Spread of deadly fentanyl dramatically increases ODs
Okanogan County has seen an alarming spike in overdoses from opioids in the past two years. The crisis has escalated as fentanyl has become ubiquitous in Okanogan County, said James Wallace, Okanogan County’s health officer and a family physician at Family Health Centers (FHC).
Fentanyl, which can be 25 times more potent than morphine, makes overdoses more common, more severe — and more lethal, Wallace said.
While there are more overdoses then ever in the county, the number of fatal overdoses has dropped since Narcan (Naloxone) became widely available, Okanogan County Coroner Dave Rodriguez said. Over the past four years, Narcan, a nasal spray that quickly and safely reverses the effect of opioids, has dramatically reduced deaths from overdoses, he said.
Although Narcan solves the immediate problem of a potentially fatal overdose, it doesn’t address the underlying issues that drive opioid dependency and addiction in the first place, Rodriguez said.
People with substance-abuse disorder are acutely aware of the risks, and they assume heroin, pills, and anything they get on the street contains fentanyl, Wallace said. So, while people are terrified because they know how dangerous fentanyl is, they no longer bother to use test strips that show the presence of fentanyl, since the tests aren’t really useful, Wallace said. Besides, the tests indicate only the presence of fentanyl, not the quantity, quality or potency. “People are really scared — the situation has led a lot of people to seek treatment,” Wallace said.
Unfortunately, the demand for treatment exceeds the supply, with providers still trying to catch up after the backlog created by the COVID pandemic, Wallace said. Moreover, during the pandemic, when regular counseling became less available, some people who’d been receiving treatment for opioid-use disorder couldn’t maintain their recovery, he said.
The omnipresence of fentanyl has made users and their friends and family determined to have Narcan on hand. Health care providers give free Narcan to anyone who wants it and don’t ask questions. “We assume they want to save the life of a loved one,” Wallace said. First responders also carry Narcan kits.
While Narcan can save someone from a lethal overdose, many people still die from chronic opioid use. Often the body just wears out, leading to heart, liver or kidney failure, Rodriguez said.
Getting help
• Family Health Centers: (800) 660-2129.
• Any hospital or clinic in the county can connect people with a treatment options.
• Advance NW Recovery Navigator Program: (509) 426-3274; 24/7 hotline 1-800 641-8092
• stopoverdose.org
Narcan (to reverse overdoses):
• Advance NW, 523 Riverside Drive, Omak.
• Okanogan Behavioral Healthcare, 1007 Koala Drive, Omak.
• Okanogan Community Overdose Prevention Education, (509) 588-7925.
Rapid dependency
Opioids tap into the body’s happiness receptors, making someone feel safe and replacing stress and anxiety with a sense that there’s nothing to worry about. Dependence can develop rapidly, and it feels really good while it’s happening, Wallace said.
As the body becomes chemically dependent, people spend the majority of their waking hours trying to obtain more opioids to stave off the miserable symptoms of withdrawal, Wallace said. “It’s a dangerous road to go down,” he said.
Some people develop a dependency on opioids after a prescription for pain after surgery or an injury. In fact, the majority of patients Wallace treats became addicted through a prescription, he said. Other users start with a pill they get from a friend or at a party, Wallace said.
Today, medical providers rarely prescribe so many pills that they end up diverted for sale on the street. As a result, most users now get their drugs on the black market, Wallace said.
Opioids reduce the brain function that tells lungs to breathe. In an overdose, the lungs can slow down so much that they no longer oxygenate the blood and brain, causing a coma or death.
Fentanyl is a synthetic opioid that’s used intravenously in hospital settings and for outpatients, typically through a patch applied to the skin, Wallace said.
Treatment and recovery
Now that the COVID crisis has stabilized, health care providers and Okanogan County Public Health have been able to focus more resources on the opioid crisis, Wallace said. There are many avenues for treatment in Okanogan County, with health care providers and support networks working closely together the address the crisis.
Medical clinics – including FHC’s Opioid Treatment Network – and hospitals connect people with Okanogan Behavioral Healthcare (OBHC), which helps develops an individualized treatment plan. They can also set them up with recovery coaches.
OBHC offers counseling and self-help support groups. They can also set up medication-assisted treatment using Suboxone, said Dan Boyle, OBHC’s substance use disorder program director. Suboxone silences the receptors that cause withdrawal symptoms and reduces cravings.
Depending on their situation, clients may get help from Shove House, a supportive housing facility operated by OBHC for homeless individuals in active treatment and recovery. There’s also Highland Center, a safe, stigma-free drop-in center, where OBHC clients can gain living skills, participate in peer-group meetings, and get help finding employment and housing.
All OBHC clients who meet qualifications are referred to Okanogan County’s therapeutic court program, which includes comprehensive supervision and can lead to reductions in sentences or even dismissal of charges, Boyle said. Therapeutic courts can also help reunite families who have been separated because of substance-use disorder.
While the reasons for an increase in opioid use and overdoses are complex, health care providers say that lack of adequate treatment for mental and behavioral health issues has contributed, particularly over the past five to 10 years.
