After grim record in overdose deaths, county seeks change in Olympia

EVERETT — April Provost has seen many people recover from opioid addiction. She also knows too many who have died.

Provost, of Everett, has been in recovery for five years. She’s now an outreach coordinator for Ideal Option, a network of medication-assisted treatment clinics.

Provost has seen an already serious problem worsen due to fentanyl. At least 297 people died from overdoses last year in Snohomish County, a 4.2% increase from 2022. The data is incomplete, as the county medical examiner’s office is awaiting more toxicology reports from November and December. May was the deadliest month, with 40 overdoses.

“Barely a week passes and we hear about someone we know who ODs,” she said. “It’s haunting.”

Statewide, the overdose death rate increased 7.4%, according to provisional data from the Centers for Disease Control and Prevention. By the end of 2023, about 30 people for every 100,000 in the state died of an overdose.

“It’s only gotten worse,” said County Council member Jared Mead, who chairs the council’s Health and Community Services Committee. “Snohomish County is getting hit particularly hard.”

Opioids caused 80% of the county’s overdose deaths last year, and 76% involved fentanyl.

“Fentanyl has become an increasingly frequent killer in Snohomish County,” said county Health Officer James Lewis. “It is accessible, cheap and being cut into other drugs.”

Fentanyl deaths in the county were up at least 19.6% last year — 226 in 2023 compared to 189 in 2022.

The synthetic opioid, about 50 times more potent than heroin and 100 times more potent than morphine, sells for as low as 10 cents per pill. Two milligrams — not even enough to cover Lincoln’s face on a penny — is a fatal dose for most people, according to the federal Drug Enforcement Administration.

Over 40% of pills tested for fentanyl contained at least 2 milligrams of the drug, according to the administration. Some pills had as much as 5.1 milligrams.

The drug hit the streets around 2010 as a cheap, powerful alternative to heroin and the prescription opioids devastating communities.

‘Caught in active addiction’

Around 2007, a doctor prescribed Provost hydrocodone for her chronic pain, she said. Provost became hooked — she eventually lost her family, housing and job.

“When you’re caught in active addiction, your only future is the next fix,” she said earlier this month.

Some, like Provost, turn to street drugs like heroin, methamphetamine and fentanyl after prescription pills. About three out of four people who use heroin started on prescription opioids.

From 2006 to 2019, nearly 414 million prescription opioids flooded Snohomish County, according to a Washington Post analysis of DEA data. In 2010, the top year for pain pills in the county, pharmacies received enough to prescribe 49 pills to every resident.

In that 13-year span, more than half of the county’s pain pills came from Ireland-based manufacturer Mallinckrodt. Another drug manufacturer, Purdue Pharma, sold more than 25 million OxyContin pills in the county.

Lawsuits across the country for more than a decade alleged the pills were much more addictive than advertised. Nationwide, prescription opioids led to more than half a million overdose deaths over two decades. From 2007 to 2021, nearly 12,000 people died from an opioid overdose in Washington.

Over a decade ago, several states, including Washington, sued Purdue Pharma for deceptive marketing, alleging Purdue misled doctors and regulators on the drug’s addiction risk. The state later sued Mallinckrodt for its role in the opioid crisis.

In 2017, the county executive’s office created the Multi-Agency Coordination, or MAC, Group to tackle the crisis. That year, Everett sued Purdue, alleging the company allowed a Los Angeles drug ring to obtain OxyContin illegally and sell the pills on the black market in Snohomish County. Purdue called the claims a “flawed and inaccurate portrayal of events.”

In 2019, Snohomish County sued Purdue and McKesson, the county’s top opioid distributor with a location in Lynnwood, as well as local doctors, clinics and pharmacies for over-prescribing opioids.

“We see the suffering caused by opioid addiction in our criminal justice system, our neighborhoods and our schools,” then-Prosecutor Adam Cornell said at the time. “By filing this civil lawsuit, we are trying to force these companies to take responsibility for their reckless actions.”

The state’s settlements from opioid lawsuits — now over $1.1 billion from 11 companies — will be split in half between the state and local governments. For Snohomish County and its cities, the award is more than $50 million. The Everett suit is still ongoing, as it was consolidated with other lawsuits and moved outside the state.

‘Better results’

Those in recovery from opioid addiction advocated to have the settlement money spent on overdose prevention, treatment and other resources to combat the crisis. The county then developed a spending plan that includes expanding access to the overdose-reversing medication naloxone, known as Narcan, and providing medication-assisted treatment.

