buddy my name is Mike Sheehan I am the communications director at the Hennepin County Sheriff's Office I want to thank you all for coming we're gonna have a presentation on the status of opioid addiction crisis in Hennepin County we'll cover that for about a half hour and then we'll shift into questions and answers right now I just like to introduce sheriff rich Stanek sheriff Stanek is a 34-year veteran of law enforcement and has been serving as the elected sheriff of Hennepin County since 2007 and we're just going to talk about the current state of opioid crisis what's going on in Hennepin County and what we can address it as a community going forward so without further ado sheriff Stanek all right good you guys in a good mood tonight we've done a number of these things over the last year year and a half and sometimes we end up three four hundred people other times we end up with a smaller group nonetheless you know each and every time people walk away with a pretty good understanding about what the opiate opioid crisis is and how you might play a role in all this in terms of prevention and intervention resources our panel tonight is dynamic many of them have been with us before and they're gonna make it easy for you because they want to hear from you this is interactive right it's gonna take me about 15 minutes or so to get through my part but I'm going to set the stage and then we're going to turn it over to these folks you know they're gonna talk a little bit from each of their different perspectives law enforcement educators other resources available to you and then we want to hear from you and you can have a little interactive dialogue make sense okay well let me say this so I'm absolutely honored to be here I love coming out to the different you know groups and community centers and schools around the county and I considered a privilege every day to work on your behalf as your elected sheriff I want to thank the school district in the city of st. Louis Park for hosting us here tonight as we discussed this critically important topic and wish to extend a personal thanks to the superintendent of the school district and miss Kim Fisher from st. Louis Park School District Paul beerhouse who's here with us today he's a member of our community board it was his idea - come on out here and work with folks and of course miss Jackie Larson from the city of st. Louis Park as well joining me on stage tonight our panel is you're gonna meet him in a little bit but I'll just do a quick introduction for all of you Chief Mike Hersey from the st. Louis Park Police Department Mike's got a tough job every day and Mike does a phenomenal job every day the men and women who work at the st. Louis Park Police Department he's one of our law enforcement partners and he's passionate about what we do now dr. Steve delici is the assistant dean at the Hazelden Betty Ford Graduate School of addiction studies miss Hawley meg dance has been with us before she's the coordinator of the Hopkins public schools Hopkins one voice program and then Miss Rhoda the Michael Lind chair of at the Hopkins one voice coalition and as we're gonna soon hear she's someone who has some first-hand knowledge of the devastating effects of this opiate opioid crisis a special agent Jeff Van Ness from the FBI he's the minneapolis chief division counsel of our local FBI office an assistant US attorney and a good friend annie dunn who leads the organized crime Drug Enforcement Task Force section of their office here at the US Attorney I brought some slides because I wanna I want to bring it to life for you we created this hashtag an overdose campaign to accomplish the goal as you see here number one was the raise awareness 2 was to build partnerships and 3 was reduced a number of deaths throughout Hennepin County throughout 2017 just a couple months ago we ended the year we were actively engaged in this comprehensive effort to reverse the trend of rising overdose deaths everyone everyone has a role to play again it doesn't matter what segment of the community you come with whether you're a parent a student maybe just somebody who's interested in what we had to say this evening this has taken overdose campaign truly is a multi-level approach to reducing the number of opioid related deaths across Hennepin County and what we see in Hennepin County is the same thing we see across the state of Minnesota it's by no means magicked to Hennepin County which is one of 87 counties we happen to be the largest and then if you look at it not just on a statewide level but now level the same trend many counties many states across this country are feeling the same effects we are from opiate overdose addiction investigations and enforcement are what you expect out of a local law enforcement right we do it well and sometimes we do it too well but that is not purely not the answer to all of this we're going to continue to conduct town hall meetings and events like this across the county and throughout the year we're gonna partner with organizations like the Hennepin County Medical Center and North memorial the Steve Rummler Hope Foundation the public schools of police departments our first responders and other organizations as they come forward in order to change this trend we're going to be working with local and state governments to ensure that policy matters that can affect a number of opioid related deaths are also being addressed now you may have noticed maybe some of the digital billboards around the county I think we have 16 of them now that we use to change the messaging and we do so in order to better inform the public we're expecting them to be seen by over 4 million people over the next several months of 2018 here as we did in 2017 look folks this opioid crisis has some scary scary stuff right I bet fact I'll just ask you how many of you have friends relatives nieces nephews aunts uncles neighbors down the block maybe employees or employers who have had some addiction issue yeah a few we all have right I've had it our deputies that people on the audience have had it I've been in law enforcement for thirty four plus years and yeah I can tell you this is the kind of stuff that keeps me up at night why because like I said every single one of them's tragic but every single one of them's preventable in 2016 think about this Hennepin County saw 153 opioid related deaths in 2017 the Hennepin County has seen at least one hundred and sixty-two deaths and we're not even done counting out the year yet like I said over those last two years in 16 and 17 a 47 percent increase in this thing and you know is it gonna stop here in 2018 2019 2020 I don't know but I know folks like the panel and all of you make a difference at the end of the day and it's by sheer in pure education that we can make a difference people ask me all the time Sheriff is this a crisis what do you guys think if I had 162 homicides in my County last year in 2017 versus the 65 or so that I did have again we run about three times the number what would you say to us what would you say to law enforcement or the US Attorney or the FBI Oh to the sheriff of the county you demand more right you absolutely would that's a lot of people too often we look at these issues like this as someone else's problem right it's the neighbor down the block well it's not my kids it's my sister's kids or you know hey I'm an I'm an educator I'm a doctor I'm a businessperson it's one of my employees they've got to figure it out we all have a role in a state to play these partnerships we built to conduct the hashtag an overdose campaign have been far-reaching we've worked really hard on this we have a coalition of concerned citizens and include academics current and retired law enforcement educators public school employees community public health advocates recovering addicts and parents now you name it they come from all segments and gamuts across the county the Hennepin County Sheriff Foundation has been a strong source of material and financial support to us and all for Minnesota pro sports teams have agreed to help get the word out about the opioid crisis the Minnesota Twins and Minnesota Vikings AI Minnesota wild and the Minnesota Timberwolves and links they have all stepped up to help us there isn't a piece of this that we have that we have left out but nonetheless those numbers last year in the year