The physical and emotional toll wreaked by the COVID-19 pandemic and lockdown measures has been accompanied by an increase in opioid use and related deaths over the past year — after five years of decline — in Washington state. At the same time, use of even more dangerous synthetic opioids is becoming more prevalent, making the increased use even more hazardous.
On April 1 Whatcom County law enforcement officials announced that five local residents had died in the previous two weeks due to fentanyl-related drug overdoses. They advised caution due to the presence of the stronger, more dangerous carfentanyl found in some of the victims.
The Washington State Department of Health reported 835 overdose deaths in Washington during the first six months of 2020 compared to 607 deaths in the first half of 2019. The department also reported that fentanyl-involved deaths more than doubled from 137 to 309 during that time. Most deaths involved multiple substances.
“In Whatcom and Snohomish counties we are seeing lots of opioids with stimulants and also more fentanyl and carfentanyl,” said Dr. Camis Milam at Compass Health.
Compass Health is a community-based health care clinic that integrates medical and behavioral services to support clients. As chief medical officer, Milam covers Island, Skagit, San Juan, Snohomish and Whatcom counties.
Milam noted these counties showed a sharp uptick in usage beginning in the third quarter of 2020 — after 5 years of decrease.
Struggle in the time of COVID
In Washington and the U.S., many of the places that struggle with opioid addiction and substance abuse are areas that are also struggling economically and have limited social activity. “That opioid use has gone up during a time when people are struggling financially and socially due to the pandemic is not surprising,” Milam said.
Skagit County Commissioner Lisa Janicki has watched opioid addiction and overdoses go up in Skagit County. “I have heard both from our coroner and from law enforcement that opioid addictions and overdose have increased during the pandemic,” she said.
The Opioid Workgroup Leadership Team was formed in 2015 under Skagit County Public Health in response to the crisis in opioid use at that time. It continues to provide information and resources to the community.
According to the team’s McKinzie Gales, who works as Skagit County’s Community Health Education Specialist, Skagit County lost 32 lives to drug overdose in the first three quarters of 2020, compared to 18 in the first three quarters of 2019.
Blocking pain, heightening pleasure
To understand how opioid addiction has reached this crisis point, it is necessary to understand how opioids affect the body.
Opioids are classified as central-nervous-system depressants. “This means that they lessen the brain’s ability to do what it automatically does — like breathe,” Milam said.
The drug attaches to proteins called opioid receptors which are located on nerve cells in the brain, spinal cord, gut and other parts of the body, Gales explained. “By attaching to these receptors, opioids block pain signals from reaching the brain, which relieves the feeling of pain in our bodies.”
Along with suppressing pain, opioids increase dopamine, the feel-good chemical. The body adjusts to the pain-blocking properties and abundance of dopamine, which means larger and larger doses of an opioid are needed to sustain or get the same level of pain control or high — the brain needs larger and larger doses to feel the same effects.
An overdose occurs when too much opioid is taken, depressing the central nervous system so much that person stops breathing, Gales said.
Addicts often take other medications and substances such as alcohol and benzodiazepine in combination with opioids, making addiction even more potentially deadly. These combinations further depress the central nervous system and increase the risk of an overdose.
The nation became gripped in an opioid epidemic in part due to over-prescription of addictive painkillers, Milam said.
“There is a peculiar notion [in the medical world] that people who are in pain will not become addicted if they are using opioids for pain. I have heard that espoused by a number of physicians,” Milam said. “I continue to have difficulty understanding. Addiction is something that happens in the brain and it doesn’t care why you took it.”
Milam noted that if an addict goes through detox and then uses opioids at the same level as before detox, they would likely die since their tolerance is lowered.
Milam’s nephew Alex suffered from headaches and was given an opioid prescription. He became addicted and overdosed at 20 years old. His body was found in his dorm room by his drug dealer.
Janicki lost her son, Patrick, to an overdose. Patrick had a back injury and was prescribed opioids.
When Patrick went to rehab, one of Janicki’s friends told her to make sure she cleaned out his room and looked anywhere he could be hiding pills.
“It was probably the best advice anyone could have given me,” Janicki said. “Even though it shocked me at first, the friend told me that within Patrick’s brain is the addict brain, and the addict brain protects itself. It will do things like hide its drug.”
A problem for all ages
After Janicki lost her son, people told her how sorry they were and that they, too, were addicts.
“It was surprising, I would have had no idea. Some of them were elderly, maybe in their 80s, telling me they had been sober for seven years,” Janicki said.
“Many people who are addicted to opioids were initially either prescribed them for a physical condition or got them from someone to deal with emotional pain,” Milam said.
Opioid addiction is a problem in all age groups.
“Heroin and fentanyl, the illicits, are more common from teen through middle age,” Milam said. As opioid prescription ends, young people may take to heroin and synthetic opioids.
“I am most worried about youth as there are more and more who are disengaged — not working and not in school,” said Milam. “They are also more likely to be in the pipeline for dealers who are working toward creating a clientele and give ‘samples’ of carfentanyl laced with stimulants.”
Middle-aged people, according to Milam, are more likely to have started by using heroin or became addicted to pain pills.
More dangerous for younger users
“I can say that, from the data, addiction in general becomes more likely if initiation to substances begins in adolescence, before brain development is completed,” said Bethany Sparkle, Executive Director of MV Hope. “And the younger the initiation, the more dangerous it is.”
MV Hope is a prevention coalition out of Mount Vernon, whose mission is to “build an alliance that inspires hope; engages the community; and develops and implements strategies to prevent and reduce opioid and other substance use in Mount Vernon youth.”
“We support programs and initiatives throughout the Mount Vernon school district area. Some of the programs … have been on hold because of the pandemic, but we are in the process of getting most of them back up and running now,” Sparkle said.
“We also run Drug Take Back Day in our area, and work with our surrounding coalitions to make it a county-wide event. Our focus is really on early intervention — how do we connect with kids and support them in developing healthy relationships and coping mechanisms — so that substance use is less appealing and substance abuse significantly less likely.”
Building more treatment centers with more treatment options and fully funding mental health are keys to fighting addiction, according to Janicki.
“We need to fully fund the system. We need to create a path in colleges, community colleges, for people to become RNs and counselors,” she said. “There is such a shortage of people who work in mental health.”
Another local option, the Swinomish Indian Tribal Community’s didgwálič Wellness Center, opened four years ago to provide dental, medical and mental health services, and offers counseling for substance abuse. The facility also has housing to help people reentering society. “It is very hard to break the addiction cycle so housing is key,” Janicki noted.
The Wellness Center had an original capacity for 250 people and was recently expanded but is already operating at capacity. Patients include both tribal and nontribal people, Janicki said; most are nontribal.
Hope and love: never give up
For a loved one of an addict, “Never, never, never, never give up hope and never give up loving that person,” Milam counseled. And to an addict struggling for sobriety, “Never, never, never, never give up hope, and continue to believe in yourself. There are programs and people to help you get through this. There IS life after addiction. Science continues to work on new treatments.”
To help the addict break their cycle, Janicki suggested celebrating their milestones with them, and dropping the stigmas.
“We need a huge community education. We can help beyond chemicals, find a path beyond recovery” she said.
Janicki said that after Patrick died in 2017, she attended a summit on drug use. At least 500 people attended, which showed her that there is a hunger for real conversations around the topic and opportunities for understanding.
“I wish, if I could be any superhero, I would be able to change people’s hearts to be more empathetic and understanding,” Janicki said.