GRAND FORKS-If he could, Chuck Hilger would meet the opioid crisis with a brand-new clinic in Bemidji. It's close enough to reservations to fight a nationwide wave of addiction, one that's taking Native American lives at six times the rate of other Minnesotans.

But the world doesn't work that way.

"I would open a clinic in Bemidji if I had any chance of drawing enough counselors to meet the needs," said Hilger, a vice president with Meridian Behavioral Health - a group that offers substance abuse treatments throughout Minnesota and beyond. "It's just not even possible."

In the past decade, he's watched the opioid crisis and the attendant need for treatment explode - and the world hasn't always kept up. He shared statistics showing opioid deaths have exploded nationally, growing from three per 100,000 people in 2000 to more than four times as much by 2016.

"If a clinic opened up there (Bemidji), it could probably realistically expect to treat 700 to 1,000 patients," Hilger said. "You start talking about 500 (patients), plus supervisors and the like, I would need 12, maybe as many as 15, counselors living in the Bemidji area looking for a job. That's just not feasible."

Hilger's stymied wish is part of a trend in care around the country. Facing the same shortage, Vermont leaders shifted regulations in October to make training and education requirements less onerous. In Michigan, there's concern over a shortage of doctors able to prescribe drugs that wean users off dependency.

And nationwide, there's concern that caretakers can't staff the problem in front of them.

In Grand Forks, the opioid crisis spiked only within the past few years, police Lt. Brett Johnson said, with the department only beginning to keep statistics as the crisis surged in 2016. That year, the department responded to 28 overdoses, three of which were fatal. In 2017, those numbers rose to 32 overdoses, four of which were fatal. So far in 2018, there have been responses to 13 overdoses, two of which have been fatal.

Deborah Davis is a senior official overseeing drug and alcohol treatment in the Grand Forks region for the North Dakota Department of Health. Like others in her field, she bemoans the stigma of addiction as a personal failure instead of an affliction. But, she said, as the stigma fades, it's bringing even more people to seek care.

"I think you'll find (a counselor shortage) all around the country. Certainly it's here in North Dakota - but you will hear on a national level that this is a trend," she said. "Nationally, we need to take a look at this. Every state is short (addiction counselors)."

Complex crisis

The current crisis is profoundly complex, with regional health care workers listing a multitude of drugs, causes and solutions that figure into the crisis. The current epidemic was hastened in western North Dakota by an influx of cash and transient workers in the Oil Patch. In other places, doctors' prescriptions for painkillers placed a path to dependency in the medicine cabinet. In recent years, they say, patients have skewed younger and increasingly use methods more typical of longtime drug users, such as needles.

Davis said she's watched wait lists for longer-term care programs grow weeks long for drug treatment programs - though she stressed state workers will still see patients and offer interim services as necessary.

"We are currently meeting the need of who's coming to our door," said Tammy Ness, who oversees similar state work in Minot and Williston. "I think that's significantly different from saying, 'Do we have enough (addiction counselors) for everyone who has a substance abuse disorder?' I don't know."

Still, Hilger said there's some good news: New treatment facilities, plus more doctors prescribing anti-addiction medications, are helping turn the tide. But now, he said, care providers are already "thigh-deep" in a looming methamphetamine crisis.

"The need is going to continue to expand," he said. "We do not have the staff, we do not have the professionals that we need to serve."

There are a few ways providers are fighting the shortage. Davis said that, on June 1, staff in her area will shift to a "team-based" approach that matches patients with a group of caretakers from different fields - doing more with the same number of resources. She added that licensing changes coming to North Dakota will make it easier to become an addiction counselor.

And Hilger pointed out the value of programs that repay tuition for addiction counselors, encouraging more students to choose the field. It's far less expensive on the social level, he said, to pay tuition dollars than to carry the weight of so many disrupted lives.

"The resources are there," he said of fighting drug abuse, turning again to the cost of the Bemidji clinic - a straightforward venture both from an altruistic and a financial standpoint. "The one thing we can't just create is a trained workforce."