American Indians make up only 1.5% population of Minnesota but are seven times as likely to die from drug overdose as whites. While the Centers for Disease Control and Prevention ranks Minnesota 38th among all the states in rates of overdose deaths, this number masks this existing racial disparity. Mille Lacs and Cass counties have the highest drug overdose death rates, according to the Minnesota Department of Health.
Opioids are commonly used for the treatment of pain, but their misuse and use without medical supervision can lead to opioid dependence and other health problems. Opiate overdose causes respiratory depression, generalized Centralized Nervous System (CNS) depression and miosis. Miosis is the excessive constriction (shrinking) of your pupil, also called ‘pinpoint pupil’. Babies born to mothers with a chronic use of opiates during pregnancy or sudden withdrawal after birth show signs of opiate withdrawal, termed Neonatal Opioid Withdrawal Syndrome. Infants with NOWS are more likely to be born preterm and have low birthweight. NOWS is eight times more common in the American Indian community as compared to whites in Minnesota.
Minnesota has initiated actions against opioid overdose by enacting new reforms at the Legislature, allowing patients to access services more quickly, as well as adding important services like withdrawal management, care coordination, and peer support. The pilot Parent Child Assistance Program, a peer support program for pre- and post-natal mothers focuses on increasing access to the life-saving drug naloxone.
Although these are promising initiatives, we should focus on the populations that are most affected by the opioid crisis. The Minnesota Legislature is aware that American Indians and African Americans face the greatest burdens as a result of the opioid epidemic, but, the state often is ineligible for Federal Grant Allocations due to the low overall rate of opioid deaths compared to other states.
Minnesota’s Opioid Action Plan highlights the necessary steps needed in order to address, prevent and reduce the high rates of opioid-related deaths among the American Indian population.
How can Minnesota do better?
In order to help people of color, we must acknowledge the role structural racism and classism plays within our healthcare system and policies. The rising rates of preventable harms caused by the opioid epidemic is closely linked to the health and economic status of people of color. Improving living conditions, providing more job opportunities, and increasing access to healthcare services can help in combatting the problem.
Some physicians see opioids as a way to increase their profits, using the lack of state regulations to dispose drugs to anyone who walks through the doors of the clinic. A potential solution involves decreasing opioid prescription rates by implementing penalties against such providers routinely overprescribing drugs and strengthening the existing regulation on opioid prescription.
In order to achieve the goal of health equity, a plan of change targeting communities of color should be the top priority of the state right now.
Vedushi M Jain is a graduate student in Health Administration and Policy at the University of Minnesota School of Public Health.