A look inside the Olympia clinic serving hundreds of people battling opioid addiction

If you hit rock bottom, what would it take to pull you back up? What if the force that pulled you down was a chemical dependency you’d been facing for decades?

Sean Allen and hundreds of locals struggling with opioid use disorder may have found their answer to that question in a small, bustling walk-in clinic that opened about a year ago in downtown Olympia.

The Olympia Bupe Clinic opened at the Capital Recovery Center on Cherry Street Southeast, which also houses the county-run syringe exchange. It provides buprenorphine, which serves as a safer alternative to opioids and heroin, which is the drug people with opioid use disorder often turn to when their prescriptions run out.

‘Now I can actually live my life’

Allen, 49, was first prescribed an opioid pain reliever when he injured his back about 30 years ago, he told The Olympian.

Last year, he ended up homeless and decided it was time to get clean; he tried quitting cold turkey, but withdrawal symptoms clipped his efforts short.

That changed when a doctor referred him to the Olympia Bupe Clinic, where medical providers prescribe buprenorphine to walk-in patients battling opioid use disorder.

Buprenorphine, commonly known by the trade name Suboxone, activates opioid receptors enough to suppress cravings and withdrawal symptoms, but not enough to cause a high. It cuts the risk of dying by overdose in half, Jessica Blose with the Washington State Health Care Authority wrote in an email to The Olympian. And it reduces pregnancy risks and complications.

“Opioid use disorder is a manageable disease that affects brain function and behavior,” Blose wrote. “Medications for the treatment of opioid use disorder should be considered the first line treatment option offered to any individual with an opioid use disorder.”

Dr. Lucinda Grande, the clinic’s medical director, said bupe helps people stabilize and allows them to focus on goals outside of finding the high they once craved.

“It almost immediately changes their life,” Grande said.

Allen’s been visiting the clinic weekly for about eight months, and said he’s stopped spending his whole paycheck on drugs.

“Everything I did was centered around Vicodin or Percocet, whereas now I can actually live my life without fear of being without those pills,” Allen said.

How the Olympia Bupe Clinic works

The Bupe Clinic was the brainchild of Malika Lamont, former program director of the exchange, and Dr. Grande.

Seed funding came from the Cascade Pacific Action Alliance, as a Medicaid Transformation Demonstration pilot project, and the clinic later received $600,000 through a federal State Opioid Response grant.

One of the founders’ goals was to make buprenorphine easier to access than heroin, Dr. Grande said.

“The premise was that every day using buprenorphine instead of heroin was a safer day.”

Barriers to access care at the clinic are minimal: Walk-in patients walk away with their prescribed buprenorphine the same day.

And the medication is always free for patients, Grande said. If a patient doesn’t have insurance or when insurance coverage doesn’t fully cover the bill, the clinic pays.

At other clinics, patients may be required to complete regular urine tests. If a test comes back positive for illicit drugs, Grande said, they could lose their eligibility for treatment. At OBC, urine tests are conducted occasionally, but only to check for the presence of buprenorphine.

Other clinics may require counseling, while at OBC peers who’ve been through recovery provide support and help patients access counseling and other resources such as housing.

The clinic is open to patients starting at 4 p.m. daily. Allen said those evening hours are easier for him to access than making a doctor’s appointment, especially as someone who’s homeless and working full-time.

Thurston County’s plan

Katie Strozyk, Opioid Response Coordinator at Thurston County Public Health & Social Services, said those hours are unique. The clinic plays “a leading role” in implementing several strategies in the county’s Opioid Response Plan adopted in June, Strozyk wrote in an email to The Olympian.

The Thurston County Opioid Response Task Force, which is implementing the plan, was convened in 2018 to address the opioid epidemic. It’s co-chaired by Thurston County Prosecutor Jon Tunheim and Schelli Slaughter, director of Thurston County Public Health & Social Services.

“A major theme in the response plan is the need for increased access to treatment within the community, especially buprenorphine (Suboxone),” Strozyk wrote. “The Olympia Bupe Clinic has been able to fill a gap in this effort towards expanding access by offering walk-in treatment services in evening hours – a model which did not previously exist in Thurston County for MAT (medication-assisted treatment).”

The clinic’s nurse care manager Sofi Renes and peers serve as “clinic anchors,” and there’s a rotating staff of paid and volunteer prescribers who work within federal restrictions. Staff have frequent care coordination meetings to review individual patients’ needs.

Renes said patients are given ownership of the recovery process: They have authority over their own health and goals, with the clinic’s support behind them.

Many who visit the clinic, Renes said, have complex trauma in their pasts and started using opioids to self-medicate as early as their teens. And with that in mind, “we can take it away from the moral argument and look at the evidence-based solutions.”

