Northland family fights for bill that would tax Big Pharma in battle against opioid abuse

Meghan Wagner holds a photo of her sister Micaila Hey, who died from a purposeful overdose. She is joined by her mother, Rachel Colombe; father, Patrick Hey; and brother Jakob Hey at Brighton Beach, one of Micaila's favorite spots. Bob King / rking@duluthnews.com

By Jana Hollingsworth

April 22, 2018 at 12:40 AM

Esko native Micaila Hey, known for her warmth and eagerness to help others, took her own life in January by overdosing on pure fentanyl, a powerful and often deadly opioid.

Days later, Hey's funeral was the scene of another overdose, when a friend nearly died while sitting among others during the service. Quick action by an attending emergency responder resulted in her being revived in a back room by the overdose antidote Narcan.

"Instead of being angry," said Hey's mother, Rachel Colombe, "I channeled Micaila and urged her to get back into treatment."

Getting drug abusers quick access to treatment programs is a hot-button issue for Hey's parents. Hey, 21, sought treatment again and again and was just days away from entering a 90-day program when she died. If not for a shortage of beds and other red tape in the system, she might still be alive, Colombe said.

How to close the treatment gap is the focus of a debated question in the Minnesota Legislature: Should drug manufacturers whose products contribute to overdoses help fund the urgent need to expand treatment programs in Minnesota?

Patrick Hey, Micaila's father, is lobbying state lawmakers to pass legislation that could provide up to $20 million annually to fight the ever-growing opioid crisis. The House bill, sponsored by Rep. Dave Baker, R-Willmar, once included a "penny-per-pill" provision, essentially a prescription drug fee.

While a similar bill in the Senate still has the provision - called a stewardship fee - Baker has since removed the provision from his bill. His revised bill would draw from the surplus in the general fund and provide $16.5 million for prevention and treatment programs aimed at fighting opioid abuse, with a lesser ongoing amount.

Baker, who lost his son, Dan, to an opioid overdose in 2011, hasn't given up on the fee, he said, but some legislators don't want to approve a tax when a surplus exists.

Tapping into the surplus would come at a cost to other worthy programs, said Rep. Liz Olson, DFL-Duluth.

"The penny-a-pill is the way forward," she said. "It's a way to put the ownership back on where the problem started, which is the drug manufacturers."

Sen. Chris Eaton, DFL-Brooklyn Center, is a co-author of the Senate bill. She lost her daughter Ariel to an opioid overdose in 2007.

"For a lot of these kids, the story is the same. They were a day or two from getting help," she said. "It really makes me angry when I have to convince people here that is important."

Gov. Mark Dayton continues to push for the fee, saying he doesn't want to shift the responsibility onto taxpayers.

"My administration will continue pressing the Legislature this session to enact "penny a pill" legislation that will properly require those large pharmaceutical companies to contribute a small amount of their enormous profits to address this crisis in our state," he said.

Nick McGee, director of public affairs for Pharmaceutical Research and Manufacturers of America (PhRMA) said that the organization is against the fee, but not the Senate bill as a whole. (It now supports the House bill since it dropped the fee.)

"At the end of the day this boils down to the funding mechanism," McGee said. "Taxing prescribed medications that meet legitimate medical needs and that patients rely on is not a proper funding mechanism for a state budget."

He said PhRMA has met with legislators and has suggested alternative funding sources, such as Medicaid reimbursements. He said PhRMA has awarded grants to community groups on the "front lines" of opioid abuse, including $25,000 to the Minnesota Farm Bureau and $10,000 to the Lakeville Public Safety Foundation.

"We want to work with them on this because it's a very important issue," McGee said.

But for Patrick Hey, who travels with a small urn filled with his daughter's ashes, that's not enough to solve the problem.

Hey has spent the days since Micaila's death contacting lawmakers advocating for and learning about the proposed legislation that is meant to help people like her.

"This isn't just our story," he said.

'Battlefield medicine'

The Duluth Police Department recorded 144 opioid overdoses in St. Louis County in 2017, with the majority in Duluth. Nine of those resulted in death; a number that would probably be higher without Narcan. Through the first week of March, six in the county have already died among 19 confirmed opioid overdoses.

"(St. Louis County) has one of the highest per capita (opioid overdose) death rates in the state," said Duluth Police Lt. Jeff Kazel, commander of the Lake Superior Drug and Violent Crime Task Force. He testified before the House Health and Human Services committee in early March.

