- Associated Press - Saturday, February 24, 2018

ST. PAUL, Minn. (AP) - Opioid addictions typically end one of two ways - recovery or death.

Monica Rudolph is a survivor. She’s been sober almost a year.

Ryan Anderson didn’t make it. He died of an overdose in December.

Both became addicts by taking prescription opioids. Rudolph was prescribed the powerful painkillers after a car accident. Anderson obtained them illicitly to experiment recreationally.

Both ended up hooked on heroin. Rudolph and Anderson sought treatment for their addictions and had different experiences.

Each day, Rudolph takes a prescription containing a low dose of opioids called Suboxone. The mix of buprenorphine and naloxone helps calm her cravings and keeps her from getting high.

“It allowed me to function normally and be a human being again,” Rudolph told the Pioneer Press . “Everything has turned around.”

Anderson, of Coon Rapids, tried a similar treatment, but it didn’t stick. He couldn’t get access to other medicines, such as naltrexone, an injection that provides a monthlong reduction in opioid cravings and protects against overdose.

“I wish he would have had the opportunity to try,” said Anne Emerson, Anderson’s fiancee, who shared his story. “I feel like he really wanted to (get sober), but he struggled with it.”

In the fight against opioid addiction, there are a growing number of tools for prevention and treatment. Too often, the help addicts need is inconsistent, out of reach or comes too late.

Minnesota is trying to change that.

Lawmakers have already committed nearly $25 million in state funding and federal grants to fight the opioid crisis through improved treatment and prevention efforts. Gov. Mark Dayton wants another $12 million for the coming fiscal year, and there is bipartisan support for legislation that would create a permanent revenue stream to fight addiction.

Opioid overdoses in Minnesota have skyrocketed.

In 2000, fewer than 200 residents overdosed on the drugs, according to state data. By 2016, overdoses had grown to more than 2,000 - an increase of more than 1,000 percent.

Not all overdoses are fatal, but the death toll is rising. In 2016, 395 people died from opioids, a more than 600 percent increase over the 54 deaths in 2000. By comparison, there were 392 traffic fatalities in 2016.

But there’s a glimmer of hope in the overdose data.

While overdoses and deaths continue to climb, the percentage of overdoses that are fatal have been falling. In 2016, one in five opioid overdoses was fatal, compared with a high point of more than one in three in 2008.

State health officials and addiction experts say the increased use of medical treatments for opioid addiction and overdoses are likely the reason. But they’re reluctant to say there’s a direct correlation.

Nevertheless, opioid antidotes like naloxone, or Narcan, that can reverse an overdose, and addiction medicines such as buprenorphine and naltrexone are becoming more widely available.

“I would hope the outcome we are seeing is from the wider availability of these treatments,” said Claire Wilson, an assistant commissioner with the state Department of Human Services.

Shown below are fatal and nonfatal overdoses per 1,000 residents of each county. Click on a county for more detail.

The opioid crisis is changing the way addiction is treated.

Minnesota’s own Hazelden Betty Ford Foundation was a pioneer in addiction treatment, which has often focused on abstinence combined with peer support and psychological treatment.

Dr. Marvin Seppala, Hazelden’s chief medical officer, said it became clear in 2012 as the opioid epidemic was ramping up that they had to try something different. Not only were patients not getting better, they were dying of overdoses after leaving treatment.

“We’ve got to do whatever we can to keep people alive so they can get sober and stay sober,” Seppala said.

Medicines that ease withdrawal and prevent relapse, such as buprenorphine and naltrexone, improve recovery rates and help prevent fatalities, Seppala said. He added that Hazelden was compiling research on the success rates of the medications.

“Our biggest goal is to keep them involved long-term,” Seppala said. “The medicines do help them stick around.”

About a year ago, she reached out to a program at CHI St. Gabriel’s Health. After a short interview, she was accepted into their treatment program.

“When I really think about it, I was so desperate to live normally,” Rudolph said. “Chasing that high was so much harder than making that phone call.”

While there are promising medical treatments for opioid addiction, there are also obstinate barriers for many addicts who need treatment.

A small but growing number of doctors and treatment centers offer medicines for opioid addictions. It can be tough for traditional abstinence-based programs to offer those medicines because they require someone with a medical background to prescribe them.

Not only can these treatments be costly, but they also are heavily regulated and often require prior approvals from insurers before they can be prescribed. Any waiting period for an addict seeking treatment could mean relapse, overdose and even death, experts say.

Heather Bell and Kurt DeVine - from the CHI St. Gabriel’s Health clinic that Rudolph reached out to in Little Falls - are two doctors working to remove those barriers. Their goal isn’t just to help their community but also rural clinics across Greater Minnesota where the opioid crisis has hit hard.

Bell and DeVine didn’t plan on being on the front lines of the battle against the opioid crisis. But the demand for pills like Oxycontin and Vicodin and the frantic late-night calls from patients seeking refills convinced them they had to do something.

“It was very uncomfortable,” Bell said of patients’ desire for prescription opioids.

St. Gabriel’s staff began working to drastically reduce the pain medication patients were prescribed, turning instead to more permanent solutions such as physical therapy or even surgery to treat chronic pain.

“Our goal isn’t to take away everyone’s pain,” DeVine explained. “It’s to improve their lives.”

Bell and DeVine also realized they had to do something for the growing number of people who were hooked on opioids. Four out of five heroin addictions started with prescription pills that were either prescribed or obtained illegally, they said.

Abstinence-based programs were not very successful and they didn’t want to rely on methadone, which is tightly regulated and requires patients to visit a clinic daily to obtain their doses.

Bell and DeVine turned to Suboxone.

The drug comes in a pill that’s taken daily, and it addresses addicts’ cravings for opioids and suppresses the euphoric feeling if they try to get high. Suboxone has helped the doctors’ patients avoid relapse and overdoses.

“It allows them to get their life back,” DeVine said.

Bell and DeVine’s opioid program is participating in the ECHO program, short for Extension for Community Healthcare Outcomes, to help smaller clinics around the state begin to replicate some of their success. ECHO was started at the University of New Mexico and is a mentoring effort to help doctors in rural areas learn about new treatments for stubborn diseases.

“Our goal is to spread what we’ve done. To get more rural family doctors comfortable prescribing (drugs like Suboxone),” Bell said.

Emerson, who lost her fiance to overdose, hopes more people will change their attitudes about opioid addiction. She believes a big reason Anderson wasn’t successful in treatment was because he was often seen as weak or a criminal.

“He just didn’t have the resources or he was thrown in jail instead of given treatment,” she said.

Emerson is sympathetic because she’s experienced addiction herself. She’s a recovering methamphetamine addict and is now studying to be a substance abuse counselor.

“We didn’t just wake up one day and decide to become an addict and hurt the people we love,” Emerson said.

Anderson tried multiple types of treatment for his addictions. But Emerson said the treatment Anderson could get was incomplete; it lacked the multifaceted approach he needed to get well.

“He would try everything he was offered,” she said. “Temporarily, they helped, but there were underlying issues of where his addictions came from that weren’t treated. I think it would have made a world of difference if he had gotten the right support.”


Information from: St. Paul Pioneer Press, http://www.twincities.com

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