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Opiate prescriptions skyrocket in Minnesota

Clay Pirkola

For the past 20 years, 39-year-old Esko native Clay Pirkola has had a drug problem. For the past 10 years, those drugs have been prescription narcotic painkillers like Oxycontin, Vicodin and methadone.

Even though those narcotics - also called opioids - are highly controlled and can only be obtained through a doctor's prescription, Pirkola said during the time he was hooked on them he never had a problem getting his hands on any pill he wanted.

"You wake up every day and you need something," Pirkola said. "And you call around: Usually somebody knows somebody who has pills they'll sell, or there are people that will get a good deal from somebody and gather them up, and they'll go sell them.

"I had unlimited pills," he said.

One of the reasons it was so easy to get the drugs: More opioid painkillers are being distributed in the Northland and in Minnesota than ever before, a joint Duluth News Tribune and St. Paul Pioneer Press investigation has found.

Narcotic prescriptions used to combat pain nearly doubled from 2005 to 2011, when there was enough oxycodone and hydrocodone distributed in Minnesota to provide 18 pills for every man, woman and child. That's up from two pills per person in 1997.

Though Minnesota ranks low overall compared to the rest of the country in opiate use, its impact on the state has been no less devastating.

As the use of those painkillers has gone up, so have the rates of opiate addiction, crimes, arrests and deaths from the drugs in the state, the News Tribune and Pioneer Press found.

Particularly alarming, experts say, is that prescription pill addicts have been switching to heroin, and Mexican drug dealers have flooded the Twin Cities with some of the cheapest and purest heroin available in the U.S.

"Clearly, we have all the ingredients of a prescription opiate and heroin epidemic in the state of Minnesota," said Carol Falkowski, Minnesota's former drug-abuse strategy officer and a national expert on the issue.

Dr. David Schultz, the founder and medical director of the Minneapolis-based MAPS Medical Pain Clinics, said the state has reached a point where too many opiate-based drugs are being prescribed.

"We're doing that, in part, because of the new products that the drug companies are creating and marketing," he said, "Secondly, it's easy for a doctor to write a prescription. Patients are happy when they get a prescription, and doctors' satisfaction ratings go up because doctors are being judged on patient satisfaction. If they say no to a patient, then they'll give them a bad rating, and it may give them a bad income. There's a lot of perverse incentives to write a prescription, and that's an unfortunate situation."

Scope of the problem

This "epidemic," Falkowski and others said, has been steadily growing since about 2000, in conjunction with an increase in the number of prescriptions for opioids.

Opioids include opiates, which are derived directly from the opium poppy, and synthetic drugs that work like opiates. These drugs, which are tightly controlled by federal law, include narcotic painkillers like morphine, codeine, oxycodone and hydrocodone, as well as stimulants, such as Ritalin and Adderall, used to treat attention-deficit hyperactivity disorder and narcolepsy. It also includes methadone and suboxone, drugs used for treating opiate addiction.

Federal Drug Enforcement Administration data tracking the legal distribution of these drugs by three-digit ZIP code area show some parts of Minnesota have higher per-capita rates, but that those rates have been rising in all parts of the state.

The legal distribution of all opioids increased statewide by 72 percent between 2005 and 2011. The largest increases were in Ramsey County and the northwestern corner of the state.

Last year, Duluth had the highest rate of all opiate painkiller distribution in the state at more than 5,000 grams per 10,000 people. St. Louis County and Minneapolis were close behind. The southwestern corner of the state had the lowest rate at 1,600 grams per 10,000 people.

The distribution of painkillers increased 43 percent statewide since 2005, but this is tempered by the fact that usage of older drugs - like Demerol and codeine - have declined, while usage of the newer, more powerful drugs like oxycodone and hydrocodone have spiked.

The highest increase in oxycodone distribution was in Ramsey County (124 percent), the western Twin Cities' suburbs (102 percent) and the northwestern edge of the state (91 percent).

How the explosion began

When he was going through medical school in the 1970s, Dr. Faris Keeling of Duluth, who specializes in chronic pain for Essentia Health, said it was considered negligence to give opioid painkillers to any patient who is "not going to die soon."

"The belief was that everyone who took them for very long would become addicted," he said.

But over the next decade a better understanding of addiction developed - that while opioids would make users physically dependent on them, they wouldn't become addicted to them.

"Addiction is craving the drug and using it compulsively, and using it despite harmful consequences, and losing control of its use," Keeling said.

Doctors began prescribe opioids for cancer patients and found most could use them without getting addicted.

"As time went on, we asked: Why are we withholding this from people who have chronic pain due to other things? What about people who have severe medical conditions causing chronic pain? We started using it some for them," he said.

Pharmaceutical companies began to manufacture powerful narcotics like Oxycontin and pushed them not only to pain experts, said Dr. Marvin Seppela, the chief medical officer at the Hazelden treatment center, but also to primary-care doctors.


What has resulted is sobering:

• A three-fold increase in the number of Minnesotans who died from prescription opiates between 1999 and 2010. Centers for Disease Control data show 191 people died in 2010, up from 42 people a decade earlier.

• The number of Minnesotans seeking treatment for opiate addiction has shot up more than 100 percent since 2007, according to data from the Department of Human Services.

• Emergency rooms are reporting an increase in admissions for opiate overdoses. Local jails are finding an increased number of inmates reporting having used opiates just before being arrested.

"All the indicators came together and painted one big broad picture that heroin abuse was on the rise in the Twin Cities and the resulting heroin overdoses and deaths were also rising," said Hennepin County Sheriff Richard Stanek, who organized a joint press conference with Ramsey and Anoka counties last April to highlight the problem. "All of which, from a law enforcement perspective, are preventable and shouldn't be happening."

Drug-motivated crimes

Experts say diversion of the narcotics a reason there's been an increase in property in crimes in the state and in the Northland.

"In order to support an addiction to illicit drugs, you need to have a supply of money to purchase them, and many times that often gets addicts involved in criminal behavior - things that we see in the news such as burglaries, property crimes, shoplifting," Falkowski said.

All of these things are means that people use who are drug addicted in order to maintain the addiction. That's the relationship between addiction and crime. Addiction is not just a public health problem; it's a public safety problem."

Last week, Cloquet police Detective Darren Berg flipped through a stack of several dozen burglaries that his small department has had to investigate over the past year.

"I'd estimate that about 80 percent of these are in some way due to narcotics," he said. "When we get a burglary, nine times out of 10, people's prescriptions are taken. Often we're seeing people steal money, jewelry and turn around and buy narcotic drugs."

Abusing opiates also generally leads to using heroin, Falkowski said, as narcotics users eventually switch from the more expensive prescription drugs to the cheaper street drug.

'Cheating' his kids

When Clay Pirkola was abusing opiates, "there wasn't anything I wouldn't rip off or steal," he said.

Pirkola, the father of three children, went to prison five times after being convicted for burglary, trespassing and violating his probation numerous times from 2003 to 2011.

"I was cheating them," he said of his kids. When he wasn't getting high, he said he was sick while looking for a fix. "Every day when I woke up, my mind was saying: Get something; get something. It turned out to be a sad existence. It turned out to be a slave to pills."

Pirkola said he's trying to turn his life around and has been enrolled in the in-patient Teen Challenge Treatment Center in Duluth since March. He said he had a relapse in August when he took heroin while on a day pass, but since then he's been clean.

His goal, he said, is to reunite with his family, and he hopes the tools he's learning in treatment will help him get there.

"What I'm learning is how to put God first, and hopefully other stuff will fall into place," he said.

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