Editor’s note: Some of the names in this article have been changed to protect the identity of individuals speaking about personal information and experiences. — MD

Since health care facilities have tightened up on prescription opiates and the abundance of drugs like hydrocodone, oxycodone and methadone has decreased, heroin (also an opiate) has been on the rise within Clallam County.

Despite having the third highest opiate-related deaths within Washington counties and higher than state averages for opiate-related hospitalizations, Clallam County does not have a detox or inpatient treatment center, according to Alcohol and Drug Coordinator for Clallam County Department of Health and Human Services Jude Anderson.

“Heroin started as a pill problem and partially as a provider problem by over prescribing,” Anderson said. “About three years ago stricter laws were placed on the prescribing of pain medications and as soon as demand appeared so did heroin.”

No local inpatient yet

Although Clallam County has a handful of drug and alcohol outpatient treatment centers, the closet detox and inpatient facility is in Kitsap County or farther yet, Tacoma.

“It is crazy to me that we have such a serious opiate problem and still don’t have a detox facility,” said Kristina Bullington, administrator for Olympic Personal Growth.

However, a vacant building at 825 E. Fifth St., in Port Angeles recently purchased by Crali Properties is intended to accommodate a 16-bed adult inpatient chemical dependency treatment center. The center will be operated by Specialty Services, an offshoot of American Behavioral Health Systems (ABHS), said Craig Phillips, business manager for ABHS.

Because the building has more than enough space to accommodate Speciality Services, ABHS also hopes to provide a detox facility, funding and permitting pending.

After meeting with Clallam County health care personnel and listening to their needs, it was clear both an inpatient and detox facility are wanted in the county, Phillips said.

“Inpatient treatment is really all about stabilizing the patients and providing the opportunity to safely expose themselves to everyday life again,” Phillips said. “Oftentimes inpatient and detox is the step needed before a patient can maintain effective outpatient care, which luckily is already readably available in the county.”

Phillips is in the planning and permitting process with the building, but anticipates being in operation by July.

The upcoming inpatient treatment center is for adults however, and thus no local inpatient or detox options for youth are available, said Pete Peterson, director of Clallam County Juvenile and Family Services. “The delay to get a youth placed into an inpatient service can be up to a few weeks or even a couple of months,” Peterson said.

Although not all impatient treatment candidates, roughly 65 percent to 70 percent of the youth Juvenile and Family Services interacts with have drug or alcohol and/or mental health issues, Peterson said.

In the meantime without any type of inpatient treatment options available within the county, the jail is the closet thing to a detox program, Anderson said.

“The truth is, most addicts go through law enforcement before receiving treatment,” Anderson said. “Because one of the main symptoms of addiction is loss of self-control, many of the outpatient programs aren’t effective for people with serious addictions.”

Despite the variety and abundance of resources and outpatient programs available in the county, Bullington thinks an inpatient and better yet, a detox facility would be a huge benefit to the community and some of their patients.

“In some cases people can’t cope with the withdrawals to even give sobriety a chance,” Bullington said.

From hospital to treatment

Sequim resident and local business owner Julie experienced first-hand the frustrations and challenges of working within the current health care confines of treating persons with addictions when her heroin-addicted daughter Sarah was admitted to the emergency department multiple times.

“We never could get to the bottom of her sickness, including an advanced MRSA (methicillin-resistant Staphylococcus aureus) infection and at one point liver failure because the hospitals were not able to make her comfortable enough to stay,” Julie said.

It wasn’t until multiple trips to Harborview Medical Center and University of Washington Medical Center that a drug and alcohol specialist finally was available to recommend something to alleviate the overpowering pain of withdrawal Julie’s daughter was experiencing.

Julie was told by health care officials it was rare that a drug and alcohol specialist was available, but Julie thinks it was her continuous pleas and fight for her daughter’s life that eventually persuaded action.

