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The opioid epidemic (including heroin and prescription painkillers) is on the march in Minnesota, with increases in accidental overdose deaths and emergency-room and treatment admissions, says a report [PDF] released Thursday. The report also shows a continued comeback in methamphetamines and an increase in exposure to LSD.

The biannual Drug Abuse Trends in Minneapolis/St. Paul: January 2014 Update, is compiled by former state demographer Carol Falkowski of Drug Abuse Dialogues, a Minnesota-based business that draws information from poison control centers and state and county law-enforcement and health officials.

There was mixed news about synthetic drugs, with declines in exposures to both THC homologs and “bath salts.” Exposures to LSD, however, tripled over the past year, from 15 to 45. “The challenge with synthetic drugs is that there are many chemical compounds that are just a small molecule away from each other,” Falkowski said. “So it’s a game of catch-up in terms of regulating them. It’s staying ahead of the inventive chemist.”

A meth comeback?

The upward trend in methamphetamines was discouraging, said Falkowski, who has monitored drug trends in the state for more than 30 years. The report found that meth was involved in 31.5 percent of drug seizures in the first half of 2013, up from 22.6 percent in 2012, and that meth-related treatment admissions were up, from 6.4 percent to 9.4 percent.

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“Methamphetamines had such a grip on the state of Minnesota in the mid-2000s,” she said in an interview. “There was really no community that was untouched. The fact that it accounts for almost one-third of all drug seizures by law enforcement in the Twin Cities in the first half of 2013 really is cause for concern because of the devastation that it has brought [in the past].”

Public policies restricting the retail sales of pseudoephedrine products were effective for a while, Falkowski said, but people “have found a way around that.” She noted an increase in the importation of methamphetamines from Mexico along the Interstate 35 corridor, and said that the percentage of meth seizures in the Twin Cities is greater than the percentage for meth seizures nationally and in many major U.S. cities. “So we are not at the bottom end of this trend by any stretch.

“With every drug, there are ebbs and flows,” she said. At the core, however, is availability, and it seems that the availability of methamphetamines must be increasing.”

Opioids on the rise

Meanwhile, all indicators show an unabated increase in the number of deaths, overdoses and treatment admissions related to heroin and prescription painkillers. The study found:

A significant increase in the number of opioid-related deaths in Hennepin County: 69 in the first half of 2013, compared with 84 in all of 2012. (The Hennepin County Sheriff’s office said today that the total number of heroin deaths for 2013 stands at 54, up from 37 in 2012.)

A record-high number of heroin-related treatment admissions, from 12.9 percent in 2012 to 13.6 percent in the first half of 2013.

An increase in the number of other opioid-related treatment admissions (mostly prescription painkillers), from 9 percent in 2012 to 10.1 percent in the first half of 2013. (Heroin and prescription painkiller treatment admissions combined were 23.7 percent, second only to alcohol admissions at 44.2 percent.)

An increase in the number of heroin exposures reported to the Hennepin Regional Poison Center, from 127 in 2012 to 147 in all of 2013.

The increase in the number of heroin-related deaths “should be a wake-up call,” said Falkowski, not only for policy-makers but also for anyone who’s considering first-time heroin use or first-time nonmedical use of prescription opiates.

Source: Hennepin Regional Poison Center, Hennepin County Medical Center, 2014 Exposures to selected drugs reported to Hennepin Regional Poison Center: 2010-2013

Falkowski said the state needs to “move past the hand-wringing stage into decisive action based on best practices.” She again called for a more rigorous prescription drug monitoring program and continuing education programs for physicians who prescribe opioids. She also urged passage of the proposed 911 Good Samaritan + Naloxone legislation, which would provide immunity to those who call 911 in good faith to save a life and increase law-enforcement and public access to the opioid antidote naloxone.

Not by policy alone

Dr. Joseph Lee, M.D., head of youth treatment programs for Hazelden Foundation, said that while policy changes are important, they should always be combined with more effective messaging. “The reason we’ve been successful with reducing alcohol and tobacco use is because of messaging, shared attitudes and culture,” he said.

With opioids, for example, the messaging “still has not penetrated homes where people are hanging onto prescription painkillers for a rainy day when they shouldn’t,” Lee said. Examples of effective messaging campaigns, he said, include those that have portrayed the drugs’ physical effects (The Faces of Meth), and those that have exposed manipulative tobacco industry tactics. The challenge, he said, is to stay ahead of and respond to changes in the drug-use trends. “As we develop policies, as we talk about drugs, we have to have an eye open for how young people will interpret the discussion,” he said.

Lee said he has seen the most recent statistics reflected in his patient population, with synthetic and methamphetamine drug use rising among rural youths, and heroin and prescription painkiller use rising among urban and suburban youths. “It’s a tale of two different substance-use patterns, two different addiction stories based on where you live,” he said. “And it’s an issue of supply and demand.”