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Meth, often mixed with opioids, leads spike in Spokane County drug overdose deaths

Trump Budget seeks to fight opioid addiction

Shooting Up Amid skyrocketing demand, Spokane’s only needle exchange cuts back its services.

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DARING WAY

Every day we experience the uncertainty, risks, and emotional exposure that define what it means to be vulnerable or to dare greatly. Based on twelve years of pioneering research, Dr. Brené Brown dispels the cultural myth that vulnerability is weakness and argues that it is, in truth, our most accurate measure of courage.

Brené Brown explains how vulnerability is both the core of difficult emotions like fear, grief, and disappointment, and the birthplace of love, belonging, joy, empathy, innovation, and creativity. She writes: “When we shut ourselves off from vulnerability, we distance ourselves from the experiences that bring purpose and meaning to our lives.” Daring Greatly is not about winning or losing. It’s about courage. In a world where “never enough” dominates and feeling afraid has become second nature, vulnerability is subversive. Uncomfortable. It’s even a little dangerous at times. And, without question, putting ourselves out there means there’s a far greater risk of getting criticized or feeling hurt. But when we step back and examine our lives, we will find that nothing is as uncomfortable, dangerous, and hurtful as standing on the outside of our lives looking in and wondering what it would be like if we had the courage to step into the arena—whether it’s a new relationship, an important meeting, the creative process, or a difficult family conversation. Daring Greatly is a practice and a powerful new vision for letting ourselves be seen.”

About Brené Brown, PhD. LMSW Dr. Brené Brown is a research professor at the University of Houston Graduate College of Social Work. She has spent the past thirteen years studying vulnerability, courage, worthiness, and shame. Brené is the author of three #1 New York Times Bestsellers: Rising Strong, Daring Greatly and The Gifts of Imperfection. She is also the Founder and CEO of The DARING WAY and COURAGEworks – an online learning community that offers eCourses, workshops, and interviews for individuals and organizations ready for braver living, loving, and leading.

Lisa St. John, the HIV and STD program manager for the Health District, which administers the exchange, says she’s not sure if the cap will save money, but it’s a first step towards reconciling a budget that she expects to shrink by 30 percent in this fiscal year. “This isn’t reflective of our service. This is a reflection in overall cuts in HIV prevention dollars,” St. John says. In fiscal year 2010, the needle exchange and HIV testing received $306,874. In the fiscal year 2011 budget, which has yet to be approved, St. John says she expects to receive $210,122. The district credits the exchange program with curbing the spread of HIV through injection drug users. It’s effective enough that social services in North Idaho, which has no needle exchange, direct their clients to Spokane and in some cases even drive them over the border themselves. The economy’s plunge in 2008 played no small part in the rise in exchanged needles, says Everson, who has worked at the exchange since it opened in 1991. But word-of-mouth has played a part, too. “More people know about [our] services,” Everson says. “I think our reputation as a safe place has gotten out.” People come to the exchange from all sorts of backgrounds. Laid off from construction, dropped out of high school, working at a call center,

These addictions can kill, but drug deaths are actually down slightly in Spokane County, according to county Medical Examiner Sally Aiken. In 2010, 64 people died from illicit drug use in the county — down from 77 the year prior. Figures peaked in 2008, when 109 died. However, drug deaths are on the rise nationally (prescription-drug overdoses are increasingly the culprit, according to a recent Los Angeles Times analysis). In 2009, the Centers for Disease control reported that more people died from drug overdoses than traffic accidents. In 2010, the way Washington funded HIV prevention changed, says Maria Courogen, office director for infectious disease at the state Department of Health. “Their big concern is that we are still here for them.” The Legislature that year opted to switch from a system in which HIV prevention money is distributed to regional agencies called AIDSNET to a system where the money is distributed from the state to local agencies directly. The Department of Health has opted to distribute its money to where the disease is affecting the most people, which Courogen says is the Seattle area. “Pretty much all of the counties outside of King County have had to cut back services,” Courogen says. “In terms of managing an epidemic, and deciding where you put the resources, it made sense to us to put money where the disease is.”