before a forty seven percent increase and not to be overlooked in any way as the natural partnership the Sheriff's Office has with the other 86 county sheriff's across Minnesota like I said what happens in Hennepin County isn't isolated to Hennepin County there's three and a half million people in this metropolitan area in about five and a half million people across the state of Minnesota during our annual Minnesota State Fair we partnered with our seven-county metro area sheriff's to staff our booth some of you Paul and others were out there working with us as well more than a million visitors came to Minnesota State Fair and tens of thousands of them stopped by our booth whether they're from Hennepin County or Ramsey or koochiching or yellow medicine whatever it was they came by and we helped educate them a little bit about the hazards of opiate or opioid overdose these drug deactivation pouches are another easy and effective way to dispose of unused medicines if you ask your pharmacist when you go next time to Walgreens or CVS or wherever it might be ask if they carry them and if they don't ask why not about 70 percent of drug abusers swipe pills from medicine cabinets of friends and family did you hear me so this is one of the questions I'm going to ask you in a little bit so I'm giving you the answers to my quiz I told you there's a quiz tonight right all right well there is a quiz it's better to tell you now than later but I already gave you a couple of the answers to the quiz so that's why I hope you're you're paying attention you think about you know there was a law passed back in 2016 that allows you to take these medicines back to a pharmacies but so far in Hennepin County only three pharmacies have added the take-back boxes right there's a there's a Walgreens over on Blake Road out here in Hopkins there's a one out in Brooklyn Boulevard in Brooklyn Park and there's one over on 45th and Hiawatha and Minneapolis three pharmacies out of how many across Central County five hundred a thousand right there should be more and you as residents of this county should demand more of these folks and I hope you do you think about the Hennepin County Sheriff's Office and partnership with local law enforcement and we disposed over 57 tons of unused unwanted expired meds and how much is 57 tons how much about one hundred fourteen hundred fifteen thousand pounds right did you hear me about 114 hundred fifteen thousand pounds that's without even trying that's people like you bringing them to us so we can dispose of them legally lawfully environmentally safe there's a lot more out there our job tonight is to help educate you a little bit about diversion as well so they don't end up somewhere else we talked about naloxone and narcan a little bit earlier urge all the first responders in this county police and fire like to carry narcan and naloxone it is a life-saving antidote it works every single day across this County there are dozens of saves either in the emergency rooms administered by paramedics police officers firefighters out in the field all of our sheriff's deputies in Hennepin County carry it many of our law enforcement agencies and/or their fire departments all of them across Hennepin County have access to it as well that's a significant policy change and something that really helps alright Mike we're gonna take this drug awareness quiz you ready you guys ready all right I promise this will be easy alright so first one on an average day in the United States how many people in initiate heroin use a B or C what do you think okay now I'm gonna give you the answers at the end of this panel but I've already given you many of the answers so this should be easy for you the second one which drugs are responsible for the most overdose deaths in the United States crystal meth cocaine or opioids painkillers and heroin which one a B or C and there is no D all of the above where do most teens obtain the pills they used to get high they get them from drug dealers they meet on social media they get them from other students with prescriptions who sell them or do they get them from their parents and our grandparents a B or C what I think yeah you know the right answer okay next one one in five teenagers in Minnesota have used prescription medication for recreational purposes true or false what I think I bet if we had a couple young people up here a couple of teenagers they tell us a lot right parents yeah so I learned most of stuff about what's going on from my own kids all right next one seventy five percent of current heroin users started with prescription pills true or false well she just gave you the answer good job okay so I introduced our panel you care which order we start I'll let you guys decide each of them have what about five minutes or so they want to talk about it from their perspective please introduce yourself again and what you do now make it easy for these folks because there you're going to inspire questions from them in an interactive piece back and forth okay thank you all for being here tonight I'm Mike Garcia and the chief of police is st. Louis Park I guess my role here is to just give you a little background on the local impact we've seen in the opioid crisis over the last five years we've looked at our numbers on overdoses and it's steadily increasing over the last five years here in st. Louis Park we measure that in all types of overdoses being at pills or illicit drug use so but there's been a steady increase over that last five years we've also tragically seen an increase in the number of overdoses overdose deaths that have increased over the last five years in 2017 we had six overdose deaths in st. Louis Park it's really changed how we look at responding to drug calls and how we deal with youth in our community and as the sheriff explained we're taking some steps initiating the use of naloxone narcan we have that in all of our fire department personnel and our police department personnel are trained in the use of that and it's carried by our fire department who responds to all of our medicals and the des terreaux bags which are available here tonight our police and fire department to also have those available to any of us st. Louis Park citizens if they want to dispose of pills they can stop by our Police Department or a fire department to pick up one of those bags and we also worked with the with the drug take-back program and we had over 230 pounds of pills and other medications that were brought to our Police Department back I think it was in nan de November or was the last take back program but so we're seeing that there's a need for all of these prevention techniques to be used in our city and the impact obviously with six deaths in our city is is tragic and another impact we're seeing is because of those six overdose deaths were kind of having to shift our investigation resources from both as our Drug Task Force group and our and our investigators here at st. Louis Park we're shifting away from other crimes in order to have to invest and investigate these deaths and we're very aggressive at that and with the help of the Hennepin County Attorney's Office being aggressive and investigating these deaths and tracking back the supplier of the illegal drugs we've been successful in charging for people with a third degree murder in these cases of these six cases we've had last year we've got also a couple of pending cases that are still under investigation and we're working with the County Attorney's office on that so just in the United States Attorney I'm a federal prosecutor and I just want to tell you a little bit about our office and then how we're responding to the opioid crisis our office is comprised of about 40 prosecutors those 40 prosecutors are broken up into four sections there's the organized crime narcotics section that's I'm the chief of that section we do guns gangs and narcotics prosecution's for the entire state of Minnesota last I looked there were 87 counties 87 County attorneys and those 10 prosecutors do guns gangs and drugs for all 87 counties because of that we've got to be selective about what we take in we can't take in everything and so the factors that we look at to see whether or not it's a federal level case are several factors one are the targets of the investigation repeat violent offenders who didn't get it maybe their first or