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[ Music ] >> Tom Layson: They are called deaths of despair, as job losses, isolation, illness and COVID all contribute to a major mental health crisis, and an associated surge in substance abuse deaths from overdose.

The current thinking is that the trauma of the pandemic is to blame for what's being called a national security emergency.

And that's part of the discussion next on Northwest Now.

[ Music ] >> Tom Layson: The numbers are just shocking.

Overdose deaths and the surge in fentanyl use are being called a national security emergency by the US Commission on Combating Synthetic Opioid Trafficking.

Nationally, overdose deaths topped 100,000 for the first time in 2021 -- more than car crashes and shootings combined.

It's costing in the economy about a trillion dollars per year.

In Pierce County, overdose deaths are up 75% between 2019 and 2020, with 2021's preliminary numbers looking even worse.

What's interesting is that UW research shows that methamphetamine combines with other drugs to cause 55% of all overdose deaths.

So it's meth that dominates as the most used component of deadly overdoses.

So yes, there's a lot of homegrown meth to be sure, but the big problem is the cheap fentanyl made with Chinese chemicals that's flooding across the US/Mexico border.

Fentanyl is what brings death into the equation as it crashes the addict's respiratory response.

In King County, a UW study shows how fentanyl deaths went from 65 in 2018, to 111, to 171 and 2020, to 388 just last year.

When considering all drugs, the statewide numbers show the same spike going from about 1,000 per year for 10 years until 2015 when numbers started steadily climbing with a spike to about 1,900 last year.

So fentanyl is highly addictive, more powerful than most addicts know, and it's completely adulterated with no way to control dosages or reactions.

But here's an interesting twist now: the power of vaccinations to save lives and improve public health has been front and center for the past two years with COVID.

So wouldn't it be wonderful if there were a vaccine against opioid addiction?

Well at the University of Washington, that's exactly what they're working on.

>> Tom Layson: Marco Pravatoni was happy enough in his University of Minneapolis lab studying the mechanics of addiction.

But his interest was also to push past mere understanding and into beneficial treatments.

So when the UW's Garvey Brain Institute endowed a new medication Development Research Center, Pravatoni was recruited to lead the search for new medications to kill addiction.

>> Mr. Pravatoni: You know, my original training, I was an addiction scientist.

I started, you know, during my PhD, I studied addiction, I studied mechanisms of addiction, but I was not satisfied because even if we study addiction, we don't really study how to cure opiate use disorder to prevent overdose.

And so that kind of drove me like into medication development, and it's something that I'm very passionate about.

>> Tom Layson: Pravatoni's lab just opened in January.

And while still small, he says it's a unique opportunity to combine lab facilities with UW's robust clinical resources in medicine and psychiatry.

An oxycodone vaccine has been in development for 10 years, and now it's currently in phase one of human safety trials.

The hope is new vaccines will kill the euphoric addictiveness of illicit drugs, but at the same time, not interfere with beneficial opioid treatments.

>> Mr. Pravatoni: And the way that this type of vaccine is different from let's say infectious disease is that the vaccine, just like any vaccine, will be injected in patients, like in your shoulder with a syringe.

And the patient's body will develop antibodies that are specific and selective for the target opioids.

So for example, a vaccine against fentanyl will trigger the body to produce antibodies against fentanyl and possibly some related compounds like arfentanyl or sufentanyl.

But these antibodies will not bind methadone, buprenorphine, Naloxone, which is the active ingredient of Narcan so that patients are protected against fentanyl for instance, but they can still receive treatment in the form of like FDA approved medications.

Or for example, if they have to have a surgery, they could still use anesthetics or painkillers that allow them to be safely treated for either their addiction or for pain management or for critical care.

>> Tom Layson: Of course, vaccinated addicts might try to switch drugs.

But the hope is that subsequent generations of vaccines will be effective across a broad spectrum of opioids.

So Pravatoni is hoping to leverage public/private partnerships to raise the hundreds of millions of dollars necessary to bring vaccines to market and reduce development times.

His stretch goal right now is to get into human trials for a fentanyl vaccine in two to three years.

>> Mr. Pravatoni: My part is essentially trying to keep moving the science forward, going to phase one, phase two, phase three clinical trials.

But also I spend a lot of time talking with potential investors, potential pharmaceutical company partners or like other private, let's say, equity stockholders that could actually move the needles toward commercialization.

And that's pretty much like the only way to get a vaccine like this to essentially the pharmacy shelf so that, you know, the physician can prescribe to patients.

