Winona County Substance Use and Overdose Profile
Download the Winona County Substance Use and Overdose Profile (PDF) for accessible tables of the data in this county profile.
The purpose of this profile is to allow users to gain a better understanding of what the overdose epidemic looks like in their community and to make data-driven prevention decisions to improve health.
Having data on overdose and substance use is essential. Data can inform prevention programming, help to identify communities being impacted, drive the creation of new services, and be shared with funders to get more resources. Everyone has a role to play in reducing drug use and preventing overdoses. People living in the community, local public health, and providers can all advocate for changes and support those with substance use disorder and those in recovery.
Drug overdose is preventable. Substance use disorder is treatable and preventable, and recovery is possible.
*NOTE: Any 2021 drug overdose death data is considered preliminary and is likely to change when finalized. The 2021 data included here is indicative of, not final, 2021 drug overdose deaths.
What does the data tell us?
For any questions on county profile data, please contact a prevention staff member at email@example.com.
Drug Overdose Data Sources
Description: Drug overdose death data come from Minnesota death certificates. After a death occurs, a death investigation is completed, along with an autopsy (88% of drug overdose deaths had an autopsy completed in 2019), and a medical examiner or coroner makes a determination of the cause and manner of death. The cause of death information is then typed into the corresponding sections of the death certificate. Once the medical examiner certifies and completes a death certificate, the information is then sent to the Office of Vital Records (OVR) at the Minnesota Department of Health (MDH). Data quality checks are completed to ensure the death certificate was completed properly and accurately. Read more on Drug Overdose Death Reporting.
To identify drug overdose deaths and the specific drugs involved from the entire death certificate file, a two-step analysis is completed. First, only death certificates with an underlying cause of death ICD-10 code in the ranges of X40-X44, X60-X64, X85, or Y10-Y14 are selected. From there specific ICD-10 drug codes in the contributing cause of death fields are searched to identify all drug overdose deaths that involved each drug category of interest (T36-T50). The drug categories are not mutually exclusive, meaning a death with heroin (T40.1) and cocaine (T40.5) will be counted in both drug categories. Data are then summarized by demographic and geographic variables of interest.
Strengths: The strengths of death certificate data include the completeness of reporting from across the state, as well as from other states when Minnesota residents die in another state. There is also consistency of reporting across and between states ensuring the data can be easily analyzed. Additionally, data can be easily grouped by the larger drug categories to allow for examination of trends in specific drug categories.
Limitations: The limitations of the death certificate data include timeliness in completing the death certificates. The death investigation and autopsy process takes considerable time and toxicology testing may take further time to properly identify the drugs involved in the death. Due to Minnesota’s current medical examiner and coroner system, there is also variability in how drug overdose deaths are reported. This includes variation in the details and specificity listed on a death certificate in terms of the specific drugs involved in a death. For example, death certificates that only list mixed drug toxicity as a cause of death do not provide the level of detailed information required to properly code the death with ICD-10. Without the correct ICD-10 code the drug overdose death will likely be grouped with “other drugs” (13.8% of drug overdose deaths with T50.9, other and unspecified drugs, as only T-code listed on death certificate). This lack of specificity does not allow for a proper examination of deaths. Finally, death certificates cannot be used to quickly identify new drug trends because of the time it takes to complete toxicology and for death certificates to be finalized and made available for analysis.
Perform your own analysis:
- CDC WONDER The CDC WONDER online mortality databases utilize a rich online query system for the analysis of public health data. Analyses of death certificates can be conducted for the U.S., as well as for any state, including Minnesota.
- CDC WISQARS CDC’s WISQARS (Web-based Injury Statistics Query and Reporting System) is an interactive, online database that provides fatal and nonfatal injury, violent death, and cost of injury data from a variety of trusted sources. Researchers, the media, public health professionals, and the public can use WISQARS data to learn more about the public health and economic burden associated with unintentional and violence-related injury in the United States.
Description: Data for nonfatal hospital-treated overdose come from the Minnesota Hospital Discharge Database provided by the Minnesota Hospital Association. Data are provided quarterly to the Minnesota Department of Health. These data include all inpatient and emergency department hospital treatments at acute care, non-federal in-state hospitals and some border hospitals. Stand-alone psychiatric facilities are not included; however, psychiatric admissions within a hospital are included. There are 147 hospitals in Minnesota, including non-acute care facilities; 137 are members of the Minnesota Hospital Association; 135 are included in the all-age injury hospital discharge database at the Minnesota Department of Health.
