Expanding Treatment for Opioid Addiction

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The lead of an article in the Washington Post the morning of June 20, 2017 read, “The coast to coast opioid epidemic is swamping hospitals, with government data published Tuesday showing 1.27 million emergency room visits or inpatient stays for opioid-related issues in a single year.”

We also learned this past week that Congress is threatening to cut the budget for mental and behavioral treatment options. Wait a minute! Don’t  the President and Congressional leaders see the magnitude of this problem and know that there’s a solution?

In King County, admissions to treatment programs for heroin surpassed those for alcohol, according to the July, 2016 report from the Alcohol and Drug Abuse Institute at the UW.  

Heroin use continues to increase in our city and region. While overdose death rates increased for youth, the greatest increase was in adults aged 55-64. When both youth AND adults are addicted to opioids and prescription drugs in increasing numbers and our emergency rooms are being swamped because of overdoses, wouldn’t you think federal and state governments should invest significantly in what we know works?

It has been nearly two years since I learned about Buprenorphine commonly referred to as “Bupe”, an alternative to methadone that effectively blocks a person’s craving for opioids. I became an advocate for expanding access to Bupe after meeting two Seattle experts who are deeply involved in Public Health and the Opioid Addiction Task Force.

Dr. Caleb Banta-Green, Affiliate Associate Professor in Health Services at the University of Washington, and Brad Finegood, Prevention and Treatment Coordinator in the King County Behavioral Health and Recovery Division met with me to explain the epidemic and  possible solutions.  They are two leaders whose work has since led to the Heroin and Prescription Opiate Addiction Task Force Recommendations and Findings.

They told me about the success of Bupe for treating opioid addiction, and the shocking difficulty people have in receiving it as treatment. I felt then as I do now, if people who are suffering from addiction are interested in receiving treatment that will help them get off opioids –and reduce crime rates and improve health outcomes as positive by-products– we should do everything in our power to help them do this.

Ideally, we should be striving for what is sometimes called “Treatment on Demand”, meaning when someone is finally ready to kick their addiction, they can receive treatment that day, instead of being added to a long wait list. Having ready access to Bupe is a common sense change, vital in fighting this crisis.

Unfortunately, as Dr. Banta-Green explained, in Seattle and virtually every other community, it is easier for someone who is addicted to heroin or prescription opioids to get illegal drugs than it is to get the medically assisted treatment (MAT) options such as Bupe that can help them recover.

Street drugs are easy to get, and the daily spin cycle looks something like this: the addicted person without financial resources breaks into someone’s car or garage or shoplifts from a store, stealing something that is easy to sell. Say for example he steals a bike from a Magnolia garage or a book from the UW Bookstore. He then pawns or sells the item for cents on the dollar. He goes where he knows he can buy his drug of choice. If he has a few extra dollars, he may walk to the local coffee shop where he can buy a coffee and use the bathroom. There he shoots up; or if he doesn’t have access to the coffee shop, he may shoot up in the alley near where he purchases the drugs. Either way he most likely will leave his needle behind for someone else to pick up.

This cycle may be repeated four to six times a day per person, contributing significantly to the

local spike in burglaries, theft and used needles found across the city

As a former prosecuting attorney and as current chair of the Human Services and Public Health committee, I was determined to learn more about how to break this cycle of addiction, overdoses, crime and death.  I was hopeful someone had figured out something that works. Turns out in San Francisco there are available treatment programs called Integrated Buprenorphine Intervention Services (IBIS) Centers, so I visited one of the centers to see how it works with my own eyes.

The IBIS Center is a low barrier clinic where people suffering from substance abuse disorder can begin a course of Buprenorphine the day they seek services, no wait lists and little paperwork. Further, clients accessing the clinic may be given a prescription for 4-7 days, and once stabilized, the client may receive an entire month’s prescription. Their care can be transferred to a primary care doctor for continued general health treatment.

This is a vast improvement to Methadone treatment, which requires patients to visit a Methadone clinic every day at the same time to receive their medications. Today there are only three Methadone treatment clinics in Seattle, one in SODO and two on First Hill.  As one of our experts said, “I’m not going to drive to Renton every day to get my morning coffee when I live in Wedgwood. Imagine having to get to the Methadone clinic every day without financial resources or without a car.”  Getting to the Methadone clinic for a daily dose requires significant personal commitment which many cannot sustain.

I went to San Francisco to learn a better way because I knew Seattle needed solutions, and quickly. To reverse the personal and social problems associated with addiction, we can increase our treatment options for people and eliminate the need to site more Methadone clinics.

Following San Francisco’s model,  I championed dedicating City funds to establish our own Buprenorphine clinic at the 4th Avenue Seattle/King County Public Health Center in Belltown. This was a new project for us, but we were optimistic that by co-locating a specialty Bupe clinic within the Public Health clinic that includes a needle exchange and a pharmacy on site, we could jump start this program.

We learned just how successful this Bupe First program is on June 14, 2017 in my Human Service and Public Health Committee.

Since opening their doors in January –just 6 months ago —the clinic has:

  • Engaged with 600 individuals;
  • Started 102 people on Buprenorphine;
  • Successfully transitioned the care of 8 people to a primary care or community health clinic.

You can watch the entire June 14 presentation on King County and Seattle investments in addiction treatment services here.  

When treatment is easier to access and is more effective, people will use it.  Word is spreading fast about the effectiveness of the services offered at the 4th Avenue clinic.

Our goal was to ensure that when people are finally ready to receive treatment for their substance abuse disorder they receive it quickly and have access to a treatment program that is right for them.

The good news is that it is working even better than we expected.  The bad news is because of space and financial restrictions, the clinic does not have the capacity to serve all those who want it. There is now a growing wait list.

As evidenced by San Francisco’s model and our own experience in the first six months, we KNOW people want access to effective treatment.  If we want to address the opioid addiction problem, we should be doing everything in our power to provide access to it.

Along with my colleagues in our Human Services and Public Health departments, I will be advocating for additional funding so we can expand treatment and increase access to programs like that which we are witnessing in the 4th Ave clinic.  We can use your help.

This is a good opportunity to tell your neighbors and elected leaders that you support expanded Bupe clinics and other medically assisted treatments in both public and private clinics. Investing in our treatment facilities is a far more effective way to address system-wide addiction  problems  than leaving it to the doctors and nurses to respond in overcrowded emergency rooms.