At Spokane’s exchange, the signs of the cuts are plain to see: sterile water, which Everson hands out in packets so that people don’t mix their drugs with tap water (which can contain minerals and other things Everson says are better kept out of your veins) is being limited. Everson used to give out containers to hold used needles. That ended, too; green Folgers coffee cans are the substitute. Talk, however, remains free, and that’s what Everson does with everyone who comes to her table. “I tell people, ‘Share food and gossip — don’t share anything else,’” Everson says. “Some people will and some people won’t.” Bill, a 35-year-old who came to the exchange, draws the line at sharing needles. But he does re-use, if he has to. When asked about it, he sticks out his left arm. Two purple marks show where he used an old needle to inject, a feeling that he says is like inserting “a barb on a fishhook” into his skin. (Needles, after repeated use, bend and become blunt.) Bill came to the exchange with a brown paper bag full of 350 needles. He says he lost his truckdriving job, and so he lost his car and his boat and just about everything else he owned, but he kept his methamphetamine addiction, and his heroin addiction as well. The needles were for him and three others, although he usually brings somewhere around 1,250. He now predicts that he’ll be coming back more often, if he can make it. If he can’t, then his addictions dictate what happens next. “It’ll make you have to reuse,” says Bill, who spoke on the condition that his last name not be published. So far, Everson hasn’t seen an increase in the negative effects of needle use, such as sharing or reusing needles. She says it’s too early to tell.

Jeremy Gifford didn’t really care about staying sober anymore after a week in the Spokane County Jail. So he bought some heroin and shot up. And then he went and saw Lynn Everson.

When Gifford got to the oddly shaped room in the oddly shaped Spokane Regional Health District building, there was a line of people, all carrying their used syringes in coffee cans, brown purses and paper bags. Everson sat behind a table, helping them count out their wares. Gifford gave her four used syringes and left with four clean ones. It was a small amount compared to what others carried. Still, it meant he had clean needles. And that’s not always the case. “I was hurting so bad, if I found a rig on the street, I would have picked it up and used it,” Gifford recalls of one occasion when he was out of town and didn’t have syringes. “Today is just busy,” says Everson, the district’s needle exchange coordinator, from behind a desk covered with needle containers, condoms and public-health pamphlets.

For 20 years, the exchange has provided drug users with clean needles in exchange for their dirty ones in order to prevent the improper disposal of the used needles and to hinder the spread of HIV and other diseases. Demand for clean needles is booming. In 2008, 394,033 needles were exchanged. In 2010, it was 736,294. The Health District predicts it will exchange 1,071,000 by the end of this year. This is an all-time high for the service. And yet the money with which it operates is rapidly shrinking. Funding has dropped to the point that in early September, the exchange opted to impose a cap of 250 syringes per person per visit — an amount that Everson estimates is how much that a typical person uses in a month.

attending Gonzaga University, subsisting on what they could

scrounge up from a scrap yard. Many whom The Inlander interviewed last week said they were addicted to heroin, methamphetamine, or both.

can bring you peace but YOURSELF. “ Ralph Waldo Emerson ”

11711 E Sprague Ave D4, Spokane Valley, WA 99206 509.927.6838

Treatment programs created in response to soaring opioid overdose deaths often have few options for people who also use methamphetamine, benzodiazepines and other drugs, Banta-Green said. In many cases, providers refuse to treat them at all, “which really means we’re only saying we only want to treat half of heroin users,” he said. The state health department publishes data on opioid deaths, but not methamphetamine overdoses. This article was updated on April 27, 2017 to clarify that the Washington Department of Health does not publish data on methamphetamine overdoses.The department does collect data on all drug overdoses. “There’s never been a statewide discussion about it.” - Caleb Banta-Green