second time around and they need their attention focused will welcome them to the federal family and the Federal Bureau of Prisons if it's a large quantity of narcotics it usually makes it to the federal level for example last week we charged a case that 150 pounds of methamphetamine were interdicted in Oklahoma destined for st. Paul Minnesota we took off that load the people came to Minnesota and we prosecuted about 10 people who are associated with that and it's got tentacles into Mexico so large quantity of narcotics organizations we try to focus on organizations rather than one defendant one-offs in that way if we focus on organizations we can try to have more impact on a community by dismantling that organization and that's why the fourth thing we look at is there interstate or international ties possibilities to an investigation that extend outside of Minnesota that we can work up the chain of distribution and hopefully target the source of supply of narcotics that are usually out of Minnesota usually out of the United States and oftentimes coming from Mexico how does that tie in to the opioid crisis because none of those factors really tick off what's happening with opioid heroin problems well in November of 2017 the Attorney General announced an increased effort to combat the opioid epidemic and there were three parts of his announcement one was he dedicated 12 million dollars in cops grand grant funding to local law enforcement to fund efforts such as this and investigations into the opioid crisis - he has tasked all US attorney's office to review their prosecution intake guidelines so that cases that normally wouldn't get accepted for federal prosecution because it didn't reach any of those four things that I talked about we're gonna start prosecuting number three each office was directed to name an opioid coordinator happens to be me to develop an anti opioid strategy and part of that strategy is prevention treatment community outreach and enforcement since I'm a prosecutor the enforcement part it's what I like to do and that's working with state local and tribal law enforcement to pair them up with federal law enforcement to find where's the best case the best place for their cases rich Peterson from DEA is in the audience and we work quite a bit with DEA in pairing them up with local law enforcement to see what opioid cases what heroin cases what Sentinel cases and Steve's going to talk about Sentinel it is a danger it's causing deaths what cases can come to the federal level the last thing I'm gonna leave you with and then I'll let Steve talk you know I've been a federal prosecutor since 1989 why my hair is white when I started it was black it's white now right I've been through the crack cocaine epidemic in the 90s I've been through the methamphetamine lab problem in the early 2000s and then the Minnesota Legislature made it hard to restricted the ability to purchase precursor chemicals like pseudoephedrine and those clandestine labs went away and it opened up the market for Mexican Mafia methamphetamine we are flooded with that in Minnesota we saw that in the 2000s up until today like I said 150 pounds of methamphetamine was taken because it's an open market for the Mexican pipelines this is the first time that I have seen public health officials addiction and treatment experts to play a role in trying to address the problem we try to prosecute our way out of the crack cocaine problem we tried to prosecute our way out of the methamphetamine problem and I'm here to tell you it didn't work what we did is we put generations of people behind bars for really long time but the problem didn't go away now any anti-drug campaign has to have enforcement has to have prosecution as part of the solution because you need to punish criminal activity you need to provide deterrence so people don't engage in that criminal behavior but you can't do it with enforcement and prosecution alone and that's why it is heartening to me to see public health officials treatment and addiction specialists because they're as much part of the solution as cops and prosecutors thank you thank you very much my name is dr. Steve delici and first of all thank you for the invitation and thank you for coming tonight I wear a couple of hats I work with hazel and Betty Ford Foundation which most of you I think are aware is a large treatment network of treatment facilities across Minnesota and the country I have been treating patients with addiction for 17 years both here in Minnesota and before that in Chicago I agree I've seen each of the epidemics come in in turn and I am heartened by the fact that we as a nation are coming together to talk about this more so than we have in the past these type of community events you all coming here for this evening to learn to talk to ask that's what's going to make an impact here and I hope that we will be able to continue this dialogue so that we're not up here talking about the next epidemic once the opioid epidemic is is dealt with because addictions not going anywhere so Mike my two hats I am an addiction psychiatrist and I do addiction treatment the other hat that I wear is as the assistant dean of our graduate school so for over a decade I've been teaching counselors nurses medical students and residents about addiction and and now I'm going out to the community to teach physicians how to more appropriately treat addiction how to more appropriately treat opioid use disorders but also how to more appropriately treat pain with different medications because that's part of this dialogue I guess my role tonight is is as one of the treatment community to stay that addiction and opioid use disorders does not discriminate it is an equal opportunity destroyer of people's lives I'm also the resident scientist I'm the the the data hound up here so if there's questions about treatment or the science behind addiction I'd be happy to answer those questions it's it's a illness that doesn't just affect the person who has the disease of addiction and I use that terminology purposefully here in 2018 we have the science that proves that addiction is a disease an illness like other chronic illnesses like heart disease hypertension diabetes and we need a similar approach when you are treating chronic illnesses you need to treat the patient you need to treat the families you need to treat the communities and you need to treat society so all of you being here is is the start of that process families are hurting families are being negatively impacted and and devastated by this disease as you will hear in in a moment to a much more personal degree than than I can speak to treating first of all prevention is the most important and the families are going to be key to that early intervention is next because treatment works that's the good news is that for most people with addiction getting the treatment and getting it early and getting sufficient treatment actually does work there's often this attitude that treatment doesn't work and there's no hope that's absolutely false that's absolutely false and we can talk more about that if you so choose but we need to have the families as part of the treatment team and that's why I'm heartened to see people here and I will with that passed the microphone my name is Rotem ichael and i'm gonna stand up because i can think better on my feet this is my boy Adam was in the Hopkins School District and Adam anybody who knew my son would say two things about him he was brilliant and he had an incredible sense of humor he just made people laugh Adam was a gifted student he was an honor student he graduated in 2016 with a 3.9 GPA a boatload of AP credits a black belt in karate he did improv theater and he struggled with anxiety and depression unbeknownst to us as parents he started to use marijuana in junior high to self-medicate for his emotional pain and then turned to pills and in July of 2016 18 months ago our son was in Utah and he called really excited to tell us that he had just enrolled in his college classes for the freshman year he planned to study psychiatry or psychology hours after that phone call we got another phone call saying he was dead he died of a fentanyl laced dose of heroin he didn't know that it had fentanyl in it and he somehow was maybe it was anxiety we don't really know what I can tell you as my son was not a partier he would