A push for patient choice and community awareness
Fifteen years ago, Rep. Dave Baker and his family faced a painful lesson in the dangers of opioid prescriptions. When seeking an alternative to opioid-based painkillers for his son Dan’s back surgery, they were met with skepticism from a medical professional. One year later, Dan died of an opioid overdose. Since then, Baker has dedicated his legislative career to ensuring families have greater control over their pain management choices.
Weeks ago, the Minnesota House Health Finance and Policy Committee advanced a bill aimed at giving patients the right to refuse opioid prescriptions. HF1379, which would allow patients to file a voluntary non-opioid directive, is designed to reduce unnecessary exposure to addictive pain medications and provide an additional safeguard for those in recovery. Supporters believe this could be a critical step in combating opioid addiction, which continues to devastate communities across Minnesota.
While the opioid epidemic has often been framed as a predominantly white, rural crisis, Black communities in Minnesota and across the nation have been disproportionately affected – yet often overlooked in public health responses. According to state data, opioid-related deaths in Minnesota spiked in 2020, with fentanyl playing a significant role in overdose fatalities. By 2023, opioid-related deaths had decreased, but nonfatal overdoses remain a persistent issue.
Historically, drug crises impacting Black communities have been met with criminalization rather than public health solutions. From the War on Drugs to the crack cocaine epidemic, punitive policies disproportionately targeted Black Americans, leading to mass incarceration rather than comprehensive treatment.
In contrast, the response to the opioid crisis has leaned toward medical intervention and harm reduction strategies — a shift that highlights stark racial disparities in drug policy enforcement. To understand the disparities, it’s important to understand how opioids work within the body.
How opioids work
Dr. Benjamin Clark, senior program manager of the U of M Department of Neuroscience, stated, “Opioids bind to and activate opioid receptors on neurons, especially the MU-subtype of opioid receptor, and this receptor inhibits signaling and information transfer. The primary reason that opioids provide pain relief is that they bind to these receptors and inhibit the pain signal.
“First, it is important to point out that we don’t have a complete biological picture explaining the neural processes and causes of substance use disorders (SUD) or addiction. We do have some pieces to the puzzle though. One mechanism that we think contributes to the addictive nature of opioids is through disinhibition.
“Basically, opioids play a role by inhibiting neurons in the dopamine/reward system that are meant to put the brakes on reward signaling. This is a little like messing with the brake pads on a car to make it difficult to stop the car. In this case opioids make it difficult for the neurons that are meant to regulate reward signaling to do their job and this can lead to misinformation about what is rewarding and ‘important.’
“Factors contributing to addiction include impaired control over drug use, social consequences, and risky behavior. Environmental and historical influences also play a role, with systemic barriers — such as lack of access to health care and economic instability — worsening the crisis in marginalized communities.
“Synthetic opioids like fentanyl have exacerbated the overdose crisis, particularly in urban centers like Minneapolis.” Clark said. “In 2022, of the 377 opioid-related fatal overdoses in Hennepin County, only 19 did not involve fentanyl.”
The potency of fentanyl, often mixed into counterfeit prescription pills, has made drug use more dangerous than ever, contributing to the urgency of harm reduction efforts.
Harm reduction strategies, such as supervised injection sites, naloxone distribution, and fentanyl testing strips, have been effective in reducing deaths. However, these approaches are often met with resistance, fueled by misconceptions that they enable drug use rather than provide lifesaving intervention.
In communities skeptical of harm reduction policies, concerns often center around increased public drug use, safety risks near schools, and the visibility of substance use in neighborhoods.
Minnesota’s efforts to combat the opioid epidemic have included a mix of harm reduction and policy-driven solutions. Legislation like HF1379 represents a crucial step in empowering patients to take control of their pain management while ensuring providers respect their choices.
As Minnesota continues to address this crisis, it is essential to center the voices of those most affected — particularly within Black communities that have long been marginalized in drug policy discussions. A comprehensive approach that includes medical alternatives, equitable access to treatment, and investment in community-based solutions will be key to breaking the cycle of opioid addiction.
The opioid crisis is not just a medical issue — it’s a racial justice issue, a public health issue, and a community issue. Addressing it requires both policy changes and a shift in societal attitudes, ensuring that harm reduction and recovery resources are available to all, regardless of race or socioeconomic statuss.
