaths and the increase of heroin use.
Over 300 people, a mix of tribal members and non-tribal members, attended the event which was held at the Grand Casino in Hinckley on Tuesday, May 16, and consisted of speakers from law enforcement, the medical field, Mille Lacs Band of Ojibwe, and those with personal testimonies.
Health care professionals speaking at the forum acknowledged their role in the epidemic.
“This is a huge issue, an issue that came from the medical community,” admitted Dr. Ryan Harden, MD, MS, and medical director at Gateway Clinic who practices in Sandstone, Hinckley and Moose Lake. “We hear many stories about people who first came in contact with opioids from a doctor. This is an epidemic that has ruined families and careers.”
Dr. Brent Thompson, pharmacy director at FirstLight Health System, agreed with Dr. Harden’s statement saying, “I have been paying attention to this for about five years and am astounded at what’s happening in the state and nation. Health care has a heavy hand in this, but we (the pharmacist community) have a fair amount of responsibility in this as well.”
Thompson added that big money drug companies have spent millions ($880 million over the past decade) marketing and lobbying opioids to healthcare professionals. “This effort (to promote the use of opioids) has been pushed upon us for about 20 years,” he said. “We didn't know what we know now. They have spent about eight times more than gun lobbyists and 200 times more than groups advocating for stricter prescription rules.”
“As doctors, nurses, and pharmacists, we deal with blood and guts and nasty stuff and we chose this for a reason,” added Thompson. “We are a bunch of compassionate folks and we want to help people, but now we need to step back. I'm really sorry because I'm part of the problem.”
United States seems to have an insatiable appetite for drugs
“It’s in our backyards now folks,” said Thompson. “It’s moving in on the midwest. We have been very protected for about 15 years or so, and the edges of our country have been struggling. We need to slow this down.”
Dr. Brent Thompson stated that in 2009, drug overdoses surpassed motorcycle accident deaths, and right now, fentanyl use is dangerously rising. He said that the United States has an insatiable appetite for narcotics and statistically, the U.S. consumed 99% of the world’s supply of hydrocodone (Vicodin) in 2010.
Four out of five heroin users started out misusing prescription pain pills, and attention is now focused on the emergence of fentanyl and heroin which is increasing in use because it is a cheaper and more available alternative to pain medication.
A 2013 Minnesota Department of Health survey revealed that 24% of high school students have abused prescription drugs which is a 33% increase from 2008. And in 2013, 507 Minnesotans died from all types of drug overdoses.
The majority of jail inmates are users of illicit drugs,” said Paul Widenstrom, Chief Deputy of Pine County Sheriff’s Department. “Also, a statistic that gives a good dose of reality is that every 25 minutes a baby is born with opioid withdrawal.”
Widenstrom said that they are currently seeing an uptick of heroin use within the county. It is being brought up from Mexico and through the major U.S. cities to the Twin Cities and to Pine County from there.
“Not a day goes by that our deputies are not dealing with drug or narcotic issues,” said Widenstrom.
Michael Dieter, of the Mille Lacs Tribal Police, stated, “I have seen a lot of stuff out in the community. People make fake anything. Some of the signs that someone is a user are q-tips or pens lying around. Some of the physical signs are track marks on a person’s arm. They will move the drug around to hide it even injecting between toes and fingers. People will get violently ill if they don’t have it.”
“The typical user used to be from a disadvantaged background,” added Pine County Attorney Reese Frederickson. “But this epidemic affects everybody.” He added that in 1996, a small pharmaceutical company invented oxycontin and called it virtually non-addictive, and years later, were prosecuted for misbranding this drug, receiving a $634 million fine. “They basically walked away from the problem and dropped it on us.”
Sam Moose, Commissioner of Health and Human Services for the Mille Lacs Band of Ojibwe, stated that their community saw an increase in child protection cases starting in 2015 which has tripled since then.
“This is hitting Indian country more than most communities,” said Moose. “We felt we needed to react to those numbers.”
