How low-barrier treatment, culture-rooted care help Karen teens push back against opioids

This story about support programs for Karen teens in St. Paul was produced collaboratively by MinnPost and MindSite News, the nation’s only newsroom focused solely on mental health. Sign up for their newsletters here.

It’s a warm Wednesday afternoon in September, and teens and their young-adult mentors are filing into The Urban Village, a St. Paul, Minnesota-based nonprofit that supports young people in the city’s Karen and Karenni refugee communities. Everyone is animated, greeting each other excitedly at this first weekly meeting of the new school year. 

D, a fashionably-dressed young man wearing loose, low-slung jeans and a bright shirt, steps into the light-filled space. He greets friends and sizes up the action before Carly Roepke, Urban Village’s director of operations, arrives at his side. She’s excited to see him, but plays it cool. She was worried that something bad had happened to him. 

“I hadn’t seen him since before Metro Surge,” Roepke said later, referring to the months-long ICE immigration enforcement operation that took over the state in the winter of 2026. “Somehow he found his way back here.” 

Life in the Twin Cities has opened up since Metro Surge, when many refugee families went into hiding and students moved to online school. The years before that had also been difficult ones for many Karen and Karenni families. 

Young people from the communities have been grappling with drug use, social isolation and the pressures of adjusting to life in a new country for a number of years, and during the dark days of the COVID-19 pandemic, opioid addiction spiked among youth, leading to arrests, overdoses and even deaths. 

Opioid use and addiction may have been fueled in part by the pressures Karenni and Karen teens face in their high schools, said Alice Buckner, executive director of the Karen Organization of Minnesota, a St. Paul-based nonprofit dedicated to supporting the social and emotional needs of the state’s Karen and Karenni communities. 

“Kids have said, ‘I was told I would be bullied and not be safe unless I join this gang,’” Buckner said. “There  is a lot of bullying. There are a lot of ways kids could  get caught up in fentanyl.” 

While adults have worried about teen drug use in the U.S. for decades, the drugs used today are more deadly, she said. 

“When I was a stupid 14-year-old and I drank strawberry wine and threw up, that wasn’t going to be a death sentence,” Buckner said. “With these kids it means they could get detained, arrested, they could die.” 

These concerns are the latest chapter in the long history of struggle by the Karen and Karenni people, indigenous people who have lived in the mountains of Burma, now known as Myanmar, for some 2,000 years. After facing brutal oppression by Myanmar’s military regime, members of the two ethnic minority groups fled to refugee camps in Thailand where they lived for years before resettling in countries around the world. 

The first Karen came to the United States in the early 2000s. While many settled in other parts of the country, the largest number of Karen — some estimate as high as 20,000 — live in Minnesota, with the greatest concentration in the Twin Cities, especially St. Paul. 

Urban Village, housed in a converted storefront on Arcade Street, a commercial strip on St. Paul’s East Side, was founded in 2019 by Jesse Phenow, a student at a local university who’d been inspired by a Karen family with seven boys he’d met as part of a community service program. Several nights a week, Urban Village offers programming for teens, including tutoring, social-emotional skill-building and an outdoor program that takes kids on adventures like hiking, rock-climbing and snow-tubing. 

ICE’s Metro Surge brought those efforts to a screeching halt, pushing up stress and isolation, but Roepke said that as soon as things felt safe, Urban Village staff reached out to program participants, encouraging them to return.   

Most came back for summer programming, Roepke said, but some, like D, had stayed away. Urban Village staff were concerned about him, wondering if he’d fallen back into the opioid addiction that had gotten him connected to the program in the first place. But now, here he was, smiling slyly and seemingly happy to be back. 

“He was a little embarrassed that he hadn’t shown up,” Roepke recalled. “ I said, ‘You look really good. Are you clean?’ He said, ‘I am clean. It’s been a battle, but I’m sticking to my sobriety.’” 

To Roepke, D’s story is emblematic of the successes of the coordinated efforts made by Urban Village and other organizations to reduce addiction rates among Karen teens in the community. 

The change is palpable, said Kaziah Josiah, co-director of Urban Village and a former community engagement specialist for the St. Paul Police Department. “Compared to two, three, four years ago, we’ve seen a reduced percentage of youth in our community going through opioid addiction,” said Josiah, who was born in Thailand to a Karen refugee family and came to Minnesota in 2004. “Things have changed for the better: We just don’t see as many overdoses anymore.” 