Strengths: The data represent a majority of hospitalizations for drug overdose in Minnesota, regardless of the insurance carrier or payer. The data are also de-duplicated prior to analysis, which results in the removal of counting an individual hospitalization more than once.
Limitations: Hospital discharge data are primarily intended for billing purposes, not public health surveillance. The data also do not currently contain race or ethnicity. The transition to ICD-10-CM in the final quarter of 2015 (October – December 2015) makes comparisons inaccurate, if not impossible, to previous years. Trend data is available from 2000 to 2014, and estimates for 2015 are included in the charts. Data for 2015 should be interpreted cautiously and trends should not include 2015 data because of the transition to ICD-10-CM. Trend data will start over from 2016 onward.
Perform your own analysis:
- Minnesota Injury Data Access System To support its mission of preventing injuries in Minnesota, the Minnesota Department of Health has developed MIDAS, the Minnesota Injury Data Access System. It will enable you to more easily learn about the injury and violence data for Minnesotans, whether for a specific county, for a type of injury, or by gender, time frame, or other factor.
Description: The Minnesota Student Survey (MSS) is conducted every three years among three populations of students in Minnesota public schools:
- students in regular public schools, including charter schools and tribal schools
- students in alternative schools and Area Learning Centers
- students in juvenile correctional facilities
The survey asks questions about activities, experiences and behaviors. Topics covered include tobacco, alcohol and drug use, school climate, physical activity, violence and safety, connections with school and family, health and other topics. Questions about sexual activity are asked only of high school students. The survey is administered jointly by the Minnesota Departments of Education, Health, Human Services and Public Safety.
Strengths: The MSS is a major source of information about the thoughts and experiences of Minnesota’s young people. Eighty-five percent (85%) of Minnesota school districts participated in the 2016 survey, and nearly 169,000 students in regular public schools took the survey. The MSS allows for sub-state analysis and the ability to track behaviors over time.
Limitations: The survey asks questions about behaviors or beliefs that are sensitive in nature, which may result in the underreporting of these behaviors or beliefs. Analyses are also limited by small sample sizes in certain geographic or demographic subgroups. Since the survey is administered in school, students not in or absent from school do not have the opportunity to participate in the MSS. Trend analyses can also be limited as the survey is updated and questions are added or removed.
Description: The DAANES is designed to provide policy-makers, planners, service providers and others in Minnesota with access to current information about chemical dependency treatment activities across the continuum of care. The Department of Human Services is required by statute to collect sufficient information to evaluate the efficiency and effectiveness of treatment for chemical dependency. In addition, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) of the Department of Health and Human Services has mandatory reporting requirements through the National Outcomes Measurements (NOMs) monitoring system. SAMHSA requires that all treatment providers who receive any state or federal funds report on this system for all treatment admissions regardless of funding source. In Minnesota, DAANES is used to meet both state and federal reporting requirements.
Strengths: The DAANES provides information on the primary substance at admission to substance use disorder treatment services for adults and adolescents. This allows for the tracking of trends in admissions for certain categories of drug, as well as primary route of administration. These data paired with complimentary data sources can provide a more comprehensive picture of substance use in Minnesota.
Limitations: Relying on the primary substance at admission to substance use disorder treatment services does not capture the complete picture of substance use, as there is often more than one drug individuals may have used. Additionally, it does not put into perspective treatment capacity and how the need is or is not being met in Minnesota. The DAANES does also not allow for quick identification of emerging drug trends.
Perform your own analysis:
- Substance Use in Minnesota (SUMN) provides data on over 100 indicators of alcohol, tobacco, and other drug consumption patterns, consequences, and contributing factors in Minnesota. Data are provided at the county level, regional, and state level, and by demographic group when possible.