A 2015 survey by the University of Washington’s Alcohol and Drug Abuse Institute of 22 Spokane needle-exchange users found 91 percent had used meth in the past three months, and nearly one-third had used both methamphetamine and heroin together. Statewide, it’s clear people are mixing the two.The Washington Department of Health collects data on fatal opioid overdoses, which lists every drug found on individual death certificates. Though it’s not an opioid, methamphetamine was the second-most commonly listed drug in 2015, contributing to 155 opioid overdoses. In 2010, methamphetamine was present in just 44 opioid overdoses and ranked well behind common painkillers like oxycodone. Rates of people using only methamphetamine also appear to be going up, said Caleb Banta- Green, the principal research scientist for the institute. Overdose deaths have increased in King County after holding steady for nearly a decade, he said, and that appears to be a trend across the state. The institute is releasing a report on rising methamphetamine use in Washington in a few weeks. As public attention has been focused on responding to an opioid overdose epidemic, there’s less talk about methamphetamine. After a crackdown on the cold medications used to make the drug in the United States, production shifted largely to Mexico. Use declined for a few years, Banta-Green said. But its gradual increase over the past few years has gone largely unnoticed because it doesn’t come with the dramatic spectacle of police raiding meth labs. Crackdowns on prescription pain medication over the past decade have made it harder for people addicted to opioids to get drugs legally. In response, drug traffickers used the same routes they set up for methamphetamine to bring more heroin into the country, Banta- Green said.

Killer

/mbo Spokane police haven’t busted a methamphetamine lab in at least three years, almost the same amount of time “Breaking Bad” and its meth-cooking protagonist have been off the air. But methamphetamine is contributing to more drug overdose deaths than any other drug in Spokane Meth, often mixed with opioids, leads spike in Spokane County drug overdose deaths

County, and that number rose significantly in 2016. That’s according to a Spokane County Medical Examiner’s office report on 2016 deaths released Tuesday, which found an increase from 29 fatal overdoses involving methamphetamine in 2015 to 49 in 2016, a 69 percent jump. Overall, accidental overdoses in Spokane County rose from 82 in 2015 to 115 last year. Fatal heroin and opioid overdoses are the usual focus of conversations about drug use and deaths, but methamphetamine is a rarely- discussed contributor to soaring overdose death rates in Washington. In many cases, public health officials say that’s because people are using opioids in combination with methamphetamine. Methamphetamine is a stimulant and can cause fatal overdoses by putting strain on their heart or circulatory system.The drug elevates core body temperature and usually kills by cardiac failure. “When you do both at the same time you compound the effects of both drugs...” -Mike Lopez

Fatal overdoses on opioids are more common. Those drugs are depressants that can suppress breathing, leading to fatal respiratory failure. “When you do both at the same time you compound the effects of both drugs. One doesn’t counteract the other,” said Mike Lopez, medical services manager for the Spokane Fire Department. The medical examiner report says how many times a drug was listed on death certificates in 2016, but it doesn’t provide a clear picture of how people are using those drugs. People often overdose and die with more than one drug in their system, so without the details of individual death certificates, it’s impossible to say if most local methamphetamine overdoses also involved an opioid.The medical examiner’s office had not responded to a request to provide more detailed data by Wednesday evening.

Lendin Helpin Han Breakthroug Recover Center In. 11711 E SPRAGUE AVE D4, SPOKANE VALLEY, WA 99206

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We are all sensory beings bombarded with input coming in from the environment through our senses. This sensory input can be challenging for persons with mental illness and persons recovering from drug/alcohol addiction. Breakthrough’s state-of-the-art multi-sensory room offers a patient-centered haven of comfort. Multi-sensory rooms provide opportunities for client-centered exploration of the senses helping the person to feel empowered and better regulated through interactions with the therapist.

This specifically designed sensory room provides a powerful tool for use in substance abuse rehabilitation as it provides opportunities for addressing triggers, stress management, and self-regulation allowing clients to focus on overcoming barriers to community re-entry. It also provides a deeply supportive environment to assist in acquiring, learning, and implementing mindfulness-based approaches to life and recovery.

Be empowered to enjoy a more rewarding life living substance free.

