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Fentanyl, a highly addictive opioid 50 times stronger than heroin, is flooding into Clark County.
According to Clark County Public Health, fentanyl overdose deaths in the county increased by 200 percent from 2019 to 2020, or from 13 deaths to 39 deaths, and trends in 2021 are expected to be worse.
One organization bearing the brunt of that impact in Clark County is Columbia River Mental Health Services and its outpatient clinic NorthStar.
Addiction counselors there are seeing fentanyl laced in other drugs, including methamphetamine and heroin. Because of that, people struggling with other addictions are simultaneously building up an addiction to fentanyl. Now, addiction counselors are starting to see patients using fentanyl as their primary drug, a startling development, considering fentanyl’s strength.
Longtime employee and addiction counselor supervisor Amy Ruge remembers the first time she had a patient whose urinalysis came back fentanyl primary last year. The result frightened her.
Over her five years at the clinic, she mostly worked with patients suffering from heroin and methamphetamine addiction. Sometimes, patients tested positive for medical grade fentanyl, but it wasn’t something she was seeing on a regular basis. For years, she had heard warnings about an incoming crisis as illicit fentanyl worked its way across the country.
Reduce overdose risk
Clark County Public Health urges people who use drugs to take steps to reduce the risk of fentanyl overdose.
- Carry at least three doses of naloxone and know how to use it. Naloxone is a widely available medication that can reverse an opioid overdose. Naloxone is available at most pharmacies and does not require a prescription.
- Let friends know that you have naloxone, where you keep it and how to use it.
- Don’t use alone. Someone using alone cannot call for help during an overdose.
- If you are going to use while you’re alone, call a friend or Never Use Alone at 800-484-3731 so they can send help if needed.
- When using with others, go one person at a time. Watch and wait before the next person uses.
- Don’t mix drugs. Mixing different types of drugs, such as opioids, alcohol, methamphetamine or cocaine increases your risk for overdose.
- Call 911 if someone overdoses. The state’s Good Samaritan Overdose Law protects you and the person you are helping from drug possession charges.
After that first case, she started seeing fentanyl trickle in more and more. By the end of 2020, that trickle became a flood. Every patient seemed to be struggling with fentanyl, whether they knew they had been taking it or not.
The crisis had arrived.
Now, fentanyl patients eclipse heroin patients at the clinic by two to one, and addiction counselors expect things to get worse before they get better.
“Fentanyl is here, and it hasn’t peaked,” said Mike Delay, director of Substance Use Disorder Services at Columbia River Mental Health Services. “It will continue to grow in prevalence in our community.”
In late November, Public Health issued a warning about a surge of fentanyl overdoses — 10 to 12 — that were identified by the Washington Department of Health’s data monitoring system between Nov. 15-21.
As illicit fentanyl continues to spread, overdose surges will become more common.
But addiction counselors at NorthStar all agree: Clark County has built up a strong system of treatment and support for people struggling with fentanyl addiction, one that could become a model for other counties to follow in the future. Additionally, treatment is working at NorthStar, and people are heading there in droves to restore their lives.
Things are bad right now, addiction counselors say, but there is hope.
Treatment at NorthStar
NorthStar recently transitioned to a medication-first model, which prioritizes providing patients with medication before conducting an assessment and connecting them with other resources. In the past, patients seeking treatment would spend a day at the clinic suffering through withdrawals, making the experience difficult and painful for both patients and clinicians.
With medication provided first, patients don’t suffer through withdrawals, so they’re more relaxed and coherent. Addiction counselors can then collect more valuable information, which in turn leads to better treatment, Ruge said.
There are two primary ways patients begin treatment at NorthStar: referrals and walk-in appointments. Addiction counselors have started seeing walk-in appointments every day, and they are usually able to get people started on treatment the same day. With walk-in appointments and medication first, Ruge said the clinic has seen better retention rates.
“We are able to reach people in their moment of need,” Ruge said. “So much can change from the time someone calls if they have to wait for medication. It could be anything from the worst-case scenario — they died from an overdose because they couldn’t get in — or, the people who are functional users, they might get a job, they might change housing, something might change in that short period of time that will keep them from coming back to seek services.”
Another factor leading to patient retention is second chances.
“We greet people back with open arms. We don’t hold it against people if they disappear and come back,” Ruge said. “That is not a barrier. You can try as many times as you need to. We’ll try forever.”
Medication
Addiction counselors are seeing great success with methadone when treating fentanyl addiction because it can be tailored to each patient’s need. Suboxone is also showing promising results. Having both options is key, Ruge said, because treatment isn’t one-size-fits-all.
On top of medication, NorthStar clinicians focus on behavioral health.
“Medication-first has to come with a behavioral health component, as well, for it to be truly effective,” Delay said. “What we’re really trying to do is provide a robust system of clinical care to go along with the medication. So rather than simply a light touch, really making sure that we’re providing a variety of treatment options to individuals.”
That robust system includes referrals for people seeking in-patient care, an on-staff peer specialist who has lived experience with addiction, and on-staff case managers who help patients find housing and community services and apply for things such as Social Security.
According to Delay, fentanyl addiction has introduced new challenges for behavioral health specialists.
Because fentanyl addiction is so intense, withdrawals tend to be more drawn-out than those experienced on heroin and other opiates. Plus, violence and aggression are more common with fentanyl withdrawals.
At NorthStar, methadone treatment has proven successful in mediating these withdrawals. However, the dosing is higher than most addiction specialists at the clinic have ever dealt with before.
Peer specialist
One person who understands what patients are going through is John Amato, NorthStar’s certified peer specialist. Amato struggled with addiction for 24 years; now, he helps others on the road to recovery.
He is the first peer specialist at NorthStar and, according to addiction counselors, his work has been instrumental in treating people with fentanyl addiction.
Oftentimes, what leads to addiction is food insecurity, homelessness and trauma. As a peer specialist, Amato helps patients with their needs outside of addiction, such as housing, transportation, child care and everything in between, making recovery more achievable.
He works with various Clark County organizations, such as Council for the Homeless, Recovery Café, Southwest Washington Accountable Community of Health and more, to help get people whatever resources they need to succeed.
How these organizations work together showcases the quality of care and treatment in Clark County, something Amato spoke of as a source of hope in the fight against the fentanyl epidemic.
“From my experience in networking with the community, Vancouver is building a model that I think that the nation should be taking a look at,” Amato said. “I think the groundwork is being laid right now, and the effort that’s being put in is going to continue to build on itself.”
Delay agreed. Like others at NorthStar, he hopes to see naloxone, or Narcan, become more accessible in the future, as well as treatment options overall. But Clark County is on the path to recovery, he said.
Dr. Kevin Fischer, chief medical officer at NorthStar, agreed.
“Recovery is happening, even in the face of fentanyl,” he said.
