FARGO, N.D. - The number of opioid-related deaths and overdoses that resulted in ambulance crews administering antidotes decreased sharply last year as the narcotic epidemic in the area showed signs of tapering off after peaking in 2016.
Meanwhile, in a trend public health officials regard as encouraging, the number of clients enrolled at a local clinic prescribing methadone, which helps addicts wean themselves from opioids, has risen dramatically.
Law enforcement and public health officials expressed optimism that the opioid epidemic in the metro area might be waning after skyrocketing in 2016, but they cautioned that the decreases could reflect the now widely available antidote kits, resulting in fewer overdose deaths or ambulance calls.
In Cass County, public health officials identified 15 opioid-related deaths in 2017, less than half the 31 deaths recorded in 2016, according to preliminary figures. Drug overdose deaths of all kinds decreased from 48 to 29 during the period, according to figures compiled by the Cass County Coroner's Office.
In 2016, Fargo police responded to 69 overdose calls involving 71 people. Of those, 15 died from drug overdoses, including 11 from opioids, according to police figures.
Police responded to far fewer overdose calls in 2017 - 39 calls involving 40 people - although 19 people suffered fatal overdoses, including eight that were opioid-related.
"I think we still have a significant problem," said Lt. Shannon Ruziska, who oversees narcotics investigations for the Fargo Police Department. Although opioid-related deaths declined during the past year, they still remain disturbingly high, Ruziska added.
In Moorhead, police records indicate opioid-related calls dropped sharply, and opioid overdose deaths decreased from four in 2016 to three last year. Clay County doesn't track drug deaths.
"A year ago, it was more busy," said Sgt. Clint Stephenson of the Moorhead Police Department. "It's quieted down," but he added, that could just mean many heroin users now have antidote kits and are making fewer calls for first responders, so they remain invisible to law enforcement.
Last year, FM Ambulance Services paramedics administered fewer doses of Naloxone, the antidote for opioid overdoses, after six years of increasing or stable overdose calls. The ambulance service's paramedics provided 102 doses of Naloxone last year, a sharp reduction from the 146 doses given in 2016, the peak year in a trend dating back to 2011.
The dramatic decrease during the past year is encouraging, said Don Martin, FM Ambulance's communications director. "It looks like we're almost going back to the previous years," 2014 to 2015, when paramedics provided 90-plus antidote doses.
"I can only speculate if the usage is going down," Martin said. "I think it's an accumulation of many things," including greater public awareness of the dangers of opioids, widespread availability of antidotes and efforts to restrict opioid prescriptions.
The number of opioids dispensed fell 22.5 percent from early 2015 until fall 2017, according to a prescription-tracking database maintained by the North Dakota Board of Pharmacy. An analysis of Medicaid claims found opioid prescriptions dropped 72 percent from 2012 to 2017, as measured by morphine equivalent doses to allow comparison.
More addicts are seeking treatment at Community Medical Services in Fargo, a clinic that provides methadone. The clinic, which opened in April 2017, now has 164 enrolled clients, up from 60 in July.
"I would say it's continuing to grow at a fairly rapid pace," said Mark Schaefer, Community Medical Services' regional director. "It's been fairly consistent."
Around 90 percent of the clinic's clients are from Fargo-Moorhead, with the rest from outlying communities, he said.
The clinic's client base has grown significantly, mostly through word of mouth, but it still represents a small portion of the area's opioid addicts, Schaefer said.
"It's nowhere near the number actually using," he added. "These are clients saying, 'I want to stop. I want treatment.'"
The clinic provides daily doses of methadone to allow patients to avoid painful withdrawal symptoms while staying off opioids. The course of treatment should be sustained for one or two years to be effective, Schaefer said.
The North Dakota Department of Human Services has provided funding to defray the cost of the medication, bringing it down to as little as $15 per week or $60 per month. That has helped to bring more addicts to the clinic, he said.
All clients also receive counseling from a licensed addiction counselor, and the clinic keeps working with clients even after a relapse.
Dr. John Baird, health officer at Fargo Cass Public Health and the Cass County coroner, said he's encouraged by the increase in the number of addicts seeking treatment to get off opioids.
Ruziska agreed that treatment - and, more importantly, prevention through education - provides the keys to turning the opioid epidemic around.
"We can't arrest our way out of this, especially with the user," he said. "We have to get these folks to treatment. It's a better resolution than jail."