The tribe began holding community forums of their own and created a neo-natal response team which has had some success, explained Moose. He added that the Four Winds Treatment Center was created and will focus on treating the whole person with full treatment and cultural programming. They have also worked with tribal police using naloxone and more closely monitored prescription practices, reducing what they were prescribing by 50%.
“We will also be looking at a needle exchange program,” added Moose.
Monica Haglund, a Treatment and recovery counselor and Rule 25 Assessor from the band spoke and said that if someone is in need of treatment, they will have to have a Rule 25 assessment and that there is money available from the state to help with treatment costs if one qualifies.
“In order for recovery to happen, it needs to come from your heart,” said Haglund. “You need to make that decision, and treatment can help you make that change. Wouldn't it be great if more people would be voluntarily coming in before they are forced to by jail or overdose?”
She said there are four key areas to support recovery: 1) Health (making healthy choices); Home (having a stable, safe place to live); 2) Having purpose in life (including meaningful hobbies, working, volunteering, etc.); and 4) Community (having a supportive social network).
From the sheriff’s office, Chief Deputy Widenstrom said that there are prescription medicine drop off sites available in Pine City, Sandstone and Hinckley at the sheriff’s offices. “This is a better alternative than leaving them where they can do more harm,” said Widenstrom.
Dr. Harden said that the medical field is adjusting prescribing practices, and individuals are required to sign a contract that they're only going to use one doctor to receive narcotic prescription painkillers. If they are taking narcotics, they need to be seen by a physician every three months and will receive random drug testing, he added. Health care providers are also working together on a prescription drug monitoring database to monitor where patients are getting their medicine and identify patients who are using them inappropriately. Work in the emergency rooms is also happening, and people are no longer immediately given the pain medication they have traditionally given out.
“This is a tremendous amount of work for us, but it is the right thing to do,” Dr. Harden added.
County Attorney Reese Frederickson believes the solution to the epidemic may come in three areas: 1) Removing the stigma of people addicted to opioids; 2) Insisting insurance companies will keep people a minimum of 60 to 90 days to change brain chemistry of the users; and 3) Require elected officials hold drug companies responsible.
“The solution to this problem really needs to come from concerted effort between the medical community, pharmacists, law enforcement, teachers, parents, and community,” said Dr. Harden.
“In high school, I broke my hand and was prescribed narcotics. I liked the feeling and then moved to taking them from my parent's medicine cabinet. I would fill up the bottom of the container with cotton, so it looked like there weren’t any taken. You think of everything to hide it,” said Jordan, a young man who shared his story at the forum.
“I joined the army and stopped for awhile but drank a lot, and in 2011, was deployed and came back with way too much money. I hurt a little bit and got pain meds. I played it up like I was going to die, and they gave it to me,” said Jordan. “But it wasn't enough, and I took more and just then, heroin came in. I was pretty hesitant, and it was gross, but I did it anyway and got hooked. I started by putting it up my nose at first, and that wasn't enough. The next thing you know, you’re jabbing yourself with needles.”
“I went to treatment in 2015 and spent 30 days in Owatonna. It didn't do much for me other than coming out with more connects than before. That happens a lot,” he said.
Jordan spent more time in and out of rehab and said it was easy to stay clean at first but the hardest when life hit again. “The hardest part was to learn how to deal with life and everyday problems. Treatment will only work if you’re ready. I had to hit rock bottom, walking down the road with nothing after being kicked out by my dad. I will always have some desire to use, but I have learned to shut it off easier now,” said Jordan.
Jordan has been clean for over eight months. Later in the Q & A session, he advised parents to give tough love to their kids and not enable them in their habits.
Essentia Health, FirstLight Health System, Gateway Family Health Clinic, Grand Casino Mille Lacs and Hinckley, Hazelden Betty Ford Foundation, Mille Lacs Band of Ojibwe, Pine County Attorney’s office, Pine County Chemical Health Coalition, Pine County Probation, Pine County Public Health, Pine County Sheriff’s office, and U of MN-College of Pharmacy were sponsors of the event.