As opiate addiction retains its grip, Twin Cities first responders are turning to another remedy

As a pharmacist for HCMC and Hennepin emergency services, Holly Drone has seen a lot. But when Drone described the pain of opiate withdrawal on patients, she turned to her clients’ and co-workers’ experiences.

“‘It feels like the devil’s taking over my body,‘” Drone recalled a patient saying. “Paramedics have said, ‘I can’t complete any other medical care because patients are so uncomfortable. They’re crawling off the cart. They want out of the ambulance immediately.‘”

Opioid addiction, fueled in part by international criminals smuggling fentanyl into the streets, has run roughshod over people across the Twin Cities and greater Minnesota. Many who overdose are given Narcan, a brand of the drug naloxone that can reverse an overdose for a price — patients experience immediate withdrawal symptoms that can feel worse than broken bones or heart attacks. Those symptoms drive many patients to use again, leading to a fatal overdose.

But a growing number of officials in Hennepin County and Ramsey County are deploying buprenorphine. The drug is meant to stall withdrawal symptoms and decrease the chance of a fatal overdose, which becomes more likely as people suffer withdrawal. Some professionals believe it can cure opiate addictions that affect a growing number of Minnesotans, many as young as 14.

The realization of opiates’ devastating toll on the community struck St. Paul police Sgt. Toy Vixayvong when he did outreach work speaking to parents and their kids.

Vixayvong learned that more young people are getting hooked on opiates and turning to crime to support their habit. Some steal from cars. Others break into homes. All sold the stolen property to buy drugs like fentanyl pills that can cost as low as $5. But with some users taking 20 pills a day, one person’s habit grew into the city’s problem.

Vixayvong intervened by driving youths to Hennepin County clinics for prescriptions of suboxone. Suboxone, a brand of the drug buprenorphine, is a medication meant to reduce the effect of symptoms from opiate withdrawal. The drug has a small chance of making those symptoms worse, but clinicians avoid that by screening patients and their conditions.

Another St. Paul officer and the nonprofit Urban Village in St. Paul helped Vixayvong, but the demand was too much and he turned to the city for help.

“It affects the whole community, it affects everything. You start getting these kids committing crimes,” Vixayvong said. “It cost lives. Not only lives, [but] with the crimes that they’re doing it costs money. It’s the whole domino effect. ... This is beyond what the police does but it was important work that we needed to keep up.”

Addiction rewires the brain. Abuse of substances like alcohol create a dependence that can develop over years depending on the person.

However, fentanyl works quicker.

The opiate can create dependence within the brain in months, digging deeper addictions for youth under 25 whose brains are still developing.

Vixayvong presented his efforts to the St. Paul City Council, winning support from council President Rebecca Noecker and others who approved the use of buprenorphine through the fire department this January.

Saint Paul Fire Department EMS Director Dr. Aaron Burnett said the effort has been successful. Emergency workers offer the drug to people suffering from opiate withdrawal, screening their health conditions to ensure that buprenorphine is right for them. The EMS chief then responds and screens the person again before administering the drug.

So far Burnett said the entire department is trained on the procedure, and cities across Ramsey County, like Maplewood, are interested.

“It’s not a Band-Aid that only works in the immediate. It’s truly the treatment for their addiction; it’s the solution for their addiction, ” Burnett said. “Addiction is a biochemical process in your brain and suboxone [buprenorphine] is the treatment for that as it relates to opiates.”

Burnett said that Minnesota is among states leading the nation in using buprenorphine, and others could follow. Emergency workers in Hennepin County set an example, using the drug to aid their opiate response for years.

When Jackson Thiets became an HCMC paramedic four years ago, he responded to overdoses around three times a day. Sweat streamed down the face of opiate withdrawal victims. They were sick with diarrhea and vomiting, and bone pains led many to crawl out of ambulances with discomfort that Thiets said was worse than patients with broken bones. Wanting to do more, he suggested using buprenorphine after reviving people with naloxone.

“What made me really be an early adopter [of buprenorphine was] seeing patients who are fundamentally in really uncomfortable situations, acute distress from Narcan induced withdrawal, and not being able to do anything about it,” Thiets said. “It goes a lot towards building public trust with populations that can have animosity towards first responders.”

Emergency workers began offering buprenorphine in 2023, asking patients if they would like to try the drug to manage their withdrawal symptoms. After screening which patients are fit, workers like Thiets administer the drug and help connect people with prescriptions. They’ve served 121 people. Three people vomited before and after taking the drug while 85 reported improved conditions. Others reported no changes.

Dr. Tim Kummer, assistant medical director for Hennepin EMS, said Hennepin County’s results offer a glimpse at what can be fixed through emergency services. Kummer said many clinicians hesitate to use buprenorphine because of the X-waiver, a federal requirement for professionals treating opioid use disorder that was removed in 2023. The requirement included an eight-hour training that scared many providers from using it.

“The X-waiver was probably one of the most detrimental aspects of addiction care in the last many, many years. And there’s been a lot of bad things that’s happened,” Kummer said. “These marginalized communities don’t have access to healthcare, so they’re left with nothing but emergency care. Which is why it’s even more important that we are the ones who are leading the charge on this.”

As Kummer, Burnett and others lead the charge through emergency services, Dr. Dziwe Ntaba takes a different approach.

Ntaba works with M Health Fairview and co-directs the Masonic Institute for the Developing Brain’s community engagement and education service. The institute is working to develop training and mentoring for clinicians across Minnesota about buprenorphine in order to reduce stigma and normalize its use. They’re also partnering with the Minneapolis Health Department and University of Minnesota to teach young adults and youth in high school and middle school how to preventing substance use.

“Buprenorphine is one of the most powerful tools we have to prevent opioid overdose deaths and all the harms associated with untreated opioid addiction. This medication stabilizes the brain’s chemistry, reduces cravings and withdrawal symptoms, and keeps people engaged in recovery,” Ntaba said, adding that patients using buprenorphine have fewer ER visits, and run-ins with police — saving tens of thousands for the public sector.

“By expanding access to proven treatments like buprenorphine, we not only save lives, but also reduce hospital strain, improve public safety, and build a more compassionate, resilient healthcare system for all Minnesotans.”