BREMERTON — Sen. Maria Cantwell, D-Washington, visited Bremerton Feb. 23 to discuss the opioid epidemic with Kitsap health care providers and law enforcement officers.
“Ten thousand Washingtonians died in a 16-year period of time (due to opioids),” Cantwell said. “The notion that so many people in our state have died from either opioid or heroin overdoses … probably makes it one of the (worst) drug epidemics in our country’s history, and certainly, it’s on the rise to become one of the biggest public health challenges.”
Cantwell gathered a meeting at Peninsula Community Health Services in Bremerton that included Bremerton Mayor Greg Wheeler; Kitsap County Sheriff Gary Simpson; Kitsap County Sheriff Lieutenant Jon VanGesen; Harrison Medical Center’s Dr. Bill Morris; Kitsap County Public Health Dr. Susan Turner; Dr. Lisa Rey with Three County Coordinated Opioid Response Plan; Kitsap County Human Services Director Doug Washburn; Dr. Jennifer Kreidler-Moss, the Peninsula Community Health Services CEO; PCHS’s Dr. Albert Carbo; and Salish Behavioral Health Organization’s Chemical Dependency Manager Sam Agnew. Also present were two women who shared stories of their struggles with addiction, and their recovery.
The meeting was to discuss the CARES Act, also known as CARA 2.0. This act, supported by Cantwell and a bipartisan group of six senators from throughout the country, aims to “get more teeth into the law” penalizing those who are over-prescribing opioids, Cantwell said.
According to a press release, CARA 2.0:
• Imposes a three-day limit on initial opioid prescriptions for acute pain as recommended by the Centers for Disease Control and Prevention (CDC), with exceptions for chronic pain, cancer, hospice and palliative care or pain for other ongoing illnesses.
• Makes permanent Section 303 of CARA, which allows physician assistants and nurse practitioners to prescribe buprenorphine under the direction of a qualified physician.
• Allows states to waive the limit on the number of patients a physician can treat with buprenorphine so long as they follow evidence-based guidelines. There is currently a cap of 100 patients per physician for the first year in which the physician prescribes buprenorphine, and an application process for physicians to raise the limit to 275 beyond the first year.
• Requires medical practitioners, including pharmacists, to use their state’s Prescription Drug Monitoring Program (PDMP) upon prescribing or dispensing opioids if their state receives federal prescription drug monitoring grants.
• Increases civil and criminal penalties for opioid manufacturers that fail to report suspicious orders for opioids or fail to maintain effective controls against diversion of opioids.
• Creates national best practices for recovery residences to ensure housing options work for individuals in long-term recovery.
“The legislation specifically increases the penalty tenfold, trying to put a real deterrent into the law,” Cantwell said.
Cantwell has been touring Washington — she’s also visited Spokane and Seattle — to hear from local providers about how the opioid epidemic has affected the area, and what practices or programs they think could help alleviate or altogether eliminate the problem.
Morris told Cantwell that a big help would be a state-wide, easily accessible database showing each doctor the previously prescribed medications a patient has received in at least the last few months. He said currently there is a limited-access database that a doctor can access if they go out of their way to do so, but it’s not a simple or easy process.
“It’s way better than nothing and totally has changed my practice,” Morris said. “I know I can go look if I’m concerned … on the other hand, it’s pretty easy to get fooled.”
Washburn pointed out the lack of a methadone treatment clinic in Kitsap County. Such clinics are aimed specifically at helping addicted patients quit using opioids or heroin — the latter being a less expensive illegal drug users often turn to.
“Kitsap County is the largest county in the state that doesn’t have an (methadone) opioid treatment center,” Washburn said. “(One company) has tried three times … but been turned down.”
He said that the company applied for three leases and was denied each time due to the “stigma against methadone clinics.”
Wheeler asked if the idea is to normalize the use of methadone to help ease withdrawal, why could it not be available in pharmacies?
“There’s a lot more to methadone treatment than someone taking methadone,” Agnew said. “There’s a lifestyle change and the process of change … and being supported with medication management as an intervention to those addictive behaviors.”
Kreidler-Moss said giving general practitioners the ability to treat drug addiction would also help.
“By being able to provide access to substance-use disorder treatment in the primary care setting, we’re able to see more patients,” she said. “Lots of times, it’s not the first attempt (to quit that sticks). It might be subsequent attempts. Really de-stigmatizing not only the idea, but that there might be relapses on the way, and approaching it as a chronic disease (would help).”
Law enforcement was also invited to the meeting, to discuss the impact opioids have on the community.
“This issue touches everybody’s home,” Simpson said. “Everyone is touched by this somehow … it’s affecting everybody.”
Burchett said an officer recently shot was prescribed an opioid painkiller, and was repeatedly offered prescription renewals.
“Is there a standard?” Burchett asked. “What is reasonable? We treat to end suffering. Is our standard of suffering so minimal we’re willing to overprescribe?”
There was also a recent attempted robbery where the culprit was after opioid painkillers someone had stored up for a “just in case for the future” stash since their prescription was also renewed regularly.
“Law enforcement is not first responders,” Simpson said. “We’re last responders. Everything we’ve tried to address — substance abuse, alcohol, driving under the influence — someone else has tried to deal with this. We end up getting stuck with the end result, trying to fix it.
“We need to get it back into the preventative area and into the treatment area, and put our dollars into actually … preventing these issues from getting to our level. We can continue to do enforcement, but that doesn’t fix it.”
Cantwell closed the discussion by reiterating that this effort is only the first step in the attempt to curtail methadone use.
“We’re basically coming back and amending a law that’s just not working,” Cantwell said. “At the heart of it is, why do we have this law? Because the Drug Enforcement Agency found this level of addictive drug is so dangerous to have in our community, it needed restrictions. I think we need to go back to that.”
To learn more about Cantwell’s CARES Act, visit goo.gl/nXdDPo.
— Michelle Beahm is the online editor for the Kitsap News Group. She can be reached at firstname.lastname@example.org.