Editorial: Follow Tulalips’ lead on opening methadone clinics

By The Herald Editorial Board

Against the mounting numbers of drug overdoses and overdose deaths at county, state and national levels, it’s welcomed news that the Tulalip Tribes is working to open a medication-assisted treatment clinic — offering methadone doses, mental health counseling and primary care to 150 patients, tribal and nontribal — by November.

The additional treatment can’t come soon enough, and shouldn’t be the last such clinic opened in a county in clear need of more options for a treatment that is proven to save lives and can even restore some to sobriety.

While the attention of most was on the covid-19 pandemic during the last two and a half years, the opioid epidemic has continued destroying lives in the background.

In the two weeks between July 26 and Aug. 8 this year, the Snohomish County Sheriff’s Office reported that emergency crews and law enforcement responded to 40 drug overdoses, though not all were fatal. The county medical examiner, however, has reported at least 188 overdose deaths this year, the majority of them blamed on fentanyl, a synthetic opioid — 80 to 100 times stronger than morphine — that often is laced into other common street drugs, frequently without the knowledge of the person using the drug.

An estimated 107,622 fatal drug overdoses occurred nationwide during 2021, the Centers for Disease Control and Prevention reports, a nearly 15 percent increase from the estimated 93,655 overdose deaths the year previous. Of those deaths in 2021, 66 percent were attributed to fentanyl or other synthetic opioids.

The increase, in particular for Snohomish and other counties in the state, has been building for the last two decades. Figures from the University of Washington’s Addictions, Drug & Alcohol Institute show an average of 7.56 opioid overdose deaths per 100,000 residents in Snohomish County, between 2002 and 2004; by 2019-21, that rate had grown to nearly 21 per 100,000 in the county, a 377 percent increase. That contrasts against 17.37 opioid overdose deaths per 100,000 residents in 2019-21 in King County. Only three counties in the state — Mason, Grays and Clallam — had higher rates of opioid overdose deaths than Snohomish County for the same period.

Yet, there’s great hope in medication-assisted treatment; when it’s accessible.

A study, released this spring by Case Western Reserve University in Cleveland, confirmed that medications — specifically methadone, buprenorphine and naltrexone — were associated with lower rates of death from overdose and showed improved quality of life for people in recovery.

Methadone can be used to treat chronic pain and opioid addiction by blocking the high from opioids, but must be administered in a clinic. Suboxone, a combination of buprenorphine and naloxone, is used to treat opioid dependence by blocking the high of opioids, and can be dispensed by prescription, but is often administered — at least initially — in a doctor’s office.

The study reviewed data from 82,000 Medicaid claims in Ohio, examining the length of time between when a person started and stopped treatment with each of the medications. The longer the period between starting and ending treatment, the more effective the result. Overwhelmingly, the study concluded, methadone was associated with the lowest risk of relapse. However, for patients who stuck with buprenorphine for extended periods, the likelihood of continuing treatment was similar to that of methadone.

Stigma against such treatment — amongst the public, local officials and even those struggling with addiction themselves — have limited access to treatment.

Currently, methadone treatment is available through Therapeutic Health Services in Everett, the Stillaguamish Tribe’s Island Crossing Counseling Services in Arlington, and Canyon Park Treatment Center in Bothell. Suboxone treatment is available at Evergreen Recovery Centers, Sea Mar Monroe, Ideal Options, Community Health Centers locations, Island Crossing and Therapeutic Health Services. Help finding Suboxone treatment is available at www.warecoveryhelpline.org/moud-locator/.

Discussions regarding a proposed second methadone clinic in Everett ended in late 2017 without resolution, following public opposition.

The Tulalip Tribes, for its part, has been discussing its clinic for five years, The Herald’s Isabella Breda reported this week. Seeing the success of such clinics elsewhere convinced the tribal confederation to invest $5 million to open the clinic, which will receive some operational support from the state Department of Health.

What’s needed now is a commitment from more local officials to find locations for clinics and better support from the public for such proposals, such as that shown by the Tulalip Tribes.

Among the misconceptions surrounding medication-assisted treatment is that it replaces one addiction with another.

Maia Szalavitz, a journalist and author of “Unbroken Brain: A Revolutionary Way of Understanding Addictions,” wrote in a 2016 Washington Post commentary that steady and supervised use of maintenance drugs returns patients to a more normal daily life.

While the medications replace the opioid addiction with a physical dependence, it’s little different than the reliance that many have for physician-approved use of antidepressants or a diabetic’s use of insulin. With opioids’ craving and obsession under better control, patients are less likely to relapse and return to illegal and devastating drugs.

Because of that, methadone and buprenorphine are known to reduce the death rate for those with opioid addictions by 50 percent to 70 percent, Szalavitz wrote. As well their use reduces crime and the incidence of infectious diseases, including hepatitis C from shared needle use.

Nor should communities fear an increase in crime near methadone clinics.

A study in 2015 by Johns Hopkins University’s Bloomberg School of Public Health examined statistics near 53 drug treatment centers in Baltimore, comparing them to areas near 53 convenience and liquor stores. Crime was 25 percent more likely around the liquor stores and corner stores than around the clinics, the study found.

Cold turkey doesn’t work for most with opioid addictions. And ignoring the problem won’t work for communities.

“We’ve realized that we’re not going to beat this epidemic with abstinence,” Tulalip Vice Chair Misty Napeahi told The Herald’s Breda about the tribes’ decision to move forward with the clinic. “We’re going to beat this epidemic by meeting people where they’re at and giving them what they need so that they can become better citizens.”

Update: The editorial has been updated to include additional resources for Suboxone treatment.