Amy Burns: Spokane must seize opportunity to treat opioid abuse disorder

By Amy Burns, M.D.

Washington state has been awarded more than $1.1 billion in court judgments and settlements with opioid manufacturers and distributors. Nearly $36 million is coming to Spokane County. Our community has been laid low by the opioid epidemic, it’s critical that we spend this money wisely to reduce the impact on our community and help the people hurt by opioid use disorder. Becoming more aware of treatments that work and the current gaps in Spokane’s treatment system will help.

I came to Spokane about 20 years ago for residency. In the past six years, I’ve focused on addiction medicine. I’m board certified in this subspecialty and care for numerous patients with opioid use disorder. In fact, they are the reason I’m writing.

Opioid use disorder is a diagnosis defined by a constellation of symptoms. The criteria can be summarized as continued use despite negative consequences, lack of control and insatiable craving. Generally, this means that if you can stop, you don’t have OUD. Like other substance use disorders, OUD is caused by a nuanced interplay of biologic, psychological and social dynamics.

Research has proven that medication supports abstinence, increases treatment retention and reduces deaths from opioids. People taking medications like buprenorphine, methadone and naltrexone are more likely to sustain abstinence than people in support groups or therapy alone. In a review of 20 research studies looking at more than 3,200 people with OUD, the addition of support groups and therapy to buprenorphine didn’t improve outcomes. With that being said, support groups and therapy help people as they rebuild their circle of friends and practice new healthy habits. The community and people suffering with opioid use disorder deserve treatments that work. Yet, in Spokane accessing medications or residential treatment is hit and miss.

When you realize that OUD is going to kill you, you go to the ER. After waiting hours to be seen, you are given a script for a few days of buprenorphine and a list of clinics that could prescribe refills. Often, the pharmacy doesn’t have the specific form of buprenorphine in stock, so you wait until it ships from the distributor. To stay on the lifesaving buprenorphine, you’ll need an appointment with a clinic that takes your insurance. Many people run out before this happens. If you want residential treatment, you may wait weeks.

A 2020 survey of residential treatment settings in the United States by Andrew Huhn and colleagues, revealed that only 33% offer buprenorphine. We’re no different in Spokane. Some Spokane residential settings will not allow patients to stay on medications for OUD if they want in – even though it is their best shot at avoiding relapse. Other Spokane residential treatment centers will allow patients to continue buprenorphine. Unfortunately, addiction treatment is so underfunded many of these facilities cannot afford to hire prescribers. The $35.6 million could go a long way to ensure that people with OUD have access to an effective combination of treatments.

The Spokane County survey of local stakeholders agreed that the highest priority for the settlement funds was to support those in treatment and improve opioid use disorder medical care. Earlier this month, the Opioid Abatement Council for Spokane County announced plans to spend a portion of the settlement funds to remodel a building into a residential treatment facility to be managed by Pioneer Services.

The project is in the concept phase. We have opportunities to maximize the impact of the funds and avoid pitfalls. It’s important that Pioneer Services be funded adequately to offer medication as part of the treatment. Otherwise, the funds will build bed capacity without evidence-based treatment capacity. Most residential treatment centers accept patients with a variety of substance use disorders, like alcohol and methamphetamine, not just OUD. Funds earmarked to fight the opioid epidemic should fund treatment for OUD. Without guardrails, the money could inadvertently be spent on other deserving, yet adjacent use disorders, missing the mandate of the settlement funds.

While there are potential issues, they are outweighed by the potential that Spokane has to solve our system gaps. Spokane is a medical hub with expertise. Few communities are in as good of a position. We train the prescribing workforce and have graduating classes every year looking for jobs in town. We have treatments that are proven to work. Now we can bring together the pieces and fund those treatments. Understanding opioid use disorder, its treatment and Spokane’s current opportunities helps us use the $35.6 million to give the victims and our community a chance to recover.

Amy Burns, M.D., is a dual board certified psychiatrist and addiction medicine specialist working in Spokane.