San Francisco Trip Part II: Addiction Treatment and Options to Improve Public Health and Public Safety



After our visit to the San Francisco Navigation Center, our Seattle coalition — including King County Councilmember Jeanne Kohl-Welles, representatives from the Human Services Department, the Neighborhood Safety Alliance, the If Project, and Columbia Legal Services — walked to the San Francisco Department of Public Health’s Integrated Buprenorphine Intervention Service Center (IBIS Center)

The opioid addiction and overdose crisis is recognized as a major public health problem nation-wide.  No state or neighborhood is immune to the problems that arise from addictions.  We in Seattle are facing it too.

It is also a public safety problem.  The individual who has no other source of income may resort to repeated breaking, entering, burglarizing, or shoplifting to support the habit.  In Seattle, property crimes are on the rise, and many professionals observe if we can reverse addiction, we can also reduce property crimes.

My goal as a member of the Seattle/King County Board of Public Health is to implement proven best practices in Seattle to reverse this opioid crisis.  Families and neighborhoods confronting the struggles should not struggle alone. That’s why we need to know more and to treat the problem as a public health epidemic and be fully versed on the options for individuals.

Current best practices include medication-assisted treatments (MAT).  Jadine Cehand, the nurse practitioner who runs the San Francisco IBIS Center, explained what medication-assisted treatments can do  for people with opioid addictions  and the difference between two important options —  Methadone and Buprenorphine (Bupe).

Available research materials explain that doctors and patients have relied upon Methadone for years to help relieve heroin withdrawal symptoms.  We learned a little more about “agonists” and “antagonist” drugs and what different approaches have become available over the last decade.

Methadone is an opiate agonist.  An agonist is defined  as a chemical that binds to a receptor in the brain and activates the receptor to produce a biological response. Other examples of agonists include heroin, oxycodone, morphine, and opium.

An antagonist drug like Narcan blocks the brain’s neurotransmitters and can reverse an overdose.

According to the National Alliance of Advocates for Buprenorphine Treatment, “Buprenorphine  is a partial agonist meaning, it activates the opioid receptors in the brain, but to a much lesser degree than a full agonist.  Buprenorphine also acts as an antagonist, meaning it blocks other opioids, while allowing for some opioid effect of its own to suppress withdrawal symptoms and cravings.”

What we need to know is that both Methadone and Bupe are FDA-approved medications for detoxification or maintenance treatment for opioid dependence.  The needs of each patient determines the appropriate drug for each individual, but can offer stability, treatment and recovery. A person who is treated through medication-assisted treatments may feel better, and with support may recover physically and re-acquire important life skills.

At the San Francisco IBIS Center, an intake professional assesses each prospective patient and refers the patient to the appropriate services in the building. The co-location of beds and services is key to the successful treatment of opioid dependence.

“Any door is the right door,” to access treatment according to the program description.  Access to assessment is a critical  first step. The Center’s patients are largely marginally-housed or homeless with few financial resources.

In response to the heroin and opioid dependence epidemic, Mayor Murray and King County Executive Constantine formed  the Heroin & Prescription Opiate Addiction Task Force to analyze possible solutions—and even before the final report is released, it is abundantly clear we do not have sufficient treatment facilities and San Francisco’s IBIS clinic offers us a good model.

In Seattle we have drug therapy clinics at Evergreen Treatment Center, Harborview Medical Center, and Therapeutic Health Services on Airport Way, Capitol Hill and First Hill that provide Methadone maintenance through daily observed-dosing and limited access to Bupe. Methadone helps hundreds of patients now -but we need more options to be readily available.

Currently, as many as 150 people are on program wait- lists for treatment in King County.   The line-ups and waiting lists for treatment can be avoided if we in Seattle expand our MAT programs for opioid dependence through our health clinics and coordinate primary care physicians city and county wide.

When addicts are ready to seek treatment, they should not be put on a wait list—they need treatment right away.  That’s why we need “ treatment on demand.”

With clinical help and a physician’s counseling, Bupe can be obtained through pharmacies or health clinics across the city and can dramatically reduce the number of people addicted to heroin and to people who suffer from opioid overdoses.

Finally, I want to acknowledge an alternate opinion about MATs from my friend Captain Tim Rockey head of the Adult Rehabilitation Program offered by the Salvation Army.   The Salvation Army offers both housing and support for those who are ready to start on a new path.  He has open beds in his programs for both men and women in Seattle.

Captain Rockey believes that drug rehabilitation therapies described above only serve to promote addiction.  The Salvation Army approach is abstinence, in which individuals commit to a minimum six month inpatient program with housing, support, and a strong spiritual component.  Captain Rockey has been addicted  himself, and he offers this:

“To get clean and sober,  one has to stop the dance and get down to the plain truth which is that to be sober one has to stop using, no excuses, frills, or relish. The discussion about pain free detox, or soft landings are fluff. The ride costs what it costs, one can spread out payments with interest, or pay the bill up front, but the cost of Recovery is what it is, there is no bargaining for the price. “

I recognize  both Captain Rockey and Jadine Cehand’s experiences. There is no single way to treat addiction; different people and different substance dependence respond to different treatments.

Whether we look through the public health lens or the public safety lens, dealing with drug addictions in multiple ways must be part of what we do in our city.

The Opioid Task Force will release its recommendations in September.  I’m eager to hear programmatic recommendations that will improve access to options and fund regional treatment for opioid addiction. Services that are able to, “meet people where they are,” and adapt to individual needs are fundamental to creating healthy and safe outcomes for all of us in Seattle.

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