The truth about prescription opioids and addiction
About once every three weeks, a Thurston County resident dies from an opiate overdose, according to county epidemiologist Mary Ann O’Garro. For those who’ve known and loved one of them, it’s no comfort that our county’s opiate death rate is a little lower than the statewide average.
Opiates often set their hook fast and deep, hijacking normal brain functions and robbing people of their judgment, their honesty, and their autonomy.
Opiates kill teens and young adults whose first exposure was the prescription they filled when they had their wisdom teeth pulled. Opiates kill ordinary people who never thought they were at risk for addiction. And all too often, they kill people who have made the herculean effort to quit for months or even years, only to relapse and take more than their bodies can tolerate.
The opioid crisis has spawned a plethora of studies, task forces, commissions, news specials, TED talks, and emergency declarations. More recently, there have been a spate of lawsuits targeting the pharmaceutical companies that made opioids so ubiquitous and so profitable.
About a year ago, Thurston County joined that parade by declaring opioids a public health emergency and convening yet another task force to come up with yet another plan. The county also signed on to a lawsuit targeting the pharmaceutical companies.
One might be skeptical about what a county government can do to combat a national crisis, and whether one more task force could really make any difference.
But the task force plan, developed over the last year and released last month, is thoughtful, robust, and ambitious. And the county has hired a full-time coordinator to see that it is fully implemented.
The plan’s six goals are to:
Improve physician prescribing practices,
Expand access to treatment,
Prevent overdose deaths by making naloxone, an overdose reversal drug, more available,
Beef up data collection to measure progress and guide strategy,
Reduce stigma, especially for groups disproportionately at risk, and
Reduce exposure and impacts for babies, children and parents.
Nonprofits, law enforcement, criminal justice, city governments, health care and treatment providers, homeless services advocates, and education and job training all participated in crafting this plan; Schelli Slaughter, the county’s Public Health and Social Services director, reports that “we had to keep getting bigger rooms for meetings” in the course of the plan’s development.
Slaughter says her top priorities are “to improve data, especially about how to reduce overdoses, and to reduce stigma, which is a huge barrier to everything we are trying to accomplish.”
Expanding access to “medication assisted treatment,” or MAT, is also high on the list. In the past, there have been severe restrictions on the use of methadone, and lingering disapproval of giving people opiate substitutes rather than requiring them to succeed on willpower alone. But MAT is growing in acceptance as evidence supports its life-saving effectiveness. At the Capital Recovery Center, a peer-support center for people with mental illnesses in downtown Olympia, a new clinic has increased the availability of suboxone, a more flexible and effective medication. The plan calls for expanding and coordinating services like this county-wide.
Another vital strategy is to expand the availability of naloxone, the overdose reversal drug. Emergency response personnel, police, and some health care, social service and housing providers have it available, but more outreach – and more data tracking – is needed to ensure it is available when and where it’s needed, and that there is follow-up for those whose lives it saves.
Also competing for top priority is more attention – and more treatment – for pregnant and parenting moms and their partners, more intensive and consistent messaging to kids about how to avoid drug use, and wider adoption of safe home storage and safe disposal of drugs.
These are all efforts where local action matters, and where the collaboration of a wide spectrum of local partners is required. And given the anemic congressional response to the opioid crisis, local action in communities across the country may be what’s already starting to make a difference.
Nationally, opiate deaths have just started to decline, according to O’Garro; in 2017, opiates killed 47,600 people, down from the year before, when the death toll was 63,632. In our state, a similar trend took the toll for the same two years from 739 to 694.
That provides a ray of hope, but opioid deaths are still among the top reasons that life expectancy in our country continues to decline. Critical federal funding for treatment is still inadequate. And it’s a special struggle in our jails, since people who are incarcerated are ineligible for Medicaid.
Yet as Slaughter notes, “We’re all in this together. This (addiction) can happen to anyone.”
So, in the absence of a rational federal response, we should all be grateful to everyone in our county who’s working to solve this problem. We are deeply thankful that it takes a big room to hold them all.