State lawmakers passed a law last year expanding access to a key anti-overdose drug. While the law has been credited with saving lives, now there is growing concern that the drug's distribution remains too limited — and that not enough people know about it.
Nothing brought that fact home for drug-treatment advocates more than two recent overdoses north of the Twin Cities.
Jennifer Nordeen is among those who pushed hardest to expand access to the drug naloxone, also known as Narcan, which can reverse the effects of heroin and other opioid overdoses.
Nordeen's 19-year-old son, Dylan Pearson, had struggled with heroin addiction since about 2012.
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Dylan had just returned from a 90-day treatment program in Florida in late January. A week later, Nordeen found him overdosed in his bedroom.
"As involved as I'd been, and as hard as I'd fought for him," Nordeen said, "this was not something I saw coming."
She said Dylan was already cold to the touch when she discovered him; it was too late for naloxone to save him. But she said the emergency responders called to her house told her they hadn't heard about the change in antidote law, and weren't carrying naloxone.
Two days after Dylan's death, Nordeen got a phone call informing her one of Dylan's closest friends had overdosed in the back of a car in Elk River. Nordeen and her husband took a naloxone kit to the scene, where they encountered a police officer, who they said blocked them from administering the drug to the unconscious young woman.
"He just blatantly said, 'No, we don't carry it, and we wouldn't allow you to do that,'" Nordeen said. "It would save a life — we just don't understand how people don't know about this by now."
Elk River police said officers do not carry naloxone but the paramedics were already assisting the young woman.
The woman survived, but the fact that the officers she encountered during the two overdoses didn't seem to be aware of the potentially life-saving drug left Nordeen even more frustrated.
Communicating the change in law
State law allows emergency personnel to carry and administer naloxone. Lawmakers also added a "Good Samaritan" provision that gives some protections from prosecution to those who report an overdose to police.
But antidote advocates are still finding it hard to get some first responders and medical professionals to embrace it.
Representatives of about a dozen groups from across the state, including treatment centers, mental health centers and government agencies met last Thursday in Minneapolis to come up with a legislative proposal to further expand access. They want money to educate law enforcement officers about the law, and to get naloxone kits into the hands of more people at risk of overdose and their loved ones. There's no price tag on the proposals yet.
"This is really a social change that needs to happen, from law enforcement to the using community to treatment providers and doctors — everyone needs to be involved in creating change in this epidemic to have reversal of the numbers," said Lexi Reed Holtum, vice president of the Steve Rummler Hope Foundation, a group that advocates for addiction care.
"Last year was all about, 'Let's pass a good public health and safety law,' which we did," Holtum said. "This year is all about trying to find support systems throughout Minnesota in being able to implement the law."
Naloxone can be administered through a shot or nasally through a device like an asthma inhaler. Other states have also adopted laws expanding access to it in an attempt to stem the overdose epidemic in the country, which contributed to the deaths of 24,000 Americans last year, according to data from the Centers for Disease Control and Prevention.
The overall drug overdose death rate doubled between 1999 and 2013. About 280 people died from opioid overdoses in 2013, according to a Minnesota Department of Health analysis of CDC data.
Early efforts focused on the most at-risk
Treatment advocates have spent the last year trying to notify doctors, law enforcement officers and public health workers about the details of the law. Even these limited efforts have been a challenge for the small organizations.
In the last year, organizations' efforts have been focused on getting naloxone to those most at risk: injection-drug users. A Twin Cities-based treatment and mental health center called Valhalla Place has set up naloxone distribution programs with a number of syringe exchange programs around the state, including the Minnesota AIDS Project in Minneapolis.
"Valhalla Place has been doing this project without any resources," said Adam Fairbanks, director of harm reduction services at Valhalla Place. "We can't expand this project without the resources to do that."
Between 400 and 800 people exchange syringes every month at the Minnesota AIDS Project, but right now the program is only able to offer naloxone for two hours each Friday, according to Brian Warden, who runs the program's syringe exchange.
"Clients are often in a hurry, they have something else to do, and we're just a stop on the way," Warden said. "So what we do is we kind of prime them during other days and say, 'Friday, set aside 15-20 minutes so you can do this intake and so we can get you on naloxone.'"
The buildup has been slow, but they've been seeing some success, with five people walking away last Friday with new prescriptions for the overdose antidote.
The groups involved in naloxone education and distribution are helping to draft proposals to help fund naloxone programs in the state to make it more widely available. State Sen. Chris Eaton, DFL-Brooklyn Center, who carried the original naloxone bill last year, plans to sponsor the expanded use.
That includes a bill that would require treatment centers receiving state funding to offer medication-assisted opiate treatments like buprenorphine, which could make life easier for the thousands of Minnesotans struggling with opiate dependencies.
For example, Nordeen's son Dylan had gone to six different treatment programs in an attempt to kick the drug, but she found that many of the doctors in the state have already hit the cap for how many buprenorphine prescriptions they can hand out.
Eaton said she kind of expected that people would stop dying once the original naloxone law had passed.
"We've saved a few lives with our bill, but we're still losing a lot of people — we've had quite a few deaths this year already from opioid overdoses," Eaton said. "That part's pretty disappointing, but it just means we have more work to do."