By Claire Withycombe / The Seattle Times
LYNNWOOD — On the first floor of a gray and orange building on Southwest 196th Street is a clinic, where six mornings a week more than 150 patients come to get a dose of medication to treat opioid use disorder.
A visitor, taking in the clinic’s pale green walls and austere line of black chairs in the waiting area, could be forgiven for not suspecting that, months earlier, the clinic was at the center of a maelstrom over whether it should be allowed to open.
As opioid overdoses claim lives across Washington, state lawmakers have tried to make it easier to access medications like the ones available at this clinic. But from Port Angeles to Spokane, treatment programs certified to do so have faced skepticism or outright resistance from neighbors.
In Lynnwood, after an intense outcry from residents at the beginning of the year over the clinic on Southwest 196th, and after a second clinic tried to open, the City Council decided to stop accepting applications for new clinics for six months.
The clinic, operated by Tennessee-based Acadia Healthcare, met the city’s requirements at the time and opened in January. But the second clinic backed out this fall as the city formed new rules that would apply to future opioid treatment programs.
Opioid treatment programs aren’t generic clinics. They’re the only setting allowed by the federal government to provide methadone to treat opioid use disorder. Methadone is a tightly regulated but important tool in the fight against fentanyl. According to the Centers for Disease Control and Prevention, Washington overdose deaths increased 21.4% between February 2022 and February 2023, the highest jump of any state.
Washington has just 36 such treatment programs. Most are clustered around the I-5 corridor. Twenty-five of Washington’s 39 counties don’t have one.
The Legislature has pushed to allow more clinics to open, designating them as essential, just like public transit facilities and airports. They’ve shuttled millions of dollars to open new programs.
But public opposition poses a hurdle to what experts say is a lifesaving treatment that already faces regulatory and practical barriers.
Dr. Nasser Khan, group president of operations for comprehensive treatment centers at Acadia Healthcare, says it’s a dual-edged sword: People don’t want addiction — and its attendant social problems like crime, homelessness and use of health care resources — but they’re also reluctant to allow the clinics.
“Sometimes they’re successful, and we’re not allowed to build even though there’s clear need,” Khan said.
“People were concerned about what might happen,” said Christine Frizzell, mayor of Lynnwood. “But in reality, what has happened over there is that people who have drug addictions, and [are] working through them, are actually going there to get the proper medication, to get the counseling that they need. And then they are going on about their day.”
Advocates say the tenor of the complaints reveal the strength of the stigma — and misunderstanding — surrounding drug treatment.
When Khan began working in the industry, he was struck by the number of patients at opioid treatment programs who were dressed in uniforms, stopping at the clinic before going to work, and by the number of moms who came in with their children in tow.
“Lynnwood is not unique,” said state Rep. Lauren Davis, D-Shoreline, who represents the Lynnwood area in the Legislature. “Stigma against this population is alive and well.”
Public outcry
On a Tuesday night in early January, dozens of people crowded into the Lynnwood City Council chamber. Some held signs: “No opioid facility near kids.” “We need transparency.” “Protect our kids.”
The clinic’s proposed location, while on a street with other businesses, like an Enterprise Rent-A-Car, was a few hundred yards north of the Alderwood Little League fields.
Nearby residents said they were worried about the clinic’s proximity to a Boys & Girls Club and said the clinic wasn’t located on a convenient bus line. One resident worried the patients themselves wouldn’t have privacy at the proposed location. Another was concerned patients would be given paraphernalia to use illicit drugs (the clinic does not provide such paraphernalia, and illicit drug use is prohibited there).
Ken Salem, of the Boys & Girls Club, criticized Acadia as “untransparent.”
“There are plenty of commercial industrial areas where something like this would have much less impact,” Salem said. “And so apparently this expert team that was vetting the location never thought of this? I shake my head and look at the disrespect for our community.”
Eighteen percent of Washington’s heroin-related deaths come from Snohomish County, although it contains 10% of Washington’s population, Daniel Hymas, a regional vice president for comprehensive treatment centers at Acadia Healthcare, told the Lynnwood City Council. That high rate factored into the company’s decision to locate the clinic in Lynnwood after moving it from Bothell.
“I’ve got five kids of my own,” Hymas said. “I wouldn’t be putting a facility near a Boys & Girls Club if I didn’t have the confidence in our patients and in our staff to help keep people safe.”
Council members were frustrated that they’d only found out about the proposed clinic in mid-December, and that a Department of Health hearing on the clinic’s state license was scheduled for Dec. 29, in the middle of the holidays.
