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The number of nonfatal drug overdoses in Minnesota increased in 2020, mirroring the trend of fatal overdoses during the COVID-19 pandemic

The Minnesota Department of Health (MDH) on Thursday reported there were 14,475 nonfatal drug overdoses treated in hospitals in 2020. So, for every overdose death last year (there were 1,008), there were more than 14 nonfatal overdoses, MDH says.

Related [May 3]: MDH reports sharp rise in drug overdose deaths during pandemic

“The report on nonfatal overdoses in Minnesota is a reminder that so many lives are tragically impacted by substance use,” MDH Commissioner Jan Malcolm said in a statement. “The COVID-19 pandemic has been the biggest public health issue in the world for almost two years now, but the other pressing public health issues have not gone away.

"The opioid epidemic continues to be pervasive and requires continuing, comprehensive drug overdose prevention and response efforts," Malcolm added. 

While there were more than 14,000 drug overdoses treated in hospitals, MDH looked more closely at the nonfatal overdoses that were treated in emergency rooms, noting these overdoses are often unintentional or undetermined compared to other overdoses where the intent is self-harm.

Related [May 12]: Number of suicides in Minnesota decreased in 2020

There were 7,290 nonfatal overdoses that were treated in the emergency room in 2020. That's up 18% from the 6,196 nonfatal overdoses treated in the emergency department in 2019, and up a whopping 44% from 2016 when there were 5,079 nonfatal overdoses. 

The rate of nonfatal overdoses in the seven-county metro has increased faster than in greater Minnesota. From 2019 to 2020, nonfatal overdoses increased 21% in the metro and went up 10% in greater Minnesota.

The rate of nonfatal overdoses in the seven-county metro has increased faster than in greater Minnesota. From 2019 to 2020, nonfatal overdoses increased 21% in the metro and went up 10% in greater Minnesota.

Nonfatal overdoses continue to disproportionately impact Minnesotans of color, with MDH noting health inequities influenced by systemic racism contribute to drug overdose disparities for communities of color compared to their white counterparts. 

American Indians and African Americans experience a greater burden of drug overdoses. American Indians were nine times as likely and Black Minnesotans three times as likely to experience a nonfatal overdose than those who are white.

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“As with fatal overdose data, we see populations most impacted by systemic racism are more often affected by substance use,” MDH Overdose Prevention Supervisor Dana Farley said in a news release. “Recovery has a greater chance of success when communities are involved. Systemic racism and lack of access to recovery resources hinders recovery efforts for many Minnesotans."

MDH also noted nonfatal overdoses continue to involve younger Minnesotans, ages 15-34, who made up 55% cases in 2020. And boys and men typically account for a larger proportion of nonfatal emergency room visits for overdoses, making up 60% of cases in 2020.

What's driving this trend?

Opioids and stimulant drugs have driven much of the increase in nonfatal overdoses in 2020, and in recent years. 

MDH says opioids and stimulants were involved in 57% of emergency department visits for nonfatal overdoses, while the other 43% involved other drugs, such as benzodiazepines, antipsychotics and antidepressants.

Of the 57% of opioid- and stimulant-involved nonfatal overdoses, 3,649 involved just opioids (50%), 155 overdoses involved just stimulants (5%) and 155 overdoses involved both (2%). 

Nonfatal overdoses involving stimulants increased 36% from 2016 to 2020 but remained relatively stable from 2019 to 2020, increasing 5%, MDH.

Meanwhile, nonfatal overdoses involving opioids sharply increased in 2020, going up by 43% compared to 2019 (2,664 to 3,804 overdoses). They're up by 153% compared to 2016. 

Heroin overdoses make up the largest number of nonfatal opioid overdoses (1,504), with the number increasing 71% since 2016. However, heroin-related nonfatal overdoses remained "relatively stable" from 2019 to 2020, going up by 4%, MDH said. 

This rise in nonfatal overdoses caused by opioids was largely driven by increases in non-heroin opioids, MDH said, with such overdoses surpassing those involving heroin for the first time.  

There was a 90% increase in non-heroin opioid overdoses from 2019 to 2020 (1,211 to 2,300 overdoses). From 2019-2020, nonfatal overdoses involving opioids (not heroin), unspecified opioids and synthetic opioids "substantially increased":

  • Synthetic opioids like fentanyl and tramadol went up 86% (118 in 2019 to 220 in 2020)
  • Unspecified opioids increased 98% (388 to 770)
  • Opioids like oxycodone, codeine and hydrocodone increased 92% (666 to 1,282)

MDH says fentanyl and fentanyl analogs "continue to pose a major public health problem and further exacerbate the opioid epidemic" in Minnesota and the United States, MDH said. 

MDH found that despite the COVID-19 pandemic, the opioid epidemic continues to be "pervasive," which is reflected in the number of emergency department visits in 2020. Starting in March 2020 and for the rest of the year, emergency room visits overall were down, however visits for nonfatal overdoses involving opioids remained higher than 2019 each month last year. 

"As long as someone is alive, they can access treatment resources, making recovery possible,” MDH epidemiologist Shelbi Giesel said in the release. “Prevention efforts like naloxone distribution and linkages to care are promising practices that have the potential to save many lives.”

Naloxone (also known as Narcan) can reverse the effects of an opioid overdose. Anyone can carry the treatment, and it's available through multiple sources in Minnesota. Find them here.

MDH's drug overdose dashboard is available here

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