Fighting the Minnesota opioid crisis with multilayer care


The Minnesota Department of Health says opioid-related deaths decreased from 2017 to 2018. ( courtesy of Minnesota Department of Health)

The Minnesota opioid-related death rate dropped 22% from 2017 to 2018, the state’s Department of Health said July 9 announcing the results of a preliminary study.

In 2017, 442 people died of opioids in Minnesota. In 2018, that number was 331. The department says while this drop is promising, overdose rates are still historically high. 

Two local professionals offer insights into how they are combating the ongoing crisis.

Stacy Overby, program director at Phoenix Recovery Programs in Maplewood, first questions whether opioid use is actually decreasing. She suggests the increased presence and use of naloxone, also known by the brand name Narcan, which is used to rapidly reverse opioid overdoses, might be to thank for the recent downward trend in opioid-related deaths.

“When people are overdosing, [naloxone] gets into the hands of people who can stop the overdose and keep people alive,” Overby said.

She said the state’s Good Samaritan Law protects those reporting health emergencies, which is a huge step in encouraging people to reach out for help during opioid overdoses.

Scott Darling with Therapy Partners in Oakdale warns people not to underestimate the importance of physical health when treating pain and to be wary of opioid prescriptions used over a long period of time. 

He said doctors often prescribe and re-prescribe opioids for patients dealing with chronic pain. But that, he said, isn’t the point of opioids nor is it a helpful solution. For people experiencing pain, Darling asks patients if they are taking a proactive approach. 

“Are you exercising or just using these medications as your only resource to decrease your pain?” he asked. 

As a former physical therapist, Darling said many of his patients on opioids saw no other way to deal with pain. “That’s a massive problem.”

 

Factors behind addiction

Opioids can cause hyperalgesia, which makes users more aware of pain and more sensitive to what is hurting. Physical therapy, Darling said, can be massively instrumental in helping people overcome the chronic pain that led them to opioids in the first place. 

Mental health also plays a big role in fighting the opioid crisis, Overby said. The programs she directs are aimed at adolescents, and she works to help young adults understand and treat their addictions.

“We have to look at what’s going on,” she said. “Most kids are not going to progress into [an active substance user] unless there’s something else happening. A huge piece of that is untreated mental health.”

Overby said recognizing mental health issues in teenagers can be difficult because people often brush off such symptoms as them being “moody” young adults. Another link connecting substance abuse and mental health? Trauma.

“We’re starting to truly understand the role trauma plays in mental health and substance use,” she said. “For so long we’ve had the misconception that trauma is a military thing, but for kids in particular there are traumas. And they need to be treated as such.”

Divorce, car accidents, financial issues, moving schools or having a parent with an addiction or mental health issue can add up and put a big burden on a young person, Overby said. This is part of the reason Phoenix Recovery Programs is co-licensed as a mental health and substance use program.

“We understand these are only pieces of a much bigger picture of things going on,” Overby said.

And as Darling said, another one of those pieces is physical health. Three years ago, he started a pain clinic for people with general pain and opioid dependency. He said it could be a tough process to recovery for a lot of patients.

“You have to approach it slowly,” Darling said. “But if [medications are] the only resource for pain relief and you don’t teach them anything else, what are they supposed to do? They come off that medication and they go on another one.”

What is the problem with continuing to prescribe opioids for pain relief? Darling offers a scenario. Say a patient has a neck strain and they go to the doctor. The doctor gives them an opioid medication and tells them to go home and rest.

“But when you have neck pain you should be moving, stretching and trying to get it back to its normal movement,” Darling said. “It doesn’t get better right away because they’re resting. Therefore, they go back to the doctor who keeps prescribing that medication.”

Darling offers a different approach. Take pain medications for a few days if needed, then visit a physical therapist or movement specialist. 

“You have to change the mindset of every person that’s ever lived in America for the past 100 years,” he said. “It is a mindset shift for patients to know that they have a primary role in their pain relief — not just in medication.”

 

Looking beyond

Overby said she utilizes this approach with adolescents in her program. Phoenix has younger patients who work with chiropractors to address physical pain. But behind it all, both Overby and Darling said health professionals must look beyond the first layer of opioid addiction. 

“Let’s figure out what’s going on,” Overby said. “We are trying to make sure we at least make referrals and address things between the family stuff, the school stuff, the socioeconomic stuff, the physical health stuff — all of these things.”

Darling pointed out even more layers involved when treating an opioid problem.

“The only way for that patient to figure out how to address this addiction is trying other self-care measures, rather than just taking a medication,” he said. “They have to see a clinician that knows how to deal with patients on opioids.”

The Minnesota Department of Health says deaths related to synthetic opioids, especially illicit fentanyl, a powerful painkiller, rose in 2018. 

The state now has opioid prescribing guidelines and requires some health care providers to compare prescribing rates with each other, MDH says. Minnesota prescribers will now be alerted about patients possibly misusing opioids.

Those struggling with substance abuse can visit www.findtreatment.samhsa.gov or call 1-800-662-HELP (4357).

 

–Amy Felegy can be reached at afelegy@lillienews.com or 651-748-7815.

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