In outstate Minnesota, hospitals slash opioid prescriptions

Roughly 1.5 million fewer painkillers are being prescribed each year in nine rural Minnesota communities as a result of an ambitious collaboration to battle the rising problem of opioid overdoses.

The Minnesota Department of Health reported the reduction Tuesday at an event in Little Falls and called for new state grants to expand the approach.

"We are building a culture of prevention and effective treatment to tackle the opioid crisis in our state," said state Health Commissioner Jan Malcolm.

Opioid abuse has become a top public health concern due to a sevenfold increase since 2000 in the rate of deaths from overdoses of prescription painkillers such as oxycodone and illicit opioids such as heroin. The state reported 422 opioid-related deaths in 2017, up from 395 a year earlier.

Little Falls has been lauded nationally for the way its doctors and law enforcement agencies, along with CHI St. Gabriel's Health, started working together five years ago to address opioid addictions. Alarmed that 100,000 opioid pills were being dispensed each month in a central Minnesota county of 30,000 people, family practice doctors in Little Falls increased their training in alternative pain remedies and medication-assisted treatment (MAT) for opioid addiction.

The Morrison County Sheriff supported the effort in several ways, including allowing people to continue MAT therapy while in jail. Previously, inmates were cut off from treatment, which made them more likely to relapse and die from overdose upon release, said Sheriff Shawn Larsen.

"We're used to putting people in jail," Larsen said during a briefing Tuesday. "Now we're thinking … of treatment options instead."

The results were so promising that the state awarded grants to eight health care systems to copy the approach in Alexandria, Redwood Falls, Montevideo, Hibbing, Mora, Fergus Falls, Aitkin and the Mille Lacs reservation. Together, those communities are on pace to reduce opioid prescribing by 765,000 pills per year — exceeding the estimated reduction in Little Falls of 724,000 pills per year.

Doctors in Alexandria were humbled when shown data on how many opioids they had prescribed in the past, and by the realization that they were "creating a monster" of opioid addictions, said Dr. Deb Dittberner, chief medical officer of Alomere Health.

Cutting prescriptions is only a first step, she said, as communities need to expand treatment and support options for people with addictions, and improve employment and housing options that can prevent people from abusing drugs in the first place. "We need to get upstream and take on and create loving communities that support people that are dealing with addiction of any type," she said.

Malcolm said she supports a provision in the budget proposal of Gov. Tim Walz to add grants so that 20 more communities can join the collaboration.

Death records suggest that Minnesota's opioid epidemic is evolving; the number of deaths from common prescription painkillers and heroin has leveled off, but deaths from potent synthetic opioids such as fentanyl have surged.

While the grant program targets prescription painkillers, Malcolm said it can also address this new phase of the opioid epidemic. Treatment with Suboxone and other medications address all types of opioid addictions, she noted, and prescription pills are often the gateway for abusers who later turn to heroin or fentanyl.

A reduction in prescription pills in Little Falls did produce a short-term increase in illicit heroin, said Dr. Heather Bell, one of the creators of the Little Falls opioid reduction program. But she said it was still important to reduce that initial source.

"Focusing on the pills and the initial supply," she said, "has to be the goal."

Jeremy Olson • 612-673-7744