Over the past year, Sahan Journal has taken a close look at the opioid crisis in Minnesota. We analyzed five years’ worth of death records to determine which communities have been most vulnerable to the deadly drugs. We found that the death rate from overdoses increased for communities of color over the five years, while the rate dipped slightly among white people.
We were also surprised to find that young people aged 25–34 face the highest risk of death from overdose — and that the risk of death among those aged 15–24 was increasing faster than any other age group.
In our initial analysis and reporting, we identified communities we wanted to take a closer look at. Native Americans in Minnesota, for example, were 22 times more likely to die from an opioid overdose than white Minnesotans in 2023 — the worst such racial disparity in the country. Recent headlines have focused on the falling number of deaths from fentanyl, likely curbed in part by new public health efforts, such as greater availability of naloxone, an opioid-reversal drug. Yet large racial gaps remain.
This summer and fall, we visited people and programs that are offering solutions. Last month, we shared the stories of Native women from the White Earth Reservation, who helped co-create a successful treatment program — in part, by rewriting many of the rules that have constrained the effectiveness of traditional treatment.
To close out this reporting series on opioids and Minnesota communities of color, we decided to focus on the dual risks faced by young people from immigrant families.
In conversations about the opioid crisis, community leaders described different challenges and different successes. What various immigrant communities share is a sense of identity crisis: that is, teens living in two different cultures and pulled in competing directions. People described generational alienation and cultural stigma, and how those forces have contributed to opioid abuse and suffering.
All these teenagers also live in an environment where dangerous drugs are incredibly cheap and prevalent, the experts we talked to said. Opioids have never been easier for young people to buy. Multiple sources told us the same thing: Teens can order drugs via Snapchat and have them delivered anywhere within minutes. A single fentanyl-containing pill costs $1.
The result?
As challenges common among immigrant children build, the risk of substance use goes up as well, experts said. And because most immigrant kids have less access to culturally appropriate treatment and recovery, they are more likely to suffer the worst consequences of addiction.
Each newcomer community has its own distinct challenges; solutions rely on understanding and responding to these challenges. We visited programs that serve some of Minnesota’s newest immigrants: people who escaped civil war in Myanmar. They highlighted the damage caused by opioid use: most commonly, involvement in gangs that leads to arrests and issues with the criminal-justice system.
The challenges of moving to Minnesota
The community of about 20,000 immigrants from Myanmar started arriving in Minnesota in the early 2000s, fleeing violence in their home country and overcrowded refugee camps in Thailand. Most settled in and around St. Paul.
Most Minnesotans know this community by the colonial term “Karen,” but younger members of the hill tribe tend to prefer the original term, K’nyaw. (Karenni people are a distinct group, also from Myanmar.) Young K’nyaw and Karenni people carry the fairly recent trauma of fleeing from violence, whether they experienced it firsthand or inherited it. Their parents are less likely to speak English and smoothly navigate U.S. customs and systems.
The unfortunate upshot is that K’nyaw and Karenni teenagers appear to be at particularly high risk of substance-use disorder and arrest.
The Karen Organization of Minnesota tracked 75 youth, ages 13-18, who were affected by substance use in 2023-2024, up from 15 individuals just a few years ago. And among the 520 youth arrested in Ramsey County in 2023, at least 34 were K’nyaw — the highest youth arrest rate of any ethnic group. That trend has continued into 2024, according to arrest data from Ramsey County.
Young people struggling with addiction are vastly underserved in general. Most treatment centers for acute drug withdrawal don’t serve people under 18; only one or two treatment centers do. And despite the general acceptance that culturally specific care produces the best results, there is currently no Minnesota treatment program for substance use designed for Southeast Asians, much less young Southeast Asians.
Treatment that provides cultural nourishment
Often, Karenni and K’nyaw youth struggle in standard programs, said Kaziah Josiah, co-director of Urban Village, a community space for young people from Myanmar, launched to counter the effects of substance abuse. Many teens leave programs before completing treatment.
Clara Tunwin, the Health and Human Services Program Director at the Karen Organization of Minnesota, describes kids who ran away from treatment because they couldn’t handle the food. While that reasoning may seem less significant to some Minnesotans, traditional foods such as rice soup (ta k’paw) are part of healing in the K’nyaw culture, Tunwin said.
“I didn’t grow up eating this; I want to eat the food that my mom cooks,” they would tell her.
Teens are at an especially vulnerable time when they enter treatment, craving the nourishment, cultural and spiritual beliefs, and traditions they grew up with, Josiah said. When those things are missing, it’s hard for young people to develop trust in the program.
Realizing the lack of such resources, Josiah founded the Asian Youth Outreach program in 2021 under the umbrella of the Karen Organization of Minnesota, hoping to curb the growing numbers of young Karenni and K’nyaw people with substance-use disorder.
Around the same time, mental health practitioner Jesse Phenow decided to create a space with a similar mission. He officially launched Urban Village three years ago; Phenow and Josiah joined forces earlier this year. Urban Village has become one of a few programs that provides a safe place to hang out with other kids from the same background — an alternative to finding community on the streets.
Home on Arcade Street
On a rainy afternoon in November, I headed over to Arcade Street in St. Paul to visit. I found the nondescript brick building on a corner across from a beauty supply shop, barber shop, and tanning salon. The doors were locked, but a young person jumped up to open them as soon as she saw me.
