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(audience chattering amongst themselves)
- Good evening everyone.
My name's Ken Harvey,
and I'm the Communications Director for Sno-Isle Libraries.
I'd like to welcome you
to the Sno-Isle Libraries Service Center.
This is our administrative and distribution center
for our library district.
It's a chilly night.
I think summer's now (mumbles) officially behind us.
And we really appreciate those of you
who've taken the time to join us.
This is a very serious subject that we're here to discuss.
And, I think that one of the reasons why we're here is that
even with the seriousness of it, we're here
to discuss the search for solutions
and the hope that we have that
those solutions are available to us.
I wanted to just take a minute
to recognize the different organizations that are
part of this effort.
And, we've got posters here on both sides of the front
that have the logos representing
and the names of these organizations that are all
part of working towards these solutions
and to help those who are affected by the epidemic
to find their way going forward.
Also wanted to recognize the different levels of government
that are here and the different social service organizations
and those who care,
because they've been affected by this
and just wanna thank you all for taking the time
to come out tonight.
Just so that everyone is aware we've got exit doors
on both sides of the room.
And we also have doors
into this room which probably most of you came
through this door back on my left, your right,
but also this door on my right
and this, there's also an entra, an exit
out of the building from this side as well.
So just want you all to be aware of those ways
in and out of the, out of this facility.
And if you go back out to the left here
and back down through our main entry doors passed there,
there are restrooms available, if you need them.
So, I'm going to turn the program over
to our facilitator tonight
and wanna thank her for working with us
to be part of this wondrous event.
So, Shari.
- Thank you Ken.
Thank you to everybody who made the
journey out here tonight.
I wanted to let you know that this
event is being live-streamed on Facebook.
We have media in the room as well.
And, it is being recorded
for a future podcast that Sno-Isle
Libraries is going to put out.
So yes we are having a conversation
about a podcast which is being recorded
for a future podcast.
Before I introduce our two main speakers here tonight,
I just want to give you a brief overview of how
this event is gonna go.
First, Anna and Kyle are gonna talk
about making the podcast, especially,
I know I'm especially interested
in what they learned about Snohomish County.
As someone who lives here, I'm pretty close to it.
But I'd like an outsider's perspective.
And we have special guests here in the front row.
Most of them are featured in the podcast.
We'll be directing some questions to them
through the evening about topics
and subject matter that comes up
in the episodes they put together.
We will spend a portion of the
evening talking about resources.
As one of the things I hear all the time
from community members is it's a very complex
and confusing process to go
through treatment, recovery, assessment.
What does it all mean?
So, the good news is we have, again, subject matter experts
up here in the front who can answer those questions.
And then we're gonna open it up to questions for you.
We know this is a sensitive topic for a lot of folks.
So, we're gonna do the old write the question
on the note card.
If something comes up through the evening, you have a
question you want asked, I'll go ahead and facilitate those.
Write down your question.
Hold up your note card.
And again, going back
to the topic of this being very sensitive,
I would just ask the audience to keep an open mind
and remember there's a lot of folks
in this room who have gone through recovery
or are in treatment
and just be respectful of the journey they're on.
So, with that, let me introduce Anna and Kyle.
Thank you so much for bringing me into this crazy journey.
And I forgot one other thing, really quick.
I wanna thank Sno-Isle Libraries by the way
for putting this on,
because, frankly, I told them it would be me
with an iPhone and probably a yellow reflector vest.
So, it's very nice to have the pros put something together.
Thank you very much.
So, Anna Boiko-Weyrauch,
I'm very happy I can say your name now,
and Kyle Norris are the hosts
and co-producers of Finding Fixes,
which is an independent media project of InvestigateWest.
Anna grew up in Seattle.
Born in Spokane, correct?
- Born in Spokane.
- And is a reporter at Seattle NPR affiliate station KUOW.
In 2010, she was a producer in residence at K, KEXP
and launched a series of stories called Why Music Matters,
a nationally syndicated NPR's All Things Considered.
And Finding Fixes, she says, is her passion project.
Kyle is from Michigan and spent 10 years as a host
and reporter with Michigan radio.