not want to be known as the poster child and you can go to the next picture Mike just to see that was how he looked when right before he died I don't look like the face of a mother whose son used heroin and I'm here to talk about it not because my son would want to be known for his death but to make the case that it happens in families like yours it happens in families like mine my son was gifted he had good friends he had a good family he had a very good life and yet he struggled with mental health disease and he died of a heroin overdose and until we as parents and as a community can get up here and talk about addiction and talk about mental health the stigma and shame will continue and the first step is by talking about it we've touched a little bit on the the law enforcement piece but typically we hear about people who get into especially young people teenagers and I really can't speak for adults but as a parent of a teenager who got involved I can say it typically happens for two reasons one is that kids get introduced to opioids accidentally because of medical prescriptions years ago when someone had a root canal or wisdom teeth out they said it's gonna hurt for a while you know it's take some aspirin stay in bed and you'll feel better in a couple days now we walk out of dental procedures with a prescription for 30 percocet or oxycontin and while it's a very very effective pain reliever for surgeries and things it is something that can turn into addiction and dr. de Lisa can can speak to this but basically we don't know who's really vulnerable to opioids it has an amazing effect on the brain and so as parents we need to question when our kids are prescribed a dose or a prescription of 30 percocet if the doctor said I'm gonna send you home with 30 doses of heroin for your kids sprained ankle or wisdom teeth extraction we might question it but somehow when it's called percocet or vicodin or oxycontin we say okay you must know what you're talking about and we've gotten into a climate that we do everything to prevent any level of pain which has some value but as parents we have to be very very watchful of anytime our kids are prescribed opioids we have to monitor the prescription we have to rid our house of extra drugs that's number one number two is that mental health issues go hand-in-hand with substance abuse the CDC says that one in five kids across the country right now are struggling with the mental health disorder that requires treatment nine out of ten adults who struggle with addiction have co-occurring mental health problems they go hand in hand and we and an I my husband and I didn't pay enough attention to our sons emotional pain of anxiety and that's what led him to use drugs marijuana and then pills so we talked about two ways in and we have to deal with the entry issue to be able to solve the problem we have to deal with controlling the number of times our kids are exposed to opiates through prescriptions and we have to deal with the mental health piece the Surgeon General the United States in the 60s some of you are old enough to remember the 60s did a report on tobacco use and that was really instrumental in changing the culture and attitudes about tobacco and in the 1980s they came out with a report on hiv/aids and said and it wasn't until we started to look at HIV and said it's not those bad people doing bad behaviors it can happen to anybody and until we realized that that HIV could happen in a family like ours or to our sister with the blood and fusion or whatever we didn't really solve the problem and now the Surgeon General has come out with a report that says substance abuse is a pediatric disease and that's significant because number one it's a disease and number two it's a pediatric thing that we all as parents as educators have to deal with in the same way we deal with the immunizations for our kids in the same way we talk about stranger danger when they're little we have to address substance abuse as a risk that every family is going to face when one in five kids has a mental health issue and makes them vulnerable to substance abuse odds are if your kids are safe they know somebody who isn't odds are they're getting exposed to somebody who is using drugs or intoxicated or talking about self-harm or other manifestations of mental health issues so as parents we have to get our head out of the sand we have to talk about it we have to be willing to address it as aggressively as we deal with the other threats to our kids safety we have to talk about it and we have to empower our kids to have their buddies back odds are if your kids aren't using they will know somebody who is and we have to teach our kids how to have their buddies back how to recognize alcohol poisoning how to recognize drug overdose overdose more important than teaching them the Heimlich maneuver teach your kid how to recognize overdose symptoms so that they know with Steve's law that protects them from prosecution they know what to do if they witness it they know it's okay it's not ratting on a friend it's helping and we've got it as parents be much more aggressive and assertive in taking these steps if we're going to protect our kids I would give anything to protect my son it's too late for me but it happened in a family like mine I'm involved in the hop one voice coalition I'm going to introduce Holly because I think each of us has a role not just in keeping our kids safe but keeping their friends safe the week of my son's funeral in July of 2016 there were 14 individuals who came up to us after the funeral to say this is happening to my son it's happening to my neighbor it's happening to my grandson it is out there to such an extreme and I know I'm preaching to the choir because if didn't mean something to you you wouldn't have come out tonight but I'm urging you to take a more aggressive stance with your kids and talk about it because it is on their minds whether you like it or not thank you rota my name is Holly Meg dance and I coordinate the Hopkins one voice community coalition I have the very humble honour to work very closely with Rhoda she is a tremendous leader in our advocacy work and outreach to parents so Hopkins one voice is a Community Coalition so I'm actually office just down Highway seven next door here daizen Howard Community Center and I'm here to talk more upstream about some of the early prevention work that we're doing in our case at Hopkins but a lot of the strategies that we do could be implemented and are being implemented and other communities as well our Coalition has been around for about 20 years we serve the entire Hopkins schools community um so my work is primarily focused around grades K through 12 I'm actually housed and physically housed out of community education so well I work for the schools I also work for the community and that allows a great amount of agency and flexibility in terms of the outreach were able to do and we work greatly across the district as well a couple key points that I would just highlight again with Rhoda we speak quite a bit about the need for prevention because of exactly what you said that addiction is a pediatric disease the earlier a young person begins using alcohol or other drugs the more likely they are to develop dependencies one thing we haven't really talked about tonight is the fact that the brain is in active development really until about the mid 20s so when a person is 15 or 16 or 18 even even 20 their brain is still really really really actively developing and the impacts of alcohol and other drugs are more harmful and that increases the risk of addiction so that really points to the need for prevention for resources for funding for prevention as Rhoda mentioned there is a lot of associations between mental health and substance use I would say in my work with the coalition and my background is in public health honestly I'd say more than 50 percent of our time is spent addressing mental health needs of our students because they are progressing so as Rhoda mentioned the CDC came out the report that one in five kids struggle at the mental health disorder on a more local level we have a really important surveillance or survey tool called the Minnesota Student Survey and one of the reasons that we're talking so much about mental health is that we know both locally in our own communities in our own state