Minneapolis health commissioner seeks progress on fentanyl, homelessness

Growing up in public housing projects in Boston, Damon Chaplin got first-hand experience with how a neighborhood can harm your health. Researchers use the phrase “social determinants of health” to describe the conditions that people are born into—and those determinants were a challenge for Chaplin. He  was often rushed to the emergency room for his asthma, which was exacerbated by an incinerator and cigarette smoke in his building. 

Now, as a health-care leader, Chaplin likes to refer to the social determinants of health as the social determinants of hope. The 50-year-old left Massachusetts in March to lead the public health department of Minneapolis. Chaplin said he was eager to come to a city that is working diligently on issues such as health and racial equity, climate change, and social reform.

Housing—or lack of it—is one of the key social determinants he’ll be tackling here. A recent Minnesota Department of Health and Hennepin Healthcare Research Institute report found that people experiencing homelessness die at a rate three times higher than the general population. In other words, a 20-year-old unhoused person is as likely to die as a 50-year-old in the general population. 

Homelessness and encampments became more visible during the pandemic. That said, a population count conducted by Hennepin County suggests the number of people living outside in the county actually decreased from 642, in 2020, to 487, in January of 2022. Fatal drug overdoses, however, have more than doubled since 2019—creating a sense of crisis for homeless people and outreach workers. 

Most people experiencing homelessness have mental health or substance misuse issues, Chaplin said, and may not have a “medical home” or access to regular checkups and treatments. Unsheltered people often piece together health care from different places, he said, and often receive inadequate care. 

Chaplin worked closely on issues related to homelessness and poverty in his previous role as leader of the New Bedford, Massachusetts, health department. There, he co-chaired an opioid task force that created harm-reduction programs such as disposal kiosks for unused prescription medication, Narcan training, and outreach teams that visit people who overdose within 48 hours of the event. He also served as a member of an opioid task force for the Massachusetts Secretary of Health and Human Services. 

Chaplin recently sat down with Sahan Journal to talk about how homelessness impacts public health. He talked broadly about the sensitive subject, careful to point out that the issue is overseen here by several entities, including Hennepin County, the Minneapolis Health Department, Community Planning and Economic Development, the police, and regulatory services. He expressed hope that together these entities will be able to make homelessness “rare, brief, and non-recurrent.”

The conversation has been edited for length and clarity.

How has the rise of fentanyl impacted homelessness?

That’s been the challenge for us, identifying and controlling access to fentanyl. It’s pretty much in all of the illicit drugs now. Whether it’s in pill form or some other form, there’s usually traces of fentanyl in almost all of them, so it’s very difficult to police and control. 

Fentanyl does not allow people to exercise executive function. And so they really lose the ability to make rational decisions. It disables them from being able to do normal daily functions, which is a potential harm to themselves and the people around them. 

Obviously when they’re using, they go through these channels of euphoria and depression. It becomes very difficult to get them at a status where they’re neither in euphoria nor in depression. The challenge is to get them to some level of normalcy, which is where the detox and treatments really come into play.

What are your feelings on harm reduction and safe injection sites?

The first thing we need to do is keep people alive. There are several different strategies we can employ to try to keep people alive, whether it’s Narcan or safe-syringe exchanges. The biggest piece of safe syringe exchanges is the education and outreach that helps direct people to other services in the community, if they need them. 

We have not really discussed other strategies like safe injection sites. It’s a tool that some communities are considering. But the real idea is to try to keep people alive long enough to get them into recovery.

What have you found to be unique to Minneapolis?

Resources. 

This is a community that has a lot of resources available through the county, through the providers that we support, through the health department and the city. That’s unique. I’m still learning all the resources that are here. Every time I talk to someone in the homeless space or  the substance misuse space, they’re always raving about the number of services that are available. 

Just today, I was talking to someone and I was shocked that they said, ‘Yeah, I can get someone into treatment within 24 hours.’ That’s kind of unheard of. One of the challenges in Massachusetts is getting services to people when they need it, when they’re ready to receive it. And that’s always been the challenge. So 24 hours—that’s astonishing. 

When someone overdoses and receives Narcan and then reaches that “normal” point, that’s the moment when they’re likely to try treatment?

Yeah, that’s the best time.. 