His stories are driven by deep insights
into his characters' motivations and personal struggles.
And Norris is known for his conversational expressive tone.
He can really suck you in when you're on the phone
and talk you into doing a podcast.
(audience and panelists laugh)
And I wanna introduce some of the
special guests we have here.
(mumbles) I'll just ask you to stand while I embarrass you
and read your introduction.
I'm gonna start with my boss, Sheriff Ty Trenary.
He has been the Sheriff of Snohomish County since 2013.
His career in long enforcement spans almost three decades.
Since becoming...
(Shari and audience laugh)
Since becoming the CEO of the largest law enforcement agency
and jail in the county, he has shifted the Sheriff's Office
focus on addressing homelessness, the opioid crisis,
untreated addiction and mental illness and more.
In 2017, he received the County's Human Rights Award
and just this past month the National Sheriff's Association
and National Commission on Correctional Health
Care highlighted the Snohomish County
jails Medication-Assisted Treatment
or MAT program, which we'll talk
about later tonight, which is quite an
accomplishment for a cop.
Geoff Godfrey is a nurse practitioner with Ideal Options.
Any of those who've listened
to the podcast will recognize his wonderful, sultry voice.
He has a master of science in nursing
and many accents by the way
and has almost two decades of experience.
He works with doctors and physicians across the state
and the country to help provide treatment
to those in Snohomish County.
Heather Thomas is the Publican Government Affairs Manager
at the Snohomish Health District.
She's responsible for communications
on government relations.
Earlier this year, she became the President Elect of
Washington State Public Health Association.
Her work is diverse and dynamic.
On any given day, you may find her talking
about bat bites, measles, or salmonella and opioid overdose.
I'm proud to call Heather my heroin mentor
and partner in our fight against the opioid epidemic.
She's a good friend as well.
Alta Langdon is the Health Services Administrator
for the Snohomish County jail.
She received her master of science and nursing from Gonzaga.
And it is under her leadership that medical
and mental health services at the jail have gone
through a major overhaul
and partnerships have been established
with folks like Ideal Options, Western State Hospital.
We now do medical screening
and mental health screening of all inmates on booking.
And she'll talk about more of that tonight.
Deputy Bud McCurry and Lauren Rainbow.
The're our Office of Neighborhoods Deputy and social worker.
The Office was created in 2015 and partners law enforcement
with social workers to provide services
to our most vulnerable residents
in the county, especially the homeless.
Almost all of their clients are dealing
with addiction, untreated mental illness or both.
And last but not least,
Angie Jorsen is representing Human Services tonight.
She's the Behavioral Health Supervisor.
She coordinates behavioral health services
across the entire county
and manages many, many grant programs.
She is also enthusiastic, innovative, and amazing
and a great partner to have, so.
With that, I am going to start
with the very first clip, if you're okay,
and then let the two of you talk about it.
- Sure. - Alright.
Do we have our first clip?
- The audio clip.
`- [Female Narrator] Behind every addiction, there's pain.
That statement became real when we were
at a clinic in Everett, Washington that treats addiction.
And it became real when we met one patient named Amy.
She had relapsed on heroin
and on this day she is thinking of quitting again.
- [Amy] Which is scary.
It's scary (mumbles) you about (faintly speaking).
- [Female Narrator] But Amy says she's scared.
- What are you scared about?
- [Female Narrator] Amy speaks in a low voice
and even though we're all cramped
into a tiny exam room, craning forward
to hear her, sometimes she's a little hard to understand.
- [Amy] I don't know, you (mumbles) know.
- [Female Interviewer] You used to.
- [Amy] I used to not feel.
- [Female Interviewer] Not feel.
She used to not feel.
- [Amy] Probably wreckage in my past to have to deal with.
- [Female Narrator] A lot of wreckage
in her past to have to deal with.
- [Amy] I've been using drugs since I was 12.
- [Female Narrator] And how old are you now?
- [Amy] 32.
Mostly meth, until I was 28, then heroin, so, yeah.
- [Female Interviewer] Yeah, that's a long time.
- [Amy] Yeah, off and on.
It is a long time.
(mumbles) my teeth are horrible.
I thank God, they've been falling
out from the back forwards.
