This story is Part 1 of a two-part series on opioid addiction in Minnesota’s Karen community. Part 2, about Karen-developed programs working to address addiction from a culturally aware perspective, can be found here.
Pie Pie was worried. She hadn’t seen her 15-year-old daughter for more than two weeks. Perched on the edge of a chair in her sparsely furnished apartment on St. Paul’s East Side, her eyes overflowed with tears and she slowly wiped them away.
A Karen refugee from Burma (Myanmar) who has been living in Minnesota since 2012, Pie Pie’s English is limited. She told her story with the help of Mar Htay, a youth case manager at the Karen Organization of Minnesota, a social services agency that assists Karen refugees.
“When Pie Pie’s daughter was younger, she was a good kid,” Mar Htay translated, explaining that he first met Pie Pie at Humboldt High School, where his agency is contracted to support the school’s social workers in helping Karen students. He said that not so long ago, Pie Pie’s daughter went to school and helped her mother around the house. “But when she was older and COVID happened and the schools closed, she wasn’t engaged in school anymore,” he continued. “She started hanging out with friends and that’s when Mom thinks everything started.”
Pie Pie explained that, as a working single mother of three, she often feels overwhelmed. When her daughter asked to go out with friends, she told her she couldn’t. “She was upset about that,” Pie Pie recalled of her daughter. “She said, ‘Why don’t you let me go out? Other kids get to go out.’”
This spring, Pie Pie allowed her daughter to go to a friend’s house to babysit. But her daughter’s visits with her friend involved more than child care, Pie Pie said: “That’s when she started to get in trouble.”
When her daughter began coming home late and skipping school, Pie Pie suspected that she was using drugs. She’d heard about other Karen youth becoming addicted to opioids, and when she found what looked like drug paraphernalia in her daughters’ bedroom, Pie Pie took pictures and showed them to Mar Htay, who explained that the object in the photos were likely a device used to smoke the painkiller Percocet.
Pie Pie learned that her daughter had missed many days of school. Because she has to be at work at 4 a.m. every morning, Pie Pie goes to bed early, sometimes before her daughter gets home, and she leaves for work hours before she goes to school.
“She just asks her daughter, ‘Are you going to school?’” Mar Htay translated. “She says yes. But she never makes it to school. She also talked to [other residents] in her apartment building. She said they saw her daughter using drugs, throwing up, spitting.” Eventually Pie Pie’s daughter stopped coming home altogether, Mar Htay explained: “Pie Pie is very depressed about her daughter’s situation. She doesn’t know how to help.”
Pie Pie’s story is not an anomaly, said Alexis Walstad, Karen Organization of Minnesota’s co-executive director. Karen parents from around the state are increasingly concerned that their children are becoming addicted to opioids. At the organization’s weekly walk-in hours, where members of the Karen community can drop by the organization’s St. Paul office for help or advice, Walstad said, “We get parents seeking help with their kids who are struggling with substance use. It’s a big concern.”
Nawthet “Clara” Tunwin, Karen Organization of Minnesota’s community health and social services program director, said that she and her colleagues are particularly concerned about reports of Karen youth using fentanyl, a more potent and often deadly drug that some experts say is increasingly being marketed toward teens.
“The fentanyl use situation is really alarming right now,” Tunwin said. “We’re even getting reports from hospitals that Karen kids are overdosing and ending up there.”
Scope of the problem
These concerns are the latest chapter in the Karen people’s long history of struggle. After facing brutal oppression by the military regime in Burma, thousands of Karen people fled to refugee camps in Thailand where they lived for years before being granted refugee status and resettling in countries around the world. The first Karen came to the United States in the early 2000s. While many settled in other parts of the country, the largest number of Karen — some estimate as high as 20,000 — live in Minnesota, with the highest concentration in the Twin Cities, especially St. Paul.
The transition from Thai refugee camps to Minnesota has been hard on many Karen refugees, Mar Htay said. While parents struggle with work, language and culture shifts, young people, who often have an easier time learning a new language, have had to take on the role of family translator.
