The ongoing opioid epidemic has hit some groups of Minnesotans harder than others: The crisis has had the most disproportionate impact on the state’s American Indian population, followed by Black Minnesotans. In 2021, for example, American Indians were almost nine times more likely to die from a drug overdose than whites, and Black Minnesotans were three times as likely to die from a drug overdose as whites.
In response to these disturbing disparities, staff at the Minnesota Department of Human Services (DHS), in collaboration with members of the Walz-Flanagan administration, set out to speak to members of the most affected cultural groups to learn how to address the problem.
The result of these conversations is a new proposal presented this month to state legislators, an expansion of Gov. Tim Walz’s original behavioral health budget, aimed at addressing Minnesota’s drastic opioid disparities.
Eric Grumdahl, DHS assistant commissioner of the Behavioral Health, Housing and Deaf and Hard of Hearing Services Administration, joined the department in August 2022 and has helped to assemble the proposal. When we spoke last week, Grumdahl told me he believes that gathering input from members of these groups is key to creating systemic change with real impact.
“We have this unprecedented opportunity to think about: How do we lift up the needs of Minnesotans who are often not in the spotlight?” he said.
This interview has been edited for length and clarity.
MinnPost: Can you tell me more about what inspired the content of this proposal?
Eric Grumdahl: The governor’s original budget proposal had a proposed investment of $141 million in behavioral health services, which is a really remarkable starting point.
These kinds of proposals are developed over a space of months. DHS has a mantra that, “we build our legislative agenda all year ‘round.” It’s not new that the opioid crisis has been on the wrong trajectory. That’s been the case for a number of years. So the proposals that were in the governor’s original budget released in January reflect some of the things we needed to help respond to that growing crisis.
We hope that our whole response to opioids and substance use generally can go more in the direction of evidence-based responses, building on things we know work, trying to help equip our provider community to be more successful in the face of this growing pressure in the context of our workforce shortage and all of the other challenges that this group faces.
MP: How did you gather the information included in the final draft of this proposal?
EG: We have continued to listen and hear and engage with Minnesota communities most impacted by the opioid crisis. We had a really remarkable summit meeting with tribal governments in September. We had another series of meetings with community partners, especially in the urban Indian community, in November. There are lots of groups we know that are really affected by being unable to make the case for the resources that are needed to address really urgent issues in a variety of places across the state budget.
What we’ve been challenged to do is to ask, “What about the communities that are not so commonly represented? How do we make sure that we are able to lift up the needs of individuals that may be in the midst of an addiction crisis and may not have the same kind of advocacy or someone in their corner to argue for the investments that are needed for a more effective response for that group?”
Over the course of several months last fall, we challenged ourselves to say, “What would be even more transformational proposals that we could identify for responding to what we’ve heard from community partners about what works, what they need?” “What would be even more transformational proposals that would really help us get our arms around this crisis in a way that we have not been able to?”
That led to this new, revised budget proposal that was released last Thursday which, among other things, adds $45 million in the upcoming biennium for DHS’ response to the opioid crisis. It’s a really substantial increase in the overall investment that’s being proposed to address that crisis. It’s not just the level of investment. It’s the way we’ve targeted those investments.
MP: Your department’s proposal includes several elements that are designed to support the state’s American Indian population. Tell me more about the process that led to that focus.
EG: Part of what we are responding to in our proposal is not just the meteoric rise that we’re seeing in the number of opioid deaths. It’s also the disparities in who’s being most directly impacted by the epidemic.
From 2018-2021 there has been a really, really significant increase in the number of American Indian Minnesotans dying from opioids. That is not comparable to what we’ve seen for white Minnesotans. Any death from opioids is a preventable, unnecessary death, but the fact that these deaths are happening at unequal rates in communities of color has been at the center of how we’ve thought about those proposals.
I think we’ve also wanted to ground how we thought about those proposals in not just what we heard from the community but also in what we found from folks who’ve experienced this epidemic first-hand. That has been a really core value of the Walz-Flanagan administration: to really start with those folks that are closest to the issue, listen to what they identify as solutions they believe will be helpful and figure out how to organize our systems around supporting these responses. I feel proud of the way in which DHS has engaged community and come forward with proposals that really reflect what we think could be a transformational response to this crisis.
