This is the first in a two-part story focused on combating fentanyl addiction in Minneapolis.

On a Monday night in July, when asked why he’s giving out sandwiches in parking lots of north Minneapolis, Howard Dotson said, “To save one life is to save all of humanity.”

“Are you hungry?” he asked a group of people. “I got PB&J and a sausage sandwich. I also have some clothes.”

Dotson spends many of his days doing service work.

“You got Narcan on you? You know where you can get some?” he asked a woman who he gave a sandwich to from the back of his Chevy Cruze.

She didn’t know where she could find Narcan, also known as Naloxone, an injectable or nasal treatment that can reverse the effects of a fentanyl overdose. So Dotson gave the woman directions to the Twin Cities Recovery Project, an organization with a branch on Broadway in north Minneapolis that offers services for people seeking help with substance use, mental health and criminal justice.

Dotson drives around the community three to five times a week offering food, clothing and — when the supply is there — Narcan to people who don’t have any. Fatal opioid overdoses in the city increased by 130% from 2017 to 2021.

Dotson believes helping people meet their needs and doing outreach to get more Narcan out in the community can curb some of the deaths in the city. Since September, Dotson has done around 155 food runs, giving out around 4,000 meals, he estimated.

Creating community among those affected

Dotson has seen Narcan save lives. But on this Monday, he didn’t have any on him. When that happens, he tries to equip the people in the community to help each other stop overdose deaths.

“I encourage them to look out for each other,” Dotson said.

When he sees that someone who doesn’t have Narcan on them and is using drugs alone, he then tells the next people he sees in the area to check in on them and give them Narcan if they have extra.

“Can you go over to that green station and give her a Narcan if you have an extra one?” he asked a woman.

“Yeah, I can do that,” she responded.

The next Monday, he received more Narcan from the Twin Cities Recovery Project. He set out to begin his drive around the community, this time with a homemade multigrain casserole and 12 Narcan packets.

Dotson is building trust with the people he feeds.

“They trust me because I feed them so much. They all know me, so they’re like, ‘That’s the church guy who feeds us,’” he said.

“All I ask is that you carry Narcan. That’s the agreement. I feed you, you carry Narcan,” he told one man.

Dotson has been doing humanitarian work for more than two decades. He’s gone to Ukraine three times as a military liaison and previously worked a similar role in Lebanon. After seeing the number of opioid overdoses in north Minneapolis this past summer, he shifted his attention closer to home.

With opioid overdose deaths in Minneapolis surging, the city also has stark racial disparities in opioid deaths, with the rates for American Indian residents being 29.4 times higher and 3.9 times higher for Black residents compared to white residents.

Dotson said the number of overdoses have gone down this summer compared to the previous year. He attributes some of that to the Minneapolis Police Department’s Operation Endeavor.

“Last summer was a wild, Wild West. We had six dealers in the entryway [to Merwin Liquors on West Broadway Avenue]. It looked like a flea market,” Dotson said.

What are the needs?

Dotson and other advocates, like Christopher Burks, a recovery coach at the Twin Cities Recovery Project, have a sense of what people who use are needing.

“Do you need any socks or underwear?” Dotson asked of a woman.

“Yeah, I need everything,” one woman responded to him.

“Do you have any water?” another person asked him.

Once he’s served most of the food, he stopped at a Holiday gas station on Washington Avenue, where he leaves food at the counter for people who might hang around there. As soon as he stepped in, one of the employees asked him, “What do you got today?”

“He brings all types of food up in here all the time. He helps out the community the best way he can, to my knowledge,” said Davante Donaldson, a security guard at the Holiday. “I live in the area and I (see) him riding around on Broadway, stopping at the bus stops, seeing if homeless people want food.”

Housing stability is one of the biggest challenge people are facing, Burks has found. He started out with the Twin Cities Recovery Project as an outreach coordinator – where he’d go to encampments and do outreach with people who were struggling with substance use disorder.

“We introduce ourselves, let them know who we are. Sometimes it’s just me passing out a card telling them ‘I’m here when you’re ready.’ We’ve had a number of people that come through the door months later, a year later,” he said.

In his time doing that, he learned a lot about what people need.

“It’s supposed to be all these wonderful housing programs out there, but it seems like none of them (are) working or they’re not getting the people in the houses,” Burks said. “A lot of (homeless people) don’t know where they can get housing, don’t know how to go about getting the housing. And then a lot of times they have exerted all their strength to get the housing, and then the housing falls through.”

During one of Dotson’s food runs, he served the multigrain casserole to a woman named Coco. She was unhoused, and passing through a Franklin/Hiawatha encampment in south Minneapolis. Coco has been unhoused for a few years, she said. She wants stable housing, but hasn’t been able to find it. While she has case workers, she feels that they are not helping her much.

“The stuff he [her caseworker] is doing, I’m doing it myself. I think I’m working harder than he is,” she said. “I just need support. A worker that I can call and talk to.”

The Twin Cities Recovery Project has offices in both south and north Minneapolis. As a whole, Burks feels the Northside receives less support and resources.

“North Minneapolis doesn’t get nearly the help south Minneapolis gets,” he said. “Every time we do outreach over south we always see another outreach program doing outreach. I think we’ve been over north just as much as we’ve been over south and I think we’ve only seen one other organization doing outreach over north. That was just one time.”

Younger people are increasingly using fentanyl in north Minneapolis, said Marilyn Jackson, a lifelong north Minneapolis resident, who lost her husband to a fentanyl overdose three years ago.