There isn’t hard data to back up Josiah’s claims. The Minnesota Department of Health, which collects numbers on overdose rates in the state, doesn’t have numbers on this improvement — “I expect that we won’t have data at that level of granularity,” a spokesperson said.

One challenge about drug use data is that sources such as the Minnesota Student Survey, while it lists “Burmese” as an ethnic group, cannot verify specific drug-use trends among Karenni or Karen teens and pre-teens, because it aggregates smaller racial subcategories into broader checkboxes, like “Asian only” or “mixed race.”  

The Student Survey has found that drug use has declined among the state’s adolescents, but racial disparities remain. A 2026 study conducted by  the University of Minnesota Medical School found that some racial and ethnic groups in the state saw a decline in cannabis use, for instance. In 2013, non-Hispanic Black, African or African American youth were 51% more likely to use cannabis than non-Hispanic white youth; in 2025, they were 10% less likely to use cannabis than white youth.  

Still, Josiah said she has seen plenty of anecdotal evidence from staff at community organizations and addiction clinics, and she credits the change to a series of collaborations between community organizations like The Urban Village and Karen Organization of Minnesota, as well as city and state agencies and foundations that stepped up to address the problem. 

“I personally think this latest improvement is all because of a growing partnership between organizations that came forward and really tackled this issue together,” Josiah said. While this improvement feels like a relief, she added, the destabilizing stress from federal policies like Operation Metro Surge could trigger trauma responses among participants and cause a backslide, she said. “We do worry about that.” 

Related from 2022: A culturally aware approach to addressing addiction crisis among Karen teens

At the St. Paul-based Amherst H. Wilder Foundation, Jennifer McCleary,  a research manager who has studied  addiction in refugee communities, said she is hearing that fewer Karen teens are using opioids, but the improvement is still fragile. 

“If you look at raw numbers,” McCleary said, “perhaps there are fewer people who are using substances and more people who are able to access treatment that wasn’t previously accessible to them.” But if programs like Karen Organization of Minnesota or The Urban Village are hit by  funding cuts, she worries that progress could quickly  be lost: “The community is working like crazy to fill in where the system has failed.”  

Buckner agrees with McCleary. “Yes, things are getting better on the opioid front,” she said, “but we can’t take our eyes off the prize because the needs are so high and it can still get worse again.” 

Coordinated response

Fairview Roselawn Clinic, a health center located in a St. Paul strip mall, offers culturally responsive care, specialized staff and dedicated community partnerships focused on the city’s Karen and Karenni communities. In 2020 physicians and staff there began to hear about increasing rates of opioid addiction among young people. They quickly recognized that something had to be done, said Katie Parker, an addiction medicine specialist at the clinic. 

Because they wanted to make it as easy as possible for their patients to get the help they needed to fight their addictions, Fairview Roselawn created a low-barrier drop-in program to help people get access to buprenorphine, a prescription medicine that helps curb cravings for opioids. To further ease access to the clinic, Roselawn staff forged a partnership with the Karen Organization of Minnesota. Case managers at the nonprofit told clients about the program and even drove those without transportation to the clinic. 

Partnering with the nonprofit’s case managers, Parker said, made a huge difference. “We began to see familiar faces,” she said. Once the young patients were in the clinic, staff could help them with other issues, like managing their medications and providing mental health support targeted at their substance use disorders, she added. “It was a good launching pad for getting kids the things that they needed.”  

These connections helped more young people stop using opioids, Parker said. “We’ve noticed our numbers dropping.” Today, she said, “We’ve got some patients who’ve been with us for a number of years who have been really stable and are coming for follow-ups. ” 

Lah Pwee is a Karen cultural broker at Fairview Roselawn. She works out of the Karen Organization of Minnesota’s office, serving as a liaison between the Karen community and the Roselawn clinic. She helps connect community members with resources like MNsure, Minnesota’s health insurance marketplace created under the Affordable Care Act, and WIC and assists them in navigating the health system.

Related: What is a cultural broker, and how are they helping advance health equity in Minnesota?

Pwee said she’s also seen a decline in referrals for young Karen patients with opioid use disorder. While that’s encouraging, she noted there may be other factors at play. Metro Surge reduced the number of people seeking medical care at the clinic, and she’s also concerned that continued misinformation around mental illness and addiction can make it difficult for some parents to seek treatment for their teens and young adults. 

Before they came to Minnesota, many Karen or Karenni people had little familiarity with the concept of mental illness or the need for mental health support, Pwee said. Compared to other students in the St. Paul Public Schools, Karen students were less likely to be referred for mental health services than students of other ethnic backgrounds.

