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>> Tom Layson: Before COVID-19 struck, there was another public health emergency at the top of the priority list, an unrelenting wave of opioid addiction and overdose deaths.

And like everything else, we now know COVID is going to make a bad situation that much worse.

New concerns about overdose deaths, opioids, and the difficulty of getting clean during a pandemic on Northwest Now.

[ Music ] We are now in a third national wave of opioid addiction.

The CDC says the first was in the 1990s, driven largely by doctors overprescribing perhaps naively.

Then starting in about 2010, big pharma and the drug distribution industry fueled a second wave that took 450,000 lives, accountability coming only now in the courts.

Now, in a third wave, starting about five years ago, we're seeing overdose deaths zoom up.

Nationwide, deaths in the first half of 2020 were up almost 40%.

The DEA says counterfeit fentanyl pills that are made in China and Mexico and distributed by the Mexican cartels are to blame.

In Washington state, in the first six months of 2019, there were 607 overdose deaths.

In the first half of 2020, 835, with fentanyl claiming about 40% of those.

Between April and June of 2020, fentanyl overdose deaths were up 133% in Seattle.

This isn't all happening in a policy vacuum, either.

For context, consider this.

The Washington State Supreme Court recently tossed out the state's criminal drug possession laws.

Meanwhile, Seattle's conservative media exploded over the Downtown Emergency Services Center's decision to pass out heroin pipes.

And so-called booty bumping kits for use by their addicted clientele.

Both considered harm reduction strategies like needle exchanges.

Now that is not pretty and it's certainly shocking to those of us observing from the outside in.

But it's supported by people in the field trying to reduce deaths and hospitalizations.

So into all of this, walks a Northwest Now regular, the UW's Caleb Banta-Green.

Tell me a little bit.

Give me a broad overview.

What's going on out there in terms of trends with overdoses, addiction, use, and some of those things?

>> Mr. Banta-Green: Yeah, I mean, COVID's hard on everybody, and a lot of the things that it's resulted in in terms of isolation and stress for everybody, um, has turned to a lot of substance use.

So a lot of sort of trying to escape, trying to feel better, whether it's alcohol, or cannabis, uh, or whether it is what we currently have as illicit drugs in terms of cocaine, methamphetamine, heroin, opioids.

All of these things, um, people are trying to use to make themselves feel better and that's true across the continuum, whether people have substance use disorder or not.

So we're just seeing more substance use.

People who already have substance use disorder, uh, it's really ratcheting up, and we're seeing more harms related to it, more, um, overdoses and fatal overdoses.

Because, again, people are isolated.

There's no one there to help support them and provide them medical care or call 911.

>> Tom Layson: I'm not a researcher, so I may not ask this right, um, in terms of my hypothesis here.

But is there a synergistic effect of COVID on addiction, and then, in turn, addiction on COVID?

Um, are they feeding each other?

>> Mr. Banta-Green: Well, I don't know the degree to which addiction is feeding COVID except to the degree, um, that, you know, as people with substance use disorder, um, often have other health conditions.

They may develop respiratory problems are cardiovascular problems.

So if they get COVID-19, they might be more susceptible, uh, to serious consequences.

Um, but I think it's much more the situation that COVID, in terms of the isolation effects, and the economic effects, and the housing effects.

Is much more likely to be either causing or exacerbating the impact of addiction.

>> Tom Layson: Um, nice segue into a question I have for you.

A little news item here.

We've got a couple of them, but the first one, the moratorium on evictions is set to expire on March 30th.

Um, how does, you know, we talk about synergistic effects.

How does that or do you anticipate it will play into this or what are you sensing?

>> Mr. Banta-Green: Yeah, I mean, people becoming unhoused is just so incredibly hard on them physically, emotionally, socially, economically.

It just is.

Um, now you have all the pressures you had before, plus the instability of living.

You're living in situations typically outside are very unstable.

Um, so that's going to add a lot of anxiety, and it may also add physical exposure, and you're not able to have the hygiene, and other things that are happening.

So, you know, um, where I live, uh, there's a large park across the street and we've gone from about, uh, 20 tents a year ago to well over 100 now.

And the circumstances of people's lives are just it just ratchets up the chaos and the potential for harm.

>> Tom Layson: I'm going to ask you a very general question here.

I'm sure you're going to roll your eyes from a quantitative, uh, what a mess this is going to be quantitatively.

You mentioned the increase in the tents that you saw.

