Synthetics cases drop, but effects still unknownDon’t expect sympathy for Jim Carlson from Duluth’s emergency room doctors.
By: John Lundy, Duluth News Tribune
Don’t expect sympathy for Jim Carlson from Duluth’s emergency room doctors.
Carlson, owner of the shuttered head shop Last Place On Earth in Duluth’s Old Downtown, waits in Sherburne County Jail since being convicted on Oct. 7 of 51 federal crimes related to the sale of synthetic drugs.
“That just makes me happy,” said Dr. Chris Delp, an emergency room physician for 20 years in Duluth, the last 10 exclusively at St. Luke’s hospital.
Carlson’s notorious store has been closed since July 19, when a court order forced the issue. Delp said he and his colleagues at St. Luke’s and Essentia Health-St. Mary’s Medical Center witnessed an immediate difference.
“We’ve noticed a huge decrease,” Delp said. “It’s amazing. For a while there, I would come to a shift and there would always be somebody screaming and psychotic. And there’s been such a profound decrease.”
For months, Duluth’s ER doctors had been telling anyone who would listen about the effects of synthetic drugs. It was unlike anything they had seen before, they insisted.
In June, in a packed conference room of the Duluth Sheraton Hotel, a panel of St. Luke’s ER docs led by Dr. Nick Van Deelen memorably told state Attorney General Lori Swanson about the horrific cases they had seen.
Speaking in an almost clinical tone, Van Deelen told of one patient under the influence of alcohol and bath salts who removed one of his eyes with a fork and stabbed his remaining eye four times; and another who became agitated while using synthetic marijuana and “proceeded to dig out several of his own teeth with his fingers.”
But state officials didn’t want anecdotes; they wanted data. In July, Jon Roesler, an epidemiologist with the state Department of Health, was assigned to analyze data on synthetics from Duluth emergency rooms.
State epidemiologist Ruth Lynfield and a Centers for Disease Control fellow were added to the team.
Roesler knew it wouldn’t be clear-cut. The international code that assigns a number to each individual medical condition didn’t have a code for synthetic drugs. But he thought he could pull the records from synthetic drug cases known to the doctors and find common numbers in the billing codes submitted to the Minnesota Hospital Association.
That didn’t prove to be the case. “Those codes were just all over the charts,” he said.
Further complicating the situation, the CDC fellow was furloughed during the government shutdown, delaying analysis of the data that were available.
The result when Roesler as a statistician is asked about the medical impact of synthetic drugs: “We don’t know, and given our current system of data, we can’t tell.”
But what Roesler calls his “qualitative perception” after looking at about 60 specific cases has changed somewhat. Before beginning his study, Roesler pointed out that when one substance is no longer available, it’s invariably replaced by another. He stressed the importance of dealing with the underlying problems that lead to substance abuse.
Roesler says he’s as convinced as ever that the underlying causes must be addressed. But from the cases he has studied, Roesler said he thinks synthetics are in a special category.
“If we can get these synthetics off the streets, even if we haven’t addressed the underlying drug-abuse problem, I think we will have made some progress,” he said. “Because users will hopefully have switched to safer substances to abuse.”
Roesler isn’t advocating abuse of any substances, but he acknowledges that particularly heinous side effects emerged in the synthetic drug cases he studied.
“I didn’t expect to see the kinds of side effects that we’re seeing in terms of the aggression, the agitation, the paranoia,” he said.
The difficulty, Lynfield said, comes from the unknown origin of synthetics.
“The real problem is that there is no way to know what is in the synthetic compounds,” she said. “There is a synthetic drug of some sort, but often it will be with additional material. And so the potency is unknown, and the other ingredients are unknown. So there can be a variety of effects.”
Nothing has replaced the synthetics, at least in terms of emergency room traffic, Delp said.
“We were kind of bracing ourselves for the next wave of what they were going to be using, and I don’t have a feel for it, which I think is a good thing,” he said. “To me, that means that they’re not turning to anything that’s disrupting our community.”
Carlson had predicted that his customers would turn to other sources to get synthetic drugs. But Delp said he doesn’t see evidence for that. In fact, when he did treat a patient who was under the influence of synthetics in mid-October, it turned out the source of the synthetics was Last Place. The patient had kept a stash of the substances purchased there.
Although few people want to see the return of synthetic drugs, health experts want to be able to collect meaningful data if it happens. A three-pronged effort is under way. Van Deelen has petitioned to have a code for synthetics in the next iteration of the U.S. version of the international code. Roesler is working on a billing code for synthetics that would be submitted to the hospital association with each case. And Lynfield is encouraging emergency departments to report every case involving synthetic drugs to the Minnesota Poison Control System.
For now, Delp and other ER doctors in Duluth are celebrating a return to their practices as they knew them before synthetic drug cases started coming through their doors.
“Now, I’m free to pay attention to the people who really deserve it,” Delp said.
“For me, it was one of those things that made me incredibly upset when I’ve got a grandmother with a broken hip that I can’t even get to to order pain medications because we’ve got somebody who’s so psychotic I have to be in the room trying to restrain them and trying to sedate them, trying to prevent them from killing themselves or hurting themselves.”
“I’m a happy man now that it’s gone.”