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As risk of fentanyl overdose grows, public health providers say they need more tools

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Courtesy of the National Institute on Drug Abuse and the Drug Enforcement Agency
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Counterfeit prescription pills often laced with fentanyl are becoming a common way people in Washington State consume opioids.

Opioid use in Washington State is transforming. Those who were dependent on heroin and prescription pills are now using the much more lethal synthetic opioid fentanyl, and those who use other drugs, such as methamphetamines are increasingly testing positive for the substance.

Service providers say the interventions they offer aren’t as effective against synthetic opioids and they need more tools.

In Washington State synthetic opioids are now more likely to cause an overdose than heroin or prescription opioid pills – that’s according to a 2020 study by the University of Washington. The Washington State Department of Health also recently released 2021 overdose numbers, which showed more than 2,000 people died last year. The state’s chief science officer says fentanyl is a major factor in that trend.

Synthetic opioids are cheaper, more potent and far easier to obtain, says Katie Booher. She’s the syringe services coordinator at the Spokane Regional Health District. Booher’s program allows people to safely exchange needles, get free doses of the overdose reversal drug commonly known as Nalaxone, and receive training to use the drug.

But Booher says fentanyl has changed the dynamic.

“We're hearing more and more individuals using these mexi's, the fentanyl laced pills,” Booher said. “And there smoking them and we do not provide smoking supplies per an RCW law. We're really concerned about the decrease in clients coming in because we know, just from what we're hearing from those clients, that aren't coming in, our people aren't coming because they're smoking fentanyl.”

Fewer visits to the syringe exchange also means fewer referrals to services in the community and treatment, which together can offer a pathway out of addiction.

Booher says two tools that could bring people to return to the program and help avoid overdose are fentanyl testing strips and safe smoking supplies. But those are considered drug paraphernalia under Washington State law and are therefore illegal.

“It’s probably fourth or fifth hand by the time they get it in their hand, the drugs that they’re using,” Booher said. “They can’t test it at all without these strips. It’s kind of like a roulette game at this point.”

A bill that would have legalized fentanyl testing strips was proposed this last legislative session. It received unanimous support in the Senate, but it died in the House.

Senator Jim Honeyford, the Central Washington Republican who sponsored the bill, says it was modeled after a similar proposal in the Southwest. He was inspired to introduce it by a constituent who told him their brother had recently died of a fentanyl overdose.

Honeyford says he’s against drug use, and has also introduced a bill to sentence fentanyl dealers whose product can be traced to overdose deaths to life in prison. But he says he doesn’t see the purpose of taking tools away from people who are already struggling with addiction.

“People are going to be using these drugs and they should have some way to at least test them to know what they’re taking,” he said.

He says he plans to introduce the testing strip bill again, saying he believes it will save lives.

“I really believe this is something that needed to be done,” Honeyford said.

He said he was approached by the Washington State Department of Health to add other harm prevention measures to the bill, but he was concerned he would lose support, and restricted his bill only to testing strips.

According to the Department of Health, a testing strip pilot it conducted in 2018 was popular.

Health workers were able to start conversations about the risks associated with fentanyl, and people who used the strips acted to reduce their chance of overdose.

Misty Challinor, division director for the Spokane Regional Health District’s treatment services program, says one of the largest barriers to policy change, and helping those who use drugs, is stigma.

“I think the problem that a lot of people have is understanding what our program actually does,” Challinor said, “and the same with the syringe exchange program, is understanding that we're not out there promoting substance use, we're actually here ensuring that our community is safe and that we keep them from overdose and we try to help them when they're ready to engage in a recovery program.”

She says if the health district could hand out testing strips and safe smoking supplies, they could save more lives.

“Anyone in our fields can speak to the fact that we want people to understand and know, this is a desperate need for our community."

Reporter's note: Overdose reversal medication is free to anyone covered by Medicaid in Washington state. Anyone at risk of overdose themselves and the people around them are eligible without a prescription from a doctor. For information on how to acquire the overdose reversal drug Naloxone or more resources, go to stopoverdose.org.