One year after opening, Jamestown S’Klallam Tribe’s Healing Clinic now averages daily about 120 patients receiving treatment and support for opioid use disorder.

“(Opioid use is) on the rise in the community and across the nation,” said the clinic’s executive director Dr. Molly Martin.

“Even if you don’t think it affects your friends or family, odds are there is somebody who it does affect that you care about and we are here to help them,”

Martin spoke June 27 about the clinic staff’s efforts and answered business and community members’ questions at the Sequim-Dungeness Chamber of Commerce luncheon in Sunland.

The clinic opened July 6, 2022 at 526 S. Ninth Ave. in Sequim city limits and it employs 50 staff and sees a growth rate of 10-15 new patients a month.

“It’s a very labor intensive-type clinic because we offer so many services under one roof,” she said.

In an interview after the meeting, Martin said there’s no capacity limit set so long as they have enough staff to accommodate patients.

About 65 percent of patients have stayed with the clinic, she said, with most comparable clinics below 50 percent retention due to the struggles affiliated with fentanyl’s easy accessibility.

Martin notes they define retention as a patient doing intake and receiving their first dose of medication for treatment.

During the application process for the clinic, there were concerns about out-of-area residents using the services and causing crime, but Martin said 95 percent of patients live in Clallam County and 5 percent in Jefferson County, with men and women making up exactly half of patients each.

They range from under 18 to older than 65 with most in their 30s and 40s, Martin said, and that many have experienced substance abuse since their 20s.

“We’re here to help everybody,” she said.

“We do have to tailor our treatment to somebody’s age and other risk factors but know that there’s not one cookie cutter patient coming to us. It’s a really wide demographic.”

Law enforcement

Sequim Police Chief Sheri Crain said in an interview that she and deputy chief Mike Hill sit on various clinic committees, and said there isn’t an increase in crime related to it.

“The clinic’s presence has not brought negative things to our community,” she said.

“It’s had a positive impact, absolutely.

“I don’t think people appreciate how bad it would be if there wasn’t that type of presence.”

Clallam County Sheriff Brian King, who serves on the clinic’s Community Advisory Community with Crain, said the “clinic is providing a service our community so desperately needs” in “the most responsible way.”

He adds there’s been no adverse safety impacts from the clinic either.

Opioid addicts often fuel their addiction from ill-gotten proceeds through burglary and theft, he said, and most of Clallam’s crime is related to addiction.

“By effectively addressing addiction, crime goes down,” he said.

At Clallam County Jail, some inmates have benefited from the clinic’s services, he said, as it provides additional options for services to incarcerated individuals upon release.

He and Crain say that if a drug trafficking organization (DTO) is shut down, then the dealers and/or buyers choose to enter treatment and the clinic sees an increase in admissions.

“As the opioid crisis, and specifically the fentanyl epidemic, plagues our communities, we are truly blessed to have an integrated care clinic that provides comprehensive wrap-around services for sustained recovery for those struggling with addiction,” King said.

During the application process, a city-appointed hearing examiner required the tribe to pay for a social navigator for three years, and Martin said they’ve had positive feedback from law enforcement about the position. However, the position meets infrequently with clinic patients, she said, as they don’t get in trouble with law enforcement. The tribe does intend to continue the contracted position for at least three years, Martin said.

Fentanyl

Martin said Clallam County saw a significant increase in substance abuse disorders and overdoses during the COVID-19 pandemic.

A large piece of that being fentanyl, a synthetic opioid that is 50 to 100 times more potent than morphine.

Its use has “skyrocketed,” Martin said, because it’s inexpensive but has no quality control.

“One pill can kill. It’s absolutely true,” Martin said. “We have no control over the potency of one pill to another.”

At the clinic’s intake, she said about 95 percent of patients have fentanyl in their system.

“Fentanyl was (modified) by drug dealing chemists who decided to make a product that’s more addictive,” Crain said. “They’re selling it dirt cheap and intentionally flooding markets; they’ve flooded our market.”

Martin said the best way to prevent overdoses with those with substance use disorders is to treat the disorder so “they aren’t driven to use the substances that are so dangerous.”

Crain agrees with the sentiment saying, “with the whole opioid family, addiction doesn’t go away.”

“You have to have treatment,” she said.

The clinic as of June 27, has handed out 360 boxes of Naloxone (a nasal spray used to reverse to opioids’ effects) to patients with two doses per box to help with overdoses.

