News and Views

Minnesota overdose deaths up sharply last year

Minnesota drug overdose deaths hit a record high last year, mirroring a pandemic-era trend also seen in other so-called deaths of despair, like suicide and alcoholism.
The number of Minnesotans who lost their lives to drugs has more than doubled since 2018, Christopher Ingraham reports, at nearly 1,500. Fentanyl deaths are up more than four times since 2018 — the year the Legislature passed major legislation aimed at addressing opioids.
Minnesota is not unique in this rapid increase in overdose mortality: Nationwide, the number of annual drug deaths increased from about 70,000 in 2018 to nearly 110,000 last year. As in Minnesota, fentanyl is driving much of the nationwide surge, rising from less than half of overdose deaths in 2018 to roughly two-thirds last year.

We wanted to share a report that may be of interest to you. The State of Minnesota Minnesota Management and Budget MMB’s Impact Evaluation Unit, recently completed a rigorous evaluation of peer recovery services (PRS) for substance use disorder (SUD). This evaluation is part of the Minnesota legislature’s request of MMB to review the efficacy of investments in the opioid epidemic response and human services, more generally.

PRS for SUD is a form of non-clinical support where people who are more established in long-term recovery from substance use disorder come along side people who are newer to recovery and provide advice and guidance in the treatment process, help with systems navigation and access to resources, and provide an empathetic and listening ear. In 2018, this service became Medicaid-reimbursable. Our study examined the impact of participating in Medicaid-reimbursable PRS.

Overall, Minnesota's results indicate PRS is a promising service, but there are challenges, including variation in PRS delivery and the need for improved training, mentoring, and supports for peers and participants. Evidence suggests building this supporting infrastructure can improve participant outcomes. Specifically, we find:

  • Patients with at least one PRS session were more likely to complete outpatient treatment in the follow-up year than comparison patients. At the end of follow-up, PRS patients were 61% more likely to complete outpatient than the comparison group.

  • PRS patients were also more likely to visit a physician’s office for medical care than comparison patients. In the first quarter of follow-up, 73% of PRS patients visited a physician’s office compared to just 62% of comparison patients. This difference, however, only lasted for a brief duration (~3 months).

  • We found no impact of PRS on diagnosed non-fatal overdose, all-cause mortality, inpatient treatment admission, housing instability, or child welfare maltreatment reports relative to the comparison group.

This report and other evaluations can be found on MMB website here: https://mn.gov/mmb/impact-evaluation/reports-and-publications

You can also directly read the PDF File at this link https://mn.gov/mmb/assets/MMB_PRS_report_final_20220718_tcm1059-534084.pdf


Minnesota joining other states to roll out 988 mental health crisis lifeline on July 16

New three-digit dialing code streamlines access to mental health crisis support

Starting Saturday, July 16, people facing a mental health crisis can dial 988 to connect to support. The change is part of a nationwide effort to transition the National Suicide Prevention Lifeline to a phone number people can more easily remember and access in times of crisis. The shift also includes an online chat feature and new texting option.

The new 988 dialing code will serve as a universal entry point so people can reach a trained crisis counselor who can help, regardless of where they live. Anyone can dial or text 988 24-hours a day, seven days a week, to reach crisis support or use an online chat feature to connect with crisis support. People can also dial 988 if they are worried about a loved one who may need crisis support.

“Supporting mental health is a critical public health need, and one of the best ways we can do that is to make it as easy as possible for people to get the help they need when they need it,” Minnesota Commissioner of Health Jan Malcolm said. “Our hope is that 988 can be an easier way for people experiencing mental health crises to get support quickly.”

The Lifeline 10-digit number, 1-800-273-TALK (8255), will continue to be available and will route people to the same resources. People should call 911 if they suspect drug overdose or need immediate medical help.

Suicide is a serious and growing public health concern across the United States and in Minnesota. The number of suicide deaths and the suicide rate in Minnesota has increased consistently for 20 years. MDH data show:

  • From 2016 through 2020, there were more than 10,000 hospital visits for self-harm injuries in Minnesota (i.e., suicide attempts) and those were mostly among people ages 10-24, predominantly females.

  • Each year about 75-80% of suicide deaths are among males.

  • Each year about 50% of suicide deaths are the result of a firearm injury. Suicide usually represents 70-80% of all firearm deaths.

Moving to a shorter dialing code is an important step to help reduce suicide, and it is part of a larger push to improve options for Americans facing a mental health crisis. In moments of crisis, it can be challenging to look for resources or even just remember what number to call. Through 988, the Lifeline number will be easier to remember, and more accessible through chat and text. This will create more ways and make it easier for the public to find support.

About 988 in Minnesota

The Lifeline is a national network of over 200 call centers. Minnesota has four Lifeline centers that connect callers to nearby or state-specific resources and services quickly and efficiently.

Minnesota calls may be routed to the Lifeline’s national back-up centers when the four call centers are at capacity. The National Suicide Prevention Lifeline has several back-up centers that answer the overflow of calls from across the country. This will not change level of service.

Interpretation services are available through calling the number. Currently, chat and text are only available in English.

To reach the Veterans Crisis Line, dial 988 and Press 1. Calls will route to the same trained Veterans Crisis Line responders. The Veterans Crisis Line will still be available by chat (VeteransCrisisLine.net/Chat) and text (838255).