>> Tom Layson: In America, getting street drugs like fentanyl is easy, but getting treatment is incredibly difficult.

Joining us now is Washington Recovery Alliance Executive Director and 32nd District State Representative Lauren Davis.

You may remember her from her support of Ricky's law, which brought in the use of involuntary commitments for drug users who are dangerously out of control.

Representative Davis, thanks so much for coming to Northwest Now.

The first question for you is a very basic one.

Why is it so darn easy to get drugs in America and so darn hard to get into treatment?

>> Ms. Davis: That's a fantastic question.

And a lot of it actually has to do with the sheer difficulty of navigating what is just an incredibly complex system.

So we have made huge strides in investing in substance use disorder treatment in the state of Washington.

Most people are eligible for Medicaid, and so their treatment is fully covered.

And we tend to have ample access to treatment.

The issue is, how do you get in the front door in navigating this, you know, whirlwind of a system.

And we have tried to do things like same-day access for an assessment or same-day access for Suboxone or buprenorphine treatment, for instance.

But at the end of the day, it is so hard to match people with an actual available treatment provider within what we call the window of willingness.

So that brief and fleeting moment when a person has what we call sort of the gift of desperation, or this tiny seed of hope and a desire to change.

And then we have people calling, you know, 27 detox providers and not getting a call back in part because of staffing issues in the system.

And then that window of willingness elapses and we lose that person, you know, back into the oblivion and chaos of active addiction.

What we really need and what we finally funded last year is sort of system navigators.

We're calling them recovery navigators.

But these are people who actually meet people very immediately within that window of willingness, and they will be their steadfast guide throughout the process.

We talk about the addiction treatment system as kind of these islands of care.

So you have withdrawal management or detox.

And then you have inpatient treatment.

And then you have recovery housing.

But guess what, we have nobody to navigate people kind of in the water between these islands, and people just drown.

>> Tom Layson: Yeah.

>> Ms. Davis: We discharge them from detox with a gap before treatment and nowhere to go.

We discharge them from treatment into homelessness.

And we actually have funding for these services, but we have no guide and no guideposts and so it's really that system navigation that's been missing.

>> Tom Layson: Yeah.

Yeah.

I'm so glad you gave me the vocabulary for something, a concept that now I have the words for which is the window of blindness, because I was going to say between somebody hitting rock bottom and saying, "You know, something, I am going to accept treatment," and getting in, people cannot just go homeless -- they can die in there.

>> Ms. Davis: Absolutely.

Absolutely.

Yeah.

And the one thing I'd respectfully offer is actually rock bottom is a really common misconception, actually.

>> Tom Layson: All right.

I'm going to school.

>> Ms. Davis: No, it's just that -- so the general public, and that's been the rhetoric for four or five decades, right, that people have to hit rock bottom.

But the one thing that I would offer actually is that recovery is born actually not of pain, but of hope, rather.

And so the way that people enter a window of willingness is almost exclusively because of love, because of compassion, because of someone seeing their humanity and somebody offering them, you know, this little tiny window of what the future could be.

And it's not in fact piling on the negative consequences.

There's a perception that if you take enough away from a human being, that they'll have this rock bottom experience, but that's just not what we see.

What we see is at the end of rock bottom is suicide and overdose, actually.

>> Tom Layson: Okay, so it's providing a pathway of hope.

>> Ms. Davis: Exactly.

>> Tom Layson: Something to live for, a goal that works.

>> Ms. Davis: Precisely.

That's exactly correct.

>> Tom Layson: Talk a little bit about the Blake decision.

We've mentioned on this program before, but probably not everybody knows what it is.

How it changed the laws surrounding drug possession and drug use, but also how it's possibly provided what's being called, you know, a generational opportunity here for a big slug of money to come in to fund some of these things.

How do they relate?

>> Ms. Davis: Yes, fantastic question and big movement in our state.

So last year, 2021, we were about six weeks into session.

It was the 25th of February and I woke up to a text message saying, "Did you see Supreme Court decision?"

to which I responded, no.

And somebody sent me this decision that the Washington State Supreme Court had in fact categorically thrown out our possession statute.

And what that meant was overnight it was fully legal under Washington State law for any individual of any age, including children, to possess any quantity of any narcotic.

And so, because of that, and particularly because of concerns about children, you know, a 13-year-old with two kilos of methamphetamine, for instance, there was this pressure on the legislature to react fairly immediately.

