ADDICTION It remains easier to prescribe more addictive opioids for pain, he says, than to prescribe Suboxone for addiction. “If they want to just hand them a bottle of Oxy, that’s fine,” he says. “Those incentives are all screwed up.”
DEADLY DELAYS
When an overdose patient comes into Sacred Heart’s emergency room, Neven does what he can to save their life and get them stable. But some of them need more than that. Many of his patients don’t just need to get connected with a Suboxone or methadone clinic, he says, they need to go to rehab. They might need to go to a detox clinic, or get help for addictions to multiple drugs, and work on other issues in their life. “A lot of the most severe addicts need inpatient treatment with medication-assisted therapy,” Neven says. “There’s a tremendous amount of red tape and hoops you have to jump through in order to get into treatment.” Those delays can be fatal. Although there are a number of residential rehab facilities, medical detox facilities are rare in the region. Until American Behavioral Health Systems opened a new facility this fall, there wasn’t an acute medical detox center that took Medicaid in all of Eastern Washington. One major insurance carrier in Spokane won’t pay for any inpatient treatment in the area, Neven says. There may be a weeks-long waiting list. Even if there is a bed available, it can take three to five days, minimum, to get approval, he says. During that time, addicts often change their minds. “That’s what breaks my heart,” Neven says. “I don’t know where they’re going to be at in 3 to 5 days.” Spokane Police Capt. Brad Arleth, a 25-year veteran of the department, says police officers know how crucial it is for addicts to get treatment immediately. “With addiction, no matter what kind it is, when somebody says they need help and they’re willing to go — ” Arleth snaps his fingers. “They got to go now. Like, an hour from now.” Give addicts time to think about it, Arleth says, and their first stop isn’t going to be rehab. It’s going to be their drug dealer. While Spokane’s drug and community courts often send addicts to rehab, Arleth says that, unlike King County, Spokane doesn’t have a program that allows cops to send offenders directly to treatment before they’re charged.
PUTTING OUT FIRES Victoria Justice has to take a bus daily from Wellpinit for methadone.
YOUNG KWAK PHOTO
“TAKING THEIR MEDICINE,” CONTINUED... ington, Idaho, Montana, Alaska and Maryland. “We used to have a 500-person waiting list in that area about a year ago,” Jeff Allgaier, president of Ideal Option, says about the Spokane region. “We have made a priority of ours to not have a waiting list. These people need treatment right away, or they die.” Increasingly, Suboxone is being seen as a crucial tool in the fight against addiction. Sacred Heart Medical Center starts some addicts on it in the emergency room after overdoses. “It’s not abused in the traditional sense,” says Darin Neven, a Sacred Heart emergency room doctor. “I think Suboxone should be a behind-the-counter medication you can get from a consultation with a pharmacist.” But it isn’t. Doctors who prescribe Suboxone still face significant regulations. Practitioners are required to get a DEA license, extra training and a specialized waiver to prescribe it. Up until this year, nurse practitioners couldn’t prescribe Suboxone at all — only doctors could. And doctors still have a federal cap for how many patients they can have on Suboxone treatment — only 30 for the first year. Some insurance carriers don’t cover taking Suboxone or methadone treatment at all. Humphreys, for one, doesn’t want Suboxone unregulated — he still believes it’s important to provide counseling instead of just shelling out pills — but he believes the balance is out of whack.
28 INLANDER NOVEMBER 16, 2017
Last year, the Spokane Fire Department used Narcan on 145 occasions, attempting to save the lives of people who seemed to be experiencing a severe overdose. This year, with less than two months left, the number is even higher, at 175. Narcan wakes addicts up from an overdose. They can start breathing again. But it also rips them back into reality. Some addicts get angry at the paramedics who just saved their life for taking away their high — they ask to be left alone and try to leave. Doctors at Sacred Heart Medical Center’s ER used to give Narcan to overdose victims to take home, training their loved ones on how to use Narcan to save their lives if they overdose again. But in 2015, a state Pharmacy Quality Assurance Commission rule banned Washington state hospitals from giving patients prepackaged take-home medications. The legislature swiftly passed a bill to create an exception — but only for hospitals without access to 24-hour pharmacies. — DANIEL WALTERS
* * * But even for those who do get into inpatient rehab, relatively few opioid addicts will receive scientifically backed, medicationassisted treatment. Even at clinics that support opioid-replacement drugs, the use of these medications is limited. At Sun Ray Court, a Spokane inpatient facility for up to 54 men, only about 10 to 25 percent of opioid addicts are receiving medication-assisted treatment. “We don’t have a Suboxone prescriber on staff,” says administrator Tom Cook. “I don’t have the funds to employ someone who would actually work here, who would have the credential.” And of the nearly 100 patients being treated for opioid addiction at American Behavioral Health Systems in Spokane, only about 30 percent are on a full opioid-replacement treatment regimen. Paul Means, a nurse practitioner who works with ABHS, says the biggest issue is that, while he can start patients on Suboxone during their short stint in rehab, he needs to have a Suboxone provider he can hand them off to afterward. And they can be hard to find. “The bottleneck in the whole system is the numbers of providers who can prescribe Suboxone,” Means says. According to the opioid crisis commission’s report, nearly half of the nation’s counties last year didn’t have a single provider with a waiver to prescribe Suboxone. Sometimes, the patients are the ones who refuse Suboxone. “Half of patients don’t want to be on medication,” Humphreys says. “You can’t just tell them ‘Go to hell.’” ...continued on page 30