The COVID pandemic exacerbated mental health needs because of additional stress about jobs and finances and the growing housing crisis, Wallace said. Moreover, access to health care — and to health care facilities — was limited during COVID, particularly early in the pandemic, when many appointments were conducted via telehealth and others simply postponed. That created a backlog in the ability for all patients to get the care they need, for everything from routine physicals to mental health care, Wallace said. All this coincided with the increasing ubiquity of fentanyl.
Okanogan County recently received a grant for supplies and services for a program at the county jail, where inmates who already have a prescription for Suboxone can receive the drug while incarcerated, Okanogan County Sheriff Tony Hawley said. The drugs must be administered by a registered nurse and the county is in the process of negotiating with a provider. Incarcerated individuals experiencing withdrawal — but who don’t have a prescription for Suboxone — work with the jail’s contracted doctor for appropriate treatment.
The jail also connects inmates with the Advanced NW Recovery Navigator program, particularly for follow-up after release, Hawley said. The recovery navigator program consists of outreach specialists with lived experience of addiction and incarceration. They connect people who have substance-use disorder with mental and physical health care, counseling, housing and employment and provide free Narcan to those in need.
Impact of court ruling
Since the state Supreme Court ruled last year in State v. Blake that it is unconstitutional to take someone into custody for simply possessing a controlled substance, drugs have been circulating more widely in the county, Hawley said. An arrest was often an opportunity to get someone into treatment court, he said.
Police can confiscate the drugs — they are still illegal — but someone can’t be cited until the third referral, and that citation is now a misdemeanor, not a felony, Hawley said. The court ruling can also result in resentencing or vacation of prior convictions.
Hawley believes the change in law has reduced concern among users and sellers about being held accountable. It’s also expanded the market for selling drugs, meaning more people have become dependent on them, he said.
A law passed by the Legislature after the Blake decision has led to additional resources for people with substance-abuse disorder. It increases access to treatment and support for recovery and expands behavioral health services, according to the state Health Care Authority. It also helped develop the program that supports medication-assisted treatment in jails.
Money from opioid settlement
The first payments from the state’s opioid settlement with three drug companies are expected to begin reaching Washington communities within the next few weeks. Okanogan County will get more than $1.3 million (0.61% of the total $215 million).
Washington Attorney General Bob Ferguson rejected the national settlement and filed his own lawsuit against the companies. Ferguson’s lawsuit brought Washington $46 million more than the state would have received through the national settlement, according to Ferguson’s office.
All 125 eligible local governments, including Okanogan County, had to agree to the resolution for Washington to receive the full amount.
The additional $46 million will be used for treatment, housing and wraparound services for people with opioid-use disorder. Washington gets the first payment of $55 million on Dec. 1. The remaining money will cover the costs of litigation.
Ferguson also declined to settle with Johnson & Johnson in another opioid case last year and filed a separate lawsuit. That trial is ongoing.
Local governments determine how to spend their share of the money in accordance with the state’s opioid response plan. Approved approaches include expanding treatment, housing, transportation, education, job training and child care. Others include preventing opioid misuse and overprescribing through school- and youth-focused programs, and increasing distribution of Narcan.
Incomplete opioid data
Data on opioid use and overdoses in Okanogan County and North Central Washington is incomplete for a number of reasons. Okanogan County doesn’t have data on the death rate nor the number of people who’ve been effectively treated and saved with Narcan, said James Wallace, Okanogan County’s health officer.
Overdoses addressed in the field with Narcan, by a friend or family member or by emergency medical technicians (meaning the individual isn’t transported to a hospital), typically don’t show up in the data, Wallace said.
The number of opioid overdoses Aero Methow Rescue Service has responded to – about two annually – hasn’t changed in recent years, Deputy Director Justin Porter said. Because Aero Methow distributes Narcan to the public, they believe that some overdoses are being addressed without 911 intervention, he said.
The county also doesn’t have good information to track the demographics of who is using opioids.
While it’s clear overdoses have increased in Okanogan County, actual numbers are so low that it’s hard to draw conclusions.
Although it’s difficult to arrive at solid numbers in places with a low population like Okanogan County, the trends are concerning. Deaths from any opioid per 100,000 residents were 2.5 from 2002-04; they increased to 18.08 per 100,000 from 2019-21, according to the Addictions, Drug & Alcohol Institute (ADAI) at the University of Washington. (The population of Okanogan County is about 42,000.) Statewide, deaths went from 5.71 per 100,000 in 2002-04 to 16.16 in 2019-21.
While overdose deaths overall have increased, deaths from commonly prescribed opioids (without illicit drugs) decreased 65% from 2010 to 2021, although they have recently rebounded. Over the same time period, overdose deaths from prescribed opioids combined with illicit drugs increased 300%, according to ADAI.
Some of the highest death rates and largest increases have been in rural counties, including Okanogan, Yakima, Kittitas, Grays Harbor, and Mason, ADAI said.
There was already an epidemic of deaths from opioid overdoses before the pandemic, but deaths between 2020 and 2021 were the highest ever, according to a presentation to the Okanogan Coalition for Health Improvement last year.
And while opioids are a serious problem in Okanogan County, alcohol and tobacco use continue to be more problematic. Both have enormous impacts on the health care system, contributing to high numbers of deaths nationwide from heart disease, strokes, cancer and accidents, Porter said.