Shannon Sessions, president of Lynnwood’s City Council, said they were also frustrated by Acadia’s “lack of communication, with not only us, as legislators of the city, but with our public.”
Acadia clinic opens
Despite council members’ frustration at being left out of the process, Acadia had met the city’s criteria and was approved as a matter of course. The clinic opened in late January and started holding monthly meetings with community members.
Inside the Lynnwood Comprehensive Treatment Center, arriving patients punch in a unique ID number at a kiosk and get in line in the lobby. Further back is an area with four locked doors. Behind each door is a small room where the medication is dispensed.
There are three medications approved by the Food and Drug Administration to treat opioid use disorder: methadone, buprenorphine and naltrexone. You may have heard of Suboxone, the brand name for a combination of buprenorphine and naloxone, and Vivitrol, the brand name for naltrexone.
Each medication is prescribed to block the symptoms of withdrawal from opioids, suppress cravings for them and block the euphoric effects of drugs like heroin and fentanyl, said Dr. Eric Weintraub, professor of psychiatry at the University of Maryland School of Medicine.
The Lynnwood Comprehensive Treatment Center prescribes mostly methadone, said its medical director, Dr. Gregory Parada.
Methadone comes in a liquid form, and the clinic also offers buprenorphine and buprenorphine/naloxone, both tablets.
Each visit takes about six minutes, Acadia estimates. Some patients come in each morning. Others who have been coming to the clinic longer can take some of their medication home and don’t have to come in every day, Parada said.
“Often there are patients that I don’t see for long periods of time because they’re doing well and there’s no need to change anything medical in their dosage,” Parada said.
The clinic also provides counseling services.
Methadone and buprenorphine are themselves opioids but can help patients function, he said.
“It’s true that if you take methadone or buprenorphine, you’re physically dependent on those medicines,” Weintraub said. “And if you were to stop them abruptly, you would have withdrawal symptoms. But addiction’s really the behaviors that are associated with being consumed with obtaining drugs 24 hours a day, where you just can’t function and do anything else.”
Weintraub says the medications are considered “the gold standard” for opioid use disorder treatment and are shown to cut overdose deaths by 50%.
“How can you not offer somebody a medicine that would help cut their risk of dying significantly?” Weintraub said.
Barriers to opioid treatment
In 2022, about 37% to 38% of Washingtonians on Medicaid with opioid use disorder were accessing medications approved to treat it, according to the state Health Care Authority.
Methadone is tightly regulated by the federal government and especially hard to access.
But new clinics approved to provide methadone, like the one in Lynnwood, face a host of challenges when trying to open, beyond community pushback.
A provider can face high startup costs. They need to find or renovate a space that can accommodate what is essentially both a dispensary and a medical office. They need to meet a host of federal and state regulations and go through local permitting processes. And then clinics can run into issues with finding enough qualified health care workers.
Jessica Blose, statewide opioid treatment authority with the Health Care Authority, said it’s important to have opioid treatment programs in a variety of communities across the state because methadone is so tightly restricted. Some Medicaid patients in Central and Eastern Washington have to travel up to one or two hours one way to get treatment.
State lawmakers have been trying to make it easier to access treatment. They appropriated nearly $3.8 million through Senate Bill 5536 to increase the number of opioid treatment programs in rural areas and to create more mobile and fixed-site satellite clinics run by providers that already have opioid treatment program licenses.
They also designated opioid treatment programs as “essential public facilities.”
The term “essential public facility” has existed in state law for years and has covered places like solid-waste-handling facilities and mental health treatment facilities. Opioid treatment programs were brought under the same umbrella. Now local governments can’t ban opioid treatment programs from opening, but can impose “reasonable conditions.”
Sen. Ann Rivers, R-La Center, represents Southwest Washington and describes the region as a “care desert.” She voted against Senate Bill 5536, which rewrote Washington’s drug possession law. But she supports the idea of designating opioid treatment programs as essential.
“We have to get beyond the stigma,” Rivers said. “Look, if we say that we want a highly functioning, productive society in Washington state, we cannot do that while we allow people to drown in the deep pit of substance use disorder. We can’t say, ‘Yep, we want that,’ and do nothing to make sure that people can get the treatment that they need.”
A second clinic tries to open
Last August, Arizona-based Community Medical Services started looking at opening an opioid treatment program in Lynnwood. The company estimated that even with the Acadia clinic in the same city, there were about 1,200 potential patients within a 30-minute drive. The company found an old county health building, near major roads that it didn’t see interfering with a residential area or school, said John Koch, CMS’ director of community and public relations.
