Suboxone, seen in the form of a strip taken under the tongue, is a combination drug of buprenorphine and naloxone used to treat opioid use disorder. (Daniel Kim / The Seattle Times)
Yakima County will set a record for overdose deaths this year as the Yakima City Council discussed ways to help in a meeting with local experts Tuesday.
As of Tuesday, Yakima County has had 140 drug overdose deaths, including those with toxicology tests pending, according to the coroner's office. It's up from 96 drug overdose deaths in 2023 and 98 in 2021, the previous record.
Drug use, particularly the illegal use of opioids, has gotten more dangerous as fentanyl has become more prevalent.
The council invited service providers and experts to talk about their work and a broad array of solutions, honing in on the needs for more places for people facing addiction to go and the complex nature of addiction treatment. It followed a discussion in November with Yakima police about drug use trends, with the Yakima Health District about harm reduction and the creation of stay out of drug areas.
Among the possible suggestions: Setting up a community diversion or detox center. Another idea is bolstering the city's community diversion court, which gets people people who are charged with low-level crimes help with drug treatment and services instead of jail time.
The discussions come as city council members try to figure out how they can play a role. Yakima is one of many local governments in the state to receive a portion of the hundreds of millions of dollars the state's attorney general won in settlements with pharmaceutical companies to help treat opioid addiction.
The city will receive $1.3 million in payments spread over 17 years. Other local jurisdictions, including Yakima County, Grandview and Sunnyside, also received some of those funds.
Where should people go?
One topic that was raised repeatedly was where people can go when they're struggling with addiction.
Comprehensive Healthcare staff noted that other communities in Washington have diversion or detox centers for people as alternative to prisons.
"It's a dream for everyone at this table," said Gillian Zuckerman, who is leading Comprehensive Healthcare's addiction services.
It's one way to use opioid settlement funds, Zuckerman added.
Jon Schlenske, another doctor at Comprehensive, noted that Spokane had several such centers. The Spokane Regional Stabilization Center is run by Spokane County and provides a place to get medical, substance abuse or mental health treatment. Law enforcement officers can drop people off there instead of jail.
According to an article from the Spokane Spokesman-Review, 1,563 people used the facility in 2023 and the county is investing opioid settlement funds into the facility.
Local governments in the Tri-Cities are collaborating on building such a center in an old hospital building in Kennewick. The cost was estimated to be $28 million, according to a Tri-City Herald article published in January.
Zuckerman said that kind of facility would be heavily used in Yakima and could be a gateway to more treatment, but noted the challenges to building and running it.
"There's always an up-front cost," she said. "Staff recruitment is also a barrier here in Yakima."
Jocelyn Pedroza, chief medical officer at Yakima Neighborhood Health Services, added that more than 50% of people the organization treats for opioid use disorder are homeless.
YNHS has permanent supportive housing opportunities that it uses to help people with wraparound services. Giving people a place to go and support once they get there can produce better healthcare outcomes, several experts agreed.
"If they're on the street and don't have access to storing their medication or adequate time for recovery, this helps with that," said Annette Rodriguez, YNHS's chief housing and homelessness officer. "When they start having conversations about change, that's what we want to take advantage of."
What did council members say?
Council members seemed to agree with the need for an alternative to jail for people experiencing drug issues. Council member Rick Glenn was attracted to the idea, noting that local jails could not really take on addiction cases.
He said permanent housing is important, but added that, as a landlord, some tenants are difficult to house. Other council members, like Brown and Mayor Patricia Byers, noted the importance of support once people are housed.
"It's not just housing, it's services and wraparound services that make a difference," Brown said.
Byers added that programs like YNHS's medical respite were helpful. When it comes to using opioid settlement funding, she suggested another alternative: using the money for the city's community diversion court.
UW experts present
Two professors with the University of Washington's Addictions, Drug and Alcohol Institute presented on some of their findings from their time researching drug addiction.
"This era of fentanyl is unprecedented. We're never seen anything like it," said research professor Dr. Caleb Banta-Green, an epidemiologist who tracks drug trends in Washington.
Banta-Green said fentanyl was different from previous drug epidemics because of it affects the body fast and for short periods, therefore requiring more doses each day.
Using fentanyl creates a physical and psychological dependence on the drug, Banta-Green said. He said physical dependence can create a biological rollercoaster that makes social life more difficult and disrupts personal relationships.
Banta-Green added that fentanyl, when unregulated and taken illegally, varies in dosage, making it more dangerous.
Dr. Mandy Owens, a clinical psychologist and professor at UW, said part of her work involves talking to service providers and law enforcement around the state about solutions.
"The innovations that came out of all those counties were, 'Can you build us a place to take these people that's not a jail?'" she said.
Owens said jail can be a poor system for helping people with addiction or drug use problems and impacts the work of correctional facilities and their capacities. A community facility, like a detox or stabilization center, could provide an alternative, Owens said.
Banta-Green added another potential solution: opioid use disorder medications. Treatments involving drugs like buprenorphine, methadone or suboxone can be highly effective by preventing the symptoms of withdrawal from opioid addiction while not causing the same biological rollercoaster.
"You can be on opioid use disorder medications and be in recovery," he said. "You wouldn't know a person is on buprenorphine or methadone."
What did council members say?
Council members took full advantage of the array of experts at their disposal, asking numerous questions about drug addiction and treatment.
They clarified the effects of opioid use disorder medications. Banta-Green said the dosage needs to be right, but people are more functional on those treatments than on drugs like fentanyl.
Byers said she supports local suboxone programs. Comprehensive Healthcare already provides one, including services for inmates.
Treatment is hard
Service providers and doctors at the meeting noted the difficulties of treating drug addictions.
Cassidy Leslie, Triumph Treatment's clinical director of substance use disorder services, said more people are relapsing and need treatment.
Triumph has 28-day programs to help people stop using drugs. That window is set by insurance companies, she said, and sometimes people need more time for treatment.
"People are relapsing quicker, need to get back into treatment sooner," she said.
Zuckerman said that success in addiction treatment takes time. She said getting people jobs and making them whole is the end goal, but that sometimes celebrating the small wins, like being sober for a few days at a time, is important.
People relapse and it can take multiple treatment attempts to overcome opioid addictions. It is a chronic condition, not something that can be solved quickly like a broken arm, Zuckerman said.
What did council members say?
Council members asked about mandating treatment for people. Some residents and local businesses are concerned that funding isn't creating enough results, Brown said.
"They see this as a huge problem," Brown said. "It's their money that we feel like we're throwing into a bottomless pit."
Brown asked how you get people into treatment.
"You have to make it appealing. A lot of our models of care are not quite what people want," Zuckerman said.
Zuckerman added that people can't be forced into treatment. Service providers and local authorities have to create opportunities and environments that encourage patients to seek help.
Schlenske from Comprehensive said that people are right to be frustrated. The models and systems for treatment in the United States can make people feel stigmatized and isolated, he said, and new solutions and approaches should be explored.
Donald W. Meyers contributed reporting.