WILLMAR, Minn. — Before the pandemic, Dr. Kathryn Deuvel said, she thought west central Minnesota might be turning a corner on the number of overdose deaths.
But with the pandemic, drug overdoses and deaths in the region and across the country went right back up.
Minnesota’s overdose deaths had decreased in 2018, the numbers rebounded to previous levels in 2019 and skyrocketed in 2020 after the pandemic lockdowns began. Fewer overdoses occurred in rural areas, but the numbers still increased in 2020.
“It was a wake-up call,” said Deuvel, part of a team that started the Addiction Services program at the Carris Health-Willmar Main Clinic in April 2020.
The timing wasn’t ideal, just after the pandemic started, said Holly Morales, a family practice physician assistant on the team.
“People didn't know what we had to offer,” she said, but as people were referred to the program or heard about it on social media, the staff became increasingly busy.
The program sees patients dealing with all kinds of substance use disorders, whether opioids, alcohol, nicotine, methamphetamine or other other drugs.
Willmar had not had a program offering medication-assisted treatment until Deuvel, Morales and Dr. Scott Abrams began it. Abrams works with Project Turnabout treatment programs in Granite Falls and also works with inmates in the Stearns County Jail in St. Cloud. Morales also works with Project Turnabout.
Medication-assisted treatment — offering drugs that help curb cravings and reduce withdrawal symptoms — can help prevent relapse and maintain abstinence, according to the U.S. Substance Abuse and Mental Health Services Administration.
A SAMHSA report lists the ability to offer medication-assisted treatment in primary care settings and not only specialized treatment programs as a key advantage.
Before the program in Willmar, people were driving two to three hours to see a doctor who prescribed their medication. The drugs are prescribed as part of a broad program that includes counseling and treatment.
Addicts still need to work hard to find sobriety, said Abrams, who is a recovering addict.
“I’m not going to give you the magical pill that’s going to make you sober; I wanted that back in the day,” Abrams said.
“I would say to anyone, don’t come into this thinking you’re just going to take a pill and be fine,” Abrams said. “If you rely on a pill to change your behavior, you will fail every time.”
Abrams is in recovery from an addiction to opioid pain medication. Seven years ago, he lost his job as an emergency physician and his licenses to practice medicine and prescribe drugs.
After he completed a treatment program, the clinic hired him to work in urgent care under close supervision. His licenses have since been restored, and his experiences led him to practice addiction medicine.
Before drugs like Suboxone or several others were available locally, some addicts tried to buy them on the streets, Deuvel said.
“The trouble is there’s no quality control from a drug dealer,” she said.
Like many other illegal drugs, they may have had fentanyl in them.
Fentanyl is a very strong drug and a big risk of overdose for people buying illegal drugs. “There’s fentanyl in everything,” Deuvel said.
Patients will still have to work hard to overcome their addiction, Abrams said, and the program offers options for them.
Patients can be referred to several outpatient treatment programs in the area.
For those who need to keep their jobs and are trying to keep their families intact, outpatient treatment is an option, he said.
It still requires a major commitment — three nights a week, but they can stay in their community.
Inpatient treatment is another option.
Some are worried about losing their jobs if they go to inpatient treatment. Abrams uses himself as an example and tells them that if they keep using, “the job has a way of going away on its own.”
Morales said some patients come and go from the program. Some treatment programs in the past were strict with people who’ve started using again. In Willmar, the idea is to encourage them to try again.
“What we hope is they eventually find their way back to us,” Morales said. “They’re so used to being chastised for missing appointments. … That’s not what we’re about.”
Morales said she developed an interest in treating addiction after conversations with patients in her family practice about their substance use.
Patients are thankful they can be treated in their local community and that they don’t have to feel ashamed if they make a mistake and start using again, Deuvel said.
“It’s a group of people who deserve way better treatment than communities and medical systems have given,” she said. “We don’t shame people who have to take high blood pressure meds or have diabetes, why do we have to shame people with opioid addiction.”
The idea that addicts are seeking quick pleasure is a misconception — “That part goes away pretty quickly, and then it’s the avoidance of the negative,” Deuvel said.
It’s not a choice, either.
“If you had your life controlled by a chemical that was hard to get, expensive and caused emotional trauma and shame for you and your family, would you choose to use that,” she asked.
Abrams said most people can come to some understanding of addiction through their own experiences.
“Everybody’s got their thing they wish they didn't do that they keep doing,” he said.
It might be something innocuous, like eating doughnuts or ice cream. The reward pathways in the brain are similar, regardless of the substance.
“I’m not going to jail when I eat unhealthy food, it’s not the same thing, but that’s how people can understand,” he said.
Deuvel was asked to develop the program by Dr. Cindy Firkins Smith, the former head of the clinic and now vice president of rural health for Carris Health's parent organization CentraCare.
Smith asked her to develop a thorough approach for dealing with the problem of opioid addiction and overdoses, Deuvel said.
Deuvel spent many years at the clinic as an obstetrician/gynecologist. She delivered lots of babies — “How could you have a better job than that?” — but physical problems with her hands made it impossible for her to continue in that field.
She earned a master’s degree in health care delivery and Smith asked her to come back to Willmar to work on quality innovations. For Deuvel, it felt like coming home.
Deuvel said she looked at prevention, treatment and recovery and found gaps in the system.
“We developed a toolkit to help decrease the number of opioid prescriptions,” she said.
It’s a balancing act, she said, of providing adequate treatment for pain while avoiding prescribing opioids when they may not be needed.
Deuvel said she “couldn’t be prouder” of the team that’s come together in Addiction Services with Morales, Abrams and herself.
There’s a big reward in seeing patients reclaim a healthier life after treatment, she said.
‘All you have to do is have a few of those patients have their lives back,” she said. “It’s so powerful to see kids have their parents back.”