After a year in which Minneapolis first responders were called to a record 1,400 suspected drug overdoses, they are on pace to match that total in 2021.

Firefighters responded to at least 1,361 nonfatal and fatal overdose calls during a pandemic-stricken 2020 — many involving opioids — an increase of 25% from the roughly 1,089 such incidents that they handled in 2019, according to a Star Tribune analysis of thousands of incident reports. The pace of overdose calls in the first three months of this year put the city on track to nearly equal 2020's final tally.

Fire personnel administered nearly 900 doses of the opioid reversal drug, Narcan, last year — or more than twice a day, on average.

As COVID-19 swept through the U.S. last year, substance abuse experts and advocates say the country's opioid epidemic began to feel like a forgotten crisis. And yet, more than 90,000 Americans died by drug overdose in the 12 months ending in October 2020, according to preliminary federal data — more than the number of people killed by guns and car crashes last year combined.

Officials say that while most overdoses appear to be opioid-related, there has also been a rise in the use of stimulants like cocaine and methamphetamine.

The Star Tribune's analysis found that nonfatal and fatal overdoses surged locally last year, with previously hard-hit neighborhoods on the city's South Side again recording high numbers of calls. But the analysis also revealed that the opioid epidemic spread to other parts of the city unaccustomed to high calls.

Minneapolis drug overdose calls

Minneapolis firefighters responded to almost 1,400 overdose calls in 2020, an increase of 25% from 2019. The calls were most concentrated in the East Phillips neighborhood.

Data source: City of Minneapolis

The Star Tribune reviewed roughly 27 months of Fire Department reports, using keywords such as "overdose" "OD," "Narcan," and the names of other common opioids to identify calls that involved suspected overdoses. The figures almost certainly undercount overdoses since many go unreported and some victims go directly to the hospital or clinic to seek treatment. But, the data give the clearest picture yet of how the opioid crisis has spread through the city.

As in years past, overdose-related calls were most concentrated in the East Phillips neighborhood. Authorities in 2020 responded to at least 44 overdose calls in a two-block radius of a now-shuttered Speedway gas station at 25th and Bloomington avenues, the analysis shows. Another hot spot near the intersection of Franklin and Minnehaha avenues recorded 35 overdoses.

On the city's North Side, the only significant hot spot was centered along W. Broadway near N. Lyndale Avenue, which has a reputation as one of the city's largest open-air drug markets.

The pandemic undoubtedly contributed to the surge in opioid use, as many Americans found themselves struggling to navigate life amid feelings of isolation and financial stress from lost jobs, according to medical professionals and researchers who study addiction. And more people began using drugs alone, meaning there was no one around to bring them back if they overdosed. Meanwhile, many drug users were cut off from treatment as clinics closed or reduced patient contact.

"People rely on a network of support to assist in their recovery from addiction, and without having close people taking care of each other, that puts people at risk," said Dr. Serena King, a psychology professor at Hamline University who has studied gambling and substance addiction. "The pain and stress of the pandemic has affected many people, and some people have returned to substances of abuse to address existing pain and suffering they're experiencing."

At the same time, she says, the pandemic also exposed longtime disparities in access to opioid treatment, based on race, income and other demographic factors.

Authorities say that another reason for the rise in overdoses is the growing availability of the synthetic painkiller fentanyl, which is 50 times more powerful than heroin and can be lethal to non-opioid users in doses as small as two milligrams. In 2016, the DEA issued a warning about the increasing number of dealers buying pill presses and cheap fentanyl on the internet and then making fake oxycodone or Xanax pills and selling them for $30 to $35 each. The small tablets are often crushed and snorted, to produce a faster high. The problem is that most dealers aren't mixing the fentanyl correctly, authorities say, leaving users guessing at the potency of the drugs — turning casual drug use into a form of Russian roulette.

The spread of fentanyl has coincided with the growing overdose death rates of Black, Latino and Native Americans, officials say, groups that have also been disproportionately affected by the pandemic.

Such disparities were one of the reasons that in 2015 Marc Johnigan founded Twin Cities Recovery Project, which offers culturally specific recovery services and serves as a "safe space [where] individuals who're in transition could come and have social events."

Because of the racial inequities of the past War on Drugs, which led to over-policing in Black neighborhoods and the disproportional incarceration of men, many Black users are reluctant to openly discuss their addictions, he said.

"Our community needs to understand that this is a disease, that it's not a moral failing," he said.

In recent months, officials have ramped up outreach in the Native and East African communities. Mayor Jacob Frey included $100,000 in his proposed 2022 budget to develop an opioid treatment center for people who were wary of visiting the hospital. And last month, the city applied for a $1.2 million grant from the U.S. Justice Department to "develop, implement, or expand comprehensive programs in response to illicit opioids, stimulants, or other substances of abuse." The proposed project would focus on the Phillips and Powderhorn Park neighborhoods and specifically on a five-block radius around the intersection of Bloomington Avenue and E. Lake Street.

In Hennepin County, deaths related to opioids jumped last year, notably picking up in March, around the initial surge in the pandemic as the health care system struggled to cope with the virus' outbreak. At least 285 people died from opioid overdoses countywide in 2020 — almost exclusively from fentanyl and its analogues — up from 170 in 2019, setting a five-year high. Preliminary county data show the trend has continued this year, with 164 fatal opioid overdoses through June, compared with 128 in the same period in 2020.

The Star Tribune's analysis found that not only did the overall number of drug-related calls increase citywide, but there were more overdose hot spots in 2020 than the year before.

In 2019, one small area along Hiawatha Avenue accounted for more than 60 overdoses. While that area saw fewer incidents in 2020 — possibly due to the closure of a nearby homeless encampment — there were at least 29 areas with 10 or more overdoses in 2020.

In the first three months of 2021, neighborhoods like East Phillips, Elliot Park, the North Loop, Jordan and Audubon Park were on pace to exceed their 2020 totals, while Willard-Hay, Seward and Ventura Village — a major hot spot two years ago — were on pace for declines.

Emily Ralph, who runs a food shelf in Ventura Village, said that drug buyers and sellers who hang out in the area occasionally cause a commotion that startles the families lining up to receive food. But given the ongoing debate over the role of police since the murder of George Floyd, Ralph said she now thinks twice about calling 911.

"We would like to know what other resources are out there, maybe more community-oriented resources," she said.

Terry Haigler takes a different view, saying he wishes that authorities would have stepped up law enforcement over the years he ran a series of Christian sober houses, including one in the Seward neighborhood.

"I can see if you want to have compassion and not harass people who were in active addiction … but sitting on a park bench where children play it's still a crime, and you don't solve a problem by ignoring it," said Haigler. Many hot spots were centered on homeless encampments.

Mo Mike, a syringe services specialist at the Indigenous Peoples Task Force in the East Phillips neighborhood, sees a link between homelessness and addiction, saying that nothing will change until the city solves its affordable housing shortage. On top of that, Mike says, "a lot of people out there are just really dealing with intergenerational trauma" and untreated mental illnesses.

And yet, city officials seem more interested in tearing down encampments than in helping the people who call them home, according to Linda Julik, a regular presence along Bloomington Avenue who for years has collected used needles and passed out Narcan, fentanyl test strips and other necessities.

With so many people losing their safety nets due to the pandemic, Julik said that she has noticed the unsheltered people are increasingly turning to fentanyl or drugs laced with bath salts, which send users "flip-flopping like a crappie."

That more people aren't dying, she said, is thanks to the wide availability of Narcan.

Libor Jany • 612-673-4064 Twitter: @StribJany

Michael Corey • 612-673-4750 Twitter: @mikejcorey