As somebody who ran for public office for the purpose of addressing behavioral health challenges and community, I saw this as an incredible example to kind of use as sort of a wedge or leverage rather to funnel money into this topic.

And there was a great desire to actually learn from mistakes of the past and recognize that, as we talked about earlier, the desire for recovery and for change is actually not born of negative consequences.

In fact, part of the diagnostic criteria of substance use disorder is continued use despite negative consequences.

>> Tom Layson: Yeah, but importantly is that you can't say, "Well, they're going to get treatment in jail.

Incarcerate them, they'll get treatment in jail, and it's all going to be okay."

No.

>> Ms. Davis: Precisely.

So that was a big misconception, though.

So there's a lot of the general public and probably people watching who have a perception that, in fact, treatment is actually afforded in jail.

It's not.

We're trying to make some investments.

In fact, we did this year.

But the reality is, for example, of the about 9,000 people arrested for drug possession in Washington state every year prior to the Blake decision, only 3% of those folks ever ended up in drug court.

So what that means is 97% of the individuals who got a possession charge, got no services.

But what they did get was a felony, which made it very difficult for them to get employment and housing, and employment and housing are highly correlated with long-term recovery.

So you take away the hope, you erect additional barriers to recovery.

So we decided to do something different and kind of try sort of this grand experiment of what happens when you actually treat the disease that's actually the source of the criminogenic behavior, rather than punishing and penalizing a person for having this particular brain disease.

And so -- >> Tom Layson: So that's where that $88 million comes from out of the punitive piece, and into the treatment piece because of the change in the law.

I want to make sure I try to connect those dots for folks.

>> Ms. Davis: Yeah, I would say it's not a precise science.

But that was the general sentiment.

We took general fund state dollars, which does pay for our state's correction system and other things, and we funneled it into a number of different investments that totaled about $88 million.

The kind of flagship program is what I mentioned earlier, this recovery navigator program, basically, providing somebody -- these are primarily people who actually in recovery themselves, people with lived experience, who have experienced homelessness, incarceration, trauma, substance use disorder, mental illness.

And they are now turning around and serving as that guide to get people out of the same fire that they once came from.

So it's really powerful.

And I'm hearing just this morning reports from Okanagan County about how wildly effective that program is statewide.

>> Tom Layson: I want you to also talk about this.

We often hear from lawmakers on both sides of the aisle and everybody's in agreement, drug addicts need treatment.

Treatment, treatment, treatment.

Well, treatment isn't necessarily pushing the easy button, because there's pieces on both sides of treatment.

Talk about the -- and I know you could do this for an hour -- but give us a back of the napkin view of the stages of treatment and how that needs to come together in an integrated way.

>> Ms. Davis: Sure, so I talk about the substance use disorder continuum of care as sort of having three component parts.

The first being outreach, or what we sometimes call pretreatment services.

So this is, how do you actually provide access to treatment for people who are interested in care?

And it turns out that somewhere between 80 and 95% of people in active addiction are actually interested in care.

And we have a ton of data to suggest that that's true.

But only 11% of those people actually get treatment.

And so if we can invest some funds in the outreach and kind of closing that delta to make sure that people who actually want care get care is huge.

So that's the outreach piece.

Then there's treatment itself, which of course includes you know, detox or withdrawal management, residential treatment, medications for opioid use disorder like methadone, Suboxone, you know, counseling, et cetera.

And then you have recovery support services, which is a huge umbrella that includes everything from recovery housing to social connectedness places like Recovery Café, to employment and education supports, recovery high schools, collegiate recovery.

How do you create a life worth living, and how do you sustain the investment and treatment that you made and actually keep people in recovery for the long haul?

Because it is in fact a chronic disease not dissimilar to cancer, hypertension, diabetes, and we need to do chronic disease management not an acute model, which is how we've historically treated addiction, which is totally counterintuitive, because you don't treat a chronic disease with an acute care model.

>> Tom Layson: Devil's advocate question now.

Of course, if you provide addicts with everything from their housing to education and the whole nine yards basic, basically retire them, their troubles will end, just like it might for me.

So do you really expect this population to stand itself up after having a lot of money spent on them and a lot of time and energy spent on them to stand up and compete in this American game of Survivor?

>> Ms. Davis: Absolutely, because people with substance use disorder are people who are profoundly suffering, but it's an entirely treatable brain disease.

And these individuals are no different than you or I.