In 2020, when COVID forced schools to move online, parents had to keep working, and their children were left to their own devices at home. “From what I know from working with students, most of them say they started using drugs when COVID happened,” Mar Htay said. “I think the number of Karen youth using drugs has gone way up from COVID to now.”
Ner Mu, a youth health educator and program manager for community health at the Karen Organization of Minnesota, said he and his colleagues have not been able to find an accurate count of the number of Karen youth struggling with addiction.
“But I notice one big thing: A rising number of calls I’m getting about this issue from community members, faith leaders and social workers from different schools. Based on that evidence I think the number of youth using fentanyl and other opioids is increasing in our community,” he said.
Just like in other groups, addiction has existed for generations in the Karen culture, Walstad said: “Alcohol abuse and substance use are also problems in Burma and Thailand.” While substance abuse may not be new in Karen culture, what is new are the consequences that it can bring. In the U.S., if a refugee is convicted of possession or sale of illegal substances, Walstad explained, “It can lead to deportation. That really has added a lot of stress to this community.”
Lwepaw New Kacher is a Karen community cultural broker who is employed by M Health Fairview. Her office is based at the Karen Organization of Minnesota. “My focus is on social isolation, mental health and chemical dependency,” she explained. “I help connect community members to resources.”
Because of her role, Kacher often gets calls from concerned community members. For example, one recent caller said three of their nieces and nephews were addicted to Percocet and needed help finding a treatment program. A few weeks later, Kacher said she learned that an 11-year-old Karen child had overdosed with fentanyl. “It opened my eyes,” she said. “This problem is real.”
For many people with substance use disorder, the next step toward healing is finding a recovery program. But for many members of the Karen community, taking this next step is complicated.
Part of the problem is that addiction treatment is a foreign concept for many Karen people, Kacher explained. Addiction treatment as it is known in the United States wasn’t something that happened in Burma or in the Thai refugee camps where many Karen people lived for years. Cultural norms around mental health also limit families’ willingness to bring their children in for treatment, Kacher added: Many Karen parents feel uncomfortable with Western-style therapy because they are uneasy talking to strangers about their personal lives. The cultural disconnect is clear.
“Our community doesn’t really understand what addiction is,” Kacher said: Most Karen people enrolled in addiction treatment programs in Minnesota ended up there because they got a DWI and addiction treatment was required as part of the legal process.
Longer-term residential addiction programs aren’t a good fit for many Karen people, Kacher continued. “They don’t want to go to a program for a month or two because no one speaks their language. And we don’t have our own program in the community, one that understands Karen language and culture.”
Tunwin said that many Karen families have turned to the Karen Organization of Minnesota for help with their children’s drug use because they trust the organization to understand their culture and approach to parenting. But the nonprofit is limited in what it can do to help.
“We’re not a clinical health program,” she said. “We focus on prevention and on connecting clients with services. We are similar to a cultural liaison. We don’t do therapy or any type of treatment but we try to connect our community to other treatment settings. Our community members don’t trust the health care system here. That’s why they come to us. We are a bridge for them.”
For Karen families like Pie Pie’s, that bridge to addiction treatment is shaky at best, Mar Htay said. Because Pie Pie’s daughter has been truant from school, social workers have filed a warrant in hopes that police will locate her and bring her in for assessment and treatment.
Pie Pie’s youngest daughter is 13. She is also worried about her sister, and she came to the school social work office for help. That’s how her family got connected to Mar Htay. “She’s very resourceful,” Mar Htay said of the girl. But even if Pie Pie’s middle daughter is located by police, if she refuses to go to a treatment program, they will have to let her go. And the cycle will continue.
“A lot of kids don’t want to do treatment,” he said, slowly shaking his head. “They refuse.” And of those who agree to enter a program, only a few stay sober, he continued: “They go to treatment because they don’t want to be bothered by their parents.” But the kind of treatment that’s offered to them doesn’t always work for Karen kids, Mar Htay said: “When they get out they just go back to doing drugs. The system is failing these kids.”