“Once in treatment, chances of overdose are very, very low, but they may be still hanging out with someone where the potential for overdose may be very high,” Martin said.

Treatment

The clinic offers services Monday-Saturday, and is open for intake Monday-Friday for anyone in Clallam and Jefferson counties who has an opioid problem, Martin said. Intake takes about 3 hours and all treatment is voluntary.

“They have to be willing to engage in treatment,” Martin said. “Ultimately, (patients are) responsible to the courts to get treatment (if mandated by a judge). We are not forcing anyone to get treatment, which makes for a positive clinic culture because everyone who wants to be there is there.”

Staff will focus on the most dangerous substance abuse issue and focus on the second and third depending on the need following a harm reduction model, she said.

Patients will engage in some form of counseling to address the issues that led to their abuse in the first place, Martin said.

Counseling sessions, whether individual or group, last 90 minutes to three hours, and to make the sessions more fun, staff incorporate other activities, such as art, yoga, gardening, drumming, and more.

“Anything we can do to make people feel like it’s a loving environment while focusing on recovery, we’re gonna do it,” Martin said.

Wrap around services are also available, such as primary care and dental care.

About 60 percent of patients receive door-to-door transportation to and from the clinic.

“It’s amazing to see the changes in our patients as they start to stabilize,” Martin said.

“It was like pulling teeth to get some folks on our vans by 11 in the morning. Now if we’re not at their house by 7 in the morning, they’re calling to figure out where we are.”

The clinic also offers a Child Watch program for up to three hours for each patient’s child/children from 6 weeks old to 12-years-old.

Medications

Martin said research shows patients have more sustained sobriety with FDA-approved medications for opioid use disorder than with quitting cold turkey.

Most patients at the Healing Clinic, a certified prescriber of methadone, take it for opioid-use disorder, she said.

Other clinics typically prescribe Suboxone, which doesn’t require the same certification, Martin told the Chamber of Commerce audience, but “it hasn’t worked, so often it’s why we switch to the stronger and in many cases more effective methadone.”

All medications clinical staff dispense are observed by a nurse to ensure they are taken fully.

Patients take home a dose on Sundays secured in a childproof container inside a lock box that only clinic staff and the patient know the code to get into, Martin said.

There’s also a plethora of food around the clinic so they don’t feel queasy with the medications.

Martin said opioid withdrawal is severe and it feels like the worst stomach flu for several days or even weeks.

“For our patients, to stabilize them, we help them see what it’s like to live without fentanyl or other opiates in their body and they start to think more clearly and function more effectively,” she said.

One myth, Martin often hears is they’re replacing one bad drug with another. But she said their medications are FDA-approved and have been for many years.

“I can tell you first hand they work … patients don’t get high from the medicines we’re giving them,” she said.

“They feel normal. They feel they can function again in a way they did before they were using substances. Not in constant up and down and being in withdrawal.”

Patients aren’t on timelines for medications, she said.

“We’re not going to force them to come off before they’re ready because we want to keep them safe and the safest way to do that is to keep prescribing meds to them,” Martin said.

“If they keep coming back we will keep seeing them regardless of how many years it takes.”

Each treatment plan is individualized, she said. If a patient wants to taper off, Martin said they try incredibly hard to be unbiased.

“We don’t want people to feel like they’re pressured to pick one treatment over another and have to stay on one thing and can’t come off of it,” she said.

For patients who want to go off of medication, Martin said they and their health provider come up with a tailored treatment program and it’s not done in a way to convince them to stay on a medication. The rate of tapering can be quickly, slowly, or at the healthcare provider’s discretion with patient permission, she said.

Future

Looking ahead, Martin said they have a tentative plan to expand services to western Clallam County later this year as they continue to assess needs.

Tribal leaders also seek more state funding in 2024 for a 16-bed psychiatric evaluation and treatment facility adjacent to the Healing Clinic to serve people in crisis.

For Healing Clinic services, Martin encourages people to walk in, call 360-681-7755, or visit jamestownhealingclinic.org.

“We know from what we’ve been doing so far, recovery is possible,” Martin said. “And we are absolutely here to help. If there is anyone who needs our services, please tell them to seek us out.”

Photo courtesy Jamestown Healing Clinic staff/ Opened in July 2022, the Jamestown Healing Clinic sees about 120 patients daily and continues to grow 10-15 patients a month, according to staff.