Sen. Maria Cantwell heard about the myriad difficulties local officials face in trying to combat the opioid crisis including lack of funding, insufficient personnel, lack of supplies and complicated regulations around providing care to those suffering from opioid-use disorder.

Cantwell, D-Mountlake Terrace, was in Port Angeles on Aug. 17 to discuss with local officials what Congress could do to help combat the state’s ongoing opioid crisis, now dominated by the synthetic opioid fentanyl.

“We know that there have been 26 people who died in overdoses in 2022 in this county,” Cantwell said at a roundtable discussion with local health, law enforcement and county officials at Peninsula Behavioral Health.

This was the seventh fentanyl roundtable Cantwell has held throughout the state. She noted Congress had recently passed the Fentanyl Eradication and Narcotics Deterrence (FEND) Off Fentanyl Act, which targets money-laundering operations related to fentanyl.

“In general we think that the I-5 corridor has put our state in the epicenter of increases in the amount of fentanyl being trafficked,” Cantwell said.

“And we want to do everything we can to stop that.”

Communities across the United States have been combating an opioid epidemic for almost a decade but in the past few years, the crisis has become dominated by fentanyl, a synthetic opioid the Centers for Disease Control and Prevention says is up to 50 times stronger than heroin.

“Since about a year and a half, two years ago, virtually everyone coming in (for substance-abuse disorders) has fentanyl in their system,” said Dr. Michael Maxwell, CEO of North Olympic Healthcare Network (NOHN).

In addition to people taking the drug on its own, fentanyl also is laced into other substances such as cocaine and methamphetamine leading to many unintentionally taking the drug.

Naloxone

Local health and law enforcement officials have been given additional access to the opioid-rescue drug naloxone, which often comes in the form of the nasal spray Narcan.

However, demand for those drugs is high across the state and getting enough can be a challenge for authorities.

Chief Criminal Deputy Amy Bundy of the Clallam County Sheriff’s Office heads the Olympic Peninsula Narcotics Enforcement Team.

She applied for a state grant for naloxone but was told that because of high demand a committee was being formed to figure out how to distribute the medication.

“At the time, our sheriff’s office could not receive naloxone from our Health and Human Services Department due to their grant funding,” Bundy said. “They could give it to community members but not to law enforcement.

“However law enforcement and the community paramedics are doing more overdose reversals than I can count. That’s why I have deputies running out of naloxone in short order and I’m telling them to go in in plain clothes and get some at the community center.”

Regulatory burdens

Local officials asked the senator to do what she can to reduce regulatory barriers to providing substance abuse treatments and to ensure funding to law enforcement remains consistent.

“When you look at an investigation at the federal level we have to realize that most of these informants and most of the intelligence comes out of these local communities,” Clallam County Sheriff Brian King said.

“You have to have these local task forces working in partnership with your federal task forces in order to really be able to make a difference.”

King said local law enforcement personnel across the state are concerned about continued access to the Edward Byrne Memorial Justice Assistance Grants which provide funding for a range of programs. Without those and other grants, King said local task forces which provide critical information to federal partners will no longer be funded.

“Next year we don’t have a grant to continue our local task force and if we really want to affect that supply chain from an enforcement perspective, then we need to fund our task forces,” King said.

Health officials said the process of providing opioid-replacement drugs such as methadone is still bogged down in regulations.

“Help needs to be easier to get than fentanyl,” said Molly Martin, executive director of the Jamestown Healing Clinic in Sequim.

“It’s harder to get help because there are so many state and federal regulations that go into being an opioid treatment program that were put in place in the ‘70s and every time we try to change them what it actually means is another layer of rules going up,” Martin said.

Martin said there are four different regulators for opioid treatment centers and their rules don’t always align. There’s also a lengthy and complicated intake process for patients which can be a deterrent for those suffering from withdrawal symptoms.

Furthermore, once the intake process is completed, the doses of opioid treatment drugs are too low to combat the strong effects of newer drugs like fentanyl.

“When that dose was approved years and years ago, there’s a ceiling on how much we can give on the first day,” Martin said. “That dose was approved back in the era of fairly mild heroin, not in the era of fentanyl, and it has not been adjusted since then.”

Dr. Linsey Monaghan, lead physician for NOHN’s opioid treatment program, said if the administrative burden around Medicaid reimbursement requirements were removed it would increase access to care.

In 2016, the Clallam County jail became the first on the West Coast to offer the opioid-treatment drug buprenorphine or suboxone to inmates. But that program is grant-funded, Monaghan said, because federal regulations require a person’s Medicaid to be deactivated if they become incarcerated.

Offering treatment in the jail leads to a decrease in people attempting to smuggle opioids into the jail, and keeps people’s tolerance up so there are less fatal overdoses upon release.

“Any time you take opioids away for a period of time without any treatment, especially incarceration is a big time for that, then you release people to the street, the overdose rates are 10, 20 times higher,” Monaghan said. “Since this grant which we’ve had for the past year our jail has had zero overdose deaths post-release.”

Cantwell said later that Congress is working on a budget that may be able to provide funding for grant programs.

“The Byrne JAG grant, which is our support for these organizations, we’re going to be passing a budget, this is what we could be doing to help them now and that’s something we could do in the next few months,” Cantwell said.

Cantwell said she believed there was bipartisan support for combating the fentanyl crisis, noting the FEND Off Fentanyl Act was supported across the aisle.