Just 2 milligrams of fentanyl is a lethal dose in most people (compared here with a U.S. penny, about .75 of an inch in diameter). Whatcom County officials report they are seeing an increasing amount of fentanyl powder compared to pills coming into the area, as accidental deaths from use of the drug are also on the rise. (Image United States Drug Enforcement Administration, Public domain, via Wikimedia Commons)
It only takes two milligrams.
That’s the amount of fentanyl — enough to coat the tip of a pencil, equivalent to 10 or 15 grains of table salt — that can kill a human being. Fifty times more powerful than heroin, this is the synthetic opioid fueling an explosive increase in overdose deaths both nationally and locally.
Numbers are staggering. In just eight years (2014 to 2021), drug-involved overdose deaths in the United States have doubled, according to data from the National Institute on Drug Abuse (NIDA). In 2021 alone, more than 70,000 people died after overdosing on synthetic opioids other than methadone, more than double the deaths in any other drug category.
In Whatcom County, the statistics are equally distressing:
Of the 88 accidental deaths investigated by the Whatcom County Medical Examiner’s Office in 2021, 50 were related to drugs – nearly three times the second leading cause of accidental death (traffic accident). Of those, fentanyl was present in 29 cases, while 2020 statistics showed 43 overdose deaths, with 19 featuring fentanyl involvement. And fentanyl’s role in deadly overdoses is growing.
While the office’s 2022 report hasn’t yet been released, Whatcom County Sheriff Bill Elfo told the Whatcom County Council last October that 37 fatal overdose deaths occurred during the first seven months of the year. Twenty involved fentanyl.
In addition, Whatcom’s Gang and Drug Task Force reportedly seized more than half a million fentanyl-containing pills in 2022. That’s about four times what was seized in 2021 and more than 25 times the number seized just two years ago.
Destabilizing society
Shannon Boustead, a physician who’s run the medication-assisted treatment (MAT) program at Sea Mar Community Health Centers in Whatcom County for the last six years, said the fentanyl crisis is even larger than most people understand, and is becoming destabilizing to society at large.
Boustead said that he is seeing more people seeking treatment for opioid addiction than ever before, and seeing more people in increasingly severe stages of addiction. Fentanyl is causing behavior changes more quickly, he added, than is seen with other opioids.
While all treatment centers are doing the best they can, the amount of people needing treatment is dramatically higher than what’s available, he added. Statistically, only about 20% of those needing treatment can access it.
Bellingham has had only one methadone clinic for the past year, he added, and it has a long waitlist.
Jason McGill, executive director for Bellingham’s Northwest Youth Services — a nonprofit youth homelessness organization — said waitlist times for services at places like Unity Care extend for two to three months.
The MAT program at Sea Mar can treat up to 100 patients at a time, providing them both necessary medications like Suboxone and other resources, like a substance-use therapist, if desired. Most people who show up at the clinic are seeking help for themselves, Boustead said, and are not there as part of court-ordered treatment.
One thing that makes opioids so nefarious, Boustead said, is their often-severe withdrawal symptoms. He compares it to being stuck underwater, with a person doing anything they can to get oxygen at the surface.
“Someone can be 100% ready to go into treatment and get help, and 20 or 30 minutes later, things could be very different for them just because of the draw to these substances,” he said.
“There’s not a lot of options in our community, unfortunately, and then the wait time to getting to see someone is super long,” he said. “And by that time, young people are just not interested or they’re just disengaged from the entire service area.”
Substance abuse itself has significant effects on the human neurological system — specifically the brain’s opioid receptor. Even once clean, patients often require continued stimulation of that receptor from methadone and Suboxone to stay that way.
Boustead said to think of it terms of type 1 diabetics, who depend on insulin in order to stay alive. Without their medications, opioid addicts face significant relapse risk: in abstinence-based programs, that risk is as much as 90% within one year. In MAT programs like Sea Mar’s, that number can drop to 50 or 60%.
Everywhere at once
The sheer availability of fentanyl is another part of the problem.
Most Sea Mar patients are using both fentanyl and methamphetamine, Boustead said, and many are doing so unintentionally. Pills or powders laced with fentanyl are dominating the illicit supply because it’s cheaper to purchase for resale.
“In the past, everyone was shocked when (oxycodone pills) had fentanyl in it,” Boustead said. “Now, there is almost no oxycodone in the illicit supply. There is almost no heroin in the illicit supply. Everything that people are getting is fentanyl.”
On the law enforcement side, both Whatcom County Prosecutor Eric Richey and Whatcom County Undersheriff Doug Chadwick said they are seeing fentanyl powder enter the local drug supply in increasing amounts.
This powder has joined the supply of commonplace blue pills, and carries some risk for anyone who encounters it, especially with prolonged exposure.
