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County health officer to order hospitals to report overdoses

SNOHOMISH COUNTY — “My brother overdosed in front of me, foaming out of the mouth,” the man remembered. “They only kept him at the hospital a couple hours and released him. He was using the next day.”
Robert Riley II, who struggled for years with his own addiction as well as his brother’s, understands the opioid epidemic intimately. How 23 percent of those who use heroin become addicted, according to the National Institutes of Health. And how that addiction, responsible for 900 Snohomish County deaths in the past decade, often starts in the place one might least expect: the doctor’s office.
Riley said his addiction started with a post-dental work prescript-
ion for hydrocodone and led to many overdoses.
Dr. Gary Goldbaum, director of the county’s health district, has seen enough Rileys of all ages, genders, occupations and backgrounds. Their records fill medical charts and often coroner’s reports.
So, Goldbaum says, in November he will issue an edict to area hospitals, and potentially later to emergency management services, that will require these facilities to inform the Snohomish Health District through an immediate incident report when it treats a patient for an opioid overdose.
Snohomish County would become the second, and the largest, county in the state to enact a mandatory reporting protocol.
The policy is two-pronged for data collection and outreach.
First, when a patient is treated for an opioid overdose, whether a prescription like methadone or an illicit drug like heroin, the facility must report the incident to the health district.
Currently, the district must wait up to a year for overdose data and only receives it for fatalities. Going forward, the district will know
within a day or two about fatal and non-fatal overdoses.
Second, the district will offer patients voluntary drug counseling as well as naloxone, a lifes-aving medication known for reversing overdose effects.
It will also reach out to the patient’s prescribing
physician to give data on the overdose, as well as the most up to date prescription guidelines.
“After treatment for an overdose, that’s a very important moment to try and make contact,” Goldbaum said, when the “person may be in a place where they recog-nize the dangers they face,
may be willing to consider treatment.”
“I think it makes perfect sense for prescribing physicians to hear someone’s had an overdose” and that “offering naloxone… makes incredibly wonderful sense, that one is almost a no brainer,” said Kent Runyon of Florida’s Novus Medical Detox Center.
Dr. Chris Frank, Clallam County’s health officer, concurs. In January, Clallam County was the first in the state to initiate a similar program.
“The hospitals and ERs have been hugely supportive and definitely extremely collaborative because … they’re on the front lines, seeing it every day, and it’s extremely frustrating,” to not be able to do more about addiction, Frank said.
Goldbaum said the overarching aim is to “get more people into treatment, reduce overdoses and possibly reduce the transmission of infectious diseases like HIV and hepatitis” as well as stay better abreast of trends.
The plan will align drug overdose policies with the district’s approach to communicable diseases like measles where robust information gathering and rapid intervention can make the difference in a potential outbreak.
As with those disease protocols, the Health District will safeguard the privacy of individual patients. “Readers should know that Public Health takes privacy really seriously, our credibility is on the line if we violate it,” and staff are already well accustomed to handling sensitive information such as in dealing with sexually transmitted infection cases, Goldbaum said.
The total cost to administer the program is still being calculated, but the Health District will have some help from a CDC grant toward hiring a nurse to help run the program, which is expected to launch with a pilot at Providence Regional Medical Center Everett.
The need appears more pressing than ever to many in health care with the proliferation of super-potent synthetics such as Fentanyl.
Fentanyl is an opiate prescribed for severe post-operative pain or during procedures such as open heart surgery, but can also be found illicitly under names like “friend,” “Goodfella,” and more appropriately, “Murder8.”
It is up to 100 times more powerful than heroin according to the National Institutes on Drug Abuse.
And though 10 percent of Washington residents live in Snohomish County, 18 percent of overdose deaths occurred here between 2011 and 2014. Between 2011 and 2013, overdoses were up by 68.9 percent in the county compared to the period from 2002 to 2004.
As for Riley, he escaped the statistics. After years of addiction he entered an outpatient program that offered suboxone, a combination of naloxone and buprenorphine. It was a
“game changer for real. I wouldn’t have (had) a chance without it,” Riley said.
Riley went on to co-found the Missouri Network for Opiate Reform and Recovery and advocate for legislation increasing access to naloxone and monitoring opioid prescriptions, as well as providing drug counseling.
“I don’t know if it would have made a difference at the time, but it certainly would have planted the seed for help being available,” Riley said of the Health District’s proposed policy.
The Health District and numerous other agencies already tackle addiction through a variety of programs but hope to help short circuit the cycle of use, misuse, addiction and overdose that claims more lives every year than automobile crashes and murders combined, buying time to cure this epidemic.

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