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An emergency for Native Minnesotans is hidden inside the state’s opioid epidemic

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Madelyn Klabunde
Overall, Minnesota’s opioid epidemic has avoided national attention.

According to recent data on opioid overdose deaths by state, Minnesota’s opioid death rate ranked 11th lowest out of 51 states and the District of Columbia. In this case, 11th place is a comfortable place to be. Minnesota doesn’t have the lowest rate of opioid overdose deaths – we didn’t even break the top 10 – but we certainly don’t have the highest rate — far from it. When it comes to managing opioid overdose deaths, we’re not going to break our arms patting ourselves on the back, but there’s really no cause for alarm. Is there?

Minnesota’s statewide opioid death rate masks the startling disparity in overdose deaths among American Indian Minnesotans. Although many view opioid overdose as a white man’s problem – enough to spur action by President Donald Trump – the population-specific rates of opioid death in Minnesota tell a different story.

According to the Minnesota Department of Health (MDH), American Indians in Minnesota are six times more likely to die of a drug overdose than their white counterparts – in 2016, population death rates per 100,000 individuals stood at 64.6 for Native people compared to 11.7 for whites. Between 2014 and 2016, 70 percent of the overdose deaths in American Indian Minnesotans involved opioid drugs, making opioids the leading cause of overdose death in this population.

This is where Minnesota stops being inconspicuous and truly requires attention: The overdose death disparity between Native and white Minnesotans is the worst race rate disparity in the entire country.

How did this happen?

American Indian Minnesotans experience risk factors that increase their probability of dying from an opioid overdose. One of these factors is exposure to adverse childhood experiences (ACEs), which include stressors like hunger, domestic violence, and parental substance abuse. American Indian children are two times more likely to experience two or more ACEs than white children. Living in poverty, which disproportionately affects Native Minnesotans compared to whites, is another factor that increases the chance of dying of an opioid overdose.

The available mental health and substance abuse programming in Minnesota also puts Native people at a disadvantage compared to white people. The ratio of American Indian behavioral health providers in the U.S. to the American Indian population nationally is about 1 to 1000. Less than 2 percent of all mental and behavioral health providers in Minnesota are American Indian, where over 94 percent of these providers are white. Studies suggest that individuals may not seek treatment for substance use if a program’s staff doesn’t include someone from a background similar to their own.

What does this mean?

It feels unempathetic to consider this when discussing a social injustice, but opioid-related deaths in American Indian Minnesotans are costing the state a lot of money. If you consider the cost of an opioid overdose death (estimated at $5.4 million, primarily from lost productivity), the overdose death rate among American Indian Minnesotans in 2016 (64.6/100,000), the percentage of overdose deaths from opioids (estimated 70 percent) and the American Indian population of Minnesota (60,916), the cost of American Indian opioid deaths in Minnesota is around $150 million each year. This cost is equal to about 30 percent of the state’s annual budget allotment for health promotion.

Minnesota’s opioid overdose death rates have risen over the past few years and, more important, so have death rate disparities by race. Both rates are likely to continue rising, unless we take action now.

What can be done?

As a white woman, I’ve never worried that my doctor might not understand my cultural background. I have always had the profound privilege of receiving care that is appropriate for me. I cannot imagine how frustrating it is to decide between culturally inappropriate care and no care at all. I want Minnesota to ensure that American Indians experiencing opioid misuse can access care that meets their needs to save their lives.

Let’s work harder to ensure that American Indians receive culturally appropriate substance use prevention and treatment. At a minimum, let’s ensure that providers are trained in culturally appropriate care for Native people dealing with substance abuse. Let’s help Native people enter the medical workforce by providing funding for their education.

More than anything, let’s continue to look beyond the facts that hide rampant disparity. Inequity isn’t new for Minnesota. In 2014, MDH published a report on advancing health equity due to stark inequity in infant mortality, HIV, obesity, and the topic at hand — overdose deaths among minority groups. Addressing American Indian opioid overdoses in Minnesota is a step toward meeting the long-term goals set out by MDH.

Let’s work on making Minnesota stand out for the right reasons.

Madelyn Klabunde is pursuing an MPH degree in public health administration and policy at the University of Minnesota.

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Comments (2)

  1. Submitted by Ray Schoch on 01/22/2019 - 10:35 am.

    This piece might have more impact if at least one example were provided (more would be better) of “culturally appropriate” vs. “culturally inappropriate” health care or response. As written, it’s too vague and general to give me, as a reader and fellow-citizen, some clue(s) about what issues might exist in health care for the Indian population that might be attended to.

    What is a “culturally appropriate” response to opioid addiction? What is a “culturally INappropriate” response to that additction? What evidence is there (beyond platitudes and the occasional anecdote) that one approach actually works better than the other?

    • Submitted by Pat Terry on 01/22/2019 - 11:25 am.

      I wondered the same thing. I get the idea that the lack of Native providers may discourage people from going, but I’m not sure how treatment for opioid addiction has much of a cultural aspect. I’m willing to to learn if the author wants to follow up.

      When we talk about opioid addiction, do we distinguish between abuse of prescription pain medication and street drugs? My understanding is that the deaths at the Hiawatha encampment last year were from heroin overdoses. I realize that prescription opoid abuse can lead to street drugs and the things that accompany them (homelessness, etc.) But from a healthcare standpoint, they seem to be very different problems.

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