With opioid deaths on the rise, Spokane County expands methadone treatment program

Spokane County has eliminated two of the biggest barriers for people seeking treatment for heroin and opiate addiction.

County commissioners unanimously approved 142 new slots in the health district’s addiction treatment program for Medicaid patients in early January, all but eliminating the long waiting list many prospective patients faced.

The program also got approval to treat patients in the Spokane County Jail, something providers and jail officials have long advocated.

“It’s something that we’ve been struggling with for several years,” said Sgt. Tom Hill, who oversees medical care at the jail.

The program supplies methadone, which is used to treat addicts who have built up a large tolerance to opioids. The drug, which has to be taken daily, relieves physical symptoms of withdrawal, allowing clients to be receptive to counseling and other treatment to fight their addiction.

The expansion gives the program a total of 740 slots for Medicaid patients. For years, the program has had a waiting list of more than 100 people, even as deaths from overdoses have increased. Now there are about 100 open slots, though more are getting filled every day.

Program administrator Julie Albright said the only people still waiting are people who signed up for the list with a phone number that’s now out of service.

“As they call in we will bring them right on,” she said.

Commissioner Shelly O’Quinn said commissioners acted because of data showing increases in deaths from opioid overdoses over the past few years. In the first half of 2016, 63 people died from opioid-related overdoses, according to data from the county Medical Examiner’s Office.

That’s a large jump from past years. State Health Department data show 64 fatal opioid overdoses in 2015, up from 36 in 2014.

Funding for the expansion comes out of the state’s Medicaid program, not county funds, O’Quinn said.

Access for patients who are not on Medicaid is still an issue. Though many have private insurance, it doesn’t always cover opioid treatment.

O’Quinn said the county has submitted a request to the Legislature for $130,000 in funding to provide treatment for 130 non-Medicaid clients.

“Those are the dollars that are always more challenging to get for the county,” she said.

At the opioid treatment program, the methadone is dispensed to patients daily in liquid form. It’s kept under lock and key to prevent theft, and patients have to show up every day to take their dose.

That posed a problem for patients who ended up in jail, often on outstanding warrants.

“I can see the jail from here right now and they would not allow a licensed nurse to transport pre-labeled, pre-bottled methadone with seals and everything to the jail until now,” said Dr. Matt Layton, the program’s medical director, speaking from his office in the health district building.

If methadone patients got arrested after months or years in treatment, “they would have to go in for a week to clear their warrant, and that’s when everything would break down,” Layton said.

Without access to a replacement drug in jail, patients would slip into opioid withdrawal, which can cause nausea, vomiting, anxiety and fever-like chills. When they got out, they’d turn back to heroin or whatever drug they were using before entering treatment, Layton said.

Because their tolerance for the drug had decreased while in jail, many would overdose and some would die.

“We felt like people were just getting punished right when they were stabilizing,” he said.

DEA regulation of methadone was loosened in January, allowing the treatment program to sign a contract with the jail’s medical care provider, Birmingham, Alabama-based NaphCare Inc.

Sgt. Hill said jail and health district officials are working on logistics and preparing to open a second exam room in the jail. The program will target inmates who are placed on NaphCare’s opioid detox regimen.

Soon, nurses from the health district will make the short trip to the jail to administer methadone and provide counseling. Nurse practitioners at the jail will handle intake for new inmates who would like to enroll in the program.

“It isn’t simply just giving inmates the medication,” Hill said. “There’s an assessment piece of this. There’s a counseling piece of this.”

The program can now also treat people with buprenorphine, the generic name for Suboxone, another replacement drug. Buprenorphine is a more expensive drug that’s better for addicts with less tolerance to opioids.

It’s less tightly controlled than methadone and can be prescribed by some doctors. Albright said it’s less popular at the clinic because many patients have tried it before and found it wasn’t enough to fight withdrawal.

Chad Sokol contributed to this report.