Description: In 2009, Minnesota Statutes required the Board of Pharmacy to develop and maintain a database of controlled substance prescriptions for the purpose of promoting public health and welfare by detecting abuse, misuse, and diversion of controlled substance prescriptions. The goal of the PMP is to assist in improving patient care and reducing the misuse of controlled substances. In mid-2014, a change in Minnesota Statutes became effective which allowed the PMP to participate in the interstate exchange of data with prescribers and pharmacists in other states. Prior to July 1, 2014, dispensers were only required to report Minnesota schedule II-IV controlled substances to the Minnesota PMP database. In July 2014, dispensers were required to report schedule V controlled substances as well as butalbital and tramadol. Beginning in 2016, dispensers were also required to begin reporting gabapentin. Gabapentin is not federally scheduled, but it is considered a drug of concern in Minnesota.
Strengths: PMPs have proven to be effective in assisting prescribers and dispensers in identifying patients displaying high-risk behavior by obtaining controlled substances from multiple prescribers and pharmacies. Additionally, PMP data has aided in investigations of inappropriate prescribing or dispensing, overdose deaths, and suspected controlled substance crimes. The PMP collects information on all dispensations of schedule II-V, butalbital, and gabapentin dispensed in Minnesota. It also actively exchanges PMP history data with authorized account holders in 43 other states and jurisdictions to eliminate unknown prescription activity across borders. The PMP uses Controlled Substance Insight Alerts (CSIAs) to notify prescribers and pharmacies when a patient in their care has met or exceeded a set threshold that may indicate the patient is at risk for an overdose.
Limitations: Prescription data in the PMP are only as accurate as the records submitted by the dispensers. A law went into effect July 1, 2017 mandating that all prescribers and pharmacists practicing in Minnesota must create and maintain a PMP account. As of Jan. 1, 2021, prescribers in Minnesota are required to utlize the PMP in certain circumstances of prescribing an opioid. Multiple exemptions exist to this requirement. Tracking compliance is difficult without access to protected health information to evaluate the clinical decision making of the prescriber. Additionally, statutory restrictions on the privacy of PMP data make it difficult to track the impact of PMP utlization on public health.
Note: Minnesota's Prescription Monitoring Program (PMP) is generally called a Prescription Drug Monitoring Program or PDMP.
Prevention action steps and resources
- Learn the language of substance use disorder and practice using words that can reduce stigma.
- Support those in your life that might be impacted by substance use disorder and opioid use disorder or are in recovery by being non-judgmental and listening.
- Join a community task force that is focusing on improving access to drug treatment, harm reduction services, or other social services necessary for recovery like housing and employment opportunities.
- Learn about how substance use is influenced by many different factors by reading about the social determinants of substance use & overdose prevention.
- Complete a naloxone (also called Narcan) training and carry naloxone, a drug that can be used to reverse an overdose. The following organizations offer naloxone trainings:
- Find naloxone near you using the Naloxone Finder map.
- Explore funding opportunities to increase capacity to monitor substance use in your community and fund prevention programming.
- Subscribe to the MDH Opioid Overdose Prevention email list to get regular updates on data, programming, research, and funding opportunities.
- Lead a community task force focused on reducing substance use and overdose in your community.
- Provide regular naloxone trainings to the community.
- Become knowledgeable of local prevention work. Connecting with Winona County Public Health and with the Southeast regional prevention coordinator is a great place to start.
- Support patients exploring alternative pain management methods and reduce opioid prescriptions.
- Review the Minnesota chronic pain opioid prescribing recommendations.
- Prescribe naloxone to all patients who are also prescribed or are using opioids.
- Become a buprenorphine waivered practitioner to provide medication for opioid use disorder (MOUD) to patients.
- Learn about the TOWN model, developed by CHI St. Gabriel’s, which can support people who use drugs or people in recovery.
For example, in some small counties, there could be a year without any fatal opioid overdoses and very few nonfatal overdoses. These small numbers do not tell us that substance use is not an issue in this county. There are many other negative health effects from using substances that are not collected as data points, such as having trouble maintaining a job, safe housing, or relationships with family and friends.
MDH Supported Programming in Winona County
Currently, MDH is supporting opioid overdose prevention work done by the following organizations:
- Overdose Fatality Reviews in the Southeast Emergency Medical Services region
For more information on MDH-funded programming, review the MDH Response to Substance Use and Overdose Across Minnesota webpage.
Please visit the Opioid Dashboard for more information on opioid overdose death, nonfatal overdose, use, misuse, substance use disorder, prescribing practices, supply, diversion, harm reduction, co-occurring conditions, and social determinants of health.