While opioid addiction affects a wide range of people, certain groups are disproportionately impacted due to social, economic and health-related factors. Unfortunately, the most vulnerable populations are often less likely to receive treatment for an addiction or substance use disorder.
In this episode of Off the Charts, Dr. Aaron Burnett, medical director for Regions Hospital emergency medical service and the St. Paul Fire department, and Steve Sampson, assistant chief of the St. Paul Fire department, discuss the opioid crisis on St. Paul streets and what they’re doing to meet people where they’re at. Listen to the episode or read the transcript.
The opioid crisis close to home
Since the 1990s, there’s been a steady increase in addiction and overdose deaths related to opioids (prescription and illegal), both nationally and within our local communities. Then, about five years ago, opioid use and misuse jumped exponentially. In Minnesota, the number of overdose deaths were nearly three times higher in 2022 than they were in 2018.
Steve recalls seeing a map in May of 2024 that showed the impact of the opioid crisis on St. Paul. “There was not a single corner, a single street, a single ward that wasn’t impacted by it.”
This increase is likely related to the COVID-19 pandemic, an increase in unhoused populations and a shift in the types of narcotics that people are using.
Aaron explains, “What we’ve seen is, individuals who are using drugs recreationally on the street have started to use opioids much more commonly. And that likely has some to do with the physician prescribing practices about 15 years ago and has some to do with the industrial quantities of fentanyl, which can be made in a factory.”
Addressing the immediate need
The first priority in an opioid emergency is preventing overdose. That’s where Narcan (naloxone) comes in. It’s a life-saving medication used when someone is experiencing or suspected of having an opioid overdose.
Opioids bind to receptors (attachment sites) in the brain and body that control pain and breathing. In high doses, they can slow breathing to dangerous levels or stop it altogether. Narcan acts as an opioid blocker. It quickly binds to those same receptors, displacing the opioids and helping the person start breathing again. While Narcan stops the overdose, it doesn’t help with withdrawals or the underlying addiction.
Steve says, “The withdrawal syndrome you go through when you stop opiates is very disturbing, very painful and unlike what we see with other drugs such as cocaine or methamphetamine.”
To manage withdrawal symptoms, people often take more opioids. So it’s not uncommon for people to overdose again, sometimes having multiple overdoses within 24 hours. This is heartbreaking and frustrating.
“Our folks were craving an ability to help these folks beyond what we currently had, which was essentially Narcan, and then the ability to get them to a hospital,” says Steve.
More than a short-term solution
Thanks to the new Suboxone program, teams responding to overdose calls are now able to offer help that may prevent future overdoses.
Suboxone is a medication that can help people break free of opioid dependence. It works by reducing withdrawal symptoms and cravings associated with stopping opioid use.
Aaron notes, “Studies in the medical literature show that if you get people started on Suboxone right after they overdose, the number of patients who remain sober, remain in treatment, and ultimately the number of patients who don’t die improves.”
Meeting people where they’re at
Suboxone has been used for decades to treat opioid use disorder (OUD) and other conditions. The difference is the medication is now being taken into the community and offered to vulnerable populations who didn’t have access to it before.
There are reasons that vulnerable populations may steer clear of traditional health care. For some, it’s the power imbalance between patients and providers. Others may feel let down by a system that hasn’t served them well in the past. And for some, legal concerns may be a barrier to seeking care. But the Suboxone program bypasses these concerns, allowing for timely, compassionate care.
“We have the ability to meet them where they are. Whether that’s an encampment, whether that’s in their mom’s basement, wherever it is,” Steve says. “And if they meet the certain parameters to receive the medication, we’ll give it to them. The other thing is that, if they’re not ready, we’ll just have those conversations, be able to follow up with them potentially in the future.”
Creating awareness on the front lines
Being able to offer Suboxone is a start. But there’s work to be done to create awareness about its availability and value. Steve, Aaron and their teams are working hard to share information about the program with community leaders, shelter workers, librarians and others who interact with vulnerable populations on a daily basis.
“They’re already kind of living in this world,” Steve says. “They know who those folks are that are suffering from opioid-related addiction. They know the groups and the encampments specifically that are ravished with these substances.”
Steve says these conversations are “generating additional awareness to what we’re showing up with, or what we can show up with.”
Partnering with the community for sustainable success
While there have been great successes so far, Steve and Aaron expect the program to change and evolve. One area of focus is connecting people with more comprehensive services to help them overcome addiction.
“We got good community partners who are helping to guide us, but we’re going to learn a lot along the way. And I have no doubt this will look a little bit different a year from now than it does today,” says Aaron.