So the front still look okay.
But the side's getting pretty close, so yeah.
- [Female Narrator] Meth is making her teeth fall out.
That's a common side-effect.
But she laughs, because at least the ones
in the back are going first.
(soothing music)
That's some dark humor.
Any really taught me something that day.
People who aren't addicted
to drugs, like myself, don't usually understand something
very key to addiction.
Amy is saying once she stops using drugs that's
when life is going to get hard.
She's going to have to feel.
The drugs are not the problem.
It's the pain of living that's the problem.
And pain is driving this opioid epidemic.
(soothing music)
- So.
I would like to just start
with why Snohomish County and why opioids.
- Why Snohomish County and why opioids?
So let's see.
Well first I wanna just comment
on what we heard a little bit. - Yeah.
- So, that is the first part of the first episode.
And I think that,
and I put that at the very, very beginning,
because I think that's a key takeaway in all of this is that
the way that we've understood addiction
or that we often understand
addiction is wrong, that it's a moral failure.
When really it's a medical condition.
And we focus on the drugs.
When really we need to understand what is it that is driving
people to use the drugs in the first place.
We can circle back on that.
So, why Snohomish County, why opioids?
So, as a reporter, I often find that a lot of...
Sorry, I'm always, I'm a little particular
about my mic placement.
(audience and panelist laugh)
I always find that,
so in so many stories that I've done opioids,
drugs, addiction have come up.
Even though the story seemingly has nothing to do with it.
So, the foster care system or the criminal justice system.
Addiction is just (mumbles), it plays such a role
in so many social issues that we see
and in so many stories that as a journalist you might cover.
And so I kept seeing it over and over and over again.
And, I kept seeing it
on the streets of Seattle, where I live,
that, there are, there is a house two doors down
from me now that's boarded up.
And every so often, and everyday I walk by it in fact
and I look in the yard, and there's a tourniquet.
And there's a syringe.
So I see it.
I see people using drugs in doorways.
And I wanted to know why.
I wanted to know what's going on.
And the more that I looked at doing a project
about it, I wanted to find something different,
something new, something hopeful too,
because there's no way that I could've done
all of this reporting
and spent, I mean, a long time, a lot of Sundays putting
this together if it wasn't hopeful.
And because I also think that at this point there's a lot
out there that you can read
about why we have an opioid epidemic, why we're
in the place that we're in.
But we don't know what's working
and how we can get out of the situation that we're in.
And why Snohomish County?
I live in Seattle, so it's close.
You know a lot of times when we think
about opioid epidemic, people think Ohio, West Virginia.
But, and, in the national news,
this isn't really the setting
from which the opioid epidemic is told.
But, I thought that what you all are doing
in Snohomish County is interesting
in that you have, here's a county that,
from a very high level is trying
to tackle this in a different way
and that there are solutions that could be relevant
to the rest of the country that are happening here.
- I remember Kyle you called me
and said, what's, what are you doing in Snohomish County.
And I think I probably talked non-stop
for about 48 minutes
and I think you said that's really interesting,
'cause I know I was very excited
to see government try to come together
and break through some of the barriers too.
But again, obviously something was interesting to you.
I'd love to hear your perspective as well.
- Yeah, I mean, I'm more of a storyteller.
So I'm just looking for characters who are surprising,
bodies of government that are doing something
for a reason or people doing something for a reason.
I'm just, yeah, I'm more of the storyteller,
and so I just, everything we kept kind of learning
about seemed really interesting, different, and unique.
And I don't know much about this topic at all.
I come to this as a journalist, pretty open minded
and curious about it.
And I just, I always wanted to tell good stories.
And we kept getting the green light.
You were on board, and you filtered us
to people who were on board.
And as a reporter I call it the green light,
where you reach out to someone,
and they say yeah I'll talk with you.
And that's what you want.
And we just kept getting green lights.
And I was like, let's just keep going
and see what happens.
So, it just kept being a green light.
Yeah, I don't know there was something here.
I'm from a town that's very much, a county
in Michigan that's very much like this county.
This was very familiar
to me, even though I've never been here in my life.
