Suboxone clinic proposed for downtown Monroe

Facility would fill gap for recovery work with opioid-addicted patients

MONROE —  A proposed new site for an addiction clinic in downtown Monroe will also help East County residents with opioid dependence as far away as Index.
Started in 2012 by Dr. Jeff Allgaier and Dr. Ken Egli in Kennewick, Ideal Option is one of the nation’s largest providers of medication-assisted treatment for opioid, methamphetamine and alcohol addiction. The currently have four clinics in Snohomish County located in Arlington, Marysville, Everett, and Mountlake Terrace.
Ideal Option closed its old site, located in an industrial area, in 2020 from a combination of location, low census and COVID restrictions. The new proposed office at 101 E. Main St. facing S. Lewis Street will provide easy access for clients.
Their old office was located in an industrial section near Lake Tye in the Fryelands Industrial Park. Although the bus stop at Freylands Boulevard and Tye Street SE is a 10-minute walk —the next closest stop being half an hour away— it could make for an uncomfortable journey after dark.
April Provost, a Community Peer Outreach Specialist at Ideal Option, described the area around 169th Drive SE as challenging to get to by bus, bike or walking.
“It was surrounded by industrial buildings and manufacturing companies. When it got dark, it could be pretty scary to walk through,” Provost said.
In separate interviews with The Tribune, Cmdr. Paul Ryan of the Monroe Police Department and Mayor Geoffrey Thomas expressed general support for treatment programs for opioid dependence. Especially as fentanyl, a synthetic opioid, is being found in a wide range of illicit drugs.
Police Cmdr. Ryan said, “The Monroe Police Department supports anyone looking to help out.”
Mayor Thomas, in general, views treatment programs as a step in the right direction. “It is time we start loving our neighbor and consider the needs of others, period,” he said.
Ideal Option’s proposal is still being processed to obtain city permits, including a special use conditional permit to operate a medical clinic in this location due to zoning. This is a standard practice for cities to maintain continuity among the businesses in an area.
According to Mayor Thomas, the staff is performing the initial review of the application. Then, a notice will be distributed for public comment, followed by a public hearing before the Hearing Examiner. The Examiner will consider staff recommendations and public comment and determine if the proposal meets city codes.
This overall view of treatment services will be necessary to address the opioid crisis. Provost has been sober for three years and working in the recovery field for two and a half. She knows the challenges of conquering addiction firsthand.
“You can’t plan for the future because you can’t see past your next fix. You can’t imagine one; there’s no hope. It’s a very dark place to be in,” Provost said.
For Provost, her opportunity for recovery came from the Snohomish County Sheriff’s Office of Neighborhoods outreach program, which was disbanded earlier this year. With that program’s help, she climbed out of her dark place and used that experience to help others, proving that the outreach program made a difference.
“My story is my greatest asset, and I pray it will inspire others and help reduce stigma by showing successful recovery is possible.” Provost said.
For those who don’t need treatment services, a new office location may not seem significant; however, it could help brighten the path to recovery for their clients.

What patients need to know about Suboxone
Although Suboxone has become the preferred treatment medication due to the reduced withdrawal symptoms compared to methadone, patients should be aware of some side effects. Unless the guidelines for taking the drug are followed, patients can become ill with the first dose.
It can also make teeth decay.
In an interview, Sharen Ross, Vice President of Marketing and Community Development for Ideal Option, explained how to prevent tooth decay and when a patient should take their first dose. The information is given to clients in greater detail during orientation.
Ross said the opiates must be out of the patient’s system before taking their first dose, or they will have withdrawal symptoms. The main ingredient of Suboxone is buprenorphine, a partial agonist —meaning it will occupy the opioid receptor just as a full agonist, such as heroin or fentanyl, but without the high.
The opioid receptor in the brain can be thought of as a facet. Buprenorphine only partially turns the handle, subduing the withdrawal symptoms. In contrast, heroin and fentanyl turn the handle to full blast, creating a euphoric effect.
The second ingredient, naloxone, can be related to a limiter that prevents the opioid receptor “facet” from opening up fully. It is an opioid antagonist that blocks the high in case buprenorphine or another opioid is abused. Since there is no euphoric effect on the brain’s receptors, opioid use is less likely.
Tooth decay is also a concern for Suboxone users. The medication is delivered by a plastic strip placed under the tongue. However, it is very acidic and can destroy tooth enamel and cause decay. This increased risk of dental issues makes oral hygiene critical for patients using Suboxone.
Ross said clients should brush their teeth an hour after taking the medication. This time frame will give the Suboxone time to absorb into the system and is soon enough to remove acids from the patient’s teeth. A complete guide to oral hygiene is provided to clients during orientation.

A proposed pilot program could make it easier to get to a treatment from Monroe to the east Sky Valley.
Many low-income patients cannot afford a dependable vehicle, and rides can be inconsistent.
Ideal Option has a proposal to the Snohomish Health District for funding to help patients along the U.S. 2 corridor as far east as Index by providing ride service to the Monroe location if it opens.
There isn’t a timeline for when the proposal may be finalized, Snohomish Health District spokeswoman Kari Bray said.
The proposal outlines two proposed methods of getting patients to their appointments, either by renting or leasing a vehicle in six-month intervals, or by giving vouchers for rides on the Uber or Lyft ride-hailing systems.
In their proposal, Ideal Option stated that a ride service voucher “allows clients to schedule appointments when it’s convenient for them and is not limited to the days the driver is working in the first option.”
The estimated cost is $130,000 a year. Transportation was calculated using 15 patients taking $60 round trip Uber rides from Gold Bar to Monroe for 52 weeks.
Ideal Option stated in their proposal that “this budget is meant to offset but not cover the anticipated cost to expand sustainable evidence-based.”
The transportation route will stop along U.S Route 2, including Sultan, Gold Bar and Index at the county’s edge. These stops are significant for Gold Bar and Index, where the closest pharmacy is in Sultan.
Ideal Option has clinics in Arlington, Marysville, Everett, and Mountlake Terrace. — Rick Sinnett