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Combating Heroin’s rapid spread

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DULUTH -- Law enforcement officials and health experts say they have been taken aback by the sudden emergence of heroin as a player in the drug scene of northeast Minnesota and northwest Wisconsin.

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While officials acknowledge that the highly-addictive, widely available drug likely won’t be completely eradicated any time soon, they remain hopeful of at least getting the problem under control.

“Nothing good comes quickly,” said Duluth police Lt. Steve Stracek, commander of the Lake Superior Drug and Gang Task Force. “It’s going to take a lot of trial and error to find the right solution.”

The proposed solutions are varied, but there’s one thing that most everybody agrees on: Stopping the flow of heroin is going to take a unified response.

“This is a community problem that law enforcement can’t solve alone, treatment centers can’t solve alone, social services can’t solve alone, mental health professionals can’t solve alone, corrections or incarceration can’t solve alone,” said Dennis Cummings, executive director of Duluth Bethel.

“This is a community problem that really takes a community response from all agencies,” Cummings said.  

Here’s a look at what’s being done, and what’s being considered:

Law enforcement approach

Law enforcement officials and prosecutors are quick to admit that traditional policing methods alone won’t be enough to stop the outbreak of heroin.

“We can’t incarcerate our way out of this problem,” St. Louis County Attorney Mark Rubin said. “You can’t put everybody in jail or prison because they’re using heroin. The traffickers belong in prison. But those who are addicted, we’ve got to find a way to address their addiction in a way that they can get on with their lives once they’ve been held accountable for their criminal activity.”

While prison isn’t an option for most drug offenders, officials say it’s important to have stiff penalties for the major traffickers.

“Many of the big dealers aren’t even using any drugs,” Stracek said. “They’re simply in it for the money.”

But what about the street-level offenders?

Officials say it’s important to ensure that addicts get the treatment they need. Police and prosecutors have applauded the Duluth Drug Court. Through the program, drug defendants are closely monitored as they receive treatment and frequent drug testing.

“I think what we’ve learned from Drug Court is that it’s not enough to just put someone on probation and say, ‘Don’t use that drug,’” Rubin said. “If we’re going to do that, we also have to combine it with some type of supportive program. We have to recognize the power of addiction.”

Stracek said the community could also benefit from a walk-in center for people to get help. He noted that police routinely bring intoxicated individuals to a detoxification center, but said there is no similar option for drugs.

“As we encounter addicts on the street, there’s really no place where we can bring them in for immediate help,” he said. “There are not a lot of resources out there.”

Above all else, law enforcement officials say it will take a large-scale education campaign to raise awareness of the dangers of heroin and prescription drugs.

“There needs to be an education component,” Duluth Police Chief Gordon Ramsay said. “The sooner we can get kids engaged, the more souls we can save.”

Fighting Drugs with Drugs

Methadone is a sore subject in the region, in part because of a 2012 News Tribune series that uncovered problems in clinics dispensing the drugs in the state. The one clinic in Duluth, the Lake Superior Treatment Center, is operating under a revoked license.

Moreover, two Carlton County employees were killed in a 2012 accident that was linked to methadone. The driver of the other car pleaded guilty to vehicular homicide earlier this year and admitted in court that she had been under the influence of the substance.

Richard Howell, who leads a recovery group at the Damiano Center, is unimpressed by the approach.

“I mean, so you kick them off one addiction and you put them on another,” Howell said. “I don’t think that’s a cure.”

But others say methadone, administered appropriately, can be an effective treatment. They liken it to treating diabetes with insulin.

“The most effective treatment for opiate addiction is the use of medications,” said Carol Falkowski, CEO of the nonprofit Drug Abuse Dialogues. “If this is a disease, and if there’s medicine that can be brought to bear to help treat this, it should be brought to bear.”

Kim Munoz, a Carlton County chemical dependency case manager, agreed it can be helpful under carefully monitored circumstances.

“If it’s done right, and the person is motivated, it can be effective,” Munoz said.

