Minnesota studying nonfatal drug overdoses to prevent fatal ones

State leaders are hoping that detailed tracking of drug overdoses in Minnesota will uncover effective ways to promote recovery and prevent death.

A correlation between homelessness and nonfatal overdoses in northeast Minnesota was one of the first publicly reported findings from the Minnesota Drug Overdose and Substance Use Surveillance Activity. Only 1% of the population in the region is homeless, compared to 29% of patients who recently received emergency hospital treatment for drug overdoses or misuse, according to a report publicized Thursday.

Whether homelessness is the cause or effect of disabling substance abuse is unclear, but the relationship is proof that doctors and public health workers need to increase their prevention efforts in this population, said Deepa McGriff, a drug overdose epidemiologist at the Minnesota Department of Health.

"It doesn't tell us the answer to the chicken or egg question, but it tells us there is a relationship — one we need to disrupt," she said.

The surveillance system puts Minnesota at the forefront nationally in the tracking of overdoses to try to stem the increase in fatalities. The number of fatal drug overdoses in Minnesota that were unintentional — or in which intent couldn't be determined — increased from 569 in 2018 to 1,256 in 2021, according to the CDC.

Too few states monitor nonfatal overdoses, even though they predict fatal overdoses just as well as mini-strokes predict major strokes, said Dr. Rahul Gupta, the White House drug czar. He visited the University of Minnesota on Wednesday and met with Gov. Tim Walz to discuss drug policies.

"We need to make sure we are treating that medical emergency as a medical emergency," he said of nonfatal overdoses.

Gupta has refocused U.S. drug policy away from abstinence alone and toward "harm reduction," or the idea of reducing dangers when people take illicit drugs. He is a proponent of broader access to test strips, which can identify unknown substances in illicit drugs that present heightened risks.

Cocaine-related deaths are on the rise in the U.S., partly because users are receiving drugs tainted with fentanyl, a highly potent opioid, or more recently with an animal tranquilizer called xylazine.

"They don't know what they're getting," said Dr. Elisabeth Bilden, an emergency physician with Essentia Health.

The Duluth-based hospital provider was one of the first to work with Minnesota's new surveillance system, tracking nonfatal overdoses at five of its emergency departments for the most recent report.

In addition to patient demographics, the surveillance system provides a detailed look at the substances patients take. Opioids, amphetamines and marijuana were most commonly found among nonfatal overdose patients in northeast Minnesota in recent years.

Tracking of Twin Cities-area patients started at the end of 2022, and showed that opioids were involved in almost all overdoses. Walz's proposed budget for the next two years seeks to add at least six more hospitals to the surveillance system and increase state lab capacity to handle the increase in drug specimen testing.

Bilden said surveillance of the types of drugs causing overdoses in different parts of the state is important. Testing found that opioids laced with xylazine have reached northern Minnesota, prompting revised training to doctors on treatment strategies.