OPIOIDS- New Drug Treatment Hotline

Earlier this year, the Washington State Department of Health (WSDOH) expanded its Telebuprenorphone (Telebupe) Hotline statewide. The hotline helps people suffering from withdrawal due to Opioid Use Disorder (OUD) with Buprenorphine (also known as Suboxone).

While deaths due to opioid overdose have declined, opioid deaths in Washington State are still above the opioid death rate in the U.S. as a whole. As a result, WSDOH has partnered with the University of Washington Emergency Medicine to expand a pilot program that started in King County to provide rapid, short-term access to Buprenorphine statewide.

Washington State Opioid Deaths:

2019	828
2020	1,194
2021	1,619
2022	2,048
2023	2,819
2024	2,489

 

The goal of this service is to reduce opioid deaths by providing short-term support that stabilizes withdrawal symptoms, then the service offers longer-term care to providers within the caller’s community

Someone, aged 13 years old or older, in need of Buprenorphine can call the hotline at 206-289-0287, 7 days a week between 9:00am and 9:00pm. Callers first speak with a linkage-to-care coordinator who is familiar with local clinics and resources who will ask a few questions. Then the caller will talk to a UW Emergency physician. If the physician determines that a medication is appropriate a prescription will be sent to a pharmacy of the caller’s choice. Within 72 hours, a Linkage to Care Coordinator will check in on the callers and offer resources for ongoing Medicated Opioid Use Disorder (MOUD) care. If you call outside of the hotline’s work hours, you can leave a voicemail, and someone will return your call the next day.

The Tele visit is not billed, but patients need to pay for prescribed medications. If you do not have insurance, the hotline can provide coupons to help with the cost of the medication as much as possible.

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For more information about the Telebupe Hotline check out the following links.

 

University of Washington Emergency Medicine:

https://em.uw.edu/sections/population-health/wa-telebuprenorphine-program

 

Washington State Department of Health:

https://doh.wa.gov/newsroom/washington-state-expands-same-day-support-opioid-use-disorder

 

The Seattle Times:

https://www.seattletimes.com/seattle-news/health/wa-expands-drug-treatment-hotline-for-buprenorphine-statewide/

 

FENTANYL UPDATE- Trends and Treatment Programs

Fentanyl has been a scourge to our citizens, however, fewer deaths to fentanyl overdoses have been reported over the last year and a half. And the Snohomish County Health Department continues with new initiatives to reduce overdoses.

Learn more about Fentanyl in Snohomish County and how you can get help for yourself, a family member, or a friend in the latest issue of the Snohomish County Sheriff’s Office’s crime prevention newsletter, “Partners in Crime Prevention.”

 

 

Snohomish County Sheriff’s Office: https://www.snohomishcountywa.gov/ArchiveCenter/ViewFile/Item/7306

 

 

OPIOID EPIDEMIC- Using Opioid Settlement Money to Solve the Opioid Epidemic

With settlements being reached in lawsuits by state attorneys general nationwide against the pharmaceutical that produced opioids for their part in feeding the opioid epidemic, local and state governments are working to apply that money into programs to prevent future opioid overdoses and treatment and recovery programs to reduce overdoses and deaths from these dangerous drugs.

Washington State’s share of the settlement money so far is $1.29 billion according to the Washington State Attorney General’s Office.

This money comes at a time when drug overdose deaths have fallen slightly between 2022 and 2023 for most of the country, except for Washington which is among 12 states that have seen an increase in drug deaths, according to the Centers for Disease Control and Prevention (CDC). In fact, Washington and Oregon are among the three worse states for an increase in drug deaths. Washington has seen a 24.85% increase from 2022 to 2023 and Oregon has seen a 22.78% increase.

Earlier this year Representative Rick Larsen’s (D, 2^nd Congressional District) office issued a report, “The Opioid Crisis in Washington’s Second Congressional District and a Comprehensive Solution,” with a plan to battle the opioid epidemic. The report focuses on four pillars to address the opioid crisis, Prevention, Interdiction, Treatment, Recovery:

 

·         Prevention- The report’s goal to prevention is “… to prevent individuals from relying on opioids, instead of implementing stopgaps that simply mitigate the impacts of the crisis.” It lists a variety of programs within the 2^nd Congressional District that work on prevention including the Snohomish County Human Services contract with school districts within in the county that provide Student Support Advocates as well as youth substance use prevention for teachers and counselors. The programs concentrate on youth to try to steer them away from using opioids. The report also lists other programs that use different strategies to reduce dependence on opioids and encourages the development of help to local governments to add other strategies such as helping with mental health and chronic pain.