“And it does allow people to go up to the clinic at 5:30 in the morning and still get to a job at 8. Some successful people actually do the program and leave the program.”

Methadone can be dispensed by doctors as a painkiller, but as an addiction treatment only at specially licensed clinics. Suboxone — the generic name is buprenorphine — can be prescribed by doctors.

Most doctors don’t want anything to do with it, said Dr. Charlie Reznikoff, an addictions specialist at Hennepin County Medical Center.  “But the intent was that primary care doctors would take it on,” he said during recent talk at Essentia Health-St. Mary’s Medical Center.

Reznikoff encouraged doctors to reconsider suboxone, saying it’s frequently successful. It’s taken only once a day and, even when stopped, still blocks receptors for more than 24 hours.

“They’re awake,” he said. “It’s something that they take once a day. They couldn’t get high if they wanted to. And … their spouse calls you and says, ‘I have my spouse back again. Thank you.’ ”

Needle Exchange

A byproduct of injections can be infections such as HIV and Hepatitis C passed through dirty needles. That’s one reason the Rural AIDS Action Network sought to establish a syringe exchange in Duluth, said Peter Golden, who directs the downtown facility.

The original plan late last summer to locate the exchange at the Center for Drug and Alcohol Treatment, located at 26 E. Superior St., drew widespread opposition because of its proximity to Lake Place Park and the Last Place on Earth, the head shop that at that point had only recently been shuttered.

“To open an exchange program a few blocks away to address a valid public health issue was bad timing,” said Sarah Gordon, hepatitis specialist for the Minnesota Department of Public Health.

Instead, the exchange quietly opened on Sept. 23 at 114 N. First Ave. W. and has had no major issues, Golden said. From then through the end of April, the exchange gave out 36,245 clean syringes and disposed of 26,727 dirty syringes, Golden said.

Clients are asked their drug of choice, and the number one reason has been heroin, followed by opiates and methamphetamine, he said. Testing for hepatitis C and HIV is offered along with referrals for treatment.

Ramsay and several other city officials were critical of the initial plan to open the exchange on Superior Street. But Ramsay said there have been no major issues at the new location and he remains supportive of the program’s mission.

“I think we worked with them and now they have a motto for going into a community and how to work with the community on getting established,” Ramsay said. “It was timing and atmosphere downtown at the time. … It was a circus down there.”

Gary Olson, CEO of the Center for Drug and Alcohol Treatment, said he still hopes eventually to have the syringe exchange as part of a clinic where methadone would be available in another location. That would give clients direct access to treatment, he said.

A Miracle Drug?

Known by the brand name Narcan, naloxone is administered to reverse the effects of heroin overdose.

“For a critical overdose we give them a small amount, and you go from comatose to full, screaming awake in seconds,” said Dr. Chris Delp, an emergency room physician at St. Luke’s hospital. “It’s amazing to watch.”

But it is no fun for the patient.

“It’s going to put them in withdrawal, immediately,” Olson said. “Serious withdrawal. So it’s a very unpleasant experience, but it will save their life.”

Currently in Minnesota, paramedics can dispense naloxone. Legislation passed this session will expand that to include police officers, EMTs and treatment center personnel, Gordon said. Similar legislation was also passed and signed into law in Wisconsin this year, requiring EMTs to carry naloxone and allowing law enforcement and firefighters to carry the drug as well.

“Our officers in the field are the first on scene,” Gordon said. “And nobody likes to show up and see a young person dying and not be able to stop it.”

Nicknamed Steve’s Law after a Minnesotan who died of a heroin overdose, the bill passed unanimously in both houses and Gov. Mark Dayton signed it into law on May 9.

Experiences in the field confirm the value of police carrying naloxone, Gordon said. Within the first year after all 200 Quincy, Mass., police officers were trained to use naloxone, it was used 179 times, and 173 lives were saved, she noted.

The naloxone legislation has been well received by law enforcement officials as well.

