- SEATTLE— Experts on the science, treatment and experience of using fentanyl shared insights last week about how King County and Seattle are reacting to the crisis and could improve.
In 2016, 22 people in King County died from a fentanyl overdose. That number has skyrocketed in recent years, and the county is on pace to exceed 1,000 deaths by the end of 2023.
Fentanyl is relatively inexpensive, sold for as little as $2 or $3 per pill, and extremely potent, about 50 times more powerful than heroin and 100 times more powerful than morphine.
The federal government considers fentanyl the deadliest drug threat in the nation. In Seattle, the crisis is overwhelming first responders, who are responding to an average of more than 100 overdose calls each week.
Still, the drug is drawing in new users.
In a live, public event held at Seattle Public Library’s downtown location, The Seattle Times gathered local experts to share more about the fentanyl epidemic, including treatment options and how policymakers should respond.
Highlights from the presentation and moderated discussion are below.
- 1. Fentanyl is more addictive than drugs prevalent in previous crises.
Like morphine and heroin, fentanyl is an opioid that acts on the endorphin system in the brain, said Dr. Caleb Banta-Green, director for Community-Engaged Drug Education, Epidemiology and Research at the University of Washington.
It creates a quick high with highly addictive properties, so people who use it are living life on a roller coaster.
“If all of us took opioids every day for a month, we’d become physically dependent on them as well,” he said. “You’d need higher doses of fentanyl to get the same effect. And if you stop using it, you’d go into withdrawal.”
Joe Barsana, King County’s drug diversion court housing case manager, and a certified peer counselor and recovery coach, said people can rapidly deteriorate when using fentanyl, even compared with other opioids. Someone he knew who had been using heroin every day for 20 years switched to fentanyl and died within two weeks.
- 2. Certain groups of people may be predisposed to the potent effects of fentanyl.
“People start off using fentanyl to feel good, and they keep using it to not feel bad,” Banta-Green said.
There is variation, however, among people depending on whether they are predisposed to enjoy the effects of opioids.
About one-quarter to one-third of people who use opioids to get high will find that they like them, said Banta-Green. Some people feel energized, he said. Many people will report feeling nauseated and sleepy.
Part of the attraction to fentanyl comes from how our society manages pain, Banta-Green said. Where there is more trauma and isolation, there is greater demand for opioids.
In particular, people experiencing homelessness are dying at higher rates than other groups, and Native Americans face the largest racial disparity in cities, rural areas and on reservations.
The American Indian and Indigenous populations have experienced some of the highest amounts of intergenerational trauma. Racism, poverty and disconnectedness contribute to why people use substances “and exacerbate shame and stigma that pushes people away into the shadows,” he said.
Dr. Susan McLaughlin, the new behavioral health and recovery division director for King County, added that historic policies, particularly related to addressing previous drug crises, contributed to the disproportionate incarceration of people of color. “Once you have been in jail and have charges, it’s harder to get employment, it’s harder to get housing and it becomes a cycle,” she said.
- 3. Treatment options have been studied and are proven to work.
The good news is that we have medications that treat opioid disorders, McLaughlin said, and “people do recover.”
Both methadone and Suboxone — a common brand name for buprenorphine — have been proven effective. However, because fentanyl creates a higher high and a shorter cycle, researchers are still examining how to appropriately dose medications to manage cravings and withdrawal symptoms.
The most important key is keeping people who have overdosed safe and alive until they can get resources, Barsana said. The first dose of medication may not be enough or it may not be the right treatment option for that person.
- 4. Harm reduction is a concept many advocates suggest should be paired with medication, therapy and community support.
Recovery can take many years and may involve using substances, Barsana said.
“You need to see it as a process. In my experience if I didn’t get harm reduction services, I don’t really think I would be here today,” he said.
Harm reduction is the idea that someone does not need to be completely sober or abstinent from drugs in order to receive treatment and care or community support and sympathy. Syringe exchanges, where people can get clean needles, are often considered a form of harm reduction.
McLaughlin said the approach serves two purposes: It keeps people safe and alive and prevents the spread of disease. It also opens a conversation about what next steps someone wants to take, so that when that person is ready to seek help, they can immediately get connected to resources.
Harm reduction is also often only considered a controversial approach for addiction. Patients with cardiac disease are not ousted from treatment for eating a cupcake, Banta-Green said. “It’s just a mind shift.”
Family and friends of people experiencing addiction should also understand that “substance use disorder is a chronic condition and relapse does happen. We should expect that that’s part of the journey for some to recover,” McLaughlin said.
- 5. Naloxone can be a lifesaving treatment for people who have overdosed.
Pharmacies should be stocked with Naloxone, or the name brand Narcan, the overdose reversal drug, according to a state order.
To determine if someone has overdosed, check for responsiveness, meaning does that person react to sound or touch, said Ashley Updike, a member of Public Health — Seattle & King County’s Overdose Prevention and Response team.
If they do not respond, call 911. Meanwhile, administer naloxone, which comes in a nasal spray container.
You can find more information about how to deliver naloxone to someone in our Seattle Times resource guide.
“Remember that people are going through an active trauma when they’re overdosing, and people can be very disoriented,” Updike said.
If the person starts showing signs of returning their breath or consciousness, encourage them to remain where they are until paramedics arrive, since there could be other medical emergencies that need attention.
People who help others can be protected under Washington’s good Samaritan Law, said Tiffany Talley, also a member of Public Health — Seattle & King County’s Overdose Prevention and Response team.
In Washington, the good Samaritan Law protects the person experiencing the overdose and the individual helping the person who is having an overdose from any legal charges around drug possession. However, if the person who overdosed has an outstanding warrant for arrest, or is on probation or has parole violations, those protections will not apply.
- 6. Long-term support can also create a life worth living.
It’s important to couple medication with other wraparound systems of care, like permanent supportive housing, Barsana said.
“Think about what it would be like to rebuild your life from the inside out,” he said. It would be difficult to take medication if you’re living in a tent and your tent gets removed by the city.
“A lot of folks who are in recovery have a criminal history background, meaning it is very difficult for us to find any type of market rate housing,” he added.
We also need to create more sustained approaches for people to be healthier, Banta-Green said. Leaders need to work with people from an early age to learn about stress tolerance and how to manage emotional pain.
“As a society, we medicate stress, we medicate pain, we medicate sleep, we medicate everything,” he said. “We’re often looking for fixes outside of ourselves as opposed to inside of ourselves.”
- 7. There are ways for people in the community to support the crisis reduction efforts.
Voters in April approved a countywide measure that will institute a new tax on property owners to fund the construction and operation of five 24/7 walk-in crisis centers for people experiencing a mental or substance use disorder crisis.
That’s a step forward to create access for on-demand services and overdose recovery, McLaughlin said. “This will be a safe place where people can go if they’re in a crisis and in need and get access to medication and then linked up to treatment and resources,” she said.
It’s important to talk with people in your community, including kids, about how to recognize the signs and symptoms of use and overdose to make sure everyone is educated and aware. Carrying naloxone is also helpful.
“Support access to treatment, support diversion from incarceration, support all the systems that allow people to get well,” Barsana said.
