Minnesota blazes a trail for other states

September 9, 2022

Minnesota has been a leader in addressing the opioid epidemic. To understand what they’ve been doing, we spoke with Representative Dave Baker, currently serving his 4th term in the Minnesota House. In honor of his late son Dan who passed away in 2011 from an accidental overdose, Representative Baker has prioritized addressing the opioid epidemic. He serves as Chair of the Opioid Epidemic Response Council (OERAC) in Minnesota.

Minnesota legislators passed a bill in 2019 that collected fees from opioid prescribers, manufacturers, and distributors (an estimated $20 million annually). You’ve been chair of the Council set up to distribute the money. How did the Council approach its work and identify the areas where the funding was most needed?

The bill set up the Opioid Epidemic Response Advisory Council (ORAC), with 19 members from around the state of Minnesota. It was a clunky first year! We had to establish bylaws, figure out terms and expiration dates, and generally establish how to work together.

Most importantly, we needed to figure out what our priorities were. We went through what really was a very lengthy and painful process – diving in and listening to a lot of people, understanding where we’re having successes, where we are falling woefully short, and where we are doing things well. We looked at everything from the end of the overdose cycle – getting naloxone to people to keep them alive – to upstream prevention efforts to everything in between…medicines to keep you alive, recovery systems, more workforce. It took us a while to really get our bucket list of priorities, but then when money did start coming in from the licensing reforms, we were able to hit the ground running.

It took you about a year to do all this background. But states and counties will be getting dollars from the opioid litigation this year. What would you tell places that are feeling some urgency to spend the money?

States should get their counties very involved. In Minnesota, we all agree that our counties are the best people to make decisions, with boots on the ground, with local public health departments that are very close to the action.

But we’re learning that some counties aren’t well equipped – they don’t have the workforce – and this is a lot of money coming into places that may not be used to this. So I’d encourage counties of all sizes to have their own advisory councils, with local advocates and with people who have been affected by the epidemic and have lived experience. Make sure you hear from a broad base of people.

The most important thing is listening to the community before you spend!

In Minnesota, 75% of the litigation money will be going to counties–is that right?

Yes, 75% will be going to counties, and 25% to the Opioid Epidemic Response Advisory Council. And the Council will still be getting the funds from the licensing fees.

Our job as the Council is to see what’s going on in counties across the state, and share the good ideas and what is really working.

With the extra money coming to the state as a result of the litigation, what are some of the areas you’re hoping that the state can devote more money to and why?

We’re now trying to look at some innovative areas. One example is digital therapeutics, which are a new way of connecting with people who are in recovery.

We’re also looking at continuing to teach our medical professionals with programs such as Project ECHO training sessions. That has really been a game-changer here in Minnesota: doctors talking to other doctors about how to handle prescriptions and how to taper people who have been on opioids.

We want to be sure that our larger and our smaller cities have naloxone available; we have some large cities that still don’t have enough naloxone.

And we need to make sure we’re educating our kids. Fentanyl is moving from a powder to a liquid source into pills, where there may be less stigma. The whole dynamics are changing, and we need to change our educational approaches to be on top of that.

These are limited dollars that will eventually run out, and it is our responsibility to make every dollar count.

How do you know if what you are funding is working? This can be such a challenge given that deaths continue to increase. 

It is such a frustrating thing. We’ve made real progress in some areas, like working closely with  our health care professionals and putting in policies to stop overprescribing. They’ve done a great job on cutting down on that.

But now there are new challenges, with drugs coming in from China and Mexico. 90% of deaths in MN last year were fentanyl related. Lots of these are fake pills that look real, like a Percocet, that a young person just might want to explore. So that has changed the whole dynamic of trying to keep people alive. So we’ve had to pivot from working on prescribing to addressing these other issues.

The number of deaths is important, but we can’t measure it simply with that. We can’t measure it simply by deaths. Are we saving more people, are we getting naloxone to people so they can be saved? Are we making inroads with our health benefits and health plans, so we’re keeping people in recovery longer? Are we addressing stigma? These are all important things to know too.

What advice would you have for other states?

I’m really a big fan of these Advisory Councils. To work though, they must have people who genuinely care, and the process can’t smell of anything partisan at all. It can’t be built on politics or headlines. I’ve worked with my friends on the other side of the aisle to get this trailblazing bill passed back in 2019, and I could not have done it without their support.

Our cities and counties have to understand that this issue is different today than it was just a few years ago, and we need to work together. We can’t throw anyone under the bus. Keep the process and discussion open, keep it fair, and keep it civil.

We are here in Minnesota for follow-up questions if anyone wants to chat with us. We have three years of experience here with our work, and want to share our info and experience with other states. We’re very open to questions.

Those wanting to speak with Representative Baker should email him at rep.dave.baker@house.mn or contact his assistant, Emilie Nelson, at emilie.nelson@house.mn.