Overdose fatalities reached 1,008 in 2020, with the first large increase coming in March as the state saw its first coronavirus cases and deaths, according to the Minnesota Department of Health.

The onset of a previously unknown virus that already had taken many lives across the world led many treatment and outreach resources to abruptly shut down, limiting access and support to those with substance use disorders.

"With COVID there's this terrible storm about lack of access to treatment medications, housing and treatment facilities," said Dr. Ryan Kelly, an assistant professor of medicine at the University of Minnesota Medical School. "It made it more difficult to access those things and people died because of that."

Drug-related deaths increased 64% in March 2020 compared with the previous year, then peaked at over 100 fatalities in the months of May and August.

Even before the pandemic, America was in the throes of a drug overdose crisis, including an increasing and more dangerous illicit drug supply and a lack of mental health treatment and supportive services, according to treatment advocates and family members.

"There needs to be so much more education about how to treat people with addiction and mental illness issues," said Judy Greske, who lost her son Jason Dobosenski in September to a drug overdose.

"COVID has led to a huge increase for a lot of reasons," said Marissa Bonnie, who does outreach for Southside Harm Reduction Services in Minneapolis. "A lot of people have isolated way more, which can lead to people using alone or having limited resources."

That includes access to lifesaving naloxone, which can reverse the effects of an overdose, as well as clean needles to prevent infections, Bonnie said.

Last week, federal officials eliminated a rule that required doctors and other health care professionals to receive more training in order to prescribe buprenorphine, a medication for opioid use disorder.

Treatment advocates hope the change will make treatment medication more available.

However, since the COVID-19 pandemic began, the number of buprenorphine prescribers has increased 12% in Minnesota, although that only includes professionals who consent to be listed on the website of the Substance Abuse and Mental Health Services Administration, a federal agency.

Still, 31 Minnesota counties do not have any prescriber listed, according to a Star Tribune analysis.

"There are major treatment deserts across the United States, especially in rural areas," said Dr. Gavin Bart, director of addiction medicine at Hennepin Healthcare. "I am hopeful that many of the changes that have occurred with COVID in allowing telemedicine will continue beyond the pandemic that at least will bring [addiction] treatment to telemedicine."

As in previous years, opioids, which include pain pills and heroin, were among the substances that led to the most overdose deaths, although some deaths are linked to several different types of medications.

But fentanyl, a synthetic opioid developed as a painkiller more powerful than morphine, is now being mixed in with many street drugs, leaving users unaware of what they are taking.

"It is likely that a year of increased stress and isolation, economic desolation, political turmoil and civil unrest have contributed to this but fentanyl is really the main indicator," said Bart. "It is greater and greater penetration of fentanyl into the drug-using market."

Altogether, deaths linked to fentanyl and closely related compounds rose 81% in 2020.

Dobosenski, 36, was one of those who died taking heroin laced with fentanyl.

"Heroin is bad enough but when they are getting and using the dose that isn't safe for them they are getting fentanyl," said Greske, a paramedic with Mayo Clinic Ambulance in Duluth.

In her 23 years on the job, Greske was on the front lines when overdose deaths became more common across the state. In 2000, Minnesota had just 129 drug overdose deaths, according to state officials.

"My heart would just sink every time I would go out on a call on an overdose," she said. "As a mother you can imagine through those times I had to play out in my head what if. What if he doesn't make it? Unfortunately, my worst fear came true."

After he had a car accident in his late teens, Dobosenski was prescribed pain medications, beginning a relationship with opioids that is familiar to many Minnesota families.

"When he wasn't getting it prescribed to him anymore that is when he went to the heroin," Greske said. "It is cheaper and easier to get."

At the same time, he sought help for underlying mental health issues but never found treatment that worked.

He did find some success with medication-assisted treatment for his opioid use, but that often was interrupted due to affordability issues, problems with insurance coverage or the lack of mental health care.

"It was such a complicated cycle for 10 years and more that ended this way," Greske said.

The problems are compounded among groups that historically are underserved by the health care system.

Compared with Minnesota's white population, Native Americans are seven times as likely and Blacks are twice as likely to die of a drug overdose, according to the state Health Department based on 2019 data. Statistics have not yet been compiled for 2020.

"We don't need to wait for a report. We know family members, we know friends," said Jase Roe, a case manager at Homeward Bound, a shelter that serves the Indigenous population.

When his clients leave the shelter, they have difficulty finding services, including drug treatment, housing and mental health care.

"There's no place for them to go, so they self-medicate," he said. "We need more culturally responsive services that are in Minneapolis."

Minnesota Department of Health officials say they are working with community groups, emergency medical services and harm reduction agencies to connect people to treatment resources, as well as providing naloxone to public safety agencies, drug users and family members.

"All of these deaths are preventable and it is our goal to prevent these deaths," said Sam Robertson, drug overdose prevention coordinator for the health agency.

Overdose deaths also increased for non-opioid drugs, including a 44% rise in deaths from psychostimulants, including methamphetamine, and a 70% growth in fatalities from benzodiazepines.

In the seven-county metro area, overdose deaths were up 40%, with a 21% escalation outside the metro.

(Patrick Sison, Associated Press/The Minnesota Star Tribune)