·         Interdiction- The report lists several federal agencies that are responsible for interdicting drugs. For example, the U.S. Coast Guard patrols our coastal waters to intercept drugs before they land on our shores. The Drug Enforcement Administration (DEA) investigates domestic and international narcotics traffickers. The U.S. Customs and Border Patrol (CBP) intercepts drugs and ports of entry and between ports of entry. In Fiscal Year 2023, CBP seized 27,023 pounds of fentanyl, an 84% increase from 2022. The report notes that more than 90% of CBP fentanyl seizures occur at Land Ports of Entry rather than between ports of entry, with an average of 1,797 pounds of fentanyl seized per day. The report advocated for improved advanced screening technology at ports of entry. The report also noted that local drug task forces have an important role in interdicting drugs before they are sold to drug users. The Snohomish Regional Drug Task Force seized more than 500,000 fentanyl pills and nearly 5,000 grams of fentanyl from January to July 2023. The report advocated for more support and resources for local drug task forces and for local tribal law enforcement.

·         Treatment- The report notes that there are many challenges to treating someone who is addicted to opioids. It notes that people with Opioid Use Disorder (OUD) are physically and psychologically reliant on opioids so that anyone who tries to stop taking opioids suffers severe withdrawal symptoms that can include generalized pain, chills, cramps, diarrhea, restlessness, anxiety, nausea, vomiting, insomnia, and intense cravings. As a result, someone with OUD is susceptible to relapses, disability, and death. It advocates for a “holistic” approach to overcome the challenges and includes normalizing harm reduction, ensuring that there are enough beds for recovery treatment, improving OUD coverage for Medicare and Medicaid, investing in a robust health care workforce, leveraging the justice system with incentives to seek treatment, and meeting patient where they are.

·         Recovery- In conjunction with treatment, someone with OUD also needs support to ensure long-term success in staying off of opioids. Individuals often need help with acquiring housing, employment, education, transportation, or legal services. Currently, support can come from local government and nonprofit organizations. The report also notes that support from family and friends can be especially important.

 

A recent article in The Herald summarized the efforts within Snohomish County to reduce overdose deaths from opioids. While the county has seen a dramatic increase in overdose deaths in recent years. However, through the end of May, there has been a 20% decline in overdose deaths compared to the same period last year. Through May, there have been 106 opioid deaths, with a peak death toll of 31 deaths in February. At least one health department official attributes the decline of deaths to the county’s efforts to prevent opioid overdoses.

Some of those prevention efforts include:

 

·         Distribution of over 500 Narcan kits since 2022.

·         In April, the county began distribution of its $28.9 million in opioid settlement money to local recovery agencies. The focus of some of the agencies are,

o   Populations of minorities bear an over-representation of overdose deaths. Native Americans represent a rate of 73.3 per 100,000 residents for opioid overdose related visits to emergency rooms while blacks represent a rate of 44.3 per 100,00. Whites, which is the largest demographic in the county, visited the hospital at a rate of 15.4 per 100,000.

o   Overdose rates are disproportionately high in rural areas such as East Snohomish County. The county is working on a multicultural communications campaign that will include multicultural outreach teams and a peer support program. Ideal Option, a recovery clinic with a new downtown Monroe office has begun to offer free shuttle along Highway 2 from Index to Monroe for those who need transportation to appointments.

o   In July, the county will begin to collaborate with local outpatient clinics to develop better opioid and polysubstance use disorder practices.

o   In conjunction with the Washington State Health Care Authority, which is working with medical, treatment and social services to create Health Engagement Hubs; a series of one-stop clinics where people who uses drugs can access a range of medical, harm reduction, and social services, the county is helping the local harm reduction center, Sound Pathways, to apply for the Health Engagement Hub program.

 

 

As local governments apply the funds from the opioid settlements, they will have to use those funds on programs that truly reduce addiction to opioids. The challenge will be to stay away from feel good or punitive programs that are based on preconceived notions and to move those funds to programs that show evidence that they are effective in keeping people away from opioids.

