Yesterday, the federal government called attention to the opioid crisis by declaring a Public Health Emergency. While the specific rulemaking or funding implications are still unknown, Public Health and our partners will be closely following any actions and impacts.
What we do know is that the solution to this crisis requires action from all levels of government. I caught up with Brad Finegood of King County’s Behavioral Health and Recovery Division and Co-Chair of the local Heroin and Prescription Opiate Addiction Taskforce to put yesterday’s federal declaration in context and to understand the important levers at the federal, state and local level that must work together to address the epidemic.
Q: As highlighted in the national declaration, overdose deaths from opioids, including prescription opioids and heroin, have more than quadrupled since 1999. What is the scope of the problem locally?
King County, like many places across the country, has seen sharp increases in the use and abuse of heroin and prescription opiates. Approximately every 36 hours, someone dies from a heroin or opioid drug overdose in King County. At this point, with fentanyl and other synthetic opiates, there is a lot of concern that we have not seen the worst of this epidemic.
Q: What does the federal action do and not do?
Declaring the opioid crisis a Public Health Emergency helps bring important attention to the epidemic. Removing some of the barriers to telemedicine could also help make treatment more accessible in rural areas of the country. Unfortunately, it allocates no new funding to address the crisis.
The President’s Commission on Combating Drug Addiction and the Opioid Crisis has said they will release a comprehensive national plan next week.
Q: What elements of federal level policy are critical to confront this epidemic?
First, positive action at the federal level should not be undercut by efforts to repeal or dismantle the Affordable Care Act because that would make it harder for millions of Americans to get the treatment they need for opioid addiction.
Second, yearly appropriations to fight the opioid epidemic must align with the scope of the problem. In 2016, President Obama signed into law the Comprehensive Addiction and Recovery Act. This was the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic including prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. Congress must continue to authorize the over $181 million each year needed to implement this law. These funds are critical for treatment resources.
And, changing federal policies could free up much needed treatment resources. Currently, federal policy limits the number of people and days people can be treated in residential treatment facilities under Medicaid.
Q: While there’s much needed at the federal level, what progress is being made at the local level?
In the many decades I’ve spent working in the field of addiction, I’ve never seen this level of collective action to confront the epidemic. Families and community members are safely disposing of unused and expired medication – including prescription painkillers. We now have 110 secured drop boxes across King County available 24 hours a day. Nearly 2,800 naloxone kits have been made available to law enforcement and treatment providers to reverse the effects of overdoses, and hundreds of kits have been distributed to substance users and their families.
And we are making progress on treatment availability. We have improved access to what is known as Medication Assisted Treatment – medications like methadone and buprenorphine that work well for opioid withdrawal and long-term recovery. For example, we have virtually eliminated the waitlist for methadone treatment. And, through a pilot project at King County’s Downtown Public Health Needle Exchange, we are offering access to buprenorphine. But we still have a long way to go to be sure everyone who is ready for treatment has access to medical providers who can manage their treatment over time.
And just last week, Valley Cities Behavioral Health Care opened a new detox facility funded in part by King County’s Mental Illness and Drug Dependency tax, or MIDD.
Public Health is working with partners to improve surveillance of overdoses so that we have the data we need to inform our response.
At the state level, the Taskforce recommendation to lower barriers to treatment was recently signed into law by the Governor.
These actions are making a difference. And yet, when I hear that we have failed at keeping people alive long enough for them to get into treatment, I know we have a long way to go.
Q: Is there something we can all do to be part of the solution?
Yes, there’s so much families and communities can do right now. Stigma is often the underlying issue we are trying to fight, so we can start a conversation with friends and family. With the right help and support, people do recover and substance use disorder is preventable.
We can turn in unused or expired prescription medications. In King County, you can turn in your medications at many drop boxes any time. And this Saturday, October 28th from 10:00 am to 2:00 pm there are additional locations available.
And, if you know someone who may need help, call the Recovery Helpline 1.866.789.1511 or you can visit stopoverdose.org.
Now that this emergency has been recognized what emergency measures can be added to addressing this Problem? Historically quarenteening was used to limit risk to the public. Could this model be used to limit risk to the addict and to the public?