and across the country that mental health concerns are really increasing in prevalence so we have to be talking about that part of my job is to administer the Minnesota student survey for Hopkins and I'm going to talk a little bit about that but here I just wanted to kind of highlight a couple tools that we use in our coalition in terms of prevention that hopefully you can think about I'm happy to answer questions afterwards but again the Minnesota Student Survey is a state tool it is a census style survey meaning that every school district in the state is invited to participate because of that fact that it's a census survey we have a huge sample size it's very representative of what our communities look like across the state in the last survey which was in 2016 we saw a really big increase in mental health concerns with our kids and the survey just surveys 5th 8th 9th and 11th graders at Hopkins we saw for 11th graders almost one in three students were reporting a long-term mental health behavioral or emotional health concern that rate almost doubled from three years before so this is something that's happening it's part of the equation we don't know why happening but we do know what it's happening the reason I wanted to bring up the Minnesota Student Survey is because I feel like having data and again this is information that students are reporting in an anonymous and confidential manner it's really it helps us understand what's going on in their lives what they're struggling with and also what's going well so when our prevention work is well we don't just talk about the risk factors what's going you know they're really scary things we can also talk about what's going very well and what's working in terms of bolstering protective factors because we know that the more protective factors in person has the less likely also they will be to use substances so going back to the protective factor piece actually in that Minnesota Student Survey we can go in and look at what are some of the risk factors and protective factors we know mental health is a risk factor but in terms of protective factors parents are a really really strong protective factor so students who think that their parents would disagree with them using alcohol marijuana or other drugs are much less likely to actually use them so a point to get out to the community is that as parents if you can talk to your kids and we say don't just have one conversation talk about it all the time there's a lot of excellent resources we can point you to to start those conversations but talk to kids about your expectations and why you think that using alcohol or other drugs at their at their age would be harmful the other part to just kind of give a shout out to schools is that we also know from the survey that schools are a really important protective factor in young people so prevention is actually happening all the time sometimes we don't even know what's prevention but if kids think that their teachers care about them if they enjoy going to school they think their school is safe if they think that just general adults in the community care about them they're also much less likely to use substances and we've kind of crossed analyze the data in a lot of different ways and we have found this as a strong protective factor so we like to get that information out to teachers and school staff because they might not think that they're doing substance use prevention just by being an awesome teacher but and in fact they are and finally I wanted to kind of end on buy-in and collaboration buy-in I think is absolutely critical to having effective prevention work because the people don't think it's a problem or they don't think it could happen to them it's really really hard to get them behind talking about it and making change so in terms of buy-in with our coalition when working with kids and primarily teens I think having buy-in in terms of having as many student driven peer-to-peer message type of prevention strategies is what we found to be the most effective and I can certainly answer questions about that later but having students be empowered and educated about what's going on in potential harms risks and choices they can make has been very effective for us in terms of parents um as Rhoda mentioned I think that denial and stigma are always barriers that we're working on and the more that we can work together at parents and start with where they're at and have open conversation and dialogue and have a two-way dialogue the more I think we can work together and in staff the more that we can do staff trainings professional development opportunities in the schools to help staff understand what's happening in terms of addiction substance use mental health the more better equipped the staff are to address with the address those issues as well and then finally collaboration I think that we that that's the number one most important part about our prevention work is working together we are so much stronger working together than we are in our own silos in our own in the community kind of coalition world we work across sectors here we're walking working across sectors you can see that all of you are such an important part of our work and I just want to end on that thank you so my name is Jeff Van Nest I'm an FBI agent here in Minneapolis and one of the things that I oversee is our community outreach effort and you know I agree with everything that Holley and rota talked about on the prevention side that it's a collaborative process opioids are different strikingly different and many in our community don't realize that and so one of the challenges for us is how do we get that messaging into schools where kids need to hear at most because if if your kids are like mine they turn the volume down on anyone over 40 years old and so they're not gonna listen and so how do we bring that message to students who need to hear at most 11 12 13 years old during the the formative years when they're making these decisions and may not understand that using an opioid for the first time could be addictive could be highly addictive and so one of the things that the FBI has done in conjunction with the DEA is we've put together a film called chasing the dragon it's a documentary could I just see a show of hands how many have heard of chasing the dragon okay a couple quite a few and so it's posted on fbi.gov and there is a discussion guide that goes along with it and so we have this wonderful resource it's it's it's been available nationwide and one of the things that we've done here in Minnesota is we've we've partnered with initially with the Minnetonka Police Department the Minnetonka School District Hennepin County drug court and the DEA and we've brought this pilot program into an eighth grade classroom and it's really a three-part program and so you ask yourself what does that conversation look like in a classroom setting you know is it a health teacher who's saying don't do drugs drugs are bad right I mean so we've we've heard that and it's it's for us in the pilot program we ask the students to watch the film it's about 45 minutes long and it profiles five young people who each detail their spiral into addiction and they each have different different pathways into addiction and most started using either alcohol marijuana age 1112 and so an eighth grade classroom is about the right place to start sending that message once the students have watched the film then we convene a panel of folks to engage the students you know really in small groups and one-on-one and on that panel we have a young person who is in recovery some have gone to the very school that they are a classroom that they are sitting and talking to these students talking about what they didn't know at the time what they didn't understand and how their life unfolded once they made some of these decisions you know we have frequently on the panel will have a parent who lost a child who can talk about their struggles and how they did not have an appreciation for the addiction that their child was struggling and it's really hitting that theme of a disappointment to family that we heard about with the with the survey and and implications to others and then we'll have somebody from law enforcement on the panel who can talk about lifestyles of individuals that have come into contact with law enforcement