So far, though, no sheriff’s department officers have been negatively affected by the powder, Chadwick said, mainly because officers do not open packages of the powder to test, instead sending it directly to the lab. The largest quantities of pills, he added, appear to be coming from Mexican cartels.
At the prosecutor’s office, one effect of fentanyl is a rise in charges of controlled substance homicide. Similar to manslaughter, the charge targets someone who provides a drug that accidentally results in overdose.
A number of county suspects are currently in custody on these charges, Richey said, and will eventually face trial. Statewide, those who see trial dates are often being convicted.
“The recognition of how dangerous fentanyl is is making it easier for prosecutors to prevail in these cases,” Richey said.
The law today …
There’s also the matter of how current laws dictate possession of drugs such as fentanyl.
Richey said he believes being unable to prosecute anyone for simple possession isn’t helping matters.
In 2021, the Washington State Supreme Court’s decision in State v. Blake decriminalized simple possession of drugs. The Senate Bill 5476 subsequently recriminalized possession, but made it a misdemeanor (punishable by up to 90 days in jail and a $1,000 fine). The bill requires at least two mandatory diversions for treatment, which Richey said usually consists of law enforcement handing the person a pamphlet for how to seek treatment. Besides referring someone for treatment, which may not be accessible, Chadwick said law enforcement will seize their drugs.
After a third stop for possession, a person can be arrested and prosecuted for a misdemeanor.
However, Richey said the legislature put no system in place on how to track diversions. Chadwick said this means that if someone is given a referral in two different counties, law enforcement in each county might be unaware the person has prior referrals. Even if someone gets to the point where they can be prosecuted, they likely won’t be arrested, Chadwick added. Instead of a jail cell, they’ll be issued a criminal citation.
… and change ahead
Current diversion and prosecution of drug possession will soon change, depending upon what the state’s legislature decides.
SB5476 ends in July, and may be replaced by Senate Bill 5536. Passed in the Senate on March 3 in a 28-21 vote, the bill makes simple possession a gross misdemeanor (up to one year in jail and a $5,000 fine).
If the law does not pass the House or get signed by Gov. Jay Inslee, the state will likely find itself with no way to police simple drug possession until another bill is proposed.
A large part of the debate over how to help people concerns how much of a role the criminal justice system should have.
From the law enforcement perspective, Richey said that he’d like to see more teeth to legislation, allowing addicts to be more strongly guided to help by law enforcement, more programs to actually help them, and charges to help encourage change for those who might otherwise not be motivated enough to change.
“Just being able to direct someone to treatment is what we need,” he said. “We need to be able to do it in more cases than we currently (are). Since simple possession’s been decriminalized, we have no way to direct people to treatment.”
Although drug court diversion programs can be helpful, Richey noted that those who enter into the county’s drug courts do not receive local treatment, but are sent out of the county.
What to fund?
A new Whatcom County jail may also actually help the treatment process, Boustead said.
“It could be a place where the people that are in with use disorders are able to access more services,” he said. “They do have access to medications (currently) while they’re in (jail), but the facility itself is so old that it limits the number of services that can be provided.”
In February, four inmates at the Whatcom County jail were hospitalized from suspected opioid overdoses.
McGill isn’t so sure about how a new jail will help. He’d like to see some of a new jail’s funding go towards behavioral health resources for mental illness and substance abuse.
“We can’t just keep locking people up,” he said, “because it’s not solving anything.”
Another way to potentially help people invest in their own healing is to pay them.
Direct cash transfers, paid to people struggling with addiction and tied to receiving treatment, might allow them better ability to focus on staying well, McGill said.
This idea is being considered seriously in places like Oregon, where a state legislative bill would establish a program called the People’s Housing Assistance Fund Demonstration Program. If enacted, the bill would provide program participants with $1,000 a month payments for a full year, usable for rent, food, child care, emergencies or any other services they want.
To qualify, a person would have to be experiencing homelessness or be at risk of it, spend more than 50% of monthly income on rent or earn 60% or less of the area median income. The $25 million program would go into effect in January 2024 and last two years, if it is passed and signed into law.
At the national level, the Mainstreaming Addiction Treatment (MAT) Act, signed at the end of 2022, will make the active ingredient in Suboxone — buprenorphine — easier to obtain than ever before.
That’s good news, said Boustead. At Sea Mar, he has seen for himself how effective a medication-based program can be.
“Every week, I get to see people who are healing, and who have healed, and are living lives again,” he said. “It’s like seeing people revived from the dead.”
Regardless of what happens next, Boustead said that a nuanced, large-scale approach to systemic issues like homelessness and chemical dependency will be required if change for the better is to occur.
“We have to save these people for our society,” he said. “We tend to stigmatize (addicts). We tend to treat them as ‘others,’ and that is really not going to last because it’s not going to be very long before (opioid addiction is) in all of our families. I really think that, in order to find good solutions, we have to start thinking about things differently.”
— Reported by Matt Benoit