For every overdose death, there were 14 nonfatal overdoses in 2020, the Minnesota Department of Health reported on Thursday. (Patrick Sison, Associated Press/The Minnesota Star Tribune)

Minnesota's emergency rooms saw an 18% increase in nonfatal drug overdoses in 2020, the state Department of Health reported Thursday.

Opioids and stimulants accounted for 57% of the 7,290 nonfatal overdoses that did not appear to be self-harm.

However, when cases of self-harm were included, the state's hospitals saw 14,475 nonfatal overdoses that were treated in the emergency department or admitted as patients.

The increases came as fatal overdoses reached a record high in 2020 of 1,008, up 27% from 2019.

For every overdose death, there were 14 nonfatal overdoses, according to the department's report.

"The report on nonfatal overdoses in Minnesota is a reminder that so many lives are tragically impacted by substance use," Health Commissioner Jan Malcolm said. "The COVID-19 pandemic has been the biggest public health issue in the world for almost two years now, but the other pressing public health issues have not gone away. The opioid epidemic continues to be pervasive and requires continuing, comprehensive drug overdose prevention and response efforts."

Nonfatal overdoses increased faster in the seven-county metro area, continuing a trend that began in 2019. The metro had a per capita increase of 21% in 2020, compared with a 10% increase outside the region.

Communities of color have been disproportionately affected. American Indians were nine times more likely and African Americans three times more likely than white Minnesotans to experience a nonfatal overdose of unintentional or undetermined intent.

"As with fatal overdose data, we see populations most impacted by systemic racism are more often affected by substance use," said Dana Farley, the department's overdose prevention supervisor.

"Systemic racism and lack of access to recovery resources hinder recovery efforts for many Minnesotans. The Minnesota Department of Health is working to amplify the work of our community partners who provide needed support for people in their recovery journey."

Fatal and nonfatal overdoses are increasing partly because people are using counterfeit pain pills and other drugs that they don't know are laced with fentanyl, a powerful synthetic opioid.

On Monday, the U.S. Drug Enforcement Agency issued a public safety warning, its first in six years, about counterfeit pills that contain fentanyl and methamphetamine.

"Counterfeit pills that contain these dangerous and extremely addictive drugs are more lethal and more accessible than ever before," DEA Administrator Anne Milgram said. "In fact, DEA lab analyses reveal that two out of every five fake pills with fentanyl contain a potentially lethal dose."

Dr. Sara Polley, a medical director at Hazelden Betty Ford Foundation who works with younger patients, said the pressures caused by the COVID-19 pandemic are contributing to substance use disorders.

"We know a lot of people are under a lot more stress than they were before, particularly young people," she said. "Now they've been attempting to get back into normal life. We've seen a lot of those kinds of young people coming into treatment."

"The fact that there's a lot of overdoses that were nonfatal means that there are a lot of people struggling that need help," Polley said. "We should focus on expanding treatment to people with substance use disorders."

Glenn Howatt • 612-673-7192

Twitter: @GlennHowatt