Opioid overdoses increased by 64% in Duluth last year from 2018, according to Duluth Police Department data. Fourteen people died from overdoses.

“Around the state, overdoses are dropping,” said Jess Nickila, opioid program technician for the Duluth Police Department. “But we’re kind of in a pocket.”

The number of overdoses in Duluth increased from 106 to 174, and the number of fatalities increased from eight to 14, Nickila reported. For all of St. Louis County, overdoses increased by 52%, from 151 to 230, and fatalities from 13 to 21.

The final fatality number will increase by one for both the city and the county, Nickila said. Toxicology reports have confirmed the presence of drugs in a recent death, but that hasn’t yet officially been added to the total.

The numbers only refer to overdoses reported via 911 calls to first responders, noted Alyssa Ryder, criminal intelligence analyst for the Lake Superior Drug and Violent Crime Task Force. It doesn't include individuals who admitted themselves to the emergency room or who recovered on their own without receiving emergency services.

National and state figures for 2019 aren’t yet available. Minnesota Department of Health statistics showed a drop in opioid overdoses statewide from 2017 to 2018.

But the epidemic has been particularly stubborn in St. Louis County, Nickila said. She pointed to an analysis by the National Capital Poison Center that the epidemic came in three waves, starting with prescription opioids, followed by heroin and then by synthetic opioids such as fentanyl. Places with higher prescription rates were hit harder and longer, according to the analysis.

The News Tribune reported last year, drawing from a Washington Post database, that two Duluth pharmacies were among the top five in the state for selling opioid pills from 2006-12. Also, about 39 pills were distributed per person each of those years in St. Louis County, and 40 pills in Carlton County. The statewide average was about 22. The Post gathered its data from the Drug Enforcement Administration.

Fentanyl, the third wave, has become a given presence in heroin, Nickila said. The U.S. Centers for Disease Control and Prevention says fentanyl is 50 to 100 times more potent than morphine.

Fentanyl is hit or miss in methamphetamines, said Sue Purchase of the Rural AIDS Action Network.

“The heroin we pretty much know has fentanyl in it,” said Purchase, who delivers the opioid overdose antidote Narcan to rural areas of the region. “The meth randomly has fentanyl in it.”

The deaths are not generally occurring in consistent users, but in occasional users or returning users, such as those who have been in a treatment facility or in jail, Nickila said.

At least five of those who died in 2019 had been released from incarceration five or fewer days ahead of their overdose, Nickila said.

“Where it gets tricky is people who aren’t daily users,” she said. “And those are the folks who I typically see who are overdosing because there’s fentanyl in it, and their body doesn’t have the tolerance of those who do use daily.”

Regular users know how to manage the fentanyl, Nickila said. They smoke instead of inject, or if they inject they do so slowly. They never use alone. Longtime users want fentanyl in their heroin, she said, because heroin doesn’t get them high anymore.

But even “old-school” heroin users can get a deadly surprise from fentanyl, Purchase said. And if fentanyl is involved, the number of uses goes up.

“On average, heroin would be three to five injections a day,” she said. “There’s an increased number with fentanyl.”

So far this year, there has been one opioid overdose in St. Louis County, Nickila said, but it did not result in death. The individual who overdosed is now in treatment.