So, we, it just kinda felt right to keep moving forward
and see what we stumbled
upon in our storytelling. - Yeah.
And you did a great job.
I mean, one of our goals in the county is
to, we know there's a lot of obstacles in the way.
So, so many obstacles.
But one of them is to humanize people who are struggling
with substance abuse disorders.
And, what I loved about the podcast when I heard it,
when I was brave enough to finally listen
to it was those stories came through.
I mean, it was humans telling their struggles
or their successes or how they were being involved.
- I teach journalism and radio storytelling to people.
I just taught a class last week.
And they always say this line that if you can tell a good
story, you touch people's hearts
and then it opens their ears,
and they'll listen to what you're saying.
So I, that's always what I'm trying
to do too is tell a compelling human story that is just
meaningful, surprising, and human,
and then people will listen
to the facts and the information.
But you gotta hook 'em first
and reel 'em in. - Right.
- And so that's what, I, that's (mumbles) what I'm
thinking of doing whenever I tell stories.
- It's funny, 'cause I used to live in Seattle
and commuted down there for years.
And I remember when I told people we were moving
to Snohomish County, their reaction,
Seattleites' reaction was, it was basically
we were moving to the moon.
I mean, we couldn't...
So, that's why I'm very curious
about your perspective after spending a lot of time
up here in Snohomish County, what you learned
about the county and our communities
and kind of how we work together.
Is it different?
Was it what you expected?
- I mean, I don't know if I really expected anything
or had any sort of image of what Snohomish County is.
It's sort of like, I don't know, living
in Seattle, it's like a, it's kind of flyover country
to get to good hikes and outdoor activities.
Sorry, no, I love Snohomish County now.
And after this, it has occurred
to me a couple of times, like, wait a second
in Everett, you can park downtown for free, right.
And I was like, you can't park anywhere
for free in Seattle.
(Anna laughs)
Why don't I move to Everett?
It has occurred to me.
I don't know.
I found everybody to be really welcoming and warm
and open and I don't know.
I like it.
I also feel like,
even though we've spent all of this time here, I don't know
that I know the soul of Snohomish County yet.
It might take me a little bit longer to.
- After 20 years, I'm still looking as well.
So don't worry.
I'm curious, going out
with the Office of Neighborhoods, which we're gonna talk
about a little later, did that change your perspective
at all about cops and the role they play
or social workers or was that, again did you just come
in to it with, let's see what they bring us?
- I mean I'm always just trying to be open
and not know what I'm gonna come across.
And that's the best way for me to be a reporter.
So that's how I was entering it.
It's fun.
This is a different kind of reporting.
We got to really spend some time
with the people we were following
and see them again and again over months and months.
Normally, as a reporter, we go in for a day
and spend an hour and then come back
and bang out a story, right.
And it's on the radio sometimes that day
and sometimes in a week.
So, that was a luxury to get to know people and hang out,
because then we'll both sides get to know each other.
But you get to see them acting in their natural environment
and even, I think we're gonna play a clip where we're
in the back of the car, and it's a conversation.
And that just happened.
And that's always what you want as a reporter is just life
to happen and you just happen
to have a microphone recording it.
So these scenes happen, and I think that was nice
to have happen because we could really spend some time
and get to know people.
- Well, in that time you spent, you've developed some
relationships too with folks, appropriate, friendly
relationships with the folks in some of the features.
And that's probably kind of a new thing as well.
(Sari drowned out by Ken) reporters tend to not do that, so.
- Yeah, I'm really rooting for a lot of the people
in our stories and hoping they do well.
And it's (mumbles), it's awesome a couple of
people are here tonight.
And we key, we text with people.
And we talk to lots of people that aren't in the podcast.
That's another thing is we had all kinds of cool stuff
and cool scenes and cool people,
we call them characters,
but all kinds of stuff that didn't make it
in there, that we stay in touch with people,
and are like how are you doing.
So it's, yeah, it's been meaningful.
- Before I jump into our subject matter experts
up here, what is the one main takeaway you would want your
listening audience to leave
with, if there was this one thing you could ask them
to keep in their mind?
- There is hope.
There are solutions.
Addiction is complicated, and it's not a choice.
But people recover and they recover all the time.
