Access to opioid addiction medication remains limited in King County

Aaron McGrady got hooked on prescription opioids several years ago after several people close to him passed away.

The 31-year-old former Seattleite has been suffering from an opioid-use disorder for roughly two years since.

“A lot of bad things happened in a short amount of time. A lot of people died,” he said of the start of his addiction. “Prescription [pills] started it, and then it just escalated from there.”

Now, after bouncing among various local drug-treatment service providers, McGrady is on medication-assisted treatment (MAT) — the current gold standard in the medical world for treating opioid addiction.

MAT drugs such as buprenorphine and suboxone are designed to act as substitutes for opioids to stave off cravings and withdrawal symptoms without any intense euphoric effects, allowing patients to get out of the cycle of addiction, stabilize their lives, improve their health, and hold down daily responsibilities like jobs.

“For opioid-use disorder, the most effective supports that we know of are medications,” said Caleb Banta-Green, a principal research scientist at the University of Washington Alcohol and Drug Abuse Institute. “A person is still physically dependent, but they are out of the chaos of addiction and that person can be in recovery.”

MAT medication can cut the chances of an opioid addict dying from a overdose by 50 percent, according to both Banta-Green and King County Public Health officials.

“It’s given me a way out,” McGrady said of his suboxone medication, which he’s been using for roughly a year from Valley Cities Behavioral Healthcare clinics in southeast Seattle.

Another advantage of these drugs is that they are less regulated than methadone, an older opioid medication. Federal law dictates that methadone can only be consumed within the sanctioned clinic where it is distributed — thereby requiring that patients take frequent trips. In contrast, suboxone can be prescribed in bulk at a variety of locations and taken at home by patients.

But that still doesn’t mean the process is easy. For McGrady and others suffering from opioid-use disorder, obtaining this potentially life-saving treatment can be a difficult, time-consuming task given the lack of MAT providers outside King County’s urban core.

Seattle’s geographic concentration of MAT providers means that getting crucial opioid treatment can require commuting for hours in the region’s snarled traffic, which is particularly trying for low-income or homeless patients.

When he lived in Puyallup, McGrady rode the bus twice a week to Beacon Hill’s Valley Cities Recovery Place detox and treatment facility to get MAT drugs because of the lack of equivalent services closer to home.

“It was a hard task to say the least,” he said of the more than two-hour commute. “It was hard to keep a lot of appointments.”

Barriers in South King County

According to a 2017 King County Public Health epidemiology report, more than 23,000 people in King County inject drugs — primarily heroin.

Local addiction-treatment medical professionals argue that spatial disparities in King County’s MAT providers is limiting which populations can get easy and routine access to crucial medication for opioid addiction.

“There’s a lack of access on the Eastside and a lack of fast access in South King County,” said Daniel Otter, a nurse-care manager at Recovery Place on Beacon Hill. “We have plenty of folks who commute up here. It makes it really challenging for them.”

In terms of making it to appointments, transportation is the number one barrier that people cite, he said.

“The people from South King County are the people who miss their appointments more frequently because, at best, they are looking at an hour-long public transportation commute,” said Otter, who estimates that roughly half of his patients commute from South King County.

Molly Carney, executive director of Evergreen Treatment Services, a Seattle-based addiction services provider with clinics across King, Thurston, and Grays Harbor Counties, said that missed appointments can be catastrophic for patients trying to stave off opioid withdrawal.

“The prescriptions are timed so that they run out on the day that the patient is due for the next appointment,” she said. “If they miss that appointment, they are going to miss their medication and go into withdrawal.”

Expanding access

Expanding access to medication-assisted treatment has been a cornerstone of King County Public Health’s broader strategy to addressing the escalating opioid epidemic.

In 2016, the King County Heroin and Opiate Addiction Task Force produced policy recommendations, including establishing safe-consumption sites for drug users, safe disposal of prescription opiates, and increasing access to treatment. The county health department has been working ever since to implement the recommendations. Actually establishing a safe drug consumption site has moved slowly due to pushback from the suburban communities.

King County Public Health’s effort has included distributing over $600,000 in county funding to local addiction-service providers to establish their own MAT programs, investing in a county-managed buprenorphine program, and coordinating with service providers that have received state and federal funding.

The county’s investments in MAT treatment are concentrated in Seattle, leaving South King County and the rural Eastside communities underserved. (Households living below the federal poverty line are also concentrated in South King County.)

Most of the “low-barrier” providers — facilities where patients can get prescriptions the day they walk in without going through numerous appointments, and won’t be turned away for having a dueling dependency on drugs like methamphetamine — are almost exclusively limited to Seattle, making it even more difficult for patients outside the city who need medication at any given moment.

King County Behavioral Health and Recovery Division Assistant Division Director Brad Finegood said that demand for MAT is highest along the I-5 corridor, citing the concentration of overdose deaths in Seattle and along the highway. According to the county, 53 percent of all fatal overdoses in 2017 occurred in Seattle, followed by south- and east-side cities like Tukwila, Des Moines and Bellevue.

Otter of Valley Cities said there are few places in South King County where a patient can “just go in and get a prescription of suboxone the same day.”

Valley Cities Behavioral Health is one of the few providers with a significant presence in South King County, with clinics in Renton, Federal Way, Kent and other cities. However, these facilities don’t offer same-day access to MAT drugs, and often require patients to go through a series of appointments to get medication like suboxone, according to Otter.

For McGrady, getting his suboxone medication is easier now that he’s moved to Des Moines, where he can get to the Valley Cities Beacon Hill clinic in 20 minutes by bus.

“Now things are a lot better,” he said.

Regional opioid epidemic

The regional opioid epidemic is only worsening. In early May, the Alcohol and Drug Abuse Institute released its annual drug-overdose deaths report, which showed the crisis worsening. According to the report, 379 people died of drug and alcohol use in 2017, up from 348 the previous year.

Heroin-related deaths were the majority of all fatal overdoses in 2017, but upticks in methamphetamine and fentanyl (a powerful synthetic opioid) use were also recorded. The report’s findings also track long-term regional trends in the opioid epidemic and general drug use and addiction. Since 2011, opioid deaths have gone up every year except 2014.

The steady increase in overdose deaths has public health officials concerned.

“The opioid epidemic in King County is worsening,” said Jeff Duchin, health officer with King County Public Health at a May 9 press conference where the latest tallies were announced.

He went on to tie the rising overdose fatalities to the regional homelessness crisis, which is escalating in tandem.

“To bend the curve on this epidemic, we have no choice but to address the underlying social, economic and psychological stressors that are driving substance-use disorders and addiction — as well as the many other causes of death and disability in our communities — including poverty, housing instability and homelessness.”

According to the county’s 2017 drug overdose report, 17 percent all overdose deaths last year were among people experiencing homelessness, despite the regional homelessness population constituting less than 1 percent of King County’s total population.

So as beneficial as MAT programs have proved to be, Dunchin believes the problem needs to be addressed earlier.

“Unless we turn off the flow of newly addicted persons and people developing substance use disorder in the first place,” he said, “we are never going to get ahead of this.”