Sara Jean Peterson, 37, was a social butterfly and a go-getter. She planned frequent barbecues, beach days and board game gatherings to ensure she could spend time with friends, extended family and her four children, ages 2-19.
Sara was also five years sober — until the coronavirus hit.
Her mother, Laura Peterson, said Sara’s recovery after 20 years of addiction hinged on her close friendships, meeting with her sponsor and attending weekly Celebrate Recovery meetings.
All these important recovery tools were taken from Sara when the pandemic began. Her sponsor and friends couldn’t visit her in person, and virtual recovery meetings were canceled due to privacy concerns.
“She said, ‘Mom, I need people,’” Laura said. "She was a people person. She needed hugs, and she needed her friends."
Sara’s battle with addiction emerged again.
She overdosed in March, and then again in May after Laura’s mom died. Narcan was used for her both times, Laura said.
After her second overdose, Sara told her mom that she didn’t want to die and asked for her help. On June 4, Sara and Laura began filling out paperwork for a recovery program and made plans to return the next day to complete it.
That morning, Laura went to pick up Sara from her house. She entered the house and found Sara dead from an opioid overdose.
“She tried so hard … throughout the year to be the best mom that she could. She promised her kids … 'I will never die; I'll never leave you,'” Laura said.
Sara is one of the 15 people who have died from opioid-related overdoses this year in Duluth — a figure that’s likely to surpass last year’s recorded deaths. Overdoses related to opioids are also on track to surpass last year's numbers, according to data from the Duluth Police Department.
Experts say COVID-19 is fueling a crisis that was already challenging Northeastern Minnesota before the pandemic began.
Recovery programs are shackled by coronavirus safety precautions. In-person meetings are limited due to safety restrictions, while alternative online meetings are challenging for some people to access. People also have been hesitant to seek treatment, as they fear being stuck in facilities with strict coronavirus policies, experts say.
“Substance use thrives in isolation. … We have nowhere to go. We have nothing to do. So folks tend to isolate, and that just breeds more substance use,” said Jessica Nickila, the police department’s opioid program technician.
Opioid-related overdoses have increased over the past two years. Recent overdose increases can also be partially attributed to the natural progression of the crisis, she said.
The pandemic has created a “vicious cycle” of isolation for people who struggle with addiction, said Tina Silverness, executive director of Duluth’s Center for Alcohol and Drug Treatment.
“Not all of them have healthy people in their lives that they can talk to and they can interact with,” Silverness said. “There's been so many things with COVID that have been shut down (like) social events, and … it isolates them even more so."
Additional life stressors, like job losses, when coupled with isolation, can cause people to turn to drinking and drug use, Silverness said.
When the pandemic began, the center started offering online meetings. But many patients have struggled accessing technology or don’t find it effective. This has likely contributed to a noticeable decrease in outpatient numbers.
“We know that there's so many people out there not being treated,” Silverness said.
Relationships are important in Nickila's role. She helps people access services for addiction, like in-patient and out-patient treatment or medically assisted withdrawal management programs and will even help them refine their resume or find a job or housing.
As has happened in many careers, a majority of her responsibilities have gone digital. Her ability to build relationships has become “very tricky,” she said.
She typically locates people in-person by using their last known address, and continues meeting face-to-face to help them in their recovery process. Now, she primarily contacts people through phone numbers listed online — which are often unreliable — and has to gain their trust through phone conversations. She has safety concerns about meeting people in person due to the virus.
“It's just really hard to find people. And then the folks that I can find, it’s very hard to make that connection and build rapport and get trust from them through just a phone call,” she said.
Nickila normally helps about 15-20 people every quarter to access some form of treatment.
She’s now averaging about five people a quarter.
“It's a very hopeless situation,” she said.
Duluth has surpassed the number of opioid-related overdoses recorded this time last year, with 152 cases as of Sept. 22. Last year, 130 opioid-related overdoses were reported at this point in the year, and only 70 in the prior year.
Deaths related to overdoses are also likely to surpass last year's figures. So far, 15 people have died in Duluth due to opioid-related overdoses. That same number of people died in all of last year, while eight people died from overdoses in 2018.
With increasing overdoses, Dr. Joe Bianco, a physician at Essentia Health, said the duty to safely prescribe opioids for treatments has heightened, especially during the pandemic.
Essentia monitors how many opioid pills each physician prescribes as part of its Chronic Opioid Analgesic Therapy program. The program helps physicians decrease their prescriptions, and ensures patients with ongoing opioid prescriptions are using them safely. Patients sign a contract agreeing to do so and are monitored as part of the program, said Kelly Black, a program manager for opioid treatment at Essentia.
At the program’s start in 2014, about 12,000 patients were enrolled in the program. Now, only about 5,000 patients are enrolled, Bianco said.
“We have an epidemic that's now in a pandemic. The opioid epidemic is not going away. Overdoses have gone up 30% across the country, increasing use of other substances has gone up as well,” he said.
Due to technological challenges, downtown Duluth’s Center for Alcohol and Drug Treatment has restarted some in-person groups with safety precautions in place, Silverness said.
The center also offers individual on-site meetings for people if they didn’t find technology effective or couldn’t access it, she said.
“There's a lot of isolation and a lot of shame already involved in addiction. So coming in or meeting to be able to talk about their issues and being able to get treatment — when they're doing that via telehealth, it doesn't always have the same impact that it does in person,” Silverness said.
The people Nickila connects with seem to be resistant to treatment during the pandemic, she said. If they enter treatment, she said they fear being put in lockdown, which some facilities enact to limit people — and virus — movement.
This fear was evident in the initial months of the pandemic, Silverness said. But they’ve recently seen in-patient numbers increase and have relaxed some in-patient restrictions, including allowing them to work part time.
Work is also starting to pick back up for Nickila. She recently reunited with her police department partner who serves as a diversion officer. He was working specialized shifts to curb the virus’ spread if a police officer was infected.
Together, they’re working on a new program that gives low-level drug offenders the opportunity to have their charges expunged if they complete an intake program.
And they’ve also returned to visiting jails and to door-knocking to locate people in person. With her children learning at home, she has only two days a week to work in person with people.
Silverness said she believes overdose numbers will continue rising as long as COVID-19 is present, unless everyone can figure out how to follow coronavirus safety precautions.
It’s difficult to tell how long the opioid epidemic will stick around, Nickila said. According to the National Capital Poison Center, the epidemic has come in three waves. Prescription opioids made up the first wave, which then turned into heroin and then eventually synthetic opioids for the third wave.
Areas with higher prescription opioids experience longer and harder epidemics. The News Tribune reported last year that two pharmacies in Duluth were among the top five pharmacies in the state for the sale of opioid pills from 2006-12.
Compared to the rest of the nation, Northeastern Minnesota saw longer-than-normal first and second waves. And the region has yet to see the peak of the third wave, she said.
“The only thing that can beat this is hope and no stigma,” she said.
Laura Peterson said she's sharing Sara's story because she wants people to know that addiction is real and that people who are struggling should get help.
"People don't realize how real it is. She'd been sober for five years and doing really well. So that's why I'm 95% positive that COVID was a huge part of it," she said.
To get help
If you need help with opioid addiction, you can reach Jessica Nickila at her cellphone, 218-391-9639. Or, you can call a national helpline at 800-662-HELP.