[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.

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