The ongoing opioid epidemic has hit some groups of Minnesotans harder than others: The crisis has had a disproportionate impact on the state’s American Indian population, followed by black Minnesotans. In 2021, for example, American Indians were nine times more likely to die from a drug overdose than whites, and Black Minnesota were three times as likely to die from a drug overdose as whites.
In response to these troubling nuances, the staff at Minnesota Department of Human Services (DHS), in collaboration with members Walz-Flanagan Managementto speak to members of the cultural groups most affected to find out how to address the problem.
The result of these conversations is new an offer This month, he presented to state lawmakers an expansion of Gov. Tim Walz’s original behavioral health budget, intended to address severe opioid disparities in Minnesota.
Eric Gromdahl, Assistant Commissioner for the Department of Homeland Security The Department of Behavioral Health, Housing, and Deaf and Hard of Hearing Services joined the department in August 2022 and helped put together the proposal. When we spoke last week, Gromdahl told me that he believes gathering input from members of these groups is key to creating systemic change that has real impact.
“We have this unprecedented opportunity to think about: How do we elevate the needs of Minnesotans who are often not in the spotlight?” He said.
This interview has been edited for length and clarity.
MinnPost: Can you tell me more about what inspired the content of this proposal?
Eric Gromdahl: The governor’s original budget proposal had a proposed investment of $141 million in behavioral health services, which is a really nice starting point.
These types of proposals are developed over a period of months. DHS has a motto, “We build our legislative agenda over the course of the year.” It is not new that the opioid crisis has been on the wrong track. This has been the case for a number of years. So the proposals that were in the governor’s original budget that were released in January reflect some of the things that we need to help respond to that growing crisis.
We hope that our entire response to opioids and drug use in general will go toward evidence-based responses, build on the things we know work, and try to help equip our provider community to be more successful in the face of this increased pressure in the context of our workforce shortages and all of the other challenges. facing this group.
MP: How did you gather the information contained in the final draft of this proposal?
For example: We have continued to hear, listen, and engage with the Minnesota communities hardest hit by the opioid crisis. We had a really great summit meeting with the tribal governments in September. We had another series of meetings with community partners, especially in the urban Indian community, in November. There are a lot of groups that we know have been really affected by their inability to advocate for the resources needed to address really urgent issues in various places across the state budget.
What we’ve been challenged to do is ask, “What about communities that are not commonly represented? How do we make sure that we are able to meet the needs of individuals who may be in the midst of an addiction crisis and may not have the same kind of advocacy or someone in their corner for advocacy?” What investments are required for a more effective response to that group?
Over the course of several months last fall, we challenged ourselves to say, “What transformational propositions can we identify in response to what we’ve heard from community partners about what works and what they need?” “What are the transformative proposals that would really help us navigate this crisis in a way that we haven’t been able to?”
That led to a new and revised budget proposal released last Thursday that, among other things, adds $45 million in the next two years to DHS’s response to the opioid crisis. It’s really a significant increase in the overall investment that’s being proposed to address that crisis. Not just the level of investment. It’s how we’ve targeted those investments.
MP: Your department’s proposal includes several elements designed to support the state’s American Indian population. Tell me more about the process that led to this focus.
For example: Part of what we’re responding to in our proposal is not just the meteoric rise we’re seeing in opioid deaths. It is also the disparities in the people most affected by the epidemic.
From 2018 to 2021, there was a really big increase in the number of Minnesota Indians dying from opioids. This cannot be compared to what we saw in Minnesota whites. Any opioid-related death is preventable and unnecessary, but the fact that these deaths occur at disproportionate rates in communities of color has been at the heart of how we think about these proposals.
I think we also wanted to quantify how we think about these proposals in not only what we’ve heard from the community but also what we’ve found from people who have experienced this pandemic firsthand. This has been a really core value of the Walz-Flanagan administration: To really start with those people who are closest to the problem, listen to what they consider solutions that they think would be helpful and figure out how to organize our systems around supporting those responses. I feel proud of the way the Department of Homeland Security has engaged the community and come forward with proposals that truly reflect what we believe can be a transformative response to this crisis.
deputy: Your proposal calls for a re-imagining of the state’s membership requirements Opioid Epidemic Response Advisory Board (OERAC), to ensure equitable representation of the group of racial and ethnic groups most affected by this crisis. Why do you and your colleagues feel the importance of this change?