 The following episodes of the Freakonomics Radio podcasts give good insights into the elements and challenges of treating people with OUD and are well worth listening to.

  

Freakonomics Radio:

https://freakonomics.com/podcast/why-has-the-opioid-crisis-lasted-so-long/

https://freakonomics.com/podcast/can-55-billion-end-the-opioid-epidemic/

https://freakonomics.com/podcast/the-opioid-tragedy-how-we-got-here/

 

Centers for Disease Control and Prevention:

https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

 

The Herald:

https://www.heraldnet.com/opinion/editorial-rep-larsen-outlines-to-do-list-for-opioid-crisis/

https://larsen.house.gov/uploadedfiles/rick_larsen_district_opioid_report_final.pdf

https://www.heraldnet.com/news/to-combat-fentanyl-snohomish-county-trickles-out-cash-to-recovery-groups/

https://www.heraldnet.com/news/as-deadly-overdoses-decline-snohomish-county-builds-on-whats-working/

https://www.heraldnet.com/news/drug-treatment-clinic-in-monroe-aims-to-reach-an-underserved-clientele/

For information on drugs and resources to find help with drug addiction check out this website from the Snohomish County Health Department,

Snohomish Overdose Prevention:

https://snohomishoverdoseprevention.com/

 

 

 

 

ADDICTION TREATMENT – Finding Neutral Unbiased Advice on Where to Go

When you want to find treatment for an addiction for yourself or a loved one, you want advice that you know is unbiased and in your best interests. You do not want a sales job.

The Washington State Attorney General’s Office (AGO) has come to an agreement with a private marketing company that the AGO found to be masquerading as a neutral source for addiction treatment referrals.

According to the AGO, Recovery Worldwide operates several websites that contain advertising for substance abuse treatment facilities. Recovery Worldwide labeled the websites as impartial resources without disclosing that much of their content was paid advertising.  

The AGO found that when people called Recovery Worldwide, they would be routed to sales representatives for addiction treatment facilities that had paid Recovery Worldwide to forward calls to them. The sales representatives did not consider the individual’s treatment needs or their preferred location. Most locations offered were outside of Washington State. The AGO could only find a few treatment centers listed for Washington State, where the treatment web site for the Substance Abuse and Mental Health Services Administration (SAMHSA) listed dozens of addiction treatment centers in Seattle alone.

The AGO obtained a consent decree that requires Recovery Worldwide to clearly disclose online content that is paid advertising and label paid listings as advertising.

The AGO recommends that if you are looking for treatment for an addiction, that you use resources that will give you unbiased alternatives. Two resources that it recommends include:

 

 

Washington Recovery Help Line:

Phone- (866) 789-1511

Website- http://www.warecoveryhelpline.org/

 

Findtreatment.gov (SAMHSA):

Website- https://findtreatment.gov/

 

Washington State Attorney General’s Office:

https://www.atg.wa.gov/news/news-releases/consumer-alert-watch-out-marketers-posing-neutral-unbiased-addiction-treatment

 

 

 

HEROIN EPIDEMIC- Where to Go for Help

If a family member or a friend are addicted to heroin you may want to find help for them in getting out of that addiction. There are organizations that can help. Some organizations include:

·         Catholic Community Services, http://www.ccsww.org/site/PageServer?pagename=homepage. Catholic Community Services provides a wide range of services including addiction recovery, mental health, services for children, youth and families, services for the homeless.

·         Cocoon House, http://www.cocoonhouse.org/. Cocoon House provides outreach to young people between 12-24 years old. It provides short and long term house for homeless young people between 12-17 years old. And it provides phone consultations, parent education and programs for parents and guardians.

·         Al Anon,  http://wa-al-anon.org/. Al-Anon/Alateen offers a recovery program for families and friends of alcoholics.

·         Changes Parent Support Network, http://cpsn.org/. The Changes Parent Support Network provides support for parents whose children are in self destructive activities such as drug abuse.

 Other resources include:

  

Snohomish Health District:

http://www.snohd.org/heroin

Snohomish County:

http://www.snohomishcountywa.gov/naloxone

SNOHOMISH COUNTY- The Effort to Stem the Opioid/Heroin Epidemic

In recent months, local law enforcement agencies have been hosting public meetings to talk about the opioid/heroin epidemic and what they, along with local social service agencies, are doing to get the homeless off the streets, addicts into treatment, and help for the mentally ill.