Is your sense, and I realize it can only be a sense here, was there progress being made in addiction and the incidents of use going down and then COVID's ramping it back up?

Um, were we on a flat and COVID's going to increase it?

Are we going to stay flat for longer?

How do you - when you look at the megatrends for some of the problems you're trying to address, how do you see it?

>> Mr. Banta-Green: Yeah, the issue is is that COVID has exacerbated things, for sure, um, and while we definitely made some really nice progress on expanding access to the overdose reversal medication, Naloxone.

I mean just phenomenal, uh, progress in terms of tens of thousands of kits being put out.

And increased access to opiate use disorder treatment medications, particularly buprenorphine and methadone.

Which have definitely blunted - they were blunting the effect of, um, the opioid overdose death rate.

So we were going like this.

I think we've seen really a leveling off ahead of some other communities in the United States.

And with, um, fentanyl, as a really potent new opioid, and with methamphetamine, those things are now continuing to increase.

So even though we've been able to retain a lot of those efforts, um, they're really being overwhelmed, um, by the impacts of COVID.

And by this continuing availability of these two drugs in particular, both fentanyl and methamphetamine.

>> Tom Layson: And a lot of the fentanyl overdoses are, um, fake pills, uh, counterfeit pills, that are catching people, um, unaware and killing them.

>> Mr. Banta-Green: Yeah, very briefly on that point but it's a super-important one that people understand.

So fentanyl is a prescription drug.

It's for severe pain.

It's used in, uh, surgeries.

And the reason it's used in surgeries is it's very fast-acting, and it's very strong, and when you stop administering it, it goes away.

Um, those things, um, in a non-medical setting, are perfect for addiction, very strong, very fast onset, it goes away.

That primes the body to addiction, that quick cycle.

Um, so what we're seeing now is that fentanyl is being manufactured, um, either with precursors from China or India.

But basically, really in Mexico and being shipped up here, almost entirely being sold as pills.

We've looked at the Washington State Patrols' crime lab, and what they found was 89% of the fentanyl evidence they tested was in a tablet form, so almost universally.

And this is not just sort of off the street, as we think about it, but it also is very much off of the Internet and off of social media.

And so we really have sort of two different phenomena happening.

Generally with more opioid-naïve people, often, therefore, younger people who are really using what they think are oxycodone 30 tablets.

They look just like them.

You can't tell the difference, but in fact, they're fentanyl.

And then people with opioid use disorder who, um, because they're not able to access treatment readily, they need to use opioids to not feel terrible.

And they're going to use whatever's most available, and cheapest, and quickest, and now, it's often these fake pills.

>> Tom Layson: A couple of news items here.

Uh, Washington State Supreme Court just recently, um, threw into question the state's drug possession laws.

Um, you know, you've always got this carrot and stick argument here.

Do we - are we going to increase addiction and hurt people by taking away, um, the stick associated with being arrested for possession and going through the criminal justice system?

>> Mr. Banta-Green: No, and here's the reason I say that.

If you step back, and as a society, and said, we have substance use disorder.

It is a serious medical condition and we want to figure out the most effective way to humanely get people into treatment.

Nobody would say it's via incarceration.

That's not what we would say.

There are historical reasons that that has happened, but that's not the most effective way into treatment, for sure.

Instead, what is most effective, is to actually offer services that people want, when and where they want them, in a kind way.

And so we've spent a long time with a treatment system and a health care system that has provided care for a small minority of people, maybe 20, 25% of people are getting their care met there.

Those other folks out in the community, it isn't that they don't want to stop or reduce their use.

We have surveyed thousands of people in the state.

The vast majority do.

The vast majority also are not able to access the health care system because they're not treated well there.

Because there's so much stigma and so much shaming.

So what my team has done at the University of Washington in partnership with others around the state is we have built on-demand, low barrier to care.

In-community settings at public health clinics, at syringe exchanges, at, um, services for people who are unhoused.

And when you build services that are evidence-based, that are on-demand, where your goal is engagement, not perfection.

Your goal is engagement and treating people well, people line up hours early to get it.

If you build the right care, if you make the most delicious care ever, people will show up.

You don't need a stick.

>> Tom Layson: Um, a little controversy, uh, for past week, week and a half, two weeks, involving DESC and their, um, promoting - it looks like promoting, uh, booty bumping kits and crack pipes.