McCleary said that despite that general cultural unfamiliarity with mental health treatment, she is still “blown away” by the resilience of the Karen and Karenni community, and by parents’ and other community members’ willingness to respond to the crisis. “They are caring for each other, supporting each other through these problems,” she said. “The way that people have come together to support and lift youth up is amazing. It’s amazing how strong and culturally grounded the responses have become.”   

With a goal of helping to bridge that gap and connecting young people to culturally focused mental health care, the Wilder Foundation, in collaboration with a Karen cultural broker, created a mental health program for students and parents named ThayGeMoo, or “The Living Root,” that honored Karen cultural practices and traditions. The program is designed for 6th to 12th graders and is based at Washington Technology Magnet School on St. Paul’s East Side, where many Karen and Karenni families live.  

To gauge the program’s effectiveness, research staff from the Wilder Foundation conducted interviews with parents and students who have participated in ThayGeMoo for between three and 12 months.  In the interviews, students and parents reported improvements in students’ behavior and social-emotional well-being, some parents noticed that their children had a stronger interest in learning about their culture, and students and parents noticed changes in how they thought about and talked about mental health.

The Urban Village has also formed a relationship with the St. Paul Police Department where Karenni and Karen teens who have come in contact with law enforcement are now transferred to the nonprofit’s mentorship program. And nearby public high schools, including Humboldt High School, now allow mentors and tutors from The Urban Village to come to the schools to work directly with teens. 

Related from 2022: How opioids are affecting Karen teens and their families

This combination of programs has added up to cause a turnaround, Roepke said. “There isn’t one secret sauce,” she said. Instead, “it is the consistency of someone checking in on these kids, of them knowing that we care about them and that we’ve got our eyes on them. It helps.” 

Josiah agreed. “Within the last couple of years, schools, community organizations, police departments, clinics and doctors have worked together to address this issue,” she said. “We have Urban Village staff at the schools. We work directly with the police department.” If they need to get Suboxone, a combination of buprenorphine and naloxone that prevents cravings for opioids, “right away we are able to get our youth into the clinic.” When it comes to saving kids, Josiah said, anything and everything helps. 

Weaving Circle connects Karen teens

Every Wednesday for the last several years, a group of Karen women has gathered at the East Side Freedom Library on the East Side of St. Paul, to practice the art of Karen weaving. The Weaving Circle is an opportunity for female elders to practice their art, and to pass it on to younger members of the community. This summer, the Weaving Circle expanded its programming, inviting Karenni and Karen teens to come and learn more about weaving.   

The program helps to rebuild community connections that have frayed as young people and the adults in their lives adjust to life in a new country, explained Than Than Kyaw, health and human services program director at the Karen Organization of Minnesota. “It uplifts and preserves the Karen culture and creates opportunities for youth and families to build connections,” he said. 

“During Operation Metro Surge, I prioritized going to the weaving program,” said Kyaw, who was born in a Thai refugee camp. He said the process of working with the fibers transports him back to what feels like a simpler, better time. 

“It felt peaceful, like going home,” he said. 

McCleary said that many young members of refugee groups come to their new country living in a complicated bicultural identity. Participating in programs like the Weaving Circle can help bolster a self-protective pride in a shared personal history. “Being able to tap into that strong Karen culture can give people a stronger feeling of, ‘This is part of my identity and I am able to rely on that,’” McCleary said. “It reduces the need for external validation that can contribute to substance abuse.” 

Related from Sahan Journal: See photos of the Karen Weaving Circle in action

Kyeh Demba attended the Weaving Circle all summer. “Part of me wanted to create something of my own,” the recent college graduate said. Tonight, she’s wearing a colorful shirt made of fabric woven by Karen women. She knows that back in Thailand and Burma, weaving was more than a hobby, and she is taking her learning seriously: “This is how we made our clothing. It is something that gets passed down by mothers from their mothers and grandmothers.” 

Demba has seen young members of her community struggle to adjust to life in this new home, and too often that has led to struggles with mental health and addiction. Spending time with elders and learning this art has helped to deepen Demba’s pride in her heritage and find an inner peace that too often feels out of reach for many young people in her community. 

“It’s good to just be there,” she said. “You spend time with someone who’s very knowledgeable and understands our history.” The learning process builds a sense of connection, she believes, and helps erase the noise of the world. “It’s my identity. I want to learn how to do it. I want to preserve this cultural heritage and pass it on.”

Editor’s note: Minors involved with the programs featured in this story were interviewed and photographed as part of the reporting process but are not being named or identified because of the story’s sensitive nature.

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