Doctor: New overdose report highlights 'dangerous time' in drug use in Minnesota

[MUSIC PLAYING] NINA MOINI: New statewide health data shows there's been a decrease in opioid overdose deaths in Minnesota for the third year in a row, but there's been an increase among all drug overdose deaths. Joining me now to talk about the numbers and what's happening on the ground more so when it comes to drug addiction is Dr. Charles Reznikoff. He works in addiction medicine at Hennepin Health in Minneapolis and at Northfield Hospital. Dr. Reznikoff, thanks for your time this afternoon.

CHARLES REZNIKOFF: Thanks for having me and for addressing this topic.

NINA MOINI: Absolutely. It's so important, and it's so nuanced, right? So we're grateful to have your perspective on this report coming out of the Minnesota Department of Health that found, again, a pretty small decrease in opioid overdose deaths in '25. So a small decrease. There were seven less deaths compared to the year prior. When you look at these types of numbers, it's hard to make a huge point out of all of it because every year is very individualized. So I know it can be hard to compare year to year. But what do those numbers tell you?

CHARLES REZNIKOFF: Yeah, thanks for asking. And you're right, it is nuanced and can seem confusing. I think one thing when you look at the charts is that there was a significant bump during COVID of deaths and overdoses. And a lot of the deaths and overdoses have returned, as bad as they are, to the pre-COVID levels.

And so that's the first thing, is that even though there's a little variation from this year to last year, and there's preliminary 2026 information out, mostly, there's good news in that since 2020, things have improved significantly in all ways. There's a lot of work left to do. And I think what COVID teaches us is that things that disrupt our society, our culture, things that create barriers to accessing health care cause life-threatening danger to people who use drugs.

NINA MOINI: Doctor, can I ask a little bit, for folks who don't know the hospital or the clinic setting as well, what your job entails? Are you dealing with people who are in crisis situations, in emergency rooms? Are you dealing with people who are in an inpatient or outpatient type of setting? What do you see in your work?

CHARLES REZNIKOFF: Yeah, thanks for asking. We often start with a crisis, an overdose, or a medical emergency. The Hennepin Healthcare EMS team starts with the call, already working on substance use disorders with best practices. But then they come to the hospital. They become stabilized. We do an inpatient hospital consult, where we visit with them while they're in the hospital recovering from their emergency.

And then we try to coordinate care after they leave the hospital. And then we continue to take care of them for years or even decades. And so we have the full range of people who are in recovery for 20 years and people who just had an overdose, the full range of that. And it's really wonderful, exciting, challenging work to see the full range of how addictions can affect health and how people can overcome addictions.

NINA MOINI: Yeah. Let's talk about stimulants. I guess, with drug overdoses in Minnesota, this data saying there was a 3% increase in drug overdose deaths attributed mostly to stimulants. Can you talk a little bit about what types of stimulants you most commonly see and what makes them addictive? Are you seeing more?

CHARLES REZNIKOFF: Yeah. So the two most important stimulants in Minnesota are methamphetamines and cocaine. And these have been the most harmful, important street stimulants for decades. And they are as important today as they've ever been in terms of harming Minnesotans. Methamphetamine is also commonly adulterated into fake pills.

So if you, for example, borrow a pill that you think is a ADHD prescription, it is likely that it is a fake pill and it's actually methamphetamines. So methamphetamine is available as a powder. It is sold as pills, sometimes fake pills. And then cocaine also can be a powder, can be smoked. These drugs can be injected as well. So they're out there, unfortunately. They're continuing to rise in how they impact our patients.

NINA MOINI: Do you see more of people who were confused or people who thought they were taking something and taking something else? I'm seeing here that the report found that 70% of Minnesota's overdose deaths in 2020, so a while ago, were due to mixed drug use. And then deaths involving both the use of opioids and stimulants have doubled since 2019. How are people accessing these drugs?

CHARLES REZNIKOFF: There's a mix. I mean, some people have no idea that they're exposed to these drugs, like stimulants like methamphetamines or opioids like fentanyl. They have no idea until they have an overdose. And then they're surprised and horrified to find out they were basically poisoned using a drug they didn't know.

And also, some people are choosing to use both substances in combination. It's a choice. They're mixing these drugs together intentionally. So there's both. There are people who are deliberately co-using methamphetamines and other drugs. And there are some people that are just being essentially poisoned by counterfeit adulterated pills. So a lot of stuff's happening out there. It's a dangerous time to be using any substances in Minnesota.

NINA MOINI: Mm-hm. Dr Reznikoff, what do you see in terms of our unhoused population? Folks may know HCMC, Hennepin County Medical Center, anybody can go there and receive treatment, right? It's like a barrier-free hospital. But I'm wondering what you see in terms of the unhoused population and how to get resources to people in that type of a situation.

CHARLES REZNIKOFF: Yeah, thank you. Also, thank you for saying Hennepin Healthcare, of course, is a low barrier to access. There is no wrong door. And that should be true for any clinic or hospital in our state. We really hope there's no wrong door. Someone seeking help for an addiction can get it at any health care facility. That's the goal. Hennepin is always striving to reach that goal. And I'm proud of working here.

Yeah, in addition to substance use, also having housing insecurity or being homeless is another complication. It's another challenge. It creates more barriers to getting into treatment. And the outcomes are less good for people who have substance use and housing insecurity.

So in some ways, they can be treated. Homeless people can be treated totally equal to people who are not homeless. And in some ways, the disease is the same. But the lack of housing does complicate how we treat them, and when they leave the hospital, how they then show up to treatment and continue to engage in recovery treatment. So it is a challenge.

NINA MOINI: Yeah, people are facing multiple challenges at different times, definitely. And you also work in Northfield, as I mentioned at the top of our segment. I mean, do you see differences when it comes to overdoses or maybe in numbers between greater Minnesota and the Twin Cities?

CHARLES REZNIKOFF: Mostly, mostly, it's the same. Mostly, they're the same drugs. They're the same challenges. They're the same treatments. There isn't a huge difference between the work I do in Minneapolis and in Rice County. There are some subtle differences. In a rural area, people have to travel farther and usually by car to the clinic. So that creates a little bit of a barrier to accessing treatment. So that's a challenge for a more rural area. And then there are certain other drugs, like, for example, kratom, which is used everywhere and is in the news a lot lately, I am noticing it more in the more rural areas.

NINA MOINI: Can you say a little more if people aren't familiar with kratom?

CHARLES REZNIKOFF: Yeah, kratom is a drug which is only partially regulated. And it can be purchased in convenience stores or in gas stations. And it acts like an opioid and also like a stimulant. So we talked about mixed drug use. Well, this one drug has two effects. It's a stimulant and an opioid. And it has the perception of being less dangerous because it's marketed as natural. However, many people develop serious problems. And there are some very potent kratom products being sold that are causing harm. So kratom is a new thing in our community that is causing harm for people to be cautious and aware of.

NINA MOINI: Mm-hm. Sometimes things are being invented and created and sold a lot faster than any regulators can keep up with what's going on. So it is important for people to continue to be aware. Dr. Reznikoff, thanks very much for your time. We hope you'll come back sometime and visit the show.

CHARLES REZNIKOFF: Thank you very much.

NINA MOINI: Dr. Charles Reznikoff works in addiction medicine at Hennepin Healthcare and Northfield Hospital.