Opioid epidemic and the future of Snohomish Health District

By Adrienne Fraley-Monillas / Board of Health

and Jefferson Ketchel / Snohomish Health District

Just a year ago, the Snohomish Health District stood at a crossroads as described in a Sept.19, 2016, Daily Herald article: “Once excellent” Snohomish Health District now “crumbling away.”

Our director and health officer of 10 years had announced his retirement, the Ruckelshaus Center had released its situation assessment report painting a picture of disengagement and obscurity, and the weight of a potential merger with Snohomish County and chronic underfunding persisted.

In parallel with these operational issues, the opioid epidemic was ravaging our communities, and the health district had not fully engaged with the problem. State law mandates that the district “supervise the maintenance of all health and sanitary measures for protection of the public health within its jurisdiction,” but it was limited in how it could use the majority of the funding — and opioids were not a funded item.

A change of direction was critical if the health district was going to deliver on this mandate and its mission “to improve the health of individuals, families, and communities through disease prevention, health promotion and protection from environmental threats.” Our leadership, with Board of Health support, approached cities and Snohomish County to form a partnership to protect existing programs and to enhance public health services, as well as address opioids. Each city and the county was asked for $2 per capita. They answered positively, and we launched our enhanced opioid efforts.

System changes to address opioids

From a public health perspective, opioid use disorder is a disease, not a failure of will. As a society, we create systems and environments that make illness or wellness easier or more difficult to achieve.

Several decades ago, tobacco use was prevalent throughout society, and smoking indoors was the norm. This norm was supported by policies that allowed this behavior, as well as a system that promoted tobacco use. Through system change, we began limiting advertising and the locations where products could be used, while also working to make services to aid quitting more available. This resulted in a decline in tobacco use by helping users quit and preventing youth from starting.

The same approach goes for opioids. We must change the system of how and why people misuse and abuse, as well as provide treatment options and reduce the collateral damage. We do not have a single silver bullet for prevention, but we do have many solutions at our disposal. In the past six months, the health district and its many community partners have made significant strides:

We implemented the eighth secure medicine take-back program in the nation, funded by the pharmaceutical industry. It now operates at local law enforcement locations and pharmacies around the county. Information can be found at www.med-project.org.

A one-stop-shop for opioid information and resources was launched and can be found at www.snohomishoverdoseprevention.com.

Community syringe cleanup kits are available at the health district’s Everett location, as well as from some other government partners.

We have distributed lock bags at community events so prescription drugs can be securely stored at home.

Innovative sources of data to report and track the opioid epidemic are being explored and carried out, such as the seven-day overdose count we oversaw in July.

We’ve maintained our services of working with law and code enforcement officers to clean up nuisance properties.

Our WIC/First Steps programs and public health nurses continue to work with at-risk and addicted parents to break the cycle by raising a healthy next generation.

And we’re collaborating with multiple local partners in developing the next phase. A lot has been accomplished, but there is still much more to do.

The future

We envision a future where the Snohomish Health District is viewed as the community’s chief health strategist. As the world changes, we must also change to meet current and future demands. Being the chief health strategist means knowing in real time the health of the community, being nimble and adaptable to new causes of illness and injury, and targeting those causes of illness quickly and effectively. It means collaboratively working with traditional and nontraditional partners to get the job done by being approachable and accountable, customer-savvy, and modern through the use of technology. We have also started the journey to national public health accreditation and expect it to be completed in 2019.

The Ruckelshaus Center stated in its assessment that “interviewees envisioned a future where public health would be recognized, relevant and of value to the people of Snohomish County.”

We couldn’t agree more, and if the past six months are an indication of the next six years, we are well on our way.

Adrienne Fraley-Monillas is the chairwoman of the Board of Health and a member of the Edmonds City Council. Jefferson Ketchel is the interim administrator of the Snohomish Health District.