Methamphetamine use is on the rise in Minneapolis/St. Paul, while heroin remains the most widely used illegal drug in the Twin Cities area, according to a new report.

Drug Abuse Trends in Minneapolis/St. Paul, released twice a year by the education and training organization Drug Abuse Dialogues, found law enforcement seized 27 meth labs last year. Meth was the top drug seized by officials in the Twin Cities area, and accounted for 22.6 percent of the drug items analyzed, Minnesota Public Radio reports. Meth activity has sharply reversed from a decline that started in 2006, the group found. Last year, 7.4 percent of treatment center admissions in the area were related to meth, while deaths from the drug rose from 10 in 2011, to 21 last year.

“What I’m really talking about is a reversal of a downward trend,” said Drug Abuse Dialogues founder Carol Falkowski. “Not as if it’s becoming the dominant drug, by any stretch. Our problems still remain with heroin and other opiates.” She said her colleagues in other parts of the country, particularly the Midwest, are also seeing increases in meth use.

The report found heroin-related emergency room visits in Minneapolis/St. Paul almost tripled from 2004 to 2011, rising from 1,180 to 3,493. Deaths from accidental overdoses of opiates rose from 92 in 2010, to 129 in 2012.

According to Falkowski, heroin is an especially big problem in rural Minnesota, which doesn’t have adequate treatment and law enforcement resources. “And once a drug takes hold in rural America, I think it’s very hard to reverse that trend. It’s hard to get it un-entrenched,” she said.