But CMS had walked into the aftermath of the battle over the Acadia clinic.
When the city got “significant community feedback” about the Acadia clinic, “it was clear that the code had a gap,” said Karl Almgren, the city’s community planning manager. The city code didn’t account for how a facility like an opioid treatment center or a 24-hour urgent care clinic would have different impacts on the area compared with something like a dentist’s office, he said.
In March, Almgren started talking with the City Council about ways to update the city’s code. Late that month, CMS’ architect applied for its permit. All the while, it was not yet clear exactly how lawmakers might change state laws concerning the siting of opioid treatment programs.
Because the city was already talking about new regulations, the council adopted a moratorium on accepting new applications April 17, Almgren said.
The next day CMS’ architect received an emailed letter from Almgren. The city had rejected its application. Almgren said it was incomplete, and any additions from CMS would not be processed due to the moratorium.
Koch said he was saddened by the news and that CMS’ submission was “100% complete.”
Koch, who is in long-term recovery from opioid use disorder, has received methadone services himself.
“You want to feel safe where you’re at, and you want to feel like the clinic is a place that’s trying to help you,” Koch said. “And so we’ve got to make sure that our clinics are clean and nice and presentable, not only to our patients but to the community as well.”
In October, the City Council approved a new ordinance saying essential public facilities must provide more information to the city, such as a security plan. Local essential public facilities, like opioid treatment programs, are subject to approval from a city hearing examiner. State and regional facilities go before the City Council.
After looking at Lynnwood’s proposed new rules, Community Medical Services withdrew its application in September, the month before the moratorium on new clinics lifted. Koch said the company had already spent $63,000 on the building.
“I don’t believe it was our intent to make it burdensome,” Frizzell, Lynnwood’s mayor, said of the new ordinance. “We understand that the opioid crisis is not going away.”
Lynnwood City Councilmember George Hurst says the City Council will now be kept in the loop on proposed essential public facilities because of the new ordinance, and can educate residents.
But Koch still worried about how long it would take to meet the city’s requirements.
“When I saw the rules, I said, ‘This is going to take too much of my time, and too much of CMS’ time, that we could be using to help other people, to fight this,’ ” Koch said.
The clinic could have served 500 patients.
How it’s going in Lynnwood now
Nearly a year — and a Little League season — has come and gone, and Acadia’s recent monthly community meetings are attended sparsely, if at all. Frizzell said the company is now moving to quarterly meetings because of low attendance.
“For all of the sort of noisemaking and fearmongering that was associated with the opening of that facility, it has been a complete nothingburger,” Davis said.
Hurst says his eyes were opened after a friend approached his wife — who sits on the city’s human services commission — during the height of the controversy over the Acadia clinic.
Unbeknownst to the Hursts, the friend had been in treatment for years.
“She felt we were attacking her, that we were saying these clients were bad and everything,” Hurst said. “And I thought, ‘My God, that’s not what we’re saying.’ And so I tried to change my conversation to, listen, yeah, this was not done well by Acadia as far as neighborhood reach-out and everything, and community outreach. But my God, you know, these people need this service.”
While there have been about a dozen calls to the Police Department from the clinic, according to records provided by the city Oct. 24, only one has involved a problem with a patient. In early October, the facility called police to report a patient who became agitated after being told she was required to provide a urine sample and “belligerent” after failing the test.
Sessions said the city has also heard from the Alderwood Boys & Girls Club authorities that they’re “grateful that Acadia has done what they asked for as far as making sure that the area is clean and secure.” (The Boys & Girls Club of Snohomish County did not respond to requests for comment from The Seattle Times.)
Khan said Acadia has “committed to getting it better next time in terms of communication” and that he learned that the company needs to know the key stakeholders in a new community.
Sessions acknowledges there is widespread need for drug treatment.
“It’s needed everywhere, but it shouldn’t all be in Lynnwood,” Sessions said. “And Lynnwood’s already done our part. And, in fact, I would say we’re a model for that.”
She also pointed to the construction of a recovery center connected to the city’s new community justice center. The recovery center will provide Suboxone and Vivitrol, as well as Sublocade, an injectable long-acting form of buprenorphine, Davis said.
Blose, of the Health Care Authority, said that even in areas where there are multiple opioid treatment programs in a similar region, the state has “never had an issue with providers not being able to find enough patients.”
“The need is so great everywhere,” Blose said.
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