‘The nuclear weapon of drugs’: Inslee, panel of experts talk Washington fentanyl epidemic

EVERETT – In many parts of Clallam County, Washington, it takes a person more than two hours to reach a mental health care facility and only five minutes to find a place to buy fentanyl on the street.

People will struggle to heal from opioid use disorder as long as that’s the case, said Allison Berry, health officer of Clallam and Jefferson counties.

“What I see every day in the clinic is my patients who use fentanyl are treating something else,” Berry said. “They’re treating trauma, they’re treating mental health disorders.”

Berry was one of 18 opioid use experts who spoke with Gov. Jay Inslee on Monday at a fentanyl recovery roundtable in Everett. The event was held at the newly opened Evergreen Recovery Center, a treatment facility for mothers experiencing substance-use disorder along with infants with neonatal abstinence syndrome. Right now in Snohomish County, five people die from drug overdoses every week, County Executive Dave Somers said.

The governor’s office announced it has allocated more than $50 million in new funding to address the statewide opioid epidemic in the next two years. The money will add to an existing pot of funds going to treatment facilities, peer support services, grants for tribal communities, criminal diversion and rental subsidies for people with substance use disorders. State money also will fund law enforcement tracking drug rings.

‘Brewing at an exponential rate’

Inslee noted on Monday that youth drug education programs born out of the ’80s and ’90s – such as Drug Abuse Resistance Education (D.A.R.E.) and ‘Just Say No’ – didn’t make a big difference in curbing substance-use disorders.

“Fentanyl is just such a quantum leap forward as for fatality per dose,” Inslee said. “I think it’s important for our young people to understand that it’s just the nuclear weapon of drugs.”

Among adolescents ages 12 to 17 in the United States, 6.3% showed substance-use disorder in 2020, according to the federal Substance Abuse and Mental Health Services Administration. Improved opioid education for young people in the state is one of six goals the governor laid out for the 2024 legislative session.

Studies show that early exposure to drugs leads to a greater risk of dependence. Fentanyl is cheap, potent and incredibly addictive. One pill is enough to cause an overdose. One pill can cost less than $1 – sometimes less than 50 cents , undercover law enforcement has reported.

In 2022, more than 2,000 people died of opioid-involved overdoses in Washington. That’s more than twice the number who died of the same cause in 2019. Indigenous communities face death rates four times higher than the statewide average.

The Tulalip Tribes of Washington, a federally recognized tribe of Snohomish, Duwamish and other Native peoples, is increasing local culture and activity as part of its youth substance use prevention strategy, Chairwoman Teri Gobin said Monday.

“When you’re talking about trauma – the historical trauma that’s grown,” the chairwoman said, “you not only have a person using, you could have their parents using and their grandparents using. That is just so devastating.”

Since the fentanyl epidemic began, the Native group has seen more than 70 overdose deaths, Gobin said. Today, they lose one to two lives each month to opioids. To combat the epidemic, the Tulalip tribal group is changing its drug laws. Now, anybody arrested and arraigned for possession of 50 or more fentanyl pills could be charged with dealing.

Fentanyl was involved in 90% of fatal opioid overdoses in the state last year and 65% of all overdose deaths, according to the University of Washington’s Addictions, Drug and Alcohol Institute.

This year, first responders have been called to more than 2,000 overdoses per month in the state. Everett Fire Department Chief Dave DeMarco said emergency crews cannot keep up.

“The demand for protecting and saving these people is brewing at an exponential rate,” DeMarco said.

‘Meeting them where they are’

Some treatments for opioid use disorder have proven to work. It’s complicated and it takes time, said Caleb Banta-Green, an addictions scientist at the University of Washington. Banta-Green, who facilitated the roundtable, began studying opioid use disorder in 1995.

Research shows medications that treat opioid-use disorder – such as methadone and buprenorphine – reduce drug-induced mortality by more than 50%. The drugs are designed to block the symptoms of opioid withdrawal and mitigate cravings for them.

Three in four people who undergo long-term treatments for substance use disorders achieve long-term abstinence, a peer-reviewed study found.

“The beauty of this, when it comes to opioid overdose prevention and response and opioid-use disorder, we have effective preventions,” Banta-Green said. “We can’t say that for every type of substance.”

Trying to remove fentanyl from the streets won’t fix the reasons people turn to drugs, Banta-Green said. And addiction recovery isn’t binary. Banta-Green said harm reduction is an essential part of helping people recover.

“How do we keep them engaged in care? It’s not firing them when they show symptoms of use,” he said. It takes people who are “meeting them where they are – literally and figuratively – engaging with them, not judging them, and helping them every single day.”

The new state money also will be spent on community health hubs, all-in-one locations for people seeking substance use treatment. Hubs are designed to be accessible spaces that offer counseling, medication, overdose education and social services. The state Health Care Authority plans to open two of these hubs in 2024 and another two by 2026.

When people enter detox for opioid-use disorder, it can take days, weeks and even months before they can get into an inpatient rehabilitation program.

“While they’re waiting, they go back out and they use again,” said Shannon Smith, program director at Sound Pathways recovery. “Or when they get into inpatient, Medicaid only covers 28 days … it takes a lot more than 28 days to kick (fentanyl).”

Community health hubs are crucial to help support people in limbo between detox and rehab, Smith said. Hubs also help people recently released from jail or prison who are trying to reintegrate into society.

Improved access to opioid-treatment programs is another listed priority in Inslee’s 2024 legislative plan. People in underserved rural or tribal communities face even higher barriers to getting treatment in the already difficult system.

Some fire department officials and scientists at Monday’s event agreed that under state law, they would like to see first responders be able to distribute buprenorphine (more commonly known by its brand name Suboxone) when they respond to overdose calls.

At the Seattle Fire Department, emergency medical technicians and paramedics are responding to between 15 and 20 overdose and drug-use calls daily, said Michael Sayre, department medical director. When first responders distribute naloxone (known by its brand name Narcan) to combat an overdose, half of the recipients then refuse further care. Sayre said he wants the state to change the law to allow first responders to distribute buprenorphine after naloxone to help with withdrawal pain. This way, patients might be more calm and more willing to accept a helping hand and pursue further treatment.

Inslee said he was intrigued by this idea.

“You’re not hearing a lot of Suboxone deaths out there,” he said.

Washington’s 2024 legislative session will begin in early January.

If you or someone you know is struggling with a substance-abuse disorder or mental health crisis, the national Substance Abuse and Mental Health Services Helpline at (800) 662-4357 is available free of charge to provide information and assistance.