The pill has become increasingly cheaper, offering greater access to younger people, with buyers saying you can find it for as low as $5.

Jackson recalled an ambulance responding to a woman who overdosed a couple of weeks ago near the AutoZone on Broadway.

“It’s so sad,” Jackson said. “When I see this, it just relives the nightmare because I believe everybody (has) been hit with it in some type of way. It just brings back what I experienced. And it’s sad because I don’t wish it on nobody; and it don’t matter what age it is. It’s a life.”

That nightmare is becoming more of the reality.

“North Minneapolis [has] definitely been hit real hard within the last two to three years,” Jackson said. “Unbelievable, the stuff that you see now.”

Frustration over city’s response

Burks, the recovery coach, knows Narcan saves lives. He has overdosed around six times. Because of his relationship with the life-saving drug, he’s made it a mission to teach others about what it can do.

“I’ve had Narcan administered to me myself. So I do understand it works,” he said.

Just last week someone overdosed at the 4th Street Saloon on West Broadway.

“We knew something was more than just the drinks he had. He just went totally cold and blue. First thing I could think of was to go grab Howard [Dotson],” said Mike Oker, the Saloon’s general manager.

​​Dotson came and began CPR. About 20 minutes later, the ambulance arrived and then administered Narcan. Dotson wants bars to be equipped with Narcan, so that it doesn’t take 20 minutes to stop an overdose.

Right now, people in the community say there’s not enough Narcan available. Dotson thinks the city should have invested in Narcan years ago.

In July, Minneapolis started receiving nearly $11 million in settlement funds as part of the U.S. Attorney General’s 2021 agreement with opioid manufacturers and distributors to pay for their contributions to the opioid epidemic. The city is using some of that settlement money to hire a consultant tasked with developing a strategic plan around community engagement and how to best distribute the funds, according to an email from a city spokesperson.

A public health specialist will also be hired. The specialist will implement the strategic plan created by the consultant, which the city estimates will happen in 2024.

That timeline enrages Dotson.

“I don’t hear a sense of urgency,” he said. “I’ve been giving [the city] a free consultancy for 10 months. You don’t need a consultant to get the answer I’ve been giving you for 10 months. Harm reduction is what this settlement’s supposed to be about. It’s like rearranging the chairs on the Titanic to sit on this money waiting for a consultant to give you an answer that I’ve been giving you.”

“We need that Narcan now,” Dotson said. “Some will say, ‘Oh there’s enough Narcan out there.’ Well, are you doing the public health outreach? Are you doing the surveys? Do you really have the data? Some officers say they all have it, and I’m like, ‘That’s not what I see. I’m out there five nights a week.’”

Burks wants to know why this plan doesn’t already exist.

“They should have had a plan by 2024. It’s like how many more people got to die for you to get a plan?” he said.

In March, MinnPost talked to Damon Chaplin, who at the time was just about to begin his role as Minneapolis public health commissioner. When asked about how he would approach the opioid crisis, he mentioned the need to develop relationships with people in the city who are already doing work around prevention, intervention, treatment and recovery.

Some members of the City Council are working to make sure the city lives up to its promises. On Wednesday, the Minneapolis Public Health and Safety Committee approved a legislative directive authored by council members Robin Wonsley and Elliott Payne that aims to establish accountability for the city’s plans regarding opioid intervention.

Wonsley said the directive originated from a presentation by the city’s health department to the committee in June, addressing the opioid epidemic.

“The presentation very clearly laid out the enormous, tragic and incredibly inequitable impacts that the opioid crisis is having on our communities,” Wonsley said at the meeting. “This legislative directive is intended to structure additional conversations around the way this body, the city of Minneapolis can show up to meet the need of that urgency and what are some best practices to respond, to provide support to the communities that are disproportionately impacted by this crisis.” 

The directive requests the mayor’s assistance in supporting a needs assessment of staff, funding and other resources required to fully implement a comprehensive opioid response program. Additionally, it calls for a follow-up report on the actions taken by the health department. The deadline for these reports is set for March and September of 2024.

A grant is said to be in the works to put Narcan dispensers at Minneapolis fire stations near encampments. Dotson likes that idea as a solution – he wants it to happen before more lives are lost. And Burks thinks it can be expanded even further.

“They (the city) know what Narcan can do. They know Narcan saves lives. Why isn’t it right in front of every store next to the gum?” Burks said. “The only negative side effect from Narcan is that a person is not high no more. So they might go into opioid withdrawals.”

Advocates emphasize that Narcan is not the solution to addiction, however. It must be accompanied by medications for addiction treatment (MAT), meaning treating of the withdrawal symptoms.

Only 10% of people with substance use disorder in the U.S. receive treatment for their condition, according to the American Medical Association. Getting that access to treatment – meaning having beds available in recovery centers and hospitals, is crucial for survival.

When someone is sent to the ER for an overdose and there are no available beds to treat psychiatric conditions, what happens?

“They Humpty Dumpty them back out in the community, and eventually they’re going to O.D. (overdose),” Dotson said. “It’s Humpty Dumpty ‘til they die.”

Dotson and Burks believe keeping people alive and expanding recovery services can be life changing and dramatically improve health outcomes in the city. In addition to giving Narcan to places like gas stations and bars near areas where he’s noticed fentanyl use, Dotson has also taught many, like the staff of the Moose Bar and Grill in Minneapolis, how to administer the drug.

Dotson is trying to do as much of this work as he can before September, when he will be leaving for Ukraine for other humanitarian work.

Part II focusing on addiction runs Aug. 11.