The opioid crisis also impacted Eric Velez, who is now in recovery. Velez works at the county’s recovery courts. He and Provost lobby for policy changes at the state level with the Snohomish County Recovery Coalition.

“Historically, we haven’t done a very good job of reaching out to the most marginalized of the community to ask them what they need,” he said.

Velez is also part of the MAC Group. The group slowed its efforts during the pandemic, but got back on track this past spring.

The group is revising its long-term goals this month, said Jason Biermann, senior policy adviser for the county. As of now, the county’s goals for this year include more drug education in schools, plans for a Mobile Opioid Treatment Program and updated community education programs.

“Many agencies are working really diligently to mitigate the impact of the drug epidemic,” Biermann said. “My hope is in the next year, we will see better results.”

The county also has plans to hire an epidemiologist focused on the opioid crisis who can identify demographic trends, Biermann said. Lewis, the county health officer, said his department is developing a program to educate providers on best practices for opioid prescriptions.

Provost wants to see an update to the traditional recovery model of detox and rehab for 28 days. There’s more than one way to recover, she said — and with fentanyl, there has to be.

Evidence has shown fentanyl stays in people’s systems and alters their brain chemistry longer than other drugs.

“We thought heroin and meth were the worst it was going to get,” she said.

Mead, the County Council chair, said the county is asking the state to expand insurance coverage for longer recovery plans.

‘No. 1 priority’

Mead said the opioid crisis is the county’s “No. 1 priority” as it went into the state legislative session in Olympia this month. The issue is personal for Mead, who has family members who have struggled with addiction.

The county hopes to expand involuntary treatment legislation, known as Ricky’s Law, to commit people who are an “overdose away from death,” Mead said. The law change could also get funding for more local treatment beds, he said.

Along with beds, the county also needs more — and a variety — of housing, Mead argued. This includes low-barrier apartments and cheaper single-family homes.

Part of the issue, he said, is that Snohomish County is one of the top 10 fastest-growing counties in the country.

“We’re bursting at the seams, and we don’t have enough services,” he said.

Updated drug education and Narcan supply in schools is another area of focus. The county wants legislation requiring all schools to have Narcan. Right now, it’s only required for schools with more than 2,000 students.

“One pill can kill is not some kind of scare-tactic misnomer,” said Biermann, who has a child in high school. “As a parent, it’s really scary.”

Velez said not to lose sight of people suffering from addiction who need support.

“In the news, all you see is overdose and death and destruction,” he said. “But I also see recovery. Sixty percent of people maintain meaningful recovery. So that means there’s more people in recovery than there are in active addiction at any given moment.”

For Provost, sharing her story is a way to inspire others.

“I went from recovering anonymously to out loud,” she said. “So people can see what’s possible.”

Overdose Prevention

The Everett Fire Department administered Narcan nearly 600 times last year, with 925 total doses.

All opioids can cause addiction and overdose, even when taken as prescribed. The health department recommends using fentanyl testing strips and never using drugs alone, with alcohol or sedative drugs as it can slow breathing. In addition, using opioids after a break can increase risk of overdose, as tolerance can lower in days.

Signs of an overdose include slow or no breathing, gurgling, gasping or snoring, clammy skin, blue lips or nails and pinpoint pupils. If someone is showing signs of an overdose: Shake them, call their name and rub knuckles hard over their chest bone. Call 911, administer Narcan and perform CPR. Someone should stay with the person until first responders arrive, as they may stop breathing when the naloxone wears off.

Under the Good Samaritan law, people who may have drugs when seeking help for or suffering from an overdose are protected from prosecution.

The human services department and South County Fire provide community overdose response training.

Narcan is available without a prescription at pharmacies in Snohomish County:

• Arlington Pharmacy at 540 N West Ave.;

• Bellegrove Pharmacy at 18800 142nd Ave. NE in Woodinville;

• Costco Pharmacy at 16616 Twin Lakes Ave. in Marysville;

• Pavilion Pharmacy, Swedish Edmonds Hospital at 7320 216th St. SW in Edmonds;

• Pharm A Save at 17788 147th St. SE in Monroe;

• Providence Pharmacy at 19200 N Kelsey St. in Monroe;

• QFC Pharmacy at 27008 92nd Ave. NW in Stanwood;

• Tulalip Pharmacy at 8825 34th Ave. N in Marysville;

• Walgreens at 2205 Broadway in Everett;

• Walgreens at 6807 Evergreen Way in Everett.

Sydney Jackson: 425-339-3430; sydney.jackson@heraldnet.com; Twitter: @_sydneyajackson.