They have hopes and dreams, they want families, they want to parent their own children, they want to give back in meaningful ways.

And when people actually work a recovery program and have sustained remission from this disease, that recovery program demands of them a life of rigorous honesty and integrity and a life of service.

And I would offer that people in recovery are actually better than the rest of us, not in spite of, but because of what they've experienced.

And so their capacity to give, their capacity to make a difference and their desire to do so actually supersedes most everyone else in community.

And they actually cherish and kind of covet this desire to have a roof over their head that they pay for, because that's something that they didn't used to have.

And so they actually make better employees than people who aren't in recovery, because they cherish the chance that they even have a job, that somebody took a chance on them.

So I would say the possibilities are absolutely endless for this population.

And they're just incredible human beings.

>> Tom Layson: And I think we'd all like to believe that.

So what does success look like when we project this out?

When it comes to suicide, when it comes to the explosion of fentanyl, when it comes to unemployment and chronic homelessness, what does success look like if this works?

>> Ms. Davis: So success at a really micro level, it looks like parents getting their kids back from the child welfare system and successfully parenting and stopping that generational trauma in its tracks.

It looks like people who are giving back in their communities.

You know, part of recovery is actually to turn around and help other people in active addiction get out.

At a, you know, more macro level, what that looks like is you're starting to see reductions in visible homelessness and community.

Not all homelessness by any stretch is caused by substance use disorder.

But there's a significant Venn diagram overlap.

You start to see huge reductions in property crime.

Unfortunately, a lot of what we're seeing, you know, car thefts, catalytic converter thefts, other property crime, unfortunately, is largely perpetuated by people who are in active addiction.

And the cause of their criminogenic behavior, fortunately, is a highly treatable brain disease.

And if we could just -- and they are suffering.

I mean, people who are experiencing that are miserable.

>> Tom Layson: Yeah, they'll tell you in tears that they don't want to wake up tomorrow, that their existence is just awful.

They've lost their children, they've lost their jobs, they will tell you that and then go right back out because it has got such a hold on them, particularly like fentanyl now.

What is your take on this fentanyl explosion?

I mean, it's been dubbed a national security crisis by the feds.

The death rate in places like Vancouver and Seattle and Portland is exploding.

Seizures are exploding.

The DEA is talking about these massive shipments coming in over the US/Mexico border with chemicals supplied by China.

I mean, it's an international problem landing on our doorstep.

As you evaluate this as a treatment director and in your role as a lawmaker, I just shake my head.

What's your reaction to it?

>> Ms. Davis: It's highly concerning.

You know, we were spared in the Pacific Northwest from the scourge of fentanyl for quite a long time.

You know, fentanyl hit the eastern seaboard and the southern United States and the Midwest, and that had a lot to do with it being in the heroin supply from certain cartels that supply those parts of the country.

And it was not in the heroin in different -- we have black tar here and when it wasn't in our heroin supply.

>> Tom Layson: Yeah.

>> Ms. Davis: So we were sort of late to this.

And now of course, it's those what they call the blues or the, you know, fake press fentanyl pills, the N30s.

But it's extremely alarming.

And it's alarming in part because of who it's impacting.

So it's not just people who have established opioid use disorder who have been using heroin who are maybe switching to these fentanyl pills, which we're seeing a lot of.

People aren't even shooting anymore.

They're actually just smoking the pills.

>> Tom Layson: Yeah.

>> Ms. Davis: But we're also seeing very young people.

So kind of that experimentation, people who would never meet diagnostic criteria for opioid use disorder, because they are just, you know, using a pill at a party.

So very young individuals.

And we're also seeing what experts are calling rapid onset opioid use disorder.

So typically, it takes quite a while for a person to develop fully fledged opioid use disorder.

But we're seeing because of the potency of fentanyl, in an extremely truncated manner that is really quite alarming.

And all the manifestations of opioid use disorder, including addictive behaviors and some of the, you know, stealing and other things that kind of coincide with that particular diagnosis.

>> Tom Layson: But it's a fast-acting addiction, a fast-acting slide.

And yeah, what you read about it and how deadly it is and how adulterated it is and how strong it is, it makes you wonder, A, just some logical questions.

I wonder why the suppliers want to kill their customers.

It doesn't quite make sense to me.

Maybe you can add some perspective there.

And actually, I wonder too, some have said that its deadliness and its kind of mystique actually gives it a little bit of street cred.

And it creates this perfect storm of overdose deaths, and I think deaths of despair with suicide.

