SEQUIM — Medication-assisted treatment facilities work, Dr. Allison Berry Unthank, Clallam County public health officer, told about 40 people gathered at a presentation hosted by the county League of Women Voters.
“What we know is the science is super, super clear that MAT works,” she said Tuesday in the Sequim City Council chambers.
“For most people, MAT is a period of years,” Unthank added. “For some people they’re going to be on MAT for life.
“While on those medications, it blocks those receptors so they can function and it gives their brain time to repair.”
Unthank, a part-time physician at the Jamestown Family Health Clinic who also treats patients with opioid addiction, said she didn’t want to speak specifically about the Jamestown S’Klallam Tribe’s proposed medication-assisted treatment facility, which will treat people from both Clallam and Jefferson counties.
She said she has no financial interest nor planning in the tribe’s Healing Campus.
Jodi Wilke of Port Hadlock, the board chair of Save Our Sequim which opposes the proposed facility, spoke up during a question-and-answer session.
Wilke attempted to contest some of Unthank’s data points but was stopped as she didn’t present a question immediately.
After the meeting, Wilke said some of her points of contention about the data included how much availability of treatment exists in Clallam County, treatment turnaround times and abstinence rates.
Unthank said the opioid epidemic has mostly been in rural counties across the country and that Clallam was hit harder than most rural counties in the state.
“As of 2016, we’ve had one of the highest overdose rates in the state,” she said. “We’ve been working hard to bring that down.”
Per 100,000 residents, Clallam County saw 62 opioid overdoses and 17 deaths in 2016, she said. Although the population of Clallam County is less than 100,000 (76,737 in July 2018 according to the U.S. Census), statistics are reported in units no lower than per 100,000 people.
“Seventeen doesn’t sound like that many people, but the number of traffic fatalities we had was 11,” Unthank said.
In actual opioid overdose and death totals, the county’s numbers have gone down from 2016-2018, she said, citing 62 opioid overdoses and 16 deaths in 2016; 31 opioid overdoses and 10 deaths in 2017; and 30 opioid overdoses and 6 deaths in 2018.
Unthank said preliminary numbers for 2018 showed two deaths, but because of delays in toxicology reports through the coroner’s office, four more came in early this year.
“We did not do as well as we had hoped in improving overdoses,” she said. “That’s still better than where it should be, but this is something no one should be dying from. This is a very preventable thing. We like to get that number even lower.”
She said health practitioners and first responders believe the biggest reason for decreasing death totals was increasing access to Naloxone, or Narcan.
Goals
A member of the Tri-County Coordinated Opiate Response Project, a team of health officers and various elected and stakeholder officials from Clallam, Jefferson and Kitsap counties, Unthank said the group set three goals: safer prescribing, increasing access to Naloxone and increasing access to evidence-based treatment.
“We wanted to see if patients were taking pills and see if clinics have protocols,” she said. “We found out a lot of them weren’t.”
Unthank they’re “not pushing everyone to stop prescribing narcotics,” but instead, “trying to make sure everyone is safe about it.”
In recent years, she said, Clallam County physicians prescribed as high as three times as many opiates per person versus Washington state’s average. Now, however, local physicians prescribe at about 1.6 times that average, she said.
She said from the most recent data available in 2012, Clallam County physicians were prescribing 76 pills per resident.
Unthank said it’s a misnomer that the number is high because of Clallam’s high elderly population.
“What we’ve seen nationwide, the number of opioid pills distributed doesn’t track with age,” she said.
Clallam County had an average of 50 years old and Jefferson County 57. Jefferson County physicians were prescribing less than half of Clallam’s rate, at about 28 pills per person.
“We’re very cautious how we prescribe to elderly people (because they) tend to be very sensitive to how they respond to medicine, so generally our elderly patients are on lower doses because we find they respond very strongly,” Unthank said.
The ample supply of pills being prescribed though were ending up on the street, she said.
“We’re working hard to change that,” she said.
Unthank said the No. 1 reason people start heroin is from pills, whether from a doctor’s office or someone’s medicine cabinet. She recommends patients lock prescriptions up.
About medication treatment
In 2018, Clallam County had more than 1,000 Medicaid patients living with opioid disorder, and Unthank said physicians know there are more in the county because that’s not counting those with private insurance and housing issues.
Of those diagnosed, Unthank said, about 45 percent have access to treatment right away.
“When we first started this treatment, the wait list was about three months, which is far too long,” she said. Since then, a few sites can begin treatment in two-three business days.
“It’s something we still need to work on,” Unthank said.
Currently, Clallam County physicians subscribe only Suboxone (Buprenorphine) and Vivitrol (Naltrexone). No facility offers Methadone now. A planned BayMark Health Services will when it opens in Port Angeles.
She said all three medicines interact with opiate receptors and “if dosed appropriately they take the extra ones offline so you can feel normal.”
“Once we find the right dose for them, if you ask them how they feel, they feel fine. They don’t feel highs or withdrawals. They just feel normal,” Unthank said.
Suboxone and Methadone help withdrawals, she said, but Naltrexone does not because a patient must go through withdrawals first before being able to start it.
The treatment medications can prevent someone from feeling high if a patient were to take heroin making them less likely to relapse, she said.
Unthank said the biggest reason people relapse is because withdrawals feel terrible.
Refering to a 2003 study in The Lancent, she said 90-plus percent of people fail in abstinence-only programs.
“While it sounds good on its face, it just doesn’t work for a vast majority of people,” she said.
Researchers no longer compare abstinence versus treatment programs. she said; they feel it’s unethical because patients might die.
Objection
After the presentation, Wilke said once BayMark opens in Port Angeles, one in 81 county residents could receive treatment in the county and once the proposed Sequim MAT opens it would be about one in 66 residents.
Wilke compared this to Pierce County, where one in 435 residents have access to treatment, she said, adding that the Sequim MAT would significantly increase capacity in Clallam County.
“The question it begs is whether the lack of treatment in the metropolitan areas will drive this (opioid use disorder) population in our direction,” she said.
Wilke also questions the treatment availability in Clallam County because Olympic Peninsula Health Services, which offers MAT services, in Port Angeles is open only three days a week.
She also said that Methadone can get people high in higher doses going against prescribed doses.
“Drug addicts divert drugs often and are also prone to manipulate providers into increasing doses,” Wilke said. “Most will do what it takes to get high, including combining Xanax and meth amphetamines with methadone to get a similar effect as heroin.”
Wilke also said everyday people are only a portion of those who face addiction.
“This is not the face of the people living on the streets of PA or in the camp in Aberdeen,” she said.
“To focus on the population that is not troublesome as if it was representative of the whole gives an unreasonable, perhaps even negligent, perception that we have nothing to worry about at all.”
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Matthew Nash is a reporter with the Olympic Peninsula News Group, which is composed of Sound Publishing newspapers Peninsula Daily News, Sequim Gazette and Forks Forum. Reach him at mnash@sequimgazette.com.