You have this, um, situation where a lot of people look at that from the outside and go, "Oh, my gosh."

So can you address this balancing up - act between the optics and harm reduction?

Um, do you understand people's point when they're a little shocked by that?

>> Mr. Banta-Green: Sure, I understand, um, people are not aware of how people use drugs and the harm associated with that.

Um, that is, in particular, people who have been using substances for a long period of time, are dependent upon them, are injecting those drugs.

And because they've used over time, the ways they are injecting get increasingly dangerous that are associated with life-threatening, uh, heart infections, uh, HIV, hepatitis C. Um, so we're talking about people who are really having severe patterns of use and effects of that use, and what we're saying to that small subgroup of people in a very targeted way where they are is.

"We want to help you use in safer ways.

And we're doing that because you're already using.

We're not saying that we want you to be using.

We're saying we care about you.

We want you to be healthy and we want to support you in using safer ways."

And that slow reduction in harm is very important for their health and their life, but also, as a human being, is engaging with them on their terms.

And a chance of them returning that, and engaging with you, and working with you, and building a relationship over time.

That may well lead for many people eventually to a pathway to, uh, health and to recovery.

That's how that happens.

It's not absolute hammer type of thing.

That doesn't make sense in that context.

This is very targeted messaging in the context of supportive housing for people with severe substance use disorder and mental health conditions.

>> Tom Layson: Yeah, the target audience there, um, isn't, uh, those of us in suburbia who look at this from a distance.

Um, it's people who are in harm's way directly.

And as bad as the optics are, maybe, and as bad as, you know, the flier about that it sounds like they're promoting it, um, may read, there's a method to the madness, is what I hear you saying.

>> Mr. Banta-Green: That's exactly right.

And if you think about it, you have a mountain climber on a precipice and you're trying to help them be safe.

You're not trying to say to everybody else, "You should go be a mountain climber."

>> Tom Layson: Yeah.

Um, last question for you here, Caleb.

What is needed?

If you could wave a magic wand and say, uh, you know, we're going to spend x number of dollars to do this, what is it that, um, you would like help advocating for?

>> Mr. Banta-Green: I think what's important to understand is that substance use disorder is a consequence, not a cause.

So just treating that consequence is not going to provide that person in our communities and their families the support they need.

We often talk about whole person care.

We talk about substance use disorder as biological, psychological, and social.

Too often, treated - treatment is focused on just the biological or just the psychological, but we need to realize the context of people's lives, the reasons they're using, the chaos it has created.

And work with them, and their communities, and their families to provide adequate supports to help a person emerge from chaos.

That is a multiyear process.

That is a multifaceted process that involves all different sectors.

And it's not about, um, enabling substance use.

It's not about that at all.

It's about enabling life, and recovery, and a restoration to humanity for people who have [inaudible] substance use disorder.

>> Tom Layson: Leaving on that positive note, uh, Caleb, thanks so much for coming to Northwest Now.

>> Mr. Banta-Green: Thanks so much for your interest.

I appreciate it.

>> Tom Layson: A recent study found that 82% of addicts want to get off drugs and about the same percentage now carry those overdose reversing Narcan kits.

While Narcan is available at pharmacies without a prescription now and there's no threat of prosecution for helping under our Good Samaritan Law.

The experts think that sheltering in place has increased addiction, triggering stress, and caused a lot of people to use alone, which means there's no help available when somebody starts to OD.

Joining us now is Brad Finegood with Seattle and King County Public Health.

>> Mr. Finegood: Yeah, thanks, Tom, and thanks for having us on.

Um, overdoses continue to rise.

We've seen, um, a trend here locally in Seattle, King County.

And we also know from information and reports that especially in the first half of 2020, uh, overdoses have risen, um, throughout the state of Washington and nationally.

We've seen, um, a lot of overdoses, uh, continue to rise predominantly due to the impact of fentanyl.

So fentanyl is an opioid that, um, fentanyl in it's like, uh, in its medicinal form is actually a very effective pain reliever that doctors have used for ages.

But what we've seen is fentanyl come into our community in a different way.

We've seen fentanyl come in in the form of counterfeit, um, counterfeit pills, and so, um, the number of people who have died of fentanyl-related overdoses has increased exponentially.

In 2015, we had three people die of fentanyl-related overdose.

And although the numbers are still preliminarily like, um, uh, so the numbers are still preliminary.