It's amazing, and some of it is illogical.

>> Ms. Davis: So you're absolutely correct that particularly before when it was a little bit less prevalent, you know, if something had fentanyl in it, it was considered hot, right?

You have really powerful stuff and that is attractive.

And I will also offer that the vast majority of people who are in active addiction don't want to die.

And so they do lots of things to try to keep themselves alive.

Right?

But at the same time, their behavior itself is incredibly risky.

So the concern, you know, of course, is that exactly, as you mentioned, kind of that how concentrated, how potent that is, and what that means for people using kind of in their -- >> Tom Layson: Their patterns of addiction.

>> Ms. Davis: Right, yeah.

>> Tom Layson: Yeah, and it is very troubling, because you have this whole deaths of despair phenomena.

And this just seems to be accelerating it.

And sometimes, unintentionally, somebody has been, you know, maybe had a short round of treatment or comes out of jail, and all of a sudden their tolerance is down and they do one of these and they're dead.

>> Ms. Davis: That's correct.

So tolerance reduces in just five days of abstinence.

And so if somebody is incarcerated for even a short period of time, their tolerance decreases substantially.

And they're at much higher risk of morbidity post-release.

>> Tom Layson: What's next?

You talked about some of the programs that are being rolled out, some of the ideas that are happening, the funding that's come in place, the danger of what we're seeing right now.

So a year from now, you know, when you and I meet next time, what will we be talking about about what's happened?

Or what's on the radar in your next session?

>> Ms. Davis: Sure.

So one thing that we made some investments in in the legislative session that just ended that we really need to be thinking about, is how do you bring people into care?

So I'll give you the example of what are called syringe service programs or needle exchanges.

So people come into a needle exchange presumably to get needles.

But actually, a lot of people are no longer shooting because of the fentanyl, as we discussed.

They are smoking fentanyl pills.

So in order to actually try to bring people into services, you might need to offer other services.

Safer smoking supplies, for instance, might be more appropriate to actually bring people in.

The point is not again that people are just, you know, using or smoking forever.

The point is that you're engaging them with a person.

>> Tom Layson: Right.

Because you can hear the arguments.

"Here we go.

Now we've given them needles, now they can come in and smoke it."

>> Ms. Davis: Right.

>> Tom Layson: "What are they thinking?"

Well, it's that point of contact.

>> Ms. Davis: That's exactly what it is.

So it's all about engagement.

The antidote is actually engagement.

That is actually how you end up treating this disease ultimately, and maintaining that engagement.

And you've got to build that bridge to trust.

And you can offer, you know, other things.

Another, you know, big evidence based intervention, tons of robust research, is something called contingency management, which is effective for all types of substance use disorder.

It's especially effective for people with methamphetamine use disorder, because we don't have medication equivalent to treat methamphetamine use disorder the way we do opioid use disorder.

But the premise of contingency management, which we funded some more of and I hope to see expanded, is you are actually giving people rewards, essentially.

So you're kind of working on that brain's reward mechanism for continuing to come to treatment, or for having a negative urinalysis test.

So for having tests that have a reduction or no substances, you're actually giving people pretty modest rewards.

But it turns out it's wildly effective with this population.

And human beings are motivated by rewards.

And so we need to start thinking more outside of the box and actually looking at the science and thinking about, particularly, how do we reach these young people who it's hard to find somebody who doesn't have opioid use disorder, but yet they're at risk of dying from a pill.

>> Tom Layson: Yeah.

>> Ms. Davis: And so how do we, you know -- is it through Tik Tok?

>> Tom Layson: There's setbacks, yeah.

Yeah.

>> Ms. Davis: I mean, how do we actually reach these young people?

>> Tom Layson: All right, boy, there's a lot to think about, Representative Davis.

Thanks so much for coming to Northwest Now.

>> Ms. Davis: Thanks for having me.

>> Tom Layson: Advocates say the injection of federal and state dollars into treatment represents a generational opportunity.

Let's hope so.

The bottom line, is solving the overdose and addiction crisis just a matter of money?

We'll see.

The results will speak for themselves when it comes to homelessness, crime rates and mental health metrics like overdose deaths and suicide.

I hope this program got you thinking and talking.

To watch this program again or to share it with others, Northwest Now can be found on the web at KBTC.org.

And be sure to follow us on Twitter @NorthwestNow.

Thanks for taking a closer look on this edition of Northwest Now.

Until next time, I'm Tom Layson.

Thanks for watching.

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