Opioid blockers have saved lives, assisted in recoveries in Whatcom County

Some of the local and national numbers involved in the ongoing crisis of opioid use show proof of significant progress, according to Whatcom County experts.

Dr. Adam Kartman, founder and medical director of Bellingham-based Cascade Medical Advantage, which specializes in medically assisted treatment for opioid use disorder, offers a spectacular number of lives saved statewide with a specific opioid blocker in the past decade.

“From various documented reports, we know more than 3,000 people with overdoses have seen their lives saved by the administration of Narcan (medical name Naloxone) since the passage of what’s known as the Good Samaritan Law in 2010,” says Kartman, who was among the first physicians to offer training in the use of Narcan. “This law allows citizens (such a family member) and law enforcement officers to administer Narcan to reverse the effects of an overdose.”

He also noted that deaths due to drug users’ abandonment of someone they witness overdosing, abandonment due to fears of calling 911 and having police, as well as paramedics, arrive, leading to legal consequences, have diminished. Though the Good Samaritan Law protects those who call 911, individuals with outstanding warrants may still be arrested. “… We’re still in a crisis, but we have made huge improvements,” Kartman says.

Eric Harry, a certified chemical dependency professional who serves as Cascade Medical Advantage’s medically assisted treatment coordinator with their collaboration with PeaceHealth, notes how many people have been assisted to become clean and sober after opioid use threatened their lives.

“In the past 22 months (all of 2019 and most of 2018), of the 535 people with opioid use disorder who have come through Cascade Medical Advantage (and also aided by its several community partners including St. Joseph Hospital), 378 have successfully completed treatment and have moved on with their lives,” says Harry, who is also embedded with PeaceHealth.

In a story Jan. 30 in The New York Times, Sabrina Tavernese and Abby Goodnough reported this progress: “Deaths from overdoses (nationally) dropped by 4.1 percent in 2018, to 67,367 from 70,327 in 2017. The decrease was largely driven by a dip in deaths from prescription opioid painkillers, which set off the opioid epidemic in the late 1990s before heroin and, later, fentanyl, moved in. Provisional data suggests those deaths continued to fall in 2019, likely in part because of restrictions on prescribing.

“But the death rate from fentanyl rose by 10 percent in 2018, and early data suggests it kept rising last year, though not at sharply as before. There were more overdose deaths in 2018 than in any year on record except for 2017, and nearly 70 percent involved opioids.”

Suboxone treatments

Dr. Bertha “Berdi” Safford, a local family medicine specialist for more than four decades, uses Suboxone to treat patients with opioid use disorder at Ferndale Family Medical Center, which is part of the Family Care Network.

Suboxone is a brand name of a relatively new form of opioid that combines Buprenorphine and Naloxone.

“In most circumstances, it’s the best treatment for (opioid use disorder),” says Safford, who has extensive experience with many dozens of patients. “It’s a very important, wonderful treatment. Suboxone does not provide any kind of euphoria or high. It blocks opioid receptors in the brain in a way that people have no cravings and they don’t experience withdrawal. Once a person begins treatment, I recommend at least for a year and sometimes longer. Many people take it indefinitely.”

Less than a decade ago, Safford “saw a need,” so she took the extra training to obtain Drug Enforcement Administration certification and now can treat as many as 30 patients at a time.

“(Opioid use disorder) is an enormous primary care problem,” she says. “Some of my most grateful patients take Suboxone. This is important for the public to understand. Many of these people are sons and daughters, sisters and brothers, community members who had no intention of becoming (opioid use disorder) patients.”

Safford notes that treatment for opioid use disorder is different from the continuing use of opioids that can be appropriate for acute pain, such as that caused by cancer or serious injuries. Chronic pain (such as caused by arthritis) is far different than acute pain and treatments vary widely.

‘Culture change’

Cascade Medical Advantage is a “hub” in the state’s “hub-and-spokes” network of medically assisted treatment centers that partner with other community organizations. Cascade partners include PeaceHealth Northwest Network, Catholic Community Services, Sea Mar Community Health, Pioneer Human Services and the Lummi and Swinomish Nations opiate treatment programs.

Harry stresses how important these relationships are in his counseling work. Kartman, who has worked locally for three decades as a doctor, expresses great joy with a “wonderful culture change” at PeaceHealth since he founded Cascade Medical Advantage.

“Within the last three years, what we’ve been blessed with is an administration, physicians, nurses, staff … really everyone … who have become very receptive to the progress in science we’ve made using (medically assisted treatment) for (opioid use disorder). We’ve had a huge transformation regarding acceptance of the success of treatment.”

At Cascade, Harry welcomes anyone who feels the need to come in and talk with him and the other counselors about problems with opioids, however those issues developed. “You can call me and tell me anything you like,” he says of encouraging people to seek help.

Limiting pain

Retired Bellingham physician Warren Howe is still active in volunteer work and is a past chair of the Washington Medical Commission and helped write the part of the current Washington Administrative Code regarding opioid prescriptions.

Despite the progress made in the tempered use of prescription opioids — most physicians try to limit or avoid the likes of powerful opioids such as Oxycontin, Percocet and Vicodin — Howe notes “there is still a frightening incidence of overdoses.”

He calls how pain at one time was taught as a fifth vital sign — joining the long-established blood pressure, heart rate, respiration and temperature — but that is no longer the case, even though all doctors take note of patient-reported pain.

“We differentiate treatment of cancer pain (and a few others) and non-cancer pain,” he says. “… We are much more aware than we were 30 years ago. “Long-acting opioids (with a sustained release and slow metabolic process) are not indicated for acute pain.”

Dr. Anthony Gargano of PeaceHealth has often talked and written about a concept he feels is very important in dealing with opioid use disorder: Trauma-informed care, dealing with how a variety of childhood trauma can contribute. Even people who did not suffer physical abuse may still be coping with neglect and the emotional aloofness of parents and other adult influences, for example.

He helps people “recognize and overcome deeply painful experiences. I don’t ask ‘What’s wrong with you?’ but instead, ‘What happened to you?’ Stress is a driver of constant pain.”

His solution is basic: “Unconditional self-love and acceptance,” though this does not mean people with opioid use disorder also should not try to improve on their short-comings.