Um, we are estimating that in 2020, that number has risen from three in 2015 to 176 people have died with fentanyl in their system, uh, in 2020 last year.

So the number of people, um, they're younger.

They're, um, and it seems as though that the fentanyl risk, um, has raised overdose numbers tremendously in our community.

>> Tom Layson: And I know you're not a pharmacist, but generally speaking, fentanyl is more potent, right?

So somebody who thinks they're getting, um, they're going to replace heroin or they, um, are going to relieve their pain because they've been taking x.

They get this counterfeit stuff, now it's x times five, or whatever the dosage may be.

>> Mr. Finegood: That's exactly right, Tom.

So fentanyl is a super-powerful opioid that is 50 to 100 times more powerful than heroin or morphine.

And so when somebody, um, sees a pill and they're most, uh, they come into our community predominantly in the form of these blue M30 pills.

So they are pills that are made to look like Percocet that you would get from a doctor or a pharmacy, but they are bought - they are brought in here illicitly.

Um, and people who have a lower tolerance to like what a normal Percocet - they might be taking Percocet for their pain or something like that.

And they take these pills 50 to 100 times more powerful, increases the lethality risk tremendously.

>> Tom Layson: Um, as a side note, what is happening with the more, I guess, you know, I'll call them traditional drugs, for lack of a better term, with heroin?

I also heard a year ago or so, that before the pandemic, um, hit us, that meth was really making a strong comeback, too.

Um, give us a little insight into what's happening in the community there.

>> Mr. Finegood: Yeah, that's really true.

Um, you know, the heroin overdose deaths have - they haven't flattened out totally, but, um, they pretty much since 20, uh, 15, 2016, um, they've been pretty stable.

Methamphetamine in, uh, overdose has continued to rise, also.

There's a tremendous amount of methamphetamine that is involved in people's overdose deaths.

We do know that with both heroin and methamphetamine, the, um, the majority of people who are dying of overdose with those drugs have multiple drugs in their system.

So they're often taking, uh, multiple drugs at the same time.

All of our information, we pride ourselves at the health department in public health, Seattle, King County, of making all the information publicly available.

So if, uh, anybody in the public goes to KingCounty.gov/overdose, um, on the Data Dashboards page, we have all, uh, of the updated information on drug overdose deaths.

>> Tom Layson: Yes, you're getting in the synergistic effect between some of these drugs.

And then somebody, if their immune system's down because they're either under stress for homelessness, or they've got COVID, or something like that, they really can take a licking.

>> Mr. Finegood: That's absolutely true.

And we've, uh, you know, continued to hear stories and stories from the community about people using methamphetamine often, um, as a coping mechanism to deal with living outdoors.

You know, um, to be, uh, to stay awake, to be vigilant, so they do not become, um, a, you know, they're not, uh, predatory, you know, so people don't - aren't predatory upon them.

>> Tom Layson: I'm - I know you're not a policy guy.

I'm not going to ask you to site, uh, to site code sections in the Washington state law.

But there has been some news recently, the Washington State Supreme Court said, you know, something, um, the possession laws are going to be tossed out.

From a behavioral health and a substance abuse perspective, I think there's a legitimate question to ask about whether that is going to help or to hurt at the user level.

We're not talking about big dealers here, people moving weight.

But at the user level, do you think the loss of the threat of arrest and prosecution is a good thing, a bad thing, are we going to have to wait and see thing?

>> Mr. Finegood: Yeah, I mean, what I would say is we know that, um, people having criminal legal system involvement for a health condition is not a good way to treat people's health conditions.

And we really, uh, believe that and we know from all of the research that people with significant substance use disorders have a health condition that needs to be treated.

Treating that with a punitive approach, um, often, uh, can exacerbate the problem.

Look at example of that is if somebody is using opioids, they go to jail.

Their tolerance is low for an extremely long period of time or even a short period of time.

They get back out, um, and they're using drugs.

That greatly increases their risk of overdose.

We know and we believe that there are very effective ways to treat people with substance use disorder.

And if we can, you know, bolster those public health approaches to treating people with substance use disorder, it has the possibility to be a really, really good thing for people.

>> Tom Layson: With that said, and I know you hear this probably all day, every day, but I want to give you a chance to hit it on this program.

Critics often see some of the harm reduction strategies like injection sites or the distribution of, uh, drug ingestion hardware, as an endorsement, um, of addiction or an endorsement of vagrancy.