Inside, the room was humming: About 25 teenagers lounged on sofas and easy chairs, chatting and peering at laptops. A handful of college students mingled amidst the high schoolers. Soccer jerseys and traditional art from Myanmar decorate every inch of the walls. A cafeteria-style window, decorated with large leaves, provides a glimpse into a kitchen where snacks are stored.
At first glance, there is no evidence that this is a substance-abuse prevention program. But preventing addiction — and its consequences, including arrests and juvenile detention — is the goal.
As mentor Kwe Knyaw showed me around, he explained that seeing his community struggle with life and addiction inspired him to help. It’s a job he performs on top of his full-time career as an elementary-school teacher.
At first, the program catered to kids in the throes of addiction. More recently, the focus has shifted to prevention. More kids can be reached, the directors realized, by intervening at a much earlier stage. Now, counselors at St. Paul high schools refer students who are struggling with schoolwork and who may otherwise find escape with gangs and substances. (A third of students at Humboldt High School, in St. Paul, come from K’nyaw and Karenni backgrounds.) Case managers at the Karen Organization of Minnesota can also refer kids who are recovering from drug use.
Each teen gets paired with a Karenni or K’nyaw mentor, whom they meet with every Wednesday. Homework help is available from college students on Tuesdays and Thursdays.
Students talk about getting back on track
Kids seemed eager to tell me about their experiences with Urban Village. We found some quiet space in the basement, and two students, Mar and Soe, recounted their summer trip to the Boundary Waters. There, Soe told scary stories every night and Mar overcame her fear of the water. Mar told me about making chocolate chip cookies with her mentor, and the plans they have to visit her gym.
Mar is a 14-year-old sophomore at Humboldt High School, who wears her long hair braided. She speaks softly but passionately about the importance of Urban Village. As a freshman, she failed most of her classes, she said. After a friend referred her to Urban Village, she’s now on track in school. She says learning about mental health has been even more valuable than the homework help.
Soe, an 18-year-old senior at Humboldt High School, started going to Urban Village when a school counselor referred him to the program. He was already familiar with it, he said, because the leaders had helped a friend of his who was in jail.
Mar and Soe grew quiet when I ask about substance use among their classmates. It makes them sad, they both said, to see so many of their peers using drugs. But substances are cheap ($1 a pill) and readily available (through social media and on the street). It can be hard for kids who are at high risk to avoid them.
“The youth we work with have quite an interesting generation. They’re going through a lot of challenges and need help navigating the intersectionality of being a refugee youth,” Josiah said. “A lot of the youth came here when they were very little. They might not remember life in the refugee camp. But trauma from parents gets passed down. In a lot of the youth we work with, there’s a lot of disconnect in the family. We’re not blaming the parents for trauma or how the system works. But parents don’t know how to navigate the system and kids don’t totally understand the trauma of their parents.”
All of that adds up to stress until kids find an alternative outlet to be a part of, she said.
Gangs, arrests and addiction
The number of arrests among young people has highlighted addiction and underscored the need for prevention.
St. Paul police have pointed to addiction to explain the increased violence between two rival Southeast Asian gangs. Many gang members fell in with the groups when they had long stretches of unsupervised time after school, Tunin said. Very often, those kids get introduced to drugs, she said.
The Karen Organization of Minnesota has stepped up efforts to keep kids engaged. The organization runs after-school programs for K’nyaw and Karenni youth that provide cultural activities, such as traditional weaving workshops, led by community elders.
Here’s what a typical success story looks like, according to Yussuf Shafie, founder of Alliance Wellness, and Dr. Ryan Kelly, a pediatrician who also works in addiction medicine at M Health Fairview University of Minnesota Medical Center. They shared a typical case study at a recent training workshop for The Minnesota Center for Excellence in Newcomer Health.
A 15-year-old boy who arrived in Minnesota from a refugee camp was bullied at his new high school in St. Paul. He started skipping school and joined a gang, where he was introduced to fentanyl.
He tried to quit using Suboxone, a drug that helps curb cravings for opioids. But, like many who have trouble with the timing and/or dosage of Suboxone, he went into painful withdrawal and couldn’t continue.
Around that time, he was arrested for theft.
Things changed when the teen started hanging out with a K’nyaw school social worker and got connected to a case manager through the Karen Organization of Minnesota. When he went into withdrawal at school, the social worker called the case manager. In the emergency department, the teen received a dose of an injectable drug called Brixadi that helps prevent withdrawal symptoms. He now receives a monthly injection of Sublocade, another drug that treats opioid dependency. He's doing well in school, and stays connected to his peer counselor.
This kind of success is a common outcome, said Arash Yousufi, a director of the Karen Organization of Minnesota’s after-school program. “Some of the conversations I’ve had with kids include ‘If it wasn’t for our Karen club, we would be on the streets. My older sibling didn’t have this program and they’re addicted.”
While organization leaders point to improved school attendance and reduced substance use, Yousufi also expressed concern about cuts to city and state funding.
But for now, the leaders seem undaunted: Someone recently donated a house to Urban Village that Josiah hopes to turn into a sober house for Karenni and K’nyaw youth.
The house is a fixer-upper, she says, and plans are still up in the air. But she dreams that it could be a safe place for youth to land after they’ve exited a juvenile detention center. A place with traditional food and culturally specific healing that teens wouldn’t want to run away from.
“We want to create something that better meets their needs,” she said. “It’s a big dream, and we know it will take time and community support, but we’re committed to making it happen.”
The series is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.
