Hennepin County embarks on its most ambitious opioid prevention strategy

Hennepin County should equip all law enforcement officers with naloxone, hire a response czar and provide more options for users to get clean as part of a strategy unveiled Thursday to combat the deadly opioid epidemic.

County commissioners were presented with a comprehensive response to a crisis that took a record 162 lives in the county last year. The problem isn't unique to Minnesota, as more than 60,000 people in the United States died from opioid overdoses in 2016, more than were killed by gunfire, traffic accidents and HIV combined.

A 40-member task force spent two months developing the plan, which identified 32 actions in the areas of prevention, response, and treatment and recovery, most of which are scheduled to be completed by the end of 2018. No costs were discussed during the one-hour briefing.

"The board asked us to look at best practices, develop a strategic framework, determine what was already being done and then fill in the gaps," said Susan Palchick, the county's public health director. "We have to flatline the number of deaths, and we have a lot of opportunity to move the line [down]."

The 26-page plan is the most wide-ranging approach since opioid victims began filling up emergency rooms and morgues several years ago. Addiction usually starts with prescription medications, but synthetic versions of the drug such as fentanyl and the extremely toxic carfentanil have thrown a new complexity into law enforcement efforts.

While the plan focuses on opioids, Board Chairwoman Jan Callison lauded the effort for its significant emphasis on treatment for American Indian and black communities, which are disproportionately affected by opioid abuse, and better follow-up after users leave jail and detox centers.

"We could also be talking about methamphetamines and a number of other addictive substances," she said. "It's a complicated problem that makes it very hard to help people make good choices to get healthy."

Before the plan's introduction Thursday, various county departments and players in the criminal justice and public health system were applying their own strategies. Several commissioners voiced hope that the hiring of a coordinator will combine those efforts.

"This one responsible person needs to coordinate our approach and have the power to break some china in order to ensure that every strategy we're using is actually making a difference," said Commissioner Jeff Johnson, who is a GOP candidate for governor.

Callison expects the working group will come back to the board soon with a candidate for the job. "The new position will require an ask for resources, which will be a signal that we are serious about this," she said.

Deputy County Administrator Jennifer DeCubellis highlighted four short-term goals: hiring the coordinator, working with disproportionately affected communities, creating a protocol for the use of naloxone, a drug that can reverse an otherwise fatal heroin overdose, and providing training on new state opioid prescribing guidelines.

Callison said she was disheartened that American Indians and blacks in the county have significantly higher rates of death from opioid overdoses. Commissioner Peter McLaughlin wants doctors at Hennepin County Medical Center (HCMC) educated on best practices of prescriptions, and training for other doctors at other county hospitals and clinics. Nationwide, more than 1,000 people are treated in emergency rooms every day for misusing prescription opioids.

Another focus is reducing the stigma around treatment. Commissioner Debbie Goettel said doctors at HCMC recently told her about a patient who was sent to a nursing home for long-term care and recovery after a stroke. The patient arrived by ambulance, but the nursing home refused to admit the patient after learning he or she was in a methadone program.

"It's just horrifying," she said. "So many people are dying of opioid addictions, but we can't even use the treatments we have available because of the stigma attached to facing the problem."

DeCubellis and Dr. Gavin Bart, head of addiction medicine at HCMC, discussed the statistical and financial hardships of the opioid crisis. Last year, the county spent $50 million on children removed from parents struggling with drug addiction. Nearly 90 percent of those parents are addicted to opioids.

Lab costs for deaths at the medical examiner's office increased by $400,000 during the same year. And it's also expected that the number of babies born with opioids in their system will grow by 113 percent next year, a figure Callison called "stunning."

Several efforts already in place need enhancement, said DeCubellis: Adding disposal boxes for unused prescriptions, tweaking drug diversion court, coordinating syringe exchange services and including opioid treatment medication in jails.

Commissioners Marion Greene and Linda Higgins even suggested a few new ideas: a detox center for juveniles and allowing security guards to carry and administer naloxone. County Administrator David Hough said he was waiting for a legal opinion from the county attorney on whether security guards could handle naloxone.