Heroin emerges as a growing problem statewide, and locally

by Joni Astrup

Associate Editor

Heroin has emerged as a growing problem in Minnesota, making inroads in Elk River and communities across the state.

“We don’t live in Lake Wobegon. This can happen anywhere,” said Carol Falkowski. She is the former drug abuse strategy officer for the state of Minnesota who now does educational workshops through her company, Drug Abuse Dialogues.

Minnesota had never really seen much of a heroin problem, Falkowski said, but over the past decade there has been a spike. Falkowski said it’s related to a national increase in the abuse of prescription painkillers.

“Many people can become addicted to prescription painkillers, and if they live in an area that has high-purity, low-cost heroin, they will switch to heroin use because it’s more affordable,” she said. Heroin is also readily available, she said.

Carol Falkowski
Carol Falkowski

A three-year study of 19 U.S. cities where there was access to heroin from Mexico found that heroin in Minneapolis had the highest purity and the lowest cost of the 19 cities, she said.

The heroin typically comes from Mexico, said Falkowski, who noted that Interstate 35 which runs through Minnesota ends at the Mexican border. Studies have shown that drug distribution can follow major transportation routes, she said.

Who uses?

One in five people admitted to Twin Cities treatment programs in 2012 needed treatment for heroin or other opiates such as prescription painkillers, according to Falkowski. That’s up from about 5 percent in 2000.

Approximately half of the people coming into treatment for heroin are white males ages 18 to 25. Many are from suburban areas and many started out abusing prescription pain medications, Falkowski said.

“It’s important for people to realize that these drugs are so accessible to young people,” she said. “It can happen to any young person in any community. … I don’t know anything that is more difficult to deal with than a child who is involved with substance abuse. It’s a serious matter. It’s important to find help before it’s too late because we are seeing record numbers of young people dying.”

Fifty years ago, illegal drugs tended to be more localized in central urban areas, but that’s no longer the case, she said. Today, young people often get heroin and other drugs by texting and then meeting someone in places like a parking lot of a mall or a fast-food restaurant.

“It’s not a matter of hanging out in a dark alley with some dangerous-looking people anymore,” she said.

Unlike many other drugs, heroin has high potential for abuse, addiction and overdose, she said.

“Heroin is such a strong drug. A little bit too much can accidentally suppress breathing, so it’s very easy to overdose,” she said.

And as addictions develop, people also develop a tolerance for the drug, so more and more is needed for the same effect.

Other factors affecting overdose are that it’s a street drug, so purity varies. And, people who have gone through treatment but then later reuse sometimes overdose if they use the same amount they did before they went into treatment.

“That’s when many accidental overdoses happen because they do not have that tolerance anymore,” she said.

Because the rise in heroin use is relatively recent in Minnesota, Falkowski said the treatment industry in the state is on a learning curve about how to treat opiate addictions.

She said two drugs, buprenorphine and methadone, can be effective, but many treatment providers in Minnesota are reluctant to use medications.

Complex to solve

Because of the relationship between prescription painkillers and heroin use, solving the problem is more complex, Falkowski said.

In 2010 more than 210 million painkiller prescriptions were written in the United States. Nationally that’s enough to medicate every adult for a month, Falkowski said.

“That’s how plentiful these prescription painkillers are. So that’s why solving this problem, unlike solving other illegal drug abuse problems, is more complicated, and it involves changing the way we practice medicine and prescribe painkillers,” she said.

Problems can start as easily as sharing some leftover sports injury pain pills at a party or by “stealing (pills) from grandma and grandpa’s sock drawer or medicine cabinet,” she said.

Falkowski, who retired a year ago as the drug abuse strategy officer for the state of Minnesota, said one of her last tasks was working with eight state agencies to develop Minnesota’s first statewide substance abuse strategy. It identified heroin and other opiates as Minnesota’s No. 1 substance abuse problem and included three recommendations:

•Require continuing medical education units for doctors on opiate prescribing and on the basics of addiction.

•Expand participation in Minnesota’s Prescription Monitoring Program, designed to prevent people from getting painkiller prescriptions from multiple doctors. Participation is currently voluntary.

•Do more education.

“None of those three things resulted in legislation this past session,” Falkowski said. “I hope they do better next time.”

For more information about drug abuse, Falkowski recommends www.drugfree.org.

Click here to read a report by Falkowski titled “Drug Abuse Trends in Minneapolis/St. Paul Minnesota: June 2013.”