“It’s missed opportunities,” Julie said. “You finally get your hands on this addicted person and have the chance to save them, but because the hospitals are reluctant to provide the drugs needed to comfort a patient experiencing withdrawals it is often easier for an addict to leave and use again before receiving adequate care or the chance to get into treatment.”

The time lapse between hospitalization and a treatment facility also can prove to be a challenge for patients dealing with an addiction. Even a relatively short amount of time can seem like an eternity for someone in withdrawal.

“I had been in the hospital a couple of days before a specialist came to talk to me about treatment options,” Julie’s daughter Sarah said. “For an addict experiencing withdrawals, you’re already mentally gone by that point and it’s too late to have a real conversation. I was already packing my bags to leave.”

Hospital staff seemed to go into sort of a “panic” once they were aware they were treating an addict, Sarah said. Sarah explained that she had trouble with what seemed to be “inexperienced” medical staffs’ abilities to draw blood from her and had a nurse refuse to give her anti-anxiety medication because of her addictive behavior.

“As soon as you go into a hospital and say you’re a drug addict, a lot of things change,” Sarah said. “I think whether the hospital treats an addiction like a disease or something you’re doing on your own will makes a difference and personally I think it’s a little of both.”

The goal of the hospital, however, is to treat the immediate symptoms for the emergency department visit, not the addiction, said Lorraine Wall, assistant administrator and chief of nursing officer at Olympic Medical Center.

“We are often dealing with people that might not be forthcoming about their particular situation,” Wall said. “We can and do give medications to help lessen the side effects of withdrawal.”

However, in Julie’s experience the hospitals were unable to administer a sufficient amount of medication to ease her daughter’s withdrawal symptoms.

“What’s missing in the hospitals from our experience is a drug and alcohol specialist who understands addictions and can give advice on what type of medications and the amounts needed to allow a patient to stay and get treated,” Julie said.”The hospitals need to realize that the immediate symptoms and addict are not separate and treating one and not the other isn’t effective.”

With all complexities aside, Wall agrees it’s a difficult balance treating patients with serious addiction and points out the hospital can’t solve it alone.

Meeting the need

New opportunities are emerging within local hospitals as drug and alcohol abuse continues to persist within the county.

“About 1,000 people are treated per year in Clallam County for substance abuse, but that is not nearly the number that needs to be treated,” Anderson said.

Since November 2013, Olympic Medical Center has been participating in the Washington State Screening, Brief, Intervention, Referral to Treatment (WASBIRT) program funded by the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, SBIRT grant and administered by the Washington Department of Social and Health Services and managed by the Division of Behavioral Health and Recovery.

OMC is using the program to help identify patients with risky behavior sooner rather than later, Wall said. Between November 2013 and March, 2, 750 chemical dependency screens were performed at Olympic Medical Center and 640 of these screens were positive for potential risky behavior requiring a full screen.

Through a series of screening and assessment “240 of the 640 patients who initially screened positive for potential risky behavior either received a brief intervention or were referred for appropriate treatment,” Wall said.

As part of WASBIRT program, Olympic Medical Center now has two behavioral health specialists on staff in the emergency department.

“The greatest success lies with patients early in their addiction,” Wall said. “We’re hoping to be able to identify patients with risky behavior before an addiction becomes serious.”

The WASBIRT program may become a helpful tool to identify a person with “risky behavior,” but the transition between hospital to treatment facility remains a challenging one, Bullington said. Although the hospital tries to discharge patients into safe and supportive environments, like family or friends, the reality is very few addicts have that safety net available.

“We communicate pretty well with the hospital, but unfortunately don’t get as many referrals that are probably necessary,” Bullington said. “It would be nice if the hospital had a chemical dependency person on staff because we know how busy the emergency department is and their staff can’t always take the time to call and set up after care.”

Olympic Medical Center was given a grant extension until April 2015 for the WASBIRT program, but the state is trying to figure out a way to fund the program after the grant expires.

“Unfortunately, treating persons with addictions is a growing concern,” Wall said.