By The Herald Editorial Board
Provided a foothold from the two-decade prescription opioid epidemic that began in 1999, opioid overdose deaths across the nation greatly increased during the covid-19 pandemic, with prescription pills largely supplanted by illicit fentanyl, more potent and easier and cheaper to produce.
While devastating across the country, the fentanyl crisis has been particularly deadly in Washington state. For the years between February 2020 and February 2023, Washington state had the highest percentage increase in opioid overdose deaths in the nation.
It has yet to lose that terrible lead. Tracking by the Centers for Disease Control and Prevention shows a 12-month average increase of 37 percent in reported overdose deaths in the state, from August 2022 to August 2023; that’s against a 1 percent drop in reported overdose deaths nationwide for the same 12-month period.
A new report by the office of 2nd Congressional District Rep. Rick Larsen, D-Eveett, has found — to no one’s surprise — similar trends since 2016 among the 2nd District’s five counties — Snohomish, Island, Skagit, Whatcom and San Juan — with Whatcom and Snohomish counties tracking near the state rate of opioid deaths of nearly 25 per 100,000 residents in 2022, with only slight declines to less than 20 deaths per 100,000 for Island and Skagit counties.
Recovery after covid: There has been no lack of effort among all levels of government, community organizations, public health agencies, behavioral health care and service providers, faith groups and more, yet the fentanyl and broader overdose crisis has proved difficult to bend back to even its pre-pandemic levels.
“Prior to the pandemic, we had made significant progress and were putting the pieces in place to combat opioids, but a lot of that was dependent upon people being together in treatment and recovery,” Larsen said during an interview this week. ”And when you can’t do that and people are alone or left alone, we saw a huge door open for the next wave of opioids, in this case, fentanyl. And that’s what we’re left with.”
The good news in the report is that the efforts that were showing effectiveness before the pandemic can now be expanded to reengage the fight.
“There’s a lot we can do in Congress to work with local governments, work with tribal governments and health care providers, substance abuse counselors and community partners and such,” Larsen said.
The hope, the 12-term congressman said, is that the report’s findings and recommendations might help regain some of the momentum lost during the pandemic in limiting the reach of opioids.
A framework for response: So the 25-page report, in addition to detailing the scope of the crisis in the district of more than 782,000 residents — with specific focus on the district’s eight Tribal nations, its youths and its veterans — identifies problems with delivery of some resources as well as a framework of response, highlighting ongoing and proposed efforts among the range of players.
The reports outlines the challenges in four areas:
Preventing individuals from turning to opioids in the first place;
Interdicting the flow of opioids and fentanyl’s precursor chemicals into the nation and communities;
Treatment to reduce harm and end individuals’ addiction to opioids; and
Recovery that supports long-term sobriety in communities.
Among examples of existing programs for each, the report notes the youth prevention work of Snohomish County Human Services with 11 school districts in the county and 52 schools to assist student support advocates and curricula on youth substance prevention for teachers and counselors.
Challenges in providing treatment also are addressed in the report, particularly noting the lack of addiction treatment beds. The report found a deficit of 58 beds in 2022 for substance use inpatient treatment in the district, with no inpatient treatment available in Island County or San Juan County and inpatient treatment facilities limited to the other counties’ larger population centers.
Also limiting access to treatment are the lack of behavioral health providers that accept Medicaid, citing reimbursement rates that don’t cover costs. In Washington state, the report says, Medicaid covers many services but does not cover partial hospital services or outpatient detoxification.
Prescription for recovery: Many of the report’s recommendations draw on proposed and pending legislation in Congress, as well as increased federal funding.
President Biden’s current supplemental budget request includes $1.55 billion to strengthen addiction treatment, overdose prevention and recovery support services; and an additional $1.2 billion to combat drug trafficking.
Among prevention recommendations, the report urges increased funding for the Drug-Free Communities Support Program to help schools and youth organizations provide prevention programs; increased access to pain management programs for veterans; and research into opioid use disorder.
On interdiction, recommendations include a dedicated funding source for multi-jurisdictional drug task forces to stop narcotics trafficking; advanced screening technology at U.S. borders for opioids and their precursors; passage of legislation from Rep. Dan Newhouse, R-Wash., and Sen. Maria Cantwell, D-Wash., that would allow tribal law enforcement officers to enforce federal law on tribal land; and passage of legislation to create a joint task force to enhance border security.
The direction on treatment seeks funding to allow Medicare beneficiaries to receive the full range of opioid use disorder services and increase Medicare’s reimbursement rate for clinical social workers; funding to allow Medicaid reimbursement for inpatient care at treatment facilities with more than 16 beds; and legislation that would reduce the time in treatment required to allow patients to take home doses of methadone and allow pharmacies to dispense methadone for opioid use disorder.
And the guidance on recovery recommends grant programs and increased funding for educational and workforce development programs, opioid peer support programs and coaches, child care and family support programs and support for wraparound services to support people in recovery.
A shared ‘to do’ list: Larsen said he considers the report a personal “to do” list, in particular for the congressional action it outlines.
“One, I want to be responsive to the people I represent,” he said. “I want to show them we’re going to be part of solutions here. And second, there’s a broader goal to share this with other members of Congress and let them know: Here’s how you can put together your own report.”
The report also should provide encouragement among communities throughout the district and elsewhere to consider what is working, what needs to be strengthened and what needs the financial and policy support of state, county and city governments.
And regarding those funding and policy proposals, there also is a responsibility looming for voters this year. Consider the elections coming for state and national representatives in state offices, the state Legislature, Congress and the president. Consider the work of those of both parties who are seeking to find compromise and agreement, specifically in Congress on budgets and the border. And then consider those who are working against such agreements and fighting compromise to further their own partisan and personal impulses.
It’s often difficult for many who have not struggled with addiction to understand what holds back someone from taking the steps to recovery and sobriety. But it’s equally difficult to understand what dissuades some from supporting efforts and investments that show promise or have already proven their success.
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