One meeting, held last week on Tuesday, July 18, at the Snohomish County PUD auditorium, showcased a number of programs in Snohomish County and King County that try to accomplish these goals each with their own approaches.

Hosted by the City of Everett, the forum included representatives from the Snohomish County Sheriff’s Office, Everett Police Department, City of Shoreline and King County.

One in five heroin deaths in the state of Washington occur in Snohomish County. During the period of 2002 to 2013 overdose deaths from heroin have quadrupled nationwide. Also, nationally, 3,600 people start abusing opioids each day.

Several speakers mentioned that addicts have to be ready for treatment before they will agree to go into a treatment plan. And having that attitude can be a fleeting mental condition. According to Sheriff Ty Trenary, “A referral and a waiting list does not work.” You have to take them right away to a treatment center.

The Everett Police Department, as well as the Snohomish County Sheriff’s Office, have introduced Law Enforcement Embedded Social Workers into their operations. The social workers team up with patrol officers and patrol deputies to make contact with homeless individuals. The social workers often add an element of trust that law enforcement personnel do not have with the homeless. Once trust is established, when someone who is addicted or is in need of mental health help is ready, the social worker can help to find the right treatment program for them.

The social worker makes the calls and the arrangements for the client. This can include a myriad of details to include stable housing, signing up for Medicaid, contacting family, as well as finding treatment. The social worker works through the bureaucracy for the client. A daunting task for the average person much less someone facing addiction or mental health problems.

Two other programs, under Everett’s Safe Streets Plan, include PAARI (Police Assisted Addiction and Recovery Initiative) and CHART (CHronic-Utilizer Alternative Response Team).

Under PAARI the police department partners with Providence Regional Medical Center Everett and Pioneer Human Services in Skagit County to provide short term detox to individuals who are seeking help to end their addiction habit before they are admitted into long-term recovery. For more information, go to https://everettwa.gov/1528/PAARI-addiction-initiative and http://myeverettnews.com/2016/05/25/26222/.

CHART attempts to identify individuals who repeatedly use emergency rooms, crisis care facilities, legal services, and the criminal justice system, to develop a plan with the individual to find a way to break the cycle of the revolving door of jail or the ER. This article from My Everett News gives a good example of how CHART works: http://myeverettnews.com/2015/12/16/chart-chronic-utilizer-alternative-response-team/.

For more information about the Everett Safe Streets Plan, go to https://everettwa.gov/1368/Everett-Safe-Streets-Plan

Members of two more programs discussed how they operated at a forum held at the Snohomish County PUD held on July 19.

The Shoreline Police Department (which contracts with the King County Sheriff’s Office for police services) has a program called RADAR (Response Awareness De-escalation and Referral). Under RADAR, police officers attempt to become aware of individuals with “behavioral health issues” to develop individualized response plans in coordination with the individual and their “circle of support” (family members, friends and caretakers). Police utilize their training, including crisis intervention training (CIT), to de-escalate any crisis situations. And finally, RADAR officers make an effort to connect the individuals with health care, mental health and fire services. For more about RADAR, go to   http://www.smartpolicinginitiative.com/SPIsites/shoreline-washington

and http://www.shorelinewa.gov/government/departments/police-department/radar

Seattle and King County have been conducting a pilot program since 2011 called LEAD (Law Enforcement Assisted Diversion) focusing on Belltown in Seattle and the Skyway area in King County. LEAD attempts to “divert low-level drug and prostitution offenders into community-based treatment and support services” before taking the individual to jail. The LEAD team coordinates closely with the community and with services including housing, health care, job training, treatment and mental health. LEAD involves a large team of government, community, and service organizations including the Seattle Police Department, King County Sheriff’s Office, King County Prosecutors Office, Washington State Department of Corrections, ACLU, Evergreen Treatment Services, and many other community groups. For more information about LEAD go to http://leadkingcounty.org/.

Each of the programs discussed at the forum attempts to achieve a similar goal; prevent crime by helping at risk individuals break the revolving door through jail or emergency rooms. Each program has a different way that it approaches its effort. The common thread among the programs, whether they be from Snohomish County, Everett or King County, is local law enforcement agencies work closely with at risk individuals, social service agencies, and treatment and mental health professionals to help the individual achieve a stable, productive life.