Fifteen years ago, Rep. Dave Baker faced an agonizing personal loss when his son Dan died from an opioid overdose just one year after spinal surgery. Their encounter with a physician who dismissed non-opioid alternatives haunts him to this day. That tragedy now underpins Baker’s legislative push to give Minnesotans more agency over pain management.
Earlier this year, the Minnesota House advanced HF 1379, a bill that would codify voluntary non-opioid directives, a written declaration by a patient that they refuse opioid prescriptions. The aim is to reduce unnecessary exposure to addictive drugs and offer a safeguard especially to those in recovery.
The opioid toll
Minnesota’s fatal overdose numbers have shown modest improvement recently. Between 2020 and 2022, opioid-involved deaths jumped 51%, more than doubling across the state since 2019.
But the picture is nuanced. In Hennepin County alone, 373 lives were lost to opioid-related overdoses in 2023, and more than 10,000 hospital or emergency visits involved opioids that same year.
Statewide, preliminary 2022 data show 1,343 drug overdose deaths among Minnesota residents. Nationally, the overdose crisis appears to have peaked in 2023.
In 2024, provisional estimates show U.S. overdose fatalities fell nearly 27%, from about 110,000 in 2023 to approximately 80,000. Opioid-involved deaths also tumbled, from 83,140 in 2023 to 54,743 in 2024, with synthetic opioids like fentanyl driving much of the earlier surge.
That drop is historic, but experts warn the gains are fragile, especially as funding pressures mount and newer synthetic compounds continue to emerge.
Racial disparity in drug policy
Throughout past drug epidemics, Black communities often bore the brunt of punitive approaches: criminalization, harsh sentencing, and neglect of treatment options. The crack era, for instance, reinforced policies that disproportionately targeted Black Americans.
In contrast, the response to the modern opioid crisis has tilted more toward medical intervention and harm reduction. But that shift has not fully reached communities of color, which continue to be underserved and underrecognized in public health strategies.
In Ramsey County, overdose death rates are higher among Black and American Indian individuals compared to White residents. Public health leaders say the disparity is rooted in systemic inequities: limited access to quality care, stigma, underinvestment in treatment resources in Black neighborhoods, and mistrust of medical systems.
“Any tool we introduce must center equity,” says Dr. Nelia Johnson, a community health specialist working in Minneapolis’s North Side. “If the non-opioid directive lives only in communities with easy access to alternatives, then we’ll just widen the health gap.”
Shifting the power balance
HF 1379 would allow Minnesotans to submit a voluntary directive indicating that health care providers should neither administer opioids nor offer them as treatment, except in emergencies when the patient is incapacitated.
Rep. Baker likens it to a “do-not-resuscitate” choice, but for pain: “This is about giving people control over their bodies…especially those who have experienced addiction or know their family history,” he told the House committee.
Backers claim the directive could:
- Lower risk of opioid misuse and dependency
- Improve clarity in provider-patient communication
- Offer consistent, recognized forms statewide
- Shield health providers acting in good faith from liability
Medical associations have pushed for language that gives providers flexibility to override the directive in emergencies or when it’s not accessible. Minnesota doctors would not be penalized for prescribing opioids when clinically justified.
Still, some clinicians worry about unintended consequences. Dr. David Schultz of Minnesota’s pain physicians society cautioned that restrictive interpretations could hamper care for patients with intractable chronic pain. A balance must be maintained between curbing abuse and preserving legitimate medical access.
In fentanyl’s shadow
The potency and ubiquity of fentanyl have transformed the opioid crisis. It’s often mixed into counterfeit pills or street drugs, making dosage impossible to gauge.
Dr. Benjamin Clark, a neuroscientist at the University of Minnesota (not interviewed here), has explained how opioids suppress “braking” neurons in the brain’s reward circuits, leading to distorted perceptions of what’s rewarding. He also notes that synthetic opioids like fentanyl exacerbate this effect and make overdoses likelier.
In Hennepin County in 2022, only 19 of the 377 opioid-related deaths did not involve fentanyl, underscoring how dominant it is in the fatal mix.
What else needs doing
The non-opioid directive is a promising step, but it can’t stand alone. Experts recommend a layered response:
- Harm reduction at scale. Distribution of naloxone, safe use education, fentanyl testing strips, and supervised consumption options save lives.
- Investment in treatment and recovery. Medication-assisted treatments (e.g. buprenorphine) must be accessible, especially in marginalized neighborhoods.
- Community-rooted models. Programs led by people with lived experience, and culturally responsive care models, build trust and continuity.
- Sustainable funding. Minnesota has secured some resources via opioid settlement payments. Recently, Attorney General Ellison announced a nationwide $720 million settlement with eight drug companies, of which Minnesota may get roughly $9.37 million. Minnesota has already allocated parts of earlier settlement funds to prevention, treatment, and harm-reduction infrastructure.
- Equitable rollout. Ensuring rural and urban communities, especially those long underserved, get access to nonopioid pain care alternatives like physical therapy, acupuncture, behavioral health, or integrative therapies.
A shift toward autonomy, equity
The story of the opioid crisis in America has often been told through tragic headlines. But Minnesotans are now pushing toward a different narrative, one where patients reclaim autonomy, where policy centers fairness, and where communities historically left behind are finally visible in the solutions.
If HF 1379 becomes law, and if it’s paired with robust investments in recovery, harm reduction and equitable care, the state may begin to undo decades of harm. But as always, the metrics will matter: who opts in, who gets access, and who benefits.
Let people say “no” to opioids. And let the state ensure they have something better in return.