And, it's possible.
It's a medical condition,
but it's a treatable medical condition.
It's not a death sentence.
- I guess it'd be something about keeping an open mind
or opening your mind a little bit,
'cause that's what I think is working.
We're trying to be like what up with Snohomish County.
Why are they kinda doing cool stuff and getting it?
And I think it's because a lot of the top players have a,
they're a little more open in general.
And all of that when you put it together, something shifts.
And it starts actually with perception
and maybe shame and judgment and all those things.
So a little openness goes a long way.
And then especially when many people have that,
it shifts big picture stuff.
- I think that's one of the things that's been really
interesting in sitting in
for the multi-agency coordination group, MAT group, is
to see so many decision makers
from such a diverse range of, you've got Fire
and EMS and the Sheriff of the county
and the Head of Public Works
in the same room, all kind of driving in the same direction.
And it's pretty, it's very powerful.
And it is kind of the secret sauce I think
in Snohomish County that makes us good at what we do.
- I wonder if everybody knows what you're talking
about when you say multi-agency coordination group.
So maybe could you just define that
and tell people what that is a little bit?
- So, back, about a year ago, the Executive, the Health
District and Council and Sheriff all agreed
to basically call the opioid epidemic
in Snohomish County what it is, a very slowly unfolding
natural, well, not natural, but disaster in our backyard
and directed the Department of Emergency Management,
I'm gonna try not to use too many acronyms
for the non-DEM folks.
So DEM folks please don't throw anything
at me if I dumb it down too much.
The Department of Emergency Management, that's our county's
agency that when we have a flood
or a wildfire or a horrific landslide, steps
in and coordinates all of us,
cops, firefighters, public health.
They came in and set up a structure for us.
It's called a Multi-Agency Coordination Group.
It's one of the pages from FEMA's playbook,
to use your phrase, that keeps policymakers
and decision makers in the room
but in our own lane so we're not walking
over the top of each other.
And we meet twice a month.
We use a list of smart objectives,
so objectives that are attainable, are on a timeline.
We're all sort of marched in the same direction.
And we're reaching our one year anniversary.
We've achieved over 70 objectives.
We have so many more to go.
And one of the functions is to have a person who coordinates
with media and communications.
And so that, that's my role.
And that was why I was
so excited when Kyle asked me, hey, what'd you just say,
what up Snohomish County.
(everyone laughs).
So though I have so many things to tell you.
A lot of us worked together in 2014 after the landslide.
So, we were familiar faces who had worked at that time.
So, approaching this and that.
From that perspective, it was a little weird.
But there are times when I remind myself
and Heather and I will have these conversations a lot.
Okay, how do we approach this problem?
Well, what would we do if it was a flood?
Well, we would use this mechanism.
And it helps us, kinda' again stay in our own lane,
but keep moving forward and not...
I think some of the challenges are agencies
across the country have run into is being either too big
or it, there's so, it's such a, either they're too big
or the problem's too big.
And it's hard to move forward, so.
- And something that's interesting to note
about this is that Snohomish County is one of the only
counties in the country that is using this approach
and now other countries are calling Shari,
counties are calling Shari and saying how do you do this.
Does, is this a thing that might work for us too?
- Yeah, so part of the podcast was featured on NPR.
And my boss was lucky enough to not be in the office
on Monday, but he and I both received multiple emails
and phone calls from across the country, Missouri,
Massachusetts, Iowa, France, asking us, what, again,
what is that secret sauce and how are we doing it.
And I can't say it's perfect,
but it's certainly, again, we're moving together.
And we've broken through some small barriers,
and we have other things to do, so.
Getting back to the podcast,
episode one deals with Suboxone.
And so I wanted to turn it over, for just a second,
to Geoff Godfrey who could probably entertain us
with a lot of other things besides talking
about Suboxone, but you clearly have a lot of passion
for what you do.
And I kind of wanted to talk to you about that
and what, why this work is interesting to you
and what motivates you.
- Well, I, I've been in medicine for quite a while.
And I've seen things that work and things that don't work.
And, working through the emergency department many years,
recognizing that I've started getting an old kind of hairy
old nasty back saying as just another user,
let's get him out of the ER, right.
