Austin Paolo had rebelled against previous efforts to overcome his opioid addiction, but his family remained hopeful when he turned to the Pinnacle clinic in Brainerd for medication to reduce his cravings.
Instead, the drug to treat the addiction killed him. The 26-year-old died in 2014 from an accidental overdose of prescription methadone.
Paolo's death underscores a stubborn dilemma as Minnesota confronts an epidemic of opioid addiction and overdose deaths. Methadone is one of the few proven treatments for opioid addiction, and physicians say it remains an essential tool. But it is addictive and dangerous in its own right, and in Minnesota it is provided largely at for-profit clinics with histories of lawsuits and licensing infractions.
Attorney Phil Sieff went so far as to ask, "Is the cure as bad as the disease?" in a presentation last month to 300 Minnesota lawyers.
"When it is done correctly, it can be a valid treatment," said Sieff, a medical malpractice attorney. "But when there is any mistake ... the problems and the risks are catastrophic."
As opioid overdose deaths have spiked in Minnesota — from 54 in 2000 to 355 last year — so has the number of methadone clinics and patients. Across the state, 16 clinics now treat some 6,700 addicts.
But methadone deaths have risen in tandem. Minnesota is on pace for more than 70 this year, up from just five in 2000, according to a Star Tribune review of death certificate data through September.
Methadone is a synthetic opioid that must be taken long-term to block the highs and cravings caused by other opioids. It can be difficult to manage, because its toxicity varies from patient to patient and it stays in the body long after its effects wear off. Patients with heart conditions face increased risks.