WASHINGTON OPIOID CRISIS – DROPS IN OD DEATHS BY COMMUNITY NARCAN USE EXPOSE MEDICAL MISINFORMATION HIDING EXPERT TREATMENT FAILURE
As consistently found in other diverse locales, opioid fatal overdoses surge until and unless interrupted by intensive targeted community outreach to distribute OD-reversing naloxone directly to high-risk areas
by Clark Miller
Published January 3, 2025
In the dramatic drops over the past one or two years after decades-long mounting opioid overdose deaths, drops established as attributable – more than attributable – to targeted, intensive, direct outreach community naloxone campaigns, the state of Washington has been “late to the game”, woefully and lethally late, remaining through 2023 and into 2024 at or near the top of the few states with seemingly anomalous increases in those deaths as others started seeing relief.
Late to the game in initiating efforts toward the the types of neighborhood level, targeted, intensive campaigns of Narcan distribution and training begun widely in other states years earlier, with examples of dramatic results tied to naloxone as early as 2018 in Ohio and earlier in Utah.
In Washington, as reported here, in March of 2024 –
With legislative steps remaining, that bill to initiate – in March of 2024 – significant state funding for the crisis was described in the piece as “opening the door” to resources and this way by one of the bill’s sponsors:“This is just going to get us started, and make sure we’re not sitting on our hands, waiting for the problem to solve itself”.
That’s late to the lethal crisis, tragically so, as it was in the Menominee tribal community in Wisconsin, where opioid OD deaths continued to surge through 2023, then were suddenly, dramatically reduced by 70 percent with a community naloxone campaign that was direct and targeted.
A Drug Addiction Intervention Team started distributing the life-saving opioid overdose reversal drug naloxone (Narcan), targeted to areas of high risk in the community.
Caldwell said the tribe also used data to find “hot spots,” places in the community with a disproportionate number of overdoses, and “hot times” when overdoses were happening more frequently. Using that data, she says the community was able to get recovery coaches on the ground to help make people aware that resources were available.
She said the community also worked on harm reduction, which included increasing the supply of fentanyl test strips and Narcan. Fentanyl test strips are small strips of paper that can detect the presence of fentanyl in different kinds of drugs, and Narcan is a medication that rapidly reverses the effects of an overdose.
“Narcan is critical,” Caldwell said. “I know there’s a lot of opinions out there thinking that we’re giving this stuff out, and it just is making people overdose or use more. But in all reality, it’s saving a life. It’s nothing more than that.”
Caldwell said she believes making Narcan available to “anyone and everyone” is likely the “No. 1 thing that changed within this community to help drop our overdose rates.”
In my search for news pieces and other sources of information for this post, I found no evidence of public health or organizational planning or implementation in Washington of the types of efforts undertaken in Wisconsin and elsewhere that focuses on getting Narcan into the hands of layperson responders – considered to be critically important for succss of Narcan campaigns.
Instead, per this description of efforts in Kitsap County, contiguous to King County and the Seattle area, concerted efforts to make Naloxone more available by “free, unrestricted access” began just this year, 2024 across the Olympic Peninsula counties of Clallum, Jefferson and Kitsap.
And despite those efforts, reported here –
But despite becoming more available, and free to those on Medicaid, barriers continue to prevent residents in need from immediately accessing naloxone. Those include cost, a lack of insurance, and the stigma of admitting opioid use to a pharmacist. …
Emergency access also remains a concern. Getting naloxone from a pharmacist or through the mail can be effective for people who want to be prepared for an overdose. But it is not an immediate solution in the event of an emergency. To be effective, naloxone has to be administered early in an overdose, said Dana Bierman, a chronic disease and injury prevention program manager for the Kitsap Public Health District.
“In the same way that we make fire extinguishers widely and freely available throughout our community so that bystanders can respond to fire, we need to ensure that naloxone is widely and freely available throughout our community so bystanders can respond quickly and effectively to an overdose”.
Counties named are identified here, on an interactive map.