“So far, one of the common threads between each patient visit is that our patients are just so gracious and grateful that we’re there,” Renes said. “They’re not used to being treated with dignity.”

A patient’s first prescription is usually for about three days, Grande said, in part to identify a suitable dose and make any needed adjustments. Often, the prescription will then increase to seven days. And if the patient is stable after several visits, he or she might start receiving two-week prescriptions.

To make it happen, pharmacist Brad Livingstone’s team fills the OBC prescriptions at his Sound Specialty Pharmacy across town.

As prescriptions come in, the pharmacy team checks the eligibility of insurance and checks individuals’ narcotics history with a statewide database — essentially putting together back stories to understand who’s getting a prescription filled, Livingstone said.

Then the pharmacy connects with the clinic and reconciles its list with the patients waiting for their medication. A technician delivers the medication in person, and that cycle repeats three times per night.

Livingstone emphasized to The Olympian that the clinic and his pharmacy need to do their due diligence “to make sure we’re serving the clients who really want to be helped but not enabling those who might be diverting it for personal gain.”

“We don’t want to be a pill mill. We just want to help people,” Livingstone said.

A patient’s success, clinical director Grande said, can look “very different from person to person.”

Some people may have the goal to quit opioids forever, Dr. Grande said. Another might want to simply reduce their usage. Yet another person may want to stop spending their time trying to find the next hit of heroin so they can get a job.

The question is, she says, “Are they making progress in achieving their own goals?”

The first 750 patients

Over 750 patients had visited the clinic as of early December, for a total of more than 5,000 visits. Grande said about half the clinic’s patients come back four or more times, about 25 percent never come back, and the remaining quarter fall somewhere in between.

Data provided by the clinic shows that, of the first 750 patients, 53 percent identified themselves as homeless on intake surveys.

The average patient age was 36, but age ranged from 18 to 78. Forty percent were experiencing chronic pain outside of withdrawal symptoms and 37 percent had experienced an opioid overdose.

An especially striking statistic: 69 percent of the Bupe Clinic’s first 750 patients had been incarcerated.

In October, Capital Recovery Center and the clinic hired Justice Outreach Specialist Krystal Pierce using funds from Thurston County’s Treatment Sales Tax.

Pierce, who previously worked as a Nisqually Public Safety Corrections Officer, seeks out clients who have been in jail or otherwise involved with the justice system. The most forward progress, Pierce said, has happened at Thurston County’s jail.

Pierce and nurse care manager Renes host presentations in the jail dormitories two times per week, Pierce said. They present information on opioid use disorder and treatment options, and answer inmates’ questions.

If an inmate is interested in pursuing treatment, Pierce will do an initial screening to determine whether they’re eligible for OBC. Any patient who has an opioid use disorder is eligible, Grande said. Someone who uses methamphetamines but has not had problematic use of opioids, though, is not a good fit.

When an inmate’s a good candidate, a more intensive intake process is conducted while they’re in custody. Pierce then picks her clients up at the jail upon release and takes them directly to the clinic, where providers shuffle plans to see them immediately.

The justice-outreach work, Grande said, “is one of the most exciting and potentially valuable things” the clinic is doing.

What’s next for the Bupe Clinic

Pierce hopes to eventually get inmates medication to treat opioid use disorder while they’re still incarcerated.

Pharmacist Livingstone has proposed installing an automated dispenser to reduce patient wait time by allowing the pharmacy to send files to a machine at the clinic electronically. He told The Olympian there have been times when a patient comes in “in rough shape” and leaves rather than waiting an hour for his or her prescription.

Part of Dr. Grande’s vision involves strengthening relationships with hospitals and jails, providing other medications and medical care on site, and starting peer-led group support sessions that patients have asked for. So far, they haven’t had the space to pursue those latter two goals.

Still, the clinic already has seen success.

A July report lists recorded patient benefits from a “non-random survey” of 37 patients:

• 70 percent showed improved mood within the first weeks of treatment.
• 70 percent improved self-image.
• 67 percent improved family relationships.
• 43 percent reduced methamphetamine use.
• 35 percent improved employment status.
• 32 percent improved housing status.

More research will look at how long people remain in treatment, and to what extent treatment keeps them out of jail and improves their health, housing, employment and relationships.

In the case of Sean Allen, he said the clinic is the center of his recovery.

“Everything is centered around the clinic. I come here, I get my Suboxone, I can live a full life,” Allen said. “If I don’t come here, I end up relapsing and I’m back to where I was before.”

Finding help

If you or someone you know is struggling with substance use, problem gambling, or mental health, the Washington State Recovery Hotline at 1-866-789-1511 and website, www.warecoveryhelpline.org, are available to connect people with resources and treatment options.

One resource available on the hotline’s website helps visitors find convenient locations that offer medications like buprenorphine.

This story was originally published December 29, 2019 at 6:00 AM.