Duluth – Rushed into the emergency room, the overdose patients are still reeling just minutes after being revived from the brink of death with a shot of opioid antidote.
Typically, doctors monitor them for a few hours. They might offer more antidote along with phone numbers and pamphlets for treatment options. Then, often, patients are simply sent home, where their intense cravings can lead to fatal relapses in the days or weeks they might wait to get more help.
But soon, specialists in Duluth will stand ready to bridge that treatment gap with the state’s first publicly funded opioid detox unit, according to the state Department of Human Services.
Set to open later this month, the unit, with six beds and its own doctor, nurse and staff, is aimed at reducing the high rate of opioid deaths in two northern Minnesota counties by speeding up access to treatment.
Organizers hope it will help catch patients at the moment they are likely to enter treatment — during a scare — and get them started on recovery rather than send them away.
“The withdrawal symptoms are really horrendous,” said Dr. Nicholas Van Deelen, an emergency room physician who sees opioid patients at St. Luke’s Hospital in downtown Duluth. “It basically drives them to do whatever they can to get another dose of opioid.”
‘We’re paving the way’
In northern Minnesota and in much of the state, opioid addiction treatment isn’t quickly or easily accessible, chemical dependency specialists say — even for willing patients who are in crisis. For most, it involves visiting an assessment office during regular business hours, then waiting days or weeks for a spot in a medication-assisted treatment program. In the meantime, intense cravings for the drug can lead to lethal relapses.
At the new opioid detox unit, at Duluth’s Center for Alcohol and Drug Treatment, six beds are split among two boarding rooms. Unlike the alcohol detox unit in the building, where police often drop off intoxicated people to sober up, the opioid detox patients will enter and stay voluntarily.
The rooms are welcoming, with carpet, overstuffed recliners and the soft glow of lamp light instead of overhead office lights — amenities that the alcohol detox units don’t have. Nearby, there is a tub room where patients can take a relaxing soak.
Staff will assess addiction and may get patients started on the treatment drug Suboxone, which eliminates opioid cravings, said Gary Olson, the center’s Chief Executive Officer. The drug shortens withdrawal symptoms that otherwise can last for days, including vomiting, diarrhea, excessive sweating and body aches.
They expect the average stay will be three to five days before patients are fast-tracked into treatment programs straight from there.
“We’re paving the way,” said Julie Seitz, the center’s clinical director. “There is no unit like this that we are modeling or mimicking.”
The problem is particularly acute in St. Louis County, which had the second-highest rate of opioid-involved overdose mortality in the state from 2011 to 2015, with 10.7 deaths per 100,000 people. Neighboring Carlton County had the highest rate with 12.4 deaths. The state average was 5.7 during that time.
The detox beds have been ready for several weeks. A doctor and nurse have been hired, but leaders have had trouble finding and hiring entry-level clinical assistants to staff the unit 24 hours a day. It’s a workforce shortage troubling many treatment centers, Olson said.
The unit is being created and funded for the first 21 months with $300,000 in state-administered federal grant money along with $450,000 from St. Louis County and $245,000 from the Sixth Judicial District.
Statewide, leaders are working to reform and speed up the treatment process and reduce opioid deaths with grants announced Friday to more than 30 agencies and organizations from $16.6 million in federal money.
“We know waiting for treatment can have disastrous effects,” Human Services Commissioner Emily Piper said in a statement.
Clay County’s detox center is getting grant money for a new coordinator to help fast-track access to opioid treatment, then support patients throughout treatment and their return to the community. The center is working toward administering Suboxone or other treatment drugs while patients are in detox, too, director Troy Amundsen said.
Minnesotans who use publicly funded treatment generally have to make an appointment for a county “Rule 25” assessment, then wait up to 30 days for a referral and perhaps even longer for a spot in a treatment program, according to the human services department.
Delays are “typical for what happens everywhere in the country, unfortunately,” said Dr. Gavin Bart, director of the Division of Addiction Medicine at Hennepin County Medical Center in Minneapolis. “If it were any other medical condition, people would be outraged by it.”
When people are in the emergency room “that is the place to begin treatment, not to give them a phone number,” Bart said.
Treatment providers are more plentiful in the metro area; Hennepin County Medical Center uses an addiction consultation service to speed up treatment access for all hospitalized patients, though that isn’t in full force in the emergency room yet, Bart said.
Fewer than 200 doctors or other qualified practitioners in the state are on a federal list as trained to prescribe Suboxone.
Bart credits the leaders in Duluth for creating the detox unit, but argues that it shouldn’t be necessary. Starting medications in the emergency room and linking patients to treatment right away should be standard, he said.
“It’s a move in the right direction and Duluth absolutely needs to be commended for it,” Bart said. “Ultimately we need a wider level of reform.”
Duluth leaders hope the opioid detox beds will provide a stopgap for northern Minnesota patients. While treatment delays aren’t ideal for people with alcohol or other addictions, they can be more lethal for those addicted to opioids.
“With alcohol, you usually get multiple chances,” Olson said. “With opioids, you may not ever see them again because they may be dead the next week.”