who had spiraled an addiction so that our students will understand what the likely outcome will be if not if not interrupted in some way and so I can tell you having watched a number of these panels it's it's very very impactful it's very emotional you know frequently we'll have students who are in tears or need to speak to a counselor because it's that powerful we're talking about you know death of very very young folks and so following the panel discussion then we will open it up for a classroom conversation and we've done this pilot in Minnetonka we're in the Bloomington schools right now and we're looking forward in the fall to roll this out here in the metro and then statewide and so that's that's our contribution is to get this message into the classroom that opioids are different this we'll kill you okay we're gonna open it up for questions and answers right now it and segwaying in for what special agent Vaness just said to dr. delici what is it about opioids that are different what makes them so much more addicting than other substances sure absolutely so any any substance that is going to be a drug of abuse has to first and foremost cross the blood-brain barrier to get into our brain and the opioids for that are not different that's going to be the same for alcohol math cocaine marijuana nicotine and the opioids once in the brain all drugs of abuse hijack the what's called the reward pathway in our brain all of us have an area in the brain that will be triggered when something happens that is rewarding to us going out with your good friends that will trigger the reward pathway having a loving relationship with another person increases the reward pathway doing well on an exam increases the reward pathway none of that increases the reward pathway activity like a drug of abuse they all completely overwhelm that part of the brain and in a very real sense that area of the brain is saying whatever you just did whatever just happened right then is the most important thing for your survival and the drugs do that more potently than any of the natural rewards that we come into contact with now with the opioids they do that and we've heard mention of heroin and we've done we've heard mention of fentanyl they do that to an extreme that blows out most other drugs of abuse it really only methamphetamine would be in that same cat camp in terms of how addictive they are so it could be that on your first or second use you now have your brain saying that substance and using that substance in the way that you just did that's the most important thing for your survival that's what the person's brain is now starting to say yeah add to that with the opioids that they do relieve pain they relieve physical pain but you know what they also relieve psychic or emotional pain we've heard a lot from our panelists already about the interplay between mental health and and addiction and and that is very very true and where do the opioids sit in that they numb that psychic pain that depression that anxiety that agitation that sense that you are no good you're just your numbed your quiet I what I hear often is the first time that I use in opioid was the first time that I ever felt in quotes normal that's what I hear from from from my patients because that depression that intense pain of the depression or that intense pain of the anxiety it's gone it's gone and so when you add those two together that amplifies the addictive properties I'll add one other piece that's just now finally hitting research and and people are finally looking at it and that is that the opioids interact with another system in our brain a hormone called oxytocin some of you might have heard of that it is famously known as the hormone that is released when a mother is breastfeeding their child and it leads to intense feelings of attachment well that doesn't happen just with oxytocin that's oxytocin plus the opioid system which is also why it's so profoundly powerful when a woman has just given birth in his breast feeding their newborn and when you use an opioid you are flooding the system with the opioid site the side of that and if there's attachment to the people you're using with or the environment that you're using with you form that attachment as if it's a family member and that adds to the addictive properties of these substances thank you I think we had a question here my name is Osman Osman are gonna be half of our touch a community we are located at 24th and Nicollet Avenue we have a connection is like sheriff we meet before and we have a couple tourists increase of that I'm asking you what is a number of to increase our sellers and buyers or any new immigrant imported with us with that producing bringing another state or do you have any number zero to one that one I'm trying to understand or this is something continuous of like American and Wiser's means Orion wise I'm not sure I'd I followed all the whole question can you repeat it please yes I already know all those people you find past years bring him in to the trucks in Minnesota or sellin is any number of the new immigrant II that can be producing or bringing in an outside of the country or in that market immigrants say like 30 years in here in Minnesota that what I'm trying to understand um at least at our level the only immigrant population that we're seeing with narcotics trafficking again at the federal level our undocumented aliens from Mexico primarily because there are methamphetamine pipe lines right across the border there are mega methamphetamine manufacturing labs and those cartels need people to bring those large quantities of methamphetamine into the United States they happen to be people who aren't here legally they sneak in with drugs and when they're arrested they really don't even know how much trouble they're in the people I took 150 pounds of methamphetamine that I told you about there was three people in the truck only one of those people knew what they were doing one of those people had a direct connect to Mexico the other two wanted to visit Minnesota okay but now they're in trouble we had a lot of 50 pounds I mean they were driving so they're but as far as immigrant population all we're seeing primarily its Mexico South America Central America that that's on the federal level that's all we're seeing no that's not to say that the drug problem doesn't affect communities across the board but the County Attorney's the City Attorney's the drug courts deal with street-level problems in the US Attorney's office it's higher up the distribution chain and that's why we really don't see that bet problem any other questions otherwise I have cards too Thanks my name is Wendy and I do work in the treatment field and I have I'm not sure how to word this but part of the treatment for opioid addiction is medication management you suboxone or methadone what my concern is not seeing any limits on when you say opioid addiction it's the same thing not seeing any limits put on the methadone suboxone medication management so what we're having what we're seeing is people going on method on suboxone doing that and sometimes I've even had people come in to the treatment center where I work and say they won't let me get off say they start there's a high doses a lot of them I'm sorry to say our cash cows it's very disturbing and they're so what do you know of any kind of action that's being taken to start limiting and making that a true aftercare issue and not a lifelong maintenance program yeah so so yes so medication assisted treatment sar available for the use of opioid use disorders you mentioned two of them methadone and suboxone there's also melt rec zone or vivitrol which is an injectable form of of the medication they're each a little bit different and I'll try to be brief methadone is a full opioid it will activate the opioid system to the maximum extent if you take enough how it differs from heroin is that it builds up in the the system more slowly and then comes out of the system more slowly heroin is instant on almost instant off and that's more addictive that's methadone suboxone has a medication called buprenorphine in the medication suboxone that is what's called a partial opioid it does activate the opioid receptors but never maximally estimates are 65 to 70 percent of of activity of a full opioid and then naltrexone or the injectable medicine that's