Ramsay said the drug reminds him of a famous scene from the 1994 film “Pulp Fiction.” In the cult classic, John Travolta’s character gives a life-saving adrenaline shot to the chest of Uma Thurman’s character, who had overdosed on heroin.

Ramsay, wanting to see naloxone in action, recently went out on an overdose call and saw paramedics revive a 41-year-old man.

“It literally brings them back to life,” he said.

Granting Immunity

A second part of the legislation recently passed in Minnesota and Wisconsin has been more controversial.

New legislation in both states will grant limited immunity to anyone who calls 911 to report a drug overdose. The new laws are aimed at saving lives by encouraging people to call 911, even if they have drugs or paraphernalia in their possession.

Studies show 52 percent of people who witness an overdose won’t call 911 because of fear of police involvement, Gordon said.

The new measure means minor drugs or paraphernalia on the scene of the emergency won’t result in arrest, Gordon said.

“It’s not a get-out-of-jail free card,” she said.

But law enforcement officials have been critical of the legislation, saying it could let dealers off easy.

“You’d hate to think that somebody that maybe supplied the drugs that caused the problem in the first place has complete amnesty,” Stracek said. “It’s kind of like if you shoot somebody and then say, ‘Well, if I call 911, I’m good to go.’”

Ramsay, president of the Minnesota Police Chiefs Association, has also expressed concerns.

“It’s been compared to the alcohol amnesty bill for under-agers that went through couple years ago,” he said. “It’s very different. The issues with alcohol are very different than heroin.”

But big-time drug dealers won’t be on the scene anyway, Gordon speculated.

“People get their drugs and they go home and it’s usually a group of friends,” she said. “You’re not going to find the Mexican cartel in Joey’s living room.”

Rubin said it’s important to understand that police and prosecutors aren’t trying to throw the book at people who save lives by calling 911 for overdoses. Often those cases aren’t charged at all. And when they are, Rubin said, prosecutors always consider the actions of the defendant.

“What the public needs to understand is law enforcement along with our office we take those things into consideration already,” Rubin said. “I kind of like the fact that we have that discretion to take in the reality of the situation when we’re charging and then resolving cases.”

Efforts Underway

Collaboration is a key to fighting heroin in the Northland, those on the front lines say.

“Everybody’s encountering this epidemic in different ways and levels and saying, wow, let’s work together to see how we can proceed differently,” said Mark Nelson, division director of adult services for the St. Louis County Public Health and Human Services Department.

One result was the formation, more than a year ago of OARS — the Opioid Abuse Response and Strategies work group. Comprising government officials, medical professionals, addiction service personnel, individuals from social services, law enforcement and others, the group seeks to provide a cohesive response to the problem, Nelson said.

It’s already making a difference, said Dr. Elisabeth Bilden, a medical toxicologist at Essentia Health, who is a member of the group.

“I’ve had a few cases now, and it has been so much smoother trying to help patients get to where they need to be once they are done being in the hospital,” Bilden said. “That summarizes it exactly, is bringing people together, and then coming up with strategies.”

Community conversations are needed, Gordon said, because it appears heroin is starting to become a drug without a gateway from other substances.

“This is so prevalent and so easy to get,” Gordon said. “I think as communities we really need to talk about this … and talk about why folks are suing and address some of those root causes.”

Tia Conley of Duluth said she saw an epidemic of heroin use among young people in the Twin Ports through her involvement in the community, so she started a coalition to combat the drug.

“I couldn’t sit there and watch another young person die because of addiction,” she said.

Through her Resources Against Drugs group, Conley put together a curriculum for support groups and launched a website with resources for families affected by drug abuse. She also gives occasional speeches about the dangers of heroin.

Conley said she believes a statewide awareness campaign is needed to stop the heroin outbreak. She pointed to the “Click it or Ticket” advertising campaign that has been used by traffic safety departments to encourage the use of seatbelts.

“Change happens in numbers,” Conley said. “The more people we have standing up, saying we don’t want this in town, the more likely we are to have success.”

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