Growing opioid use in Somali community spurs need for culturally relevant treatment

Health care workers and community advocates say there is a growing need for culturally sensitive treatment and recovery programs as opioid overdoses continue to rise in Minneapolis' Somali community.

And yet, they say, public funding has failed to keep pace.

Those fighting the opioid crisis say that a one-size-fits-all model can make it difficult to reach people in ethnic communities.

Most health providers take a Westernized approach to treatment and recovery, says Farhia Budul, founder of the Niyyah Recovery Initiative, which touts itself as the first community-run recovery organization in the country designed specifically for East Africans and Muslims.

It is not enough to translate educational materials, Budul says; an effective health campaign must be sensitive to the subtleties of Somali culture, for instance by involving a person's family in every step of the recovery process — a challenge for most traditional providers because of health privacy laws.

Without that understanding, she says that the city's efforts to address its deepening opioid crisis could backfire, potentially turning people off to lifesaving treatments.

"They all mean well. They mean really well. At the same time, when you're looking at that treatment when you lack the awareness of someone's cultural identity, you're not really able to work with them effectively," said Budul, who drew on her own experiences with opioid addiction to start Niyyah. "All of these things stem from a root problem of not having that support, and so if we're able to really show people that we care about people's values and their traditions, we need to meet people where they're at."

And yet, she says, resources are scarce, adding that "as a Somali female in long-term recovery, navigating through this bureaucratic world is a challenge in and of itself."

Deputy Minneapolis Health Commissioner Noya Woodrich, who oversees the city's overdose prevention efforts, said that like most other large U.S. cities, Minneapolis saw a jump in drug deaths during coronavirus pandemic-plagued 2020 — from 88 in 2019 to 146 last year, a roughly 66% increase that was driven largely by synthetic opioids such as fentanyl.

She said she believes opioid use is increasing in the East African community, but nobody knows for sure by how much, since the city does not separately track overdoses among Somali, Oromo or Ethiopian residents. And because of the enduring stigma associated with drug use in those communities, many cases go unreported, experts say.

The lack of opioid-related programs available for young Somali-Americans was one of the reasons that Abdirahman Warsame started Generation Hope with four friends. Like him, they had dealt with addiction and lost loved ones to drugs. He said he hoped the nonprofit would be a safe space for younger users to open up about their own struggles.

Getting parents to acknowledge their kids' drug use is another challenge in the Somali community, he said. Much like in other immigrant communities, there's a generational gap between kids and parents, as well as a deep cultural divide over drug use.

"The biggest problem is just the fear factor of shame where people don't want other people to know that they're the parents of kids who've overdosed," he said.

Budul says that Somali Americans with addiction issues face cultural barriers to getting help. For one thing, most practice Islam, which strictly prohibits the use of drugs and alcohol, she says. And so younger Somalis are sometimes reluctant to share their struggles because they don't believe their parents would understand. Others worry such a disclosure would bring shame to older family members, who have dealt with their own traumas as refugees fleeing a civil war in their homeland and emigrating to the U.S.

Generation Hope and Niyyah are among the community organizations vying for the federal dollars promised to Minneapolis through the American Rescue Plan Act to ease the city's estimated revenue loss of $281 million last year. Council Member Jamal Osman, who represents the Cedar-Riverside area that is the heart of the city's East African community, co-sponsored a $1.5 million amendment to Mayor Jacob Frey's proposed spending plan that would fund youth programs, with some of the money aimed at addressing opioid addiction.

The Minneapolis City Council approved the plan Friday.

Health data show that overdose rates skyrocketed during the pandemic, which organizations like the American Medical Association blamed on a host of factors, ranging from anxiety over job loss and eviction to the disruption of global drug supply chains to people being unable to access treatment with many facilities closed or cutting back services to prevent the virus' spread. The increase was also likely the result of forced isolation for people with addiction and mental health issues as cities across the country locked down, experts say.

In Hennepin County, deaths related to opioids jumped last year, picking up notably in March, coinciding with the initial surge in the pandemic, and as health care systems struggled to cope with the virus' outbreak, according to data from the county Medical Examiner's Office. At least 285 people died from opioid overdoses countywide in 2020 — almost exclusively from fentanyl, which is 50 times stronger than heroin — up from 170 deaths in 2019, setting a five-year high. Preliminary county data show the trend has continued this year, with 108 fatal opioid overdoses through April, compared to 69 in the same period in 2020.

While methadone and other drugs have been found to be effective in helping people recover from opioid use disorder, they remain underutilized in communities of color, where there remains general mistrust of the medical establishment because of a history of discriminatory treatment, according to Noa Krawczyk, a substance-use epidemiologist.

"A lot of the problem is that many times people don't want to necessarily use these medications; there's a lot of stigma around these treatments because people think that you're just replacing one drug with another," said Krawczyk, an assistant professor at the Center for Opioid Epidemiology and Policy at New York University.

She said more U.S. cities are investing in programs based on harm reduction, a philosophy that the goal of treatment and recovery shouldn't be to force people to abstain from using drugs, but rather to reduce their risk of dying or contracting infectious diseases.

The approach, which has faced legal challenges across the country, has been criticized for enabling drug use, but proponents say it has been shown to drive down overdose rates and HIV transmission in other countries. They see promise in the Biden administration's publicly stated desire to prioritize and expand harm reduction efforts, with the president including $30 million in the American Rescue Act specifically for evidence-based harm reduction services.

Khadar Abi, another Generation Hope founder, said that he used opioids consistently when he was younger, until one episode led to his getting locked up in jail and ordered into court-mandated treatment. He said the experience was a wake-up call; it also brought him insight into the struggles of getting one's addiction under control.

"I just wanted to do better, having a second chance, knowing that some of the people who died gave a life to give me a second chance," he said.

Libor Jany • 612-673-4064

Twitter: @StribJany