"My point was, these are your constituents you are protecting, and we need the funding source to deal with this problem," he said. "If you let this go, it will become worse."

More than 3.5 million opioid prescriptions were filled in 2016, according to the state health department. That same year, opioid overdoses killed 395 Minnesotans, and hospitals treated more than 2,000 non-fatal overdoses. Nationwide, more than 42,000 died from an opioid overdose.

Passage of the fee is "crucial," said Greg Anderson, social services supervisor for St. Louis County Public Health and Human Services. Money would go toward resources for schools, prescriber education and helping people understand addiction to reduce the stigma those who struggle with it often face.

It would also offer ongoing funding for Narcan, which has the generic name naloxone. The medication can reverse the effects of an opioid overdose, and Duluth police used it 48 times in 2017. Kazel said the police department doesn't have a line item in its budget for Narcan, but relies on community support to pay for it.

Funds could also help pay for more and better equipped treatment programs, like Duluth's Center for Alcohol and Drug Treatment's six-bed opioid withdrawal unit. Anderson said the state also has a "dire shortage" of people licensed to work with substance abuse disorders and chemical dependency treatment, which delays access for those who need the help.

The Center for Alcohol and Drug Treatment's CEO Gary Olson said he thinks the idea of a penny-per-pill fee is a good one, but it depends on how the money is spent. The state's substance abuse treatment system is "anemic," he said, with low pay rates for services set by the state. That needs to change, he said. State and county grant money - which pays for the center's opioid withdrawal unit - often doesn't cover overhead costs, Olson said, and it's tough to attract qualified staff considering the difficult and sometimes dangerous work.

"We are doing battlefield medicine," he said. "We are trying to do everything we can to keep people alive long enough to get them into recovery, and it is tough."

'We'd still have her'

Micaila Hey graduated from Esko High School in 2014. A good student, she was close to earning an associate's degree from Lake Superior College. She had a strong relationship with her family; especially her 10-year-old sister, Meghan, whom she'd regularly help with homework.

"People were drawn to her, especially children," her mom, Rachel Colombe said. "She was lit up from the inside."

But Micaila suffered from bipolar disorder, and that led her to substance abuse.

It started with marijuana to deal with anxiety, and then prescription pills. When that source was cut off, she turned to heroin.

Toward the end of her life, heroin became her coping mechanism.

Despite that, she helped others with their addictions; even leading some of her treatment meetings and holding live chats on social media. Micaila went to inpatient and outpatient treatment - both leading to long periods of sobriety - and continued treatment for her mental illness. But life happened, her stepfather Robert Wagner said, and she didn't have the skills to deal with relationship issues, fines related to a car accident and a job loss.

"It made her feel like nothing was going to get better," he said.

She accidentally overdosed twice in the months before she died, and was revived both times with Narcan.

Throughout Micaila's drug use, getting prompt and ongoing treatment was an issue. One provider would no longer treat her because she needed a higher level of care; one crisis center couldn't lodge her because it was full. While Narcan twice saved her life, she needed a long-term plan of care and support to keep her alive, Colombe said, and it didn't come in time.

The overdose three weeks before she died led her to commit to a 90-day inpatient treatment program, which she hoped would result in permanent sobriety. She took all of the proper steps, but there was a wait.

The waiting periods - whether because of bed or other resource shortages or paperwork - are a big problem, said Verne Wagner, a member of the St. Louis County task force Opioid Abuse Response Strategies, who also helped found local Nar-Anon groups.

"You can't ask a heroin or meth addict to stay clean for five to seven weeks. It does not work," he said.

Death from overdose often comes after a user tries to quit while waiting for treatment, Wagner said. Your tolerance is down if you've stopped using for a while, and your body struggles to adjust to the same amount you took before, he said.

But Micaila chose to overdose, wrongly thinking she could no longer handle her mental illness and addiction, Colombe said.

"I wish she could have seen herself through my eyes," she said. "If she could have gotten through the gap between wanting the help and getting the help, we'd still have her."

To get help:

Find local Narcotics Anonymous meetings at www.na.org .

National Suicide Prevention Lifeline: (800) 273-8255

Crisis Text Line: Text MN to 741741

Local crisis hotline numbers

South St. Louis, Lake, Cook & Carlton counties/Fond du Lac Band