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Last Place may be closed, but Duluth's synthetic drug problem endures

The Minnesota Department of Health wants hospitals to report synthetic drug incidents to better track them.

Duluth's drug problem didn't end when its downtown head shop, Last Place on Earth, closed, say health experts involved in a study on the impact of synthetic drugs.

"These are people who have substance abuse problems, and they use what's available," said Jon Roesler, an epidemiologist for the Minnesota Department of Health.

Roesler was one of nine co-authors of "A study of the health care burden of illicit synthetic drug use in Duluth, Minnesota" that appeared in the February edition of Minnesota Medicine, the Minnesota Medical Association's journal.

The dry language of the title belies the crisis that was coming to a head as Roesler was dispatched to Duluth last summer to participate in the study. Emergency room personnel told of a continuing toll from aggressive, delusional patients brought in after ingesting synthetic drugs labeled as incense and bath salts. Operators of other businesses in Old Downtown complained they were losing customers. Residents said they were afraid to be outside anywhere near the head shop. Police told of an extraordinary number of calls to the 100 block of East Superior Street, where Last Place on Earth was located.

"The thing with synthetic drugs is they had the very untoward side effects," Roesler said.

One individual on bath salts showed up at the emergency department trying to scratch out his eyeballs, he noted.

In reality, though, the worst was over by the time the study began, said Dr. Nick Van Deelen of the St. Luke's hospital emergency department. By then, store owner Jim Carlson had pulled bath salts -- which produced the most horrific effects -- off his shelves.

"A year or two or three earlier, we would have gotten really good data, and a lot of data, pretty quickly," said Van Deelen, who also was one of the study's authors. The study "underestimates the effect that we were experiencing."

The study was drawn from records of 78 patients suspected of using synthetic drugs who were treated in the emergency rooms of St. Luke's and Essentia Health-St. Mary's Medical Center from January through September of last year.

Among other findings:

  • Sixty-seven percent of the patients were unemployed.
  • Seventy-five percent arrived at the hospital by ambulance or police escort.
  • Fifty-seven percent were admitted to the hospital.
  • The median age was 34, with patients as young as 12 and as old as 73.
  • Seventy-four percent had a history of abusing multiple substances.
  • Sixty-nine percent were male.

    Taken together, the data paint a "grim picture" of the synthetic-drug users, Roesler said.

    "There's a perception out there ... that this is about youth who are experimenting and trying different things," he said. "Not really. ... (It's) a high percentage that's unemployed, a high percentage of homeless. These people are suffering."

    When Last Place on Earth was closed for good after a raid on July 19, most of its customers probably turned to other sources to satisfy their addictions, Roesler said.

    "People still need and are still looking for substances, and they're looking for whatever is cheapest," he said.

    He and others in the health department noticed that after the head shop closed, media reports emerged about heroin showing up in Duluth.

    Van Deelen agreed that substance abuse continued, but he said he thinks heroin is a separate issue. That largely stems from people who first became addicted to prescription pain killers, the doctor said, and it has been a problem for several years in Duluth.

    But another drug has re-emerged, he said.

    "I'm sorry to say that we're seeing, now, more methamphetamine again," Van Deelen said.

    Like the synthetic cathinones typically marketed as bath salts, methamphetamines are derived from amphetamines, he said. That makes it attractive to people who can no longer obtain bath salts.

    "People tend to have the drug that they prefer," Van Deelen said.

    But patients who come in for treatment because of other drugs don't exhibit nearly the egregious behavior as those who used synthetics, he said.

    "Since the closing of the Last Place on Earth, it has been an incredible improvement for the emergency departments," Van Deelen said.

    One unexpected aspect of the study was the significant number of synthetic drug users who already had been diagnosed with mental illnesses, Van Deelen said.

    The researchers evaluated 44 of the patients for mental health disorders and found that 26 of them had been diagnosed for conditions such as anxiety, depression, bipolar disorder and chemical dependency.

    "The mental health system in our state is already severely taxed, and this was just another serious burden for our local mental health resources to try to deal with," Van Deelen said.

    Both Van Deelen and Roesler said the lack of medical coding to identify synthetic drug abuse hampered the research. Van Deelen and two colleagues submitted a formal proposal that a synthetic abuse code be added to the U.S. version of ICD-10 (for International Classification of Diseases). If approved, it would be easy for researchers in the future to study cases involving synthetic drugs.

    In the meantime, the health department is asking emergency departments across the state to notify the state poison control system every time they see a synthetic drug case.

    Eye-grabbing posters have been distributed as a reminder.

    "Duluth, you guys may have gotten on top of this issue," Roesler said. "But this may be popping up in other communities, and we want to be able to be on top of it."

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