The program is facilitated in our multi-sensory room by the LifeSkills11™ Occupational Therapist. The therapist is uniquely trained to recognize the effect that the substance abuse/mental health challenges has had on the occupational functioning of the individual and the family. The focus of therapy is to attain improved functional performance in the client’s meaningful occupations including life roles, leisure, work, and social environment. The LifeSkills11 ™ program knows that clients can thrive using these improved self-regulation and life skills. Clients will find that they can change their behavior on their own terms and in their own way – empowered to enjoy a more rewarding life living substance free.

Often during the cycle of addiction‚ a person has fallen out of routine. They experience chaos in their day and they are unsure of how to regain healthy structure and habits. A Sensory-Based Occupational Therapy Program for Recovery

Our program is designed to work alongside and enhance the existing cognitive behavioral work of your treatment center.

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Comprehensive Drug/ Alcohol Evaluations: Evaluations are the core tool used to accurately identify and understand the substance abuse problem and make an individualized treatment recommendation. All alcohol/drug treatment agencies require this evaluation prior to being admitted to any treatment program.

Partial Hospitalization Program (PHP): Our Partial Hospitalization Program is highly individualized and designed for clients who are enduring the difficult process reintegrating into their communities. Clients will have extensive clinical contact through group and individual sessions allowing each individual to build their recovery skills and coping strategies in order to identify the core issues that are fueling their addiction.

Our Services Breakthrough Recovery Group is a premier provider of evidence-based addiction treatment. Our programs address not only the addiction, but also the underlying issues that may have advanced or reinforced drug abuse. We focus on a holistic approach to recovery by striving to bring the newest and most sought after treatment components into our program to assist all individuals.That is why here at Breakthrough Recovery Group we provide our clients with massage therapy, acupuncture and sensory integration. We are the only outpatient agency in the state of Washington licensed and teaching Brené Brown’s The DARING WAY & Rising Strong curriculum on “Courage, Shame, Vulnerability and Worthiness” in treatment services. A Place for Hope and Healing Breakthrough Recovery Group

Outpatient (Level 1) Treatment: Outpatient services are designed to support abstinence and ongoing recovery as patients manage demands of work, relationships, family, and recovery with minimal disruption to their daily lives. Outpatient treatment services also based on individualized treatment planning that include at least three direct contact hours per week. Intensive Outpatient (Level 2) Treatment:

The clients and their families are the center here at Breakthrough Recovery Group

Intensive outpatient services are designed to help patients achieve and maintain sobriety while remaining in their work and home environments.This is a concentrated and focused program based on at least nine direct contact hours per week.

Family Education and Support Program: Addiction affects every part of who we are and how we interact with those that love us; addiction affects families in very similar ways as the person that is struggling with substance abuse.These group and family sessions provide a safe and structured setting where open sharing can begin a personal journey of healing through exploring themes common to a family in recovery. Our goal is to empower the family and clients to discover together the power of healing and a life free from addiction.

OUR SERVICES SENSORY WORKS SELF-EMPOWERMENT FOR LIFE THROUGH THE SENSES

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Who We Are Breakthrough recovery group inc. provides quality behavioral health and substance abuse counseling, and life-coaching in an atmosphere that is safe, caring, and respectful of each person's life journey...

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“In my experience, 99 percent of people don’t understand that,” Banta-Green said. Meanwhile, local buprenorphine programs are already reaching full capacity, he said, showing the need for expanded access to buprenorphine, methadone and other treatment medications. Law-enforcement ocers can be community leaders, he said, in destigmatizing addiction and building grass-roots support for more treatment facilities. Steve Redmond, a Seattle police ocer, said he works on it every day. Addiction “is a treatable medical condition no dierent than cancer or multiple sclerosis,” said Redmond, who was on a panel with Larsen and Banta-Green. He founded a volunteer-run crisis response and referral network, Code 4 Northwest. He also is a board member of Not One More, a community group that aims to destigmatize addictions and support people with them. e Seattle police and re departments were represented last year on a Seattle-King County heroin and prescription opiate task force, Larsen noted, and endorsed its recommendations calling for expanded treatment and safe consumption sites. It’s a positive development that many state rst-responders now carry the overdose-reversing drug, naloxone, Banta-Green said. But he’s concerned naloxone is viewed by too many public-safety ocials as the silver bullet, the best they can do to help. “It is a one-hour rescue,” he said, with modest impact.