The Following Links discuss Sleep deprivation and addiction/recovery.


https://destinationhope.com/addiction-and-sleep-deprivation-a-vicious-cycle/

Insomnia and other sleep problems can be difficult for anyone to handle. When drug or alcohol abuse is added to the mix, the combination of conditions can create a vicious cycle that is hard to break on your own. Substance abuse and sleep deprivation make each other worse when they occur at the same time, and one condition often triggers the other. Not only is insomnia a common consequence of addiction, but it also affects people undergoing drug or alcohol treatment.

People who have entered treatment for drug or alcohol addiction are often surprised to experience insomnia during the process. One study of recovering alcoholics indicated that 75 percent of these individuals suffered sleep disturbances during the period immediately following detox. These sleep issues can persist throughout the early weeks of recovery.

Without intervention, ongoing insomnia and other sleep problems can increase the risk of a relapse. It’s essential for addiction treatment centers to address the issue of sleep disturbances in their treatment plans.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936493/

Sleep disturbances are extremely common in the early stages of recovery from alcohol dependence and may persist for several months despite continued abstinence. Studies indicate that sleep disturbances independently increase the risk for relapse to alcohol, suggesting that targeting these problems during recovery may support continued abstinence. However, there is limited information in the addiction literature about available and effective treatments for sleep disturbances in recovering alcoholic patients.

https://nida.nih.gov/about-nida/noras-blog/2020/03/connections-between-sleep-substance-use-disorders

Nora D. Volkow, M.D., is Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health. NIDA is the world’s largest funder of research on the health aspects of drug use and addiction.

“Most common mental disorders, from depression and anxiety to PTSD, are associated with disturbed sleep, and substance use disorders are no exception. The relationship may be complex and bidirectional: Substance use causes sleep problems; but insomnia and insufficient sleep may also be a factor raising the risk of drug use and addiction. Recognizing the importance of this once-overlooked factor, addiction researchers are paying increased attention to sleep and sleep disturbances, and even thinking about ways to target sleep disruption in substance use disorder treatment and prevention.”

https://www.pcpcc.org/resource/sleep-and-addiction

When people don’t get enough sleep, their willpower and self-control are lower than when they do. This can lead to relapses for people with drug addictions. Why Sleep is Important in Addiction Recovery Overcoming substance abuse necessitates a period of drug detox, where you eventually eliminate drug use completely. This period is extremely challenging as withdrawal symptoms occur.

One of the symptoms of withdrawal is trouble sleeping. As insufficient sleep is correlated with poor self-control, it’s important for recovering addicts to do what they can to get enough sleep and reduce the chances of a relapse. What’s more, sleep helps the body and mind to recover, and physical and spiritual healing are an important part of the recovery process.

Because all substance abuse disorders are tied to disrupted sleep, learning ways to enhance your ability to sleep can help you overcome drug addictions.

https://batonrougebehavioral.com/the-link-between-sleep-quality-and-addiction-recovery/

Sleep quality and addiction recovery have a deeply complex and interwoven relationship. Both using and withdrawing from drugs and alcohol can make getting good sleep harder, and vice versa. So if you’re suffering from a mental illness on top of your addiction, it can be doubly challenging to get the sleep you need to successfully recover from these conditions.

Not getting enough sleep during recovery leaves you vulnerable to relapse and worsens your mental health. Luckily, with the right treatment, it’s possible to recover successfully, avoid relapse, and improve your sleep problems along the way.

Sleep Deprivation Increases Vulnerability to Addiction

Research has demonstrated that people with insomnia or other sleep problems are at higher risk for developing a drug or alcohol addiction. It makes sense; one of the first solutions that people reach for when they can’t fall asleep is to use a substance. Whether it’s Ambien, alcohol, or marijuana, many people with insomnia turn to using drugs to help them sleep. They might also need other substances during the day to keep them awake. Both of these, unfortunately, can quickly turn into an addiction.

Being sleep-deprived also has been shown to lead to cognitive impairments, like increased impulsivity, poor judgment, or irritability. This might be another way that lack of sleep can lead to increased risk for drug and alcohol abuse; if you’re sleep-deprived and not thinking clearly, you’re more likely to engage in risky behaviors like drug use.

https://pubmed.ncbi.nlm.nih.gov/15532213/

Numerous studies dissecting the basic mechanisms that control sleep regulation have led to considerable improvement in our knowledge of sleep disorders. It is now well accepted that transitions between sleep and wakefulness are regulated by complex neurobiologic mechanisms, which, ultimately, can be delineated as oscillations between two opponent processes, one promoting sleep and the other promoting wakefulness. The role of several neurotransmitter or neuromodulator systems, including noradrenergic, serotonergic, cholinergic, adenosinergic, and histaminergic systems and, more recently, the hypocretin/orexin and dopamine systems, has been clearly established. Amphetamine-like stimulants are known to increase wakefulness by blocking dopamine reuptake, by stimulating dopamine release, or by both mechanisms. Modafinil may increase wakefulness through activation of noradrenergic and dopaminergic systems, possibly through interaction with the hypocretin/orexin system. Caffeine inhibits adenosinergic receptors, which in turn can produce activation via interaction with GABAergic and dopaminergic neurotransmission. Nicotine enhances acetylcholine neurotransmission in the basal forebrain and dopamine release. Understanding the exact role of the hypocretin/orexin and dopamine systems in the physiology and pharmacology of sleep-wake regulation may reveal new insights into current and future wakefulness-promoting drugs.