And one day I saw a middle aged woman who I had seen
at another emergency department three days
before coming to a different emergency department
with a broken arm.
And, I realized that she kept that arm broken
for over a year.
And she'd never healed it.
And all of a sudden I realized what are we treating.
And so my passion turned to pain control
and figuring out we're doing something wrong.
And so, working in pain management for a couple of years
and then all of a sudden addiction medicine, it's a disease.
We can heal.
We can watch patients get better.
And, that filled me full of just so much passion,
and when I die I'd like on my tombstone somebody
to write, Alta do me a favor, he tried
to break a little stigma, okay.
- That's my line.
- I know, but I'm stealing it, anyway.
So that's what we do now.
And, I tell my patients.
I got a lousy bedside manner.
I'm gonna tell it like it is.
And doggone it, they keep coming back.
So, you can't beat success.
Does that answer the question for you?
- Yes. - Alright.
- One of the other things I wanted
to address is there is such a stigma
within the recovery community about Suboxone.
So I'm gonna put you on the spot here
to tackle kind of a controversial topic.
But I know you're a believer,
so tell us why Suboxone?
- Why Suboxone?
Suboxone essentially is a partial opiate agonist.
What it does is it occupies the Mu receptor.
And I have tons of pictures and drawings
and I talk to my patients about this.
And I bore them to tears.
But if the opiates that we have been giving
and heroin that we've been using is a full opiate agonist,
this one just partially opens it
and allows your amygdala
and hippocampus, the two little brats
up there that say I want some candy,
and if you don't give me my candy I'm gonna make
you feel like crap, right.
And that's what drives that opiate need constantly
to try to stay away from getting sick,
because the sick of opiates, of what I watched, is awful,
is more than awful.
It is akin to the sickness that people get with chemo
and just the degradation that it does to the human being.
Alright, so, Suboxone, partial opiate agonist, working well
in Europe, but what do we say?
It's just another substitute.
We're just substituting one for another.
So, do we look at our diabetics that are on insulin
and Metformin and they keep eating sugar?
And we know that's bad for them.
And they have a trouble stopping it
and so they keep using the Metformin and the insulin
and the Glyburide and the Glipizide
and all the different things.
Do we treat them with that same stigma?
No.
So if this drug then can help people stop the
craving, stop the withdrawal
and say, oh my God, I got a life, I can do this
and gives them a wonderful sense of all of a sudden,
hey, wait a minute, wait a minute, I don't have
to shoot up, I don't have to snort.
I don't have to stick it in my butt.
I don't, whatever, however they're getting their med.
If it stops them for a moment
and lets them think again
and then we can have that dialogue
and say, wait a minute, what else are you missing.
What else, do we have to talk about how to get a job?
And do we talk about what were the triggers?
So when I'm working with my patients
and they're on the Suboxone
or they're writing in their journal.
And I, boy do I get 'em about the journal.
If they're not journaling, you're not stepping
up to the plate with me pal.
And, so, I am passionate about that medication.
It's not a be all, end all.
And do people come off of it?
Yes, some people say, okay, I've been
on it for a year.
I've been on it for two years.
I've been on it for six months.
I wanna try without.
Great, let's wean you off,
so you don't go through withdrawals again for that drug.
And, it's so fun to see people come back
to me after they've been clean,
and they've weaned it down.
Maybe they're on one milligram a day.
Maybe they're on 16 milli.
It doesn't matter, but they're, they've got their life back.
They are working within themselves to get better.
And they've broken their own stigma.
And that is just empowering for me.
So I gotta whole new life of my medicine.
I'll probably do this until I pop off.
- Thank you for being so candid.
But one of the challenges here,
and you guys touched on this
in the podcast is that finding providers is a challenge.
We were talking a little earlier with Geoff and Alta,
and you said Ideal Options has three providers on sight
and 800 patients, and the provider is only allowed
to prescribe up to 30 patients.
So the math doesn't.
(faintly speaking)
For the first year, okay.
So either way the math doesn't add up.
So I wanted to have Heather talk a little bit
about one of the projects the MAT group has been working
on under the leadership of the Health District
to try to bring those numbers up
or at least recognize that there's a problem.
