This is part II in a two-part story focused on the fentanyl crisis in Minneapolis following-up on part I.

The opioid epidemic has had devastating effects across the nation.

From people who’ve lost a loved one due to overdose, to those who began using and now are unable to keep custody of their children, the impact in Minnesota has been widespread.

In Minnesota, hospital-treated non-fatal overdoses suspected to have involved a synthetic opioid, like fentanyl, nearly tripled over the two-year period spanning 2020 to 2022, according to the Minnesota Department of Health. A vast majority of those overdoses (89% and 92% in 2021 and 2022 respectively) are suspected to have involved fentanyl.

Fentanyl, which is medically used to treat pain can be up to 50 times stronger than heroin and 100 times stronger than morphine.

With that surge in fentanyl use, deaths are climbing too. In 2020, 560 people died from fentanyl overdoses in the state. That number rose to 834 in 2021. Minneapolis reflects a similar increase, with opioid overdose deaths increasing by 130% from 2017 to 2021.

Howard Dotson, a community advocate, has seen and intervened in countless overdoses. In part 1 of this reporting, we detailed efforts around the city to prevent overdose deaths, including Dotson’s frequent runs where he gives out Narcan, a drug that can instantly reverse an overdose, food and supplies in areas where he’s noticed heavy fentanyl use.

Fentanyl’s effects

During one of Dotson’s food and necessity runs, a woman named Coco was passing by near the Franklin/Hiawatha encampment in south Minneapolis.

Coco, who’s been unhoused for a few years, recalled the point in her life when she began using fentanyl, which she described as “stumbling and doing drugs” with her boyfriend at the time.

She uses fentanyl in little amounts because the withdrawal symptoms make her feel unwell. The smaller doses help stop those withdrawal symptoms.

“It helps me when I’m sick, my body is physically sweating. People says it’s mental, but physically you sweat. I don’t like that feeling,” she said.

Her four children are currently staying with her family. She wants to be sober, but feels a lack of stability and community in her life makes it difficult.

“It’s hard,” she said. “I try to stay focused. I just want to get sober and it’s really, really hard.”

Coco said if there were people around her, people she could spend time with and do activities with, there would be fewer chances for her to continue using.

“You know how they have like (big) brothers, sisters? They should have that for adults. There’s a lot of people here who don’t have family, so if they don’t have somebody like that, that won’t actually help people,” Coco said referring to the role caseworkers and support systems currently play.

Another woman nearby, Mya, said her addiction began with curiosity.

“Fentanyl was something new, like nobody really knew what it was, so we (her boyfriend and she) were curious and wanted to try,” she said.

Mya would previously use with her boyfriend, but he was recently sent to jail. Since he’s been gone, Mya feels more unsafe when using.

“I have overdosed over maybe 10 times. Thankfully I had my boyfriend by my side and he did the training (to administer Narcan). If it wasn’t for him, I would not be here because not everybody out here knows how to revive somebody and how to use Narcan,” she said. “(Now), I have to remember I can’t do too much because if I go out, the EMT’s don’t always show up right away.”

It’s been a year since she started using fentanyl. She has struggled to stop because her withdrawal symptoms, like sweating, chills, back pain and vomiting, make her feel extremely sick, she said.

Dotson gave Mya a Narcan envelope that night. By the end of that night’s food run, Dotson had handed out eight doses of Narcan.

Getting sober

Christopher Burks, a recovery coach at the Twin Cities Recovery Project, who used various substances for around 30 years, has now been sober for three years.

“I quit everything.  I was serious about it,” Burks said. “It was like I hit my bottom and the bottom to me is like when you just can’t dig no more because I needed something different. I actually wanted something different.”

The factors that go into making the choice to be sober are different for everyone, he said. For him, he struggled with the idea of what his life would look like if he stopped using.

“At the time I was 47 years old. I got four kids. I’m a felon. I ain’t got no work history. What do you do? That’s not even talking about the kids. I’m talking about supporting myself,” he said. “You have those that are not ready to quit. You have those that don’t know how to quit. Then you have those that, like I was for a long time, ‘if I do quit, what’s my life look like? What am I going to do?’”

For many, substance use is intertwined with mental health struggles.

“Drugs became a coping mechanism. That’s how I coped. It made life easier. It was an escape,” Burks said. “Now that I’ve been clean sober for three years, really working the steps the way they’re supposed to be worked, what you find out is that drugs (are) not the problem. Drugs (are) just a small part of what’s really going on with you as a person.”

To address the root of most substance use addictions, the Twin Cities Recovery Project offers a grief and trauma program.

“Most people who deal with substance abuse, they have suffered some type of grief, some type of trauma, normally both of them. So we help people identify that. We help people to really dig at the root of their problems,” Burks said.

Mya, the woman who’s been using fentanyl for around a year, described the soothing effect it gives her in social situations.

“The reason I do it is because I have really bad anxiety. Having anxiety and being out here (unhoused), it’s hard.”

Marilyn Jackson, a life-long north Minneapolis resident who lost her husband to a fentanyl overdose, felt the strong connection between her husband’s mental health and his substance use.

“In my heart, I think it was childhood trauma. What he’d seen in his eyes is something I wouldn’t want to see. What he done did in his life is something I would never do. So you can only imagine what that means,” Jackson said.

Her husband, who was 52 at the time of his overdose, had been struggling with addiction. She said he tried to hide it from her because he knew how she felt about drugs.

“I used to always fuss at him about it. But it was something that I couldn’t pull him away from,” she said.

Road to recovery

Lives can be saved if people are able to access recovery services. When someone walks through the door at the Twin Cities Recovery Project, Burks and the other recovery specialists begin helping with goal-setting, step by step.

That can look like helping someone get a library card, making an initial phone call to a county for them, or as Burks has done, joining a peer for a court appearance for support.

“My first question is, ‘How can I help you? How can I assist you in your recovery?’ So they’ll tell me basically what they need,” he said.

Once someone’s on the road to recovery, the pieces of the puzzle will slowly start to fit together and the rewards of the hard work becomes apparent, Burks said.

For him, it was the feeling like he had a purpose when he began his work at the Twin Cities Recovery Project.

“That’s kind of like what helped me in my recovery. It (his outreach work) gives a person that has substance use disorder; it gives their life purpose. Like, my life means something now. I get to come here every day, and I get to help other people,” Burks said. “That’s big.”