called vivitrol that's a medicine that blocks all of the opioid receptors and so you take that either once a day by a pill or once a month by a shot and the idea there is that for some individuals it reduces their cravings and for all it blocks response if they try to use an opiate the problem is that fentanyl can displace opioid naltrexone from the opioid receptor and that's the risk of overdose is we have these patients who are safely taking them their naltrexone they have a one-time relapse and it's with something that's laced with fentanyl and that overcomes the naltrexone and then they can overdose that's what keeps me up at night because it also displaces suboxone so they're doing well on their suboxone and then they use fentanyl in it it doesn't go well now your question is what are we doing when we're using medication assisted treatment says is there the opportunity for individuals to get off the medications or if you're on one of these medicines are you on it for life we don't know is the honest answer for every person we're learning that process the fact of the matter is is that methadone has been with us for quite a long time when used appropriately along with other treatment options it improves people's quality of life significantly they're able to work there they stay out of jail they have less other medical consequences to chemical use and and so from from a health policy perspective for individuals who are not able to engage in other modes of treatment and recovery that's something that helps them to maintain and that's that there's a lot of very good data for for many decades in that regard I will agree with the spirit of your question that there are individuals who are on much too high a dose who are altered mentally altered by the medication and are not doing anything else in in terms of addressing their illness we at at Hazelden for many many years would not use anything other than they'll Trachsel so we would have people come into treatment yeah on opioids we would detox them off their opioids and their two choices were don't be on anything and start to do their continuing care plan or beyond the naltrexone the patients that were on the naltrexone if they were highly motivated did relatively well those who were on no medications did particularly poorly and we saw case after case after case I actually personally sat on the panel that had to review the cases where people relapsed shortly after leaving treatment I had to sit with parents who had lost their child after being at treatment with with me and we started to look at the the evidence what works what do we need to do to address this and our our way of addressing it is that we have now incorporated suboxone as another treatment modality in our continuum of care we continue to work with the patients all along the time that they're on the suboxone they're living in sober living they're going to 12-step meetings they have specialized opiate support groups they are able to stay with their continuing care group for as long as they want and then we work with them month by month to see how are they doing where are they out in their stability and is this an appropriate time to consider tapering their their suboxone for some individuals that has worked for others it has not and I think that one of the things that I would inject into this discussion is that we have not differentiated severity of illness very well if we think of people with cancer pretty much all of us know that if there's a diagnosis of cancer is that stage one is a stage two is at stage three is at Stage four and and we know what that means at a public level we don't talk about that with with with addiction it's that we all you have addiction and there are different severa T's of addiction and some individuals need longer term medication assistance along with the other treatments we know work other individuals don't need that same medication assistance I would argue that that's not different than some people's diabetes needing insulin and other people's diabetes needing exercise and and diet control but it has to be that you're doing the treatment together that when you use medication assisted therapies that that's an intentional language because it's medication in fact we we prefer medications in support of recovery that we're using the medications to support the individuals recovery and we were tired of seeing people who wanted to have recovery wanted to be going to 12-step meetings and working with their peers but the addiction and the cravings and the using thoughts were so intense that they were using before they could engage any of those other techniques so I got a quick question for chief r/c and then I'll come to you chief wondering if you can actually speak on the dangers of fentanyl both from an officer safety perspective but then also just to the general public even if they're not using well I would just I would just say that there's a we're seeing a lot of people that are using medically prescribed pills both legally and illegally to treat pain and and some of the addiction things that we've talked about here tonight but when they make that move to an illicit drug like heroin or fentanyl the mixture is is inconsistent and it can be deadly very easily and it does create a bit of a significant danger to law enforcement because when we're exposed to those kind of things both in the liquid and in powder form there is a danger that is presented to the officer so we've done a you know some ongoing training on how to prevent that danger to our officers and it's it really can be dealt with pretty easily but it is the it is a danger to our officers when we run around scenes like that or we're dealing with those drugs whether it's an overdose scene or just possession kind of type exposures to us has it changed the way you do business and investigations yeah I mentioned earlier the overdoses really has changed how we do business and our investigations you know we're devoting resources away from our normal everyday criminal things that we investigate daily towards dealing with these overdose deaths and trying to deal with identifying who's supplying those drugs and then and it becomes really it becomes a homicide investigation for us and it does kind of tax our our officers and work with our Drug Task Force officers and our County attorneys to do that so it does pull away from what we typically would do in our community if I can just talk a little bit I also know working with DEA FBI and local Drug Task Forces I mean exposure to fentanyl by a law enforcement officer it can kill them okay just to yeah I got to understand it for law enforcement officers that excuse me a search warrant or a traffic stop and comes into possession of a large white powdery substance they have to field-test that to figure out what they're dealing with is it heroin is it cocaine is it methamphetamine what is it that this person has in their possession and the law enforcement officer who tests fuel tests that white powdery substance if it's fentanyl and it comes into contact with them they can die which is why when law enforcement execute search warrants at a known fentanyl house they have to wear special equipment special clothing gloves everything's covered respirators in order to execute that search warrant but that's if they know think about the hundreds of cases where law enforcement is executing a search warrant and it's just a white powdery substance you don't know what it is and so they have to take precautions because what may be cocaine that they feel test ok that's it if it's fentanyl and they come into contact it in dangers their lives so it causes a lot of problems for law enforcement yeah fentanyl is several order orders of magnitude more potent than heroin so when we're talking about fentanyl we're talking about something that is much more potent than even heroin and now there's there's the reports of car fentanyl on the street and that's a hundredfold more powerful so yeah you have to be very very careful skids right yeah okay got a question right here thank you question on the prevention side of things I recently took my 15 year old son into the clinic for a moderate to minor injury and upon discharge of the clinic the doctor was prescribing a narcotic I believe it was percocet he was pretty sore from having pulled out a vast series of slivers out of