Overdose tracking sheds light on housing and treatment links in Northeast Minnesota

A recent study of participating hospitals in northeast Minnesota found that among emergency department visits for substance misuse and overdose, nearly one-third of patients were experiencing homelessness — even though less than 1% of area residents lack housing. The findings highlight the need for a comprehensive approach to break the harmful relationship between chemical dependency and homelessness.

The data comes from the Minnesota Drug Overdose and Substance Use Surveillance Activity (MNDOSA), which the Minnesota Department of Health (MDH) developed to better understand substance misuse and drug overdose patterns in close to real time. MNDOSA collects data on overdose victims and tests clinical samples to confirm what substances were involved.

“Minnesota families from every part of the state have been impacted by drug overdoses and deaths,” said Minnesota Commissioner of Health Dr. Brooke Cunningham. “To prevent these tragic incidents, we must continue to respond with naloxone distribution, treatment programs, transportation and housing. The basics are so important. The reality is that people can’t get treatment if they can’t get to treatment, or if they’re more worried about where they will sleep at night.”

Gov. Tim Walz has proposed expanding MNDOSA to better identify and track substances involved in overdoses. The budget proposal (PDF) notes MNDOSA’s findings that the overdose epidemic disproportionately affects people experiencing homelessness and that in northeast Minnesota 29% of patients with emergency department visits for drug overdoses were experiencing homelessness.

This MNDOSA report included data from five Essentia Health emergency departments. It showed that of the 459 patient visits for substance misuse or overdose between November 2017 and October 2021, 134 of those patients were experiencing homelessness. The impact of structural inequities and systemic racism on health and housing is also seen in the data with 39% of American Indian patients and 55% of Black patients studied by MNDOSA experiencing homelessness.

Nearly all the homeless patients had a history of mental illness (87%). They were also more likely to have attempted or completed a chemical dependency treatment program (43%), than those with housing (25%).

Patient care frequently gets disrupted and ends once the patient leaves the hospital, according to the study. Though homeless patients were more likely to be referred for further treatment than those with housing, they were also more likely to decline it. The reasons patients declined additional treatment are unclear. But existing treatment options may have strict abstinence-only requirements, may not be culturally responsive or may necessitate leaving community supports behind, which could make accessing treatment more difficult.

“These results point to the reality that we need a proactive, trauma-conscious, integrated and responsive approach in supporting people facing homelessness,” said Laura Birnbaum, the St. Louis County’s Housing and Homelessness supervisor. “We need culturally responsive, integrated teams to build relationships and trust with people living outside and in shelters, and to connect them with housing and other areas of care including harm reduction tools.”

Gov. Tim Walz and Lt. Gov. Peggy Flanagan’s budget proposal includes more than $225 million to address the opioid and substance use crisis. These investments include new dollars to strengthen the entire continuum of care from prevention, harm reduction, treatment and recovery, as well as at the intersection of housing and substance use.

Nonfatal Drug Overdose Dashboard

In addition to the MNDOSA report, MDH recently released its Nonfatal Drug Overdose Dashboard, which provides statewide data on hospital-treated nonfatal drug overdoses. The goal of this dashboard is to provide Minnesotans with data that will help them better understand who is experiencing nonfatal drug overdoses, where they are happening and the impacts on their communities.

In 2021, there were 11,506 nonfatal hospital visits for all drug overdoses among Minnesotans, according to the dashboard. Through September 2022, there were 8,359 nonfatal hospital-treated overdoses. These numbers are like those seen during the first nine months of 2021.

Though Black and American Indian residents are more likely to be treated in the hospital for a nonfatal drug overdose, the greatest number of overdoses were experienced by white males and 30 to 34-year-old Minnesotans in 2021.

-MDH-