The remarkable Menominee tribe experience fits with Washington Attorney General Bob Ferguson’s observation that,“These kits will make immediate impacts in that fight”.
But . . . it depends. Depends on, requires, that Narcan and associated training be provided on a targeted, neighborhood, drop-in site, layperson basis to be effective, to individuals likely to be immediately proximate to overdoses as they happen, because the window for revival is minutes or less.
A Washington high school senior gets that, recorded by Washington’s KOMO news and reported in a piece on King County’s new opioid crisis responses, consisting essentially of maintaining and funding the same failed gold standard “treatment” approaches by which Washington arrived at its current public health crisis.
KOMO News has covered countless stories of people losing loved ones and friends to the synthetic opioid. Many of them have pleaded for more action on policy to address the crisis.
“Doing more training and education in general about fentanyl, and how you wouldn’t even notice there are traces of it in your drugs until it’s too late,” Eastlake High School Senior Chinmayee Deshpande explained.
Deshpande and her classmates from Sammamish created a PSA as a school project that turned into a greater education campaign about fentanyl’s deadly reach across Washington. They are now pushing to get FDA-approved Naloxone in school bathrooms to reverse opioid overdose, they told KOMO News.
“There are rules to get Naloxone in nurses’ offices, but in bigger schools it would be better to have Naloxone easily accessible, ready in hand,” Deshpande added.
Late is better than never, and preliminary results of increases in free, more accessible naloxone are in evidence as downward shifts in OD deaths over the last quarters of 2024.
For Kitsap County, as reported in May of 2024,
On a single weekend day within the past month, staff at the Salvation Army shelter on Sixth Street shelter in Bremerton responded to seven overdoses, Lance Walters said.
With the increased use of fentanyl — a synthetic opioid 50 times stronger than heroin — overdoses have become a near-daily reality for staff.
“It’s a regular thing,” said Walters, a Salvation Army captain. “[Overdoses] happen so often, I don’t know if anyone is really keeping a tally.”
As overdoses reached record highs last year, public health officials plan to place over two dozen cabinets, stocked with the life-saving medicine naloxone, throughout Kitsap, Jefferson and Clallam counties.
and accuratedly concluded in that report, that
Those results are likely an undercount. They only reflect incidents requiring an EMS response and many nonfatal overdoses go unreported, health officials say.
We’ll come back to that, it’s important.
And reported end of year, 2024 –
Suspected opioid overdoses in Kitsap County fell during the third quarter of 2024, according to preliminary data published by the Kitsap Public Health District.
There were 81 suspected opioid overdoses during that span, 24 fewer than the previous quarter and down from a record high of 131 seen during the first three months of the year. It is the lowest number of responses to suspected overdoses since the end of 2022.
That was of course predictable, once the delayed, concerted efforts began that would get potentially fatal opioid overdose reversing naloxone units to where they could be used.
And, again,
The results are preliminary and only include instances where an emergency responder is involved, meaning they are almost certainly an undercount.
As explained in additional detail in this recent post and found consistently for all examined locales (linked to in that post), trends in nonfatal opioid overdoses – based on those recorded when medical emergency personnel are involved – are known to be increasingly significant undercounts, understood simply and directly by the effects of increasingly effective naloxone campaigns shifting the locus of OD revivals to community, layperson settings, where they are not reported or not in ways that become data available for institutional and research use.
For chronic, high-risk opioid users, it is very difficult to posit incentives to formally report being revived from overdose by associates or laypersons in natural settings, and easy to think of powerful incentives to not report.
It is inescapable to conclude that along with welcome reductions in deaths, the highly successful naloxone campaigns are hiding persistent surging of high-risk opioid use – the mounting high-risk use that gave rise to, necessitated, the wideapread, desperate campaigns to moderate fatal outcomes.
That as well is incontrovertible.
That is, recent trends in fatal and non-fatal opioid overdoses with associated evidence, along with other lines of congruent evidence, point to a persitently worsening epidemic and to failure of expert gold standard treatments.