For example: OERAC is an amazing body. I’ve seen it have a huge impact in being able to coordinate a lot of different views on what is needed to respond to this crisis. We believe that representation matters, and so making sure that individuals who are representative of the communities most directly affected by the crisis are part of the process is a really important part of making sure that the methods that OERAC takes will respond to the needs of those. Communities.
MP: The proposal mentions the idea of encouraging state prisons and prisons to provide and cover behavioral health services and medication for opioid use disorder in inmates. How often are these types of services provided in other countries?
For example: We’ve seen in a number of communities a much faster move toward making things like naloxone as a healing drug ubiquitous and available everywhere. Our community partners say this is what they really need to be more effective in stemming the tide of deaths. We’d like to build on what other communities across the country have already learned and proven to be hugely effective.
We know that The period immediately following prison release is one of the most dangerous periods for relapse, overdose, and homelessnessand so I think what you’ll see across our proposals is a variety of strategies designed to help make sure that when someone does reentry into the community, that they do so successfully and with the support needed to prevent those things that often happen with reentry from happening.
Representative: Addiction and mental health legislation has received bipartisan support in the Minnesota legislature. Are you optimistic that the bulk of your proposals will be approved in this session?
For example: I feel hopeful from the perspective of what has already been a bipartisan recognition of the urgency of this issue. We have heroes to invest in our response to this crisis from all political angles. While there may be disagreements about the details or the path forward, everyone who looks at this in any serious way understands that we need to do something big, dramatic and different so that we can change the course of this pandemic. And so I am optimistic. I feel hopeful that these are suggestions that a lot of people can be excited about.
I will also say that we’ve been really encouraged by a lot of the signs that we’re seeing outside of the Biden administration in terms of acknowledging the centrality of harm reduction in the sweep of the responses that we have to substance use disorder. People are not going to be fully served through a one-size-fits-all approach, so our direction was, “How do we have the set of tools, the range of options needed to respond to all of Minnesota?”
Every Minnesotan with addiction has their own journey back to wellness and recovery. The better our system is able to meet individuals wherever they are and go through this journey with them, the better it will be at reducing substance use disorder.
MP: Before coming to the Department of Homeland Security, you worked with several homelessness advocacy organizations as well as in the Obama administration as the Director of Policy for the Department of Homeland Security. American Interagency Council on Homelessness. Do you see a relationship between housing instability and substance abuse?
For example: Entering this role, I was very excited to be able to build and ensure that the state’s bridge between behavioral health and housing is strong. We already have some great programs covering housing instability and behavioral health, but there is opportunity to do more. Minnesota Department of HealthIn partnership with Hennepin Healthcare Research Instituterecently released File Stady who took a comprehensive look at the mortality rate of individuals facing housing insecurity and homelessness and found the startling finding that one in 10 opioid deaths in Minnesota is a person facing housing instability and that one in three deaths is a person Suffering from homelessness is an overdose.
MP: Findings like this seem to show that these problems are intertwined.
For example: Yes. And part of what motivates our proposals are strategies that acknowledge this fact. We need people not to have to choose between, “How do I walk the path of the dwelling?” And How can I get into the recovery program? This means grouping the services together in a way that recognizes that progress in both underpins whatever site they find themselves on. If they’re on a camp, if they’re moving between a lot of different locations, people need resources that aren’t. Not only smart but also responsive enough to the individual so we can help everyone on their journey from housing stability to recovery.
Representative: With the Minnesota Democrats’ “trifecta,” are you optimistic that many of these proposals will soon become law?
For example: I don’t want to count any chickens before they hatch, but I will say I’m really encouraged and optimistic about all the legislative attention around these issues and the fact that everyone recognizes that we need to make transformative and bold investments and commitments to resolve this crisis.