Bobbie Lee Silva was driving down Pacific Avenue with her co-worker in late spring when they saw a woman running past House of Charity yelling for Narcan, a naloxone nasal spray that can reverse the effects of an opioid overdose.
No one seemed to have any for a man who was overdosing in an alley nearby.
Silva’s co-worker turned the car around, and Silva jumped out to stop traffic on Division Street. The pair ran back to their office at Compassionate Addiction Treatment to get the spray. When they returned, Silva used two boxes of Narcan, blowing it up the man’s nose as they waited for an ambulance.
“If we hadn’t been driving down that street, he would have died,” Silva said.
Drug overdoses have increased during the coronavirus pandemic, including but definitely not limited to opioids like fentanyl, which is more potent than morphine.
By the end of September , there were 70 overdose deaths recorded in Spokane County, a number higher than that point during the last three years.
A little less than half of these 2020 deaths were due to opioids, and there have been 18 fentanyl overdose deaths in Spokane County during that time, according to preliminary data from the Department of Health.
Demand is high, workforce is stretched
In the wake of increasing overdoses, the demand for treatment and services, which was high before the pandemic, has grown.
Compassionate Addiction Treatment never closed its doors during the pandemic, and the number of clients seeking services there doubled. The nonprofit, which offers treatment services on a walk-up basis to whomever needs them, initially served 40 to 50 people per day.
When the pandemic shut down other treatment options, the treatment center saw 70 to 90 people per day, with staff having to rotate clients through the building to meet distancing guidelines, said Hallie Burchinal, the center’s executive director.
The nonprofit tripled its staff and also moved during the pandemic from Second Avenue to a much larger building a few blocks east on First Avenue. Burchinal and her team use a harm-reduction model, never turning away a person who shows up, regardless of whether they are sober.
When they are ready to seek services, the peer counselors at Compassionate Addiction Treatment are ready to sit down with users and help them navigate other services they might need like housing or job programs. Then, depending on what a person needs, whether that be detox or a medication-assisted treatment program, they can be referred to a doctor, nurse or another program.
“We don’t care what they’ve done, where they came from, how high they are, none of that,” said Silva, who is a housing and employment specialist and offers peer support at the center. “And they can come back every day that way.”
In 2020, Compassionate Addiction Treatment served 656 people with free services and provided addiction treatment services to 484 individuals who had Medicaid or Medicare.
Burchinal said the pandemic revealed how much more support is needed, from detox services to mental health stabilization beds. She also saw the need for more low-barrier treatment, like CAT offers.
“You need to be here when someone is ready, because it could be the difference between life and death,” Burchinal said.
Across town, the Spokane Regional Health District is looking for new space to house its opioid treatment program because of an increase in demand.
The treatment program enrolls no fewer than four new patients each day, five days a week. While turnover is consistent, with patients leaving or no longer needing the program, the intake is outpacing the turnover.
“We’ve seen an exponential increase of need,” said Misty Challinor, treatment services director at the district.
The Spokane Regional Health District offers both suboxone and methadone to patients with opioid-use disorder.
The program treats about 1,200 patients.
Challinor said staffing shortages have been challenging as demand increases. She said the program needs more space for staff to do counseling and follow-up for patients.
Offering mental health services in coordination with addiction treatment is something many providers, including both Compassionate Addiction Treatment and SRHD, are hoping to do.
The health district program also uses the harm-reduction model, Challinor said. Some patients might be 20 years into tapering doses through the program, while others are actively working through their addiction.
Addiction is a chronic disease, and anyone can become addicted to opioids. In some people, addiction can turn into a lifelong disease that requires ongoing treatment, not unlike diabetes or other chronic medical conditions.
Despite this, Challinor said she still works to combat the stigma around patients who are receiving medication-assisted treatment, despite its evidence-based success.
“You wouldn’t ask someone with high blood pressure to stop taking medication, so why would you ask someone with an addiction to stop taking medication?” Challinor said.
“We serve an amazing group of individuals, and everyone that comes to us is looking for help, and we’re happy to help them find a foundation to improve their life,” she added.
An increasing presence of fentanyl
Dr. Michael Lemberger was one of the first physicians in Spokane to begin providing medical-assisted drug treatment back in 2008.
“I’ve had a lot of experience,” he said. “But not with fentanyl.”
Over the last month or so, Lemberger has seen a huge increase in fentanyl showing up in drug screens for his patients at Compassionate Addiction Treatment.
“Almost all the drug screens we’re doing have some fentanyl on them,” Lemberger said. “It has just exploded over the last couple of months.”
Fentanyl doesn’t respond to treatment drugs like Suboxone as well as other opiates do; in fact, taking drugs that are supposed to reduce withdrawal symptoms actually increases symptoms for those who mainly use fentanyl.
“It sort of stays in the fat and collects in the fatty tissues in the body,” Lemberger said. “When we give them the suboxone, it puts them into withdrawal, unfortunately.”
For Suboxone to work, Lemberger said he has to put patients on extremely low doses. Even knowing how much Suboxone to prescribe is hard because fentanyl pills don’t have a consistent amount of the drug in them, he said.
“It’s a tightrope,” Lemberger said. “It’s a difficult situation because we don’t know how much fentanyl is in any one person’s system.”
Ideally, those patients would detox under medical supervision, he said.
While there has been an increase in drugs laced with fentanyl, there also has been an increase in use of Mexis or Mexi-blues, pills often made on the black market in Mexico. Concentrated fentanyl is imprecisely mixed with other ingredients, then stamped into pills, making it impossible to know how much of the extremely strong drug is in each tablet, Lemberger said.
“You’re playing Russian roulette when you take or smoke one of these,” Lemberger said.
Opioid-use disorder can be treated with either buprenorphine, like Suboxone, or methadone, but only two providers offer methadone treatment to clients in Spokane County, one of which is the Spokane Regional Health District.
Methamphetamine, which is a stimulant, is not treated with medication-assisted treatment. The most effective ways to treat meth addiction are programs that combine counseling, therapy, drug testing and support group services or contingency management, which incentivizes patients’ clean drug tests. In 2020, there were 32 meth overdose deaths confirmed in Spokane County through September.
Barriers to treatment
Burchinal, at Compassionate Addiction Treatment, sees accessibility as a key component for people starting treatment .
From transportation to housing and food security, there are myriad other factors that could impede a person’s path to recovery.
“Recovery is a longer path for people living unhoused,” Burchinal said.
If recovery isn’t difficult enough, getting treatment while finding housing, a supportive job and making enough money to put food on the table likely is.
Silva, who has been clean and in recovery for more than three years, deeply understands what people she now works with are going through.
She used to live unhoused in Spokane, while trying to access treatment, around 2016. Compassionate Addiction Treatment did not exist yet, and despite her efforts to get help locally, she had to go to Montana to get treatment.
When she returned to Spokane to continue outpatient treatment, the program required participants to have good hygiene, Silva said.
“If I had still been houseless and not been able to shower, and somebody said that to me, I wouldn’t go back,” she said. “Instead of saying that, how about (they) have a conversation about where to get a shower?”
Ultimately, there isn’t enough treatment to go around. Burchinal said her team made the decision during the pandemic to focus on and serve those who were homeless, despite receiving calls from potential clients who were housed.
Silva and her colleagues continue to see the need for low-barrier treatment in the city.
“If we could get some more low-barrier treatment centers up here in Spokane, I think it would do wonders,” Silva said.
S-R reporter Emma Epperly contributed to this story.