In Massachusetts, we had a number of different strategies and programs trying to get folks when they’re ready, wherever they happen to be. When they’re revived from the overdose, we know we don’t have forever. And we know there’s a finite number of times a person will continue to overdose before they actually expire … It’s really important each time we have contact to try to get them into services. It’s a space where we have to work with the community and ask families to help us.

Does Minneapolis have enough culturally competent treatment facilities that know how to treat people from different communities?

I don’t know the landscape yet, but I can tell you from prior experience that it’s always difficult to find multilingual folks who are peer recovery folks, or multilingual folks who are counselors, or recovery programs that are multilingual or multi-disciplined or multicultural. Those are always   challenges for any community. 

We have very distinct neighborhoods and pockets of cultures here, which all require a slightly different approach, whether it’s prevention, intervention, treatment, or recovery. That’s also very unique. Where I came from in New Bedford, Massachusetts, we had distinct cultures: Spanish, Portuguese, and Cape Verdean. 

Here, I think it’s even more distinct with our Hmong population, Liberian, Ethiopian, Somali, African American, Hispanic and Central American populations. There are very distinct cultures here. 

Can you speak to why it’s important to have treatment in your own language and culture?

It’s all about the approach. The approach will determine the outcome. If the approach is appropriate, there’s a better chance of a positive outcome. If you look at the Somali community and Hmong communities, a big piece of it is customs: How do you go about addressing a man,  how do you go about addressing a woman? If you violate any of those covenants within that community, it really affects the relationship and the ability to communicate going forward. 

Black and Native American communities in Minneapolis have been disproportionately affected by opioids. Is that similar to what you’ve seen?

Oddly enough, it is. We saw a significant spike in numbers since 2019–2020 in our African American population. We’re still trying to unpack what happened during COVID to cause such a significant increase. But obviously, it’s always about access and it’s about supply. And it’s about  protective factors within the community. Communities that have more of those protective factors tend to have fewer of these types of incidents. 

What do you mean by protective factors?

When we’re talking about protective factors, we’re talking about community programs, things that exist within the community that are able to enhance a person’s life: opportunities and access to additional education and sports. Those extracurricular things that communities are able to provide also provide a level of protection. 

The more things kids and young adults have to do to help propel them forward, the less likely they are to participate in other activities we prefer them not to. 

How do you plan on addressing homelessness as public health commissioner?

Number one, work with the county and get in sync with what services they’re providing and what services we can provide. The second thing we have to do is coordinate with internal partners engaging with encampments: Community Planning and Economic Development and the police. The third thing is taking a look at what’s being provided and what the need is. 

One of our roles is engaging with the community, finding out what the needs are, and then doing the outreach and education and supportive services to get them into treatment or into housing. 

How can we know if we’re making progress on homelessness and the health of homeless people?

What you will see hopefully is homelessness becoming rare, brief, and non-recurrent. We’re working to help the county achieve that goal. What we try and do is take the public health approach to making homelessness rare, brief, and non-recurrent by partnering in reducing communicable diseases and improving sanitary conditions and safety, and connecting people to services.

Is there a city that has had success with housing people that you might like to model Minneapolis after?

One of the counties we’ve been looking at is Bergen County, in New Jersey. They’ve reached “functional zero” for homelessness. It’s a model we’ve looked at prior to coming here. They provide a one-stop shop where they do mental health, substance abuse, and housing in one location. 

But the bigger thing is that they provide services with dignity. They provide homeless services that are kind of the Taj Mahal of sheltering. They have a really robust system of getting people in, providing the services that they need, and helping them navigate into the type of housing that’s most appropriate. That’s how we get to functional zero.

And I think Hennepin County is about to achieve functional zero for veterans. They are doing a good job here and we want to help support their efforts. 

How could homelessness look different here in 3-5 years? 

Functional zero does not mean you will not see homelessness. It’s more so a measure of the ability to get people into housing. It’s a housing-first model, a function of how quickly and efficiently you can get folks from homelessness into housing. It happens when you have a system set up where a person can get to treatment, to shelter, to counseling and an appropriate level of housing. 

Functional zero is a reference to how well the housing system and all systems work together.

Are you an optimist?

I am. Minneapolis is a great place to be and I’m glad I’m here.