FOCUS MORE ON TREATMENT, NOT ILLEGAL SUPPLY, SOME EXPERTS SAY A two-day summit on Washington’s opioid epidemic focused on reducing the supply of legal drugs. But some panelists wanted to stress a dierent approach: destigmatizing addiction and advocating medication-assisted treatment.

focus in life. “e opposite of addiction is not sobriety, it’s connection,” he said. Abstinence and tough-love approaches don’t address the underlying trauma or conditions that lead people to addiction. “Too many people are clinging to old ideas which are downright dangerous in this eld,” he said. Medications such as buprenorphine or Suboxone can alleviate the pangs of drug dependence while not making people feel euphoric or disoriented, he said. at can allow them to work and have relationships and seek treatment for underlying conditions such as depression. “Nancy Reagan was wrong,” said Seattle Fire Department Capt. Jonathan Larsen, a summit panelist who supervises about 70 paramedics who respond to overdoses. “is is a changed brain,” Larsen said about opioid addiction. “Medication-assisted treatment works. Nothing else works or we wouldn’t have the problem we have now.” But most people remain unaware that relatively new treatments such as buprenorphine reduce fatal overdoses and support recovery, said Caleb Banta-Green, senior research scientist at the UW’s Alcohol and Drug Abuse Institute.

An “opioid summit” convened by state law-enforcement agencies this week focused largely on reducing the illegal supply of opioids in Washington. And while armed ocers roamed the University of Washington summit and speakers addressed topics such as how to get maximum prison time for dealers, another thread emerged. Several law ocers, and others, spoke about the importance of viewing opioid addiction as a medical condition that should be destigmatized and treated with medications proven to reduce deaths and help people lead functional lives. “I really believe in medication-assisted treatment,” said King County Prosecuting Attorney Dan Satterberg, who devoted most of his 90-minute talk Friday to advocating a dierent approach than reducing supply, which has not historically succeeded.

Satterberg noted that most people who are drug-dependent lost connection with a positive

-KING COUNTY PROSECUTING ATTORNEY DAN SATTERBERG

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• Outpatient (Level 1)Treatment • Intensive Outpatient (Level 2) Treatment • Partial Hospitalization Program (PHP) • Family Education and Support Program

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seeks to fight opioid budget TRUMP addiction "address violent crime, gun-related deaths, and the opioid epidemic."

Opioid addiction is an epidemic ravaging many of the rural areas where Trump is most popular. He's made several pledges to bring relief to those communities hit hardest by the problem. A December study found that "voting patterns show that areas where Donald Trump did well were also places where opiate overdoses and deaths occurred." One historian discovered "Nearly every Ohio county with an overdose death rate above 20 per 100,000 saw voting gains of 10% or more for Trump compared with Romney and/or drops of 10% or more for Hillary Clinton compared to President Barack Obama in 2012." In this tragic context, Trump's budget appears to be making an effort to prioritize the urgent concerns of his supporters.

Embedded in the Trump administration's Budget Blueprint to Make America Great Again — amid a series of steep cuts to "non-Defense" programs — are two proposals for increased funding to fight the opioid epidemic. The first increase falls under the budget for the Department of Health and Human Services, an agency facing a proposed 17.9 percent funding decrease, one of the sharpest overall. Despite cuts to "duplicative" or "limited impact" programs

in HHS, the blueprint specifically allocates a half a billion dollar funding increase to expand opioid misuse prevention efforts and increase access to treatment and recovery services. "The opioid epidemic, which took more than 33,000 lives in calendar year 2015," the budget notes, "has a devastating effect on America's families and communities." The HHS increase aims to "help Americans who are misusing opioids get the help they need."

A second opioid-related budget increase falls under the Department of Justice. The blueprint provides an increase of $175 million to "target" criminal organizations and drug traffickers in a broader effort to "address violent crime, gun-related deaths, and the opioid epidemic."

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