MP: Your proposal calls for a re-imagining of the membership requirements for the state Opiate Epidemic Response Advisory Council (OERAC), to ensure fair representation of the range of racial and ethnic groups most impacted by this crisis. Why do you and your colleagues feel this change is important?
EG: OERAC is an amazing body. I have seen it have so much impact in being able to harmonize a lot of different perspectives around what’s needed to respond to this crisis. We believe that representation matters, and so making sure that individuals who represent the communities most directly impacted by the crisis are part of the process is a really critical part of making sure the approaches OERAC is taking are going to be responsive to the needs of those communities.
MP: The proposal mentions the idea of encouraging jails and prisons in the state to offer and cover behavioral health services and medication to treat opioid use disorder for inmates. How often are these types of services made available in other states?
EG: We have seen in a number of communities much more rapid movement toward making things like naloxone as a recovery medicine ubiquitous and available everywhere. Our community partners are saying that is what they need to really be more effective at stemming the tide of deaths. We’d like to leverage what other communities across the country have already learned and demonstrated to be tremendously effective.
We know that the period immediately following release from incarceration is one of the highest risk periods for relapse, for overdose, for homelessness, and so I think across our proposals what you’ll see is a variety of strategies that are designed to help make sure that when someone reenters community, they do so successfully and with the support needed to prevent those things that too often happen with reentry from happening.
MP: Legislation around addiction and mental health has received bipartisan support in the Minnesota Legislature. Are you optimistic that the bulk of your proposals will be approved this session?
EG: I feel hopeful from the perspective of what has really been a bipartisan recognition of the urgency of this issue. We have champions for investing in our response to this crisis from all political corners. While there may be disagreements on specifics or the path forward, everyone who looks at this in any serious way recognizes that we need to do something big and dramatic and different to be able to change the trajectory of this epidemic. And so I’m an optimist. I feel hopeful that these are proposals that a lot of folks can get excited about.
I will also say that we’re really encouraged by a lot of the signs that we see out of the Biden administration in terms of a recognition of the centrality of harm reduction in the sweep of responses that we have to substance use disorder. People aren’t ever going to be fully served by one-size-fits-all approaches, so our direction has been, “How do we have the suite of tools, the continuum of options that are needed to respond to every single Minnesotan?”
Each Minnesotan struggling with addiction has their own journey back to wellness and recovery. The better our system is able to meet individuals where they are and go on that journey alongside them, the better we will be at reducing substance use disorder.
MP: Before coming to DHS, you worked for several homelessness advocacy organizations as well as in the Obama administration as policy director for the U.S. Interagency Council on Homelessness. Do you see a connection between housing instability and substance use?
EG: Coming into this role I’ve been so excited about being able to build and make sure that the state’s bridge between behavioral health and housing is strong. We already have some great programs that span housing instability and behavioral health, but there is opportunity to do even more. The Minnesota Department of Health, in partnership with Hennepin Healthcare Research Institute, recently released a study that took a comprehensive look at the mortality of individuals facing housing insecurity and unsheltered homelessness and found the staggering result that one in 10 opioid deaths in Minnesota is a person facing housing instability and that one in three deaths of someone experiencing homelessness is an overdose.
MP: It seems that results like these illustrate that those problems are intertwined.
EG: Yes. And part of what is motivating our proposals are strategies that recognize that fact. We need people to not have to make a choice between, “How do I get on a path to housing?” and “How do I get into a recovery program?” This means putting services together in a way that acknowledges that making progress on both things supports whatever position they find themselves in. If they are in an encampment, if they are bouncing between a lot of different locations, people need to have resources that are not only nimble but also responsive enough to the individual so that we can help everybody on a journey from housing stability to recovery.
MP: With the Democratic “trifecta” in place in Minnesota, do you feel optimistic that many of these proposals will soon become law?
EG: I don’t want to count any chickens before they’re hatched, but I will say that I feel really encouraged and optimistic about all of the legislative attention around these issues and the fact that everybody recognizes that we need to make transformational, bold investments and commitments to solving this crisis.