Is there any part of addiction that is viewed by the people you're exposed to in the intervention community, um, or with whom you interact, who see addiction as a legitimate lifestyle?

Does anybody think that?

>> Mr. Finegood: Uh, you know, that's a really interesting question.

Uh, there is some new literature out that, um, that poses that question out to the community.

Um, you know, I don't think it's up for me to judge that, but what I will say is that, you know, people with substance use disorder, uh, need to be treated in whatever way that is.

You know, there is the potential for greater harms, uh, for medical conditions due to their substance use disorder are huge.

So whatever we can do to mitigate those harms, to engage people where they're at, we know that also that people who have significant substance use disorders use in a way that is risky to them.

Um, the more that we can engage them in services, put social services around people, and put services that they're - that they'd be willing to use, um, the better off that they're going to be.

Around the world, there are harm reduction strategies that are implemented that are, you know, extremely evidence-based and have great health outcomes for the people who use them.

>> Tom Layson: Right, but I guess point being is people who are addicted to drugs, um, need treatment, need to get off them.

It's not a legitimate choice.

>> Mr. Finegood: You know, it's I can only answer that question for the people that I'm tasked with serving, and those are the people with significant substance use disorders, right?

And so however they're willing to receive services, I mean, that's what I would, um, that's my job, right?

That's my job in public health is to improve the health of those individuals and the community's well-being and health.

>> Tom Layson: If you could just make something happen with this, you know, $1.9 trillion worth of stimulus we're getting.

If some of that could be set aside for community health, what are those things?

What's working?

What has you excited about, hey, this could be a game changer?

>> Mr. Finegood: Yeah, um, good question.

So there's, you know, uh, tons of research and evidence around the impacts of medication-assisted treatment and medications for opioid use, right?

We know that there's really effective medications, especially methadone and buprenorphine.

So the more that we can - and we've worked really, really hard to make that as accessible as possible.

So, um, so we would, you know, like to expand those.

We'd like to figure out, you know, for other substances like methamphetamine.

If there is more options for, you know, people, um, to, you know, there's not any like silver bullet medication like there is methadone or buprenorphine for people who are using stimulants.

Um, but I also think that housing is a major factor, right?

The more that we can, you know, put people - have people housed that are currently unhoused, and, um, you know, put the supported services around them where they're at.

I think we'll do, um, really [inaudible] person's work.

>> Tom Layson: Last question for you.

Do people care enough about this?

We're, you know, understandably preoccupied with the national health crisis around COVID.

It is a national emergency.

No doubt about it.

And but there's only so much bandwidth a person has to care and really be involved in these things.

The overdose thing, literally before COVID and now after it, has people dying in the streets in this country.

Do people care enough about it and why not?

>> Mr. Finegood: Yeah, I mean, I think a lot of people care about it significantly.

You know, so many people in this community have been touched by substance use, by overdose in their family.

I've shared publicly that my brother died of a drug overdose.

You know, I run into people every day, all day, who, you know, when I have individual conversations with them, that they feel that they can talk about it.

Substance use is cloaked in stigma, right?

So as a community, you know, we don't feel like we can always talk about it.

And I also think that, you know, to your - to one of your points, earlier, you know, people often have this, um, discourse about, um, about strategies, right?

Like, you know, what is the silver bullet strategy?

And, you know, um, other countries have done other things.

We've employed, you know, for the past, you know, almost century, a war on drugs.

And that war on drugs, you know, it seems as, you know, the data proves where we're at today has been disastrously ineffective.

And so there's a lot of things that we need to be able to do as a community.

So, um, you know, COVID, um, has exacerbated, you know, people's feeling of disconnectedness, um, and, you know, we need to be able to work on connecting people to the services that we need.

There are so many people out there doing such good work in the community, um, but it is a long game and we need to continue to do the good work to be able to connect people to the services.

>> Tom Layson: Brad, I appreciate your time to coming to Northwest Now.

Interesting perspective.

>> Mr. Finegood: Tom, thank you for your time today.

>> Tom Layson: You bet.

The war on drugs failed.

We know, because there's more supply at lower prices than ever before.

While we talked mostly about treating the demand side of the problem, I also want to clearly identify the continuing threat posed by the Mexican cartels.

As they increase their production to take the place of a thankfully declining Chinese supply.

The bottom line, it's been clear for a long time that we need one strategy for in-country users, and another, no holds barred approach, for offshore suppliers.

Our national security depends upon it.

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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