his hands and having a parent who was in psychiatry I I knew a little bit enough to say no thank you I think we'll just muscle through it easy for me to say maybe more so than him but the question I'm getting at is I think it's fantastic what you guys are doing and I'm grateful that you're here presenting this but on the medical side of things where we have perhaps some doctors who are so giddy about handing this stuff out what tools are what artery do we have a prevention and education for them it's a wonderful question because there there is no doubt that a part of this opioid epidemic that we find ourselves in societally was in part driven by something that happened in the mid 1990s which was the actually at that time it was a federal agencies coming into healthcare systems and saying you need to address pain more more appropriately I was actually a chief resident at the time that this occurred and one of my duties was I had to change all of our assessments to include an assessment on pain even if that wasn't the reason the person was coming in and if we didn't have that then we got docked we and if the person said that they had pain then you needed a pain treatment plan the problem was oh that was good we didn't have any education on how to treat pain holistically and so the opportunities for treatment was pain pills at the same time there was a letter that had come out that was a hospital based study that suggested that if you use opioids for pain there's a very low risk of developing addiction we all know that's not true now you know in hindsight 20-20-20 so there was this big increase in the amount of opioids that were prescribed at the again at the same time the extended-release the long-acting opioids came out to the market and we now know that starting with a long-acting opioid is increases the risk of developing an opioid use disorder significantly more than if you are prescribed a immediate or short-acting opioids the other thing that increases the risk is if the prescription is for more than seven days once you get at more than seven days you start to see a significant increase in the risk of developing an opioid use disorder its skyrockets at 31 days so when you when you were talking about the 30-day prescription for a dental procedure yes that was the norm that was putting people at considerable risk the CDC is now saying three day prescription and using short-acting and then you reassess from that from that point forward in terms of what's the education at the state levels there are states now mandating special continuing medical education training specifically on a safe prescribing of opioids our neighbors just across the st. Croix River in Wisconsin that I still hold that license I have to have continuing medical education every single year specifically on the safe prescribing of opioids it's also something that I do I go around and we'll teach primary predominantly primary care physicians in ER physicians on the safe prescribing habits I think we're making progress it's it's that we need to do more like all of us had said we're making progress we're doing good things we have to do it more we have to do it with more passion more energy and more together I think we have time for just a couple more questions hi we have a son and he's a senior in high school here and he started recently experimenting with kratom which is a drug for me think thailand and i thought did you say create i'm creative right so i'm just wondering he said talk to him about it says he's not really anxious or depressed you know but he says you know he's just kind of experimenting got it online we're just learning how to concern we should be I can I can take that actually just this week just this week the FDA has released a statement that kratom or kratom however you're going to pronounce it is an opioid we've known that for forever at low doses used in seeping a tea it has a mild stimulant effect it wouldn't it would not be very helpful for someone who has anxiety it would likely make that worse at higher doses it starts to become an opioid and it's actually about 7 to 10 times more potent than morphine so I consider it a substance that needs to be used used in with great care and should not be over-the-counter at this point kr8 t om are there any steps being taken to stop people from obtaining gateway drugs or substances that could lead to opioid addiction you know I'll take I'll take a stab at that just because I've heard a number of our panelists kind of talk about that these are the the young folks that are in recovery and they talk about the idea of a gateway drug and you know there's a lot of conversation now about legalizing marijuana and how it has therapeutic value and of course you know now those types of drugs that are characterized as gateway drugs are very very potent as compared you say even a decade ago so the conversation that I've picked up on from some of these folks in recovery is that if you're with the crowd that is experimenting with drugs you are maybe one person removed from the person that can get you hard drugs and if you are experimenting with drugs your judgment is impaired and that frequently will open the door to experimentation with something they may not even realize is highly addictive and so I think there's a debate back and forth on you know gateway drugs pathways but I think it's uncontroverted that someone who is experimenting may unwittingly expose themselves to something very dangerous I was I was also going to say that there's been some very good work done showing how tobacco and nicotine Prime's the teenage brain for other drug use Nora Volkow who's the director of the National Institutes of drug abuse has written some some elegant work in in that regard and and so you know that's oftentimes not something that we we talk about tobacco but that is in fact another addiction and the stark truth is that that particular addiction is likely to be the primary cause of death for most of the people that I treat okay I think we'll have our final question and then we'll do the results from the quiz which I want to let everybody know you did pretty well it's my understanding that the heroin traffic years ago when I was a narcotics detective was coming out of Asia today it's which that's coming out of Mexico basically through Chicago up a pipeline 1994 to the Twin Cities where did the car fentanyl come in is that being manufactured illicitly down in Mexico or is it being manufactured early in the states or is it getting it from pharmaceutical companies you do you want to speak to this from DEA s perspective sure um typically what we're seeing right now is the car fat now and the fentanyl's being manufactured in China and it's making its way over the United States and we believe it's primarily being cut into the heroin down in Chicago we're not seeing a lot of fentanyl car fentanyl laced heroin coming out of Mexico right now okay I think we'll wrap up thank you everybody for coming as I'm getting said if any panelists have any final thoughts or words you'd like to share yeah pins and needles right okay for our drug quiz you got all them the majority of people will respond to get everything right so in an average day in the US how many people initiate heroin use correct answer was 580 and then what drugs are responsible for the most overdose deaths in the u.s. the correct answer is opioids and right now I think the leading stat is for the the leading cause of death for people under the age of 50 is actually overdose it's surpass cars where did most teens obtain the pills they used to get high is the sheriff mentioned swiping from medicine cabinets so from parents and grandparents and then one in five teenagers have used prescription drugs for recreational purposes true and eighty percent or actually should be seventy five percent with current heroin users started with prescription pills also true so that concludes us for the evening I encourage you all as you on your way out stop by the display tables get some literature the rumbler Hope network is out there we'll all be around for a little while if you have any questions please engage us and I just want to thank you all for coming out and stay tuned Hennepin sheriff dot org for the website for the novo dose campaign but all of our experts and like to thank them for their time and your attendance [Applause] you