- I'm not sure where I'm supposed to stand.
So this is complex.
And there's a couple of things at play.
So when a provider that's eligible does a class
and they become waivered in being able
to prescribe Suboxone, they have the option of selecting
whether they want the information publicly listed.
So if they choose private, we can't go in
and find out who those providers are.
We're working on that.
We're working on calling different provider groups
to find out how many are waivered.
And then there's the other piece of how
many slots do they have.
So, in the first year, if they have 30 slots,
are they seeing 30 patients
or are they only seeing one or two?
If they're not seeing their full capacity, why?
Is it trying to connect them with patients in the community?
Are they having problems with that?
We can help.
Or are they just trying out
to make sure they get the right balance
and how to work with Suboxone and work with the clients.
Or are they, were they just doing it
for one or two patients that they were already seeing?
So we're working on some of those pieces.
I think Snohomish County has been fortunate
in that we have a very responsive medical
group in our community.
A lot of the providers actually stopped prescribing opioids
or reduced it for very severe cases.
That started happening several years ago.
And we also have some big provider
groups that have made some big commitments.
So community health centers of Snohomish County made a
commitment that all eligible providers would be waivered
in Suboxone by June 30th of this year.
That was a huge move.
Belina made a similar ask of their providers.
So we're starting to see big groups step up.
It's available in emergency rooms.
So, it's out in the community.
But there is still a stigma even
within the medical group about is it a substitution
and trying to make it
so that we can prescribe more Suboxone
and methadone in the community that's outpacing
the amount of opioids.
- [Shari] Thank you, yeah.
- Another quick stat about Suboxone
or Buprenorphine or this holds true
for methadone too is that these
drugs prevent people from dying.
It cuts overdose death by half if you're on these drugs.
And it prevents, you are 30% less likely
to relapse if you're on a medication like this.
So there's a lot of evidence
to back up the use of these medications.
- All ready to move to another drug, so to speak.
Episode two focuses on, you,
I remember you said the star of this
episode is not a person, it's a nasal spray.
Some people have called it the
Lazarus Drug, but Narcan naloxone.
Had you ever heard of Narcan before this project?
You had. - A little bit.
But I didn't know what it was.
So, yeah we went
to, what, like a training where they taught us what it was.
And, yeah, we're just trying
to think of how a listener would think about it.
They've, used heard the word, but you don't know what it is.
You shoot it in your arm (mumbles).
Or how do you use it on, so yeah.
So we tried to really explain that in a basic, simple way.
- Yeah, and you actually went from learning about it
to now you said you carry it.
- I carry it, yeah.
I have it everywhere with me.
And I actually had heard about it,
because I had been reporting in Colorado before.
And they were just starting to equip all of their emergency
or their law enforcement agents with Narcan.
But, so went to the training,
and we learned how to use it.
And they gave us boxes.
And I have one vial with me at all times.
I mean, I don't have it on me right now
'cause my purse is in the other room.
But, it's in my purse.
I took it camping with me, and my friends laughed.
They're like, what you think a bear is gonna overdose.
And I was like, you know what,
guys you never know when you can save a life.
And now I heard recently that YMCA's are going
and public libraries are now going
to be able to get free doses of Narcan
from the makers of Narcan as well.
- Yeah, it's amazing.
I've read so many of our own incident reports
when a deputy has literally taken someone who is not
conscious, barely breathing to someone 60 seconds later
who's up and ready to fight the person that's standing
between them and the doorway.
I wanted to turn to Angie who's here
on behalf of Amy Austin, who's the person
who did that Narcan training and talk a little bit
about how easy it is to get Narcan
and how to administer it.
- Yeah, thank you.
Naloxone or Narcan is available
at most pharmacies, Walgreens, Rite Aid.
You can walk in and talk to your pharmacist about it.
And it's also covered by most insurances.
It's not always, (mumbles) you're not always required
to have a prescription.
So, the idea is that the more people that are carrying
Narcan or naloxone the more lives that are saved.
I think that you don't know when you're gonna park
in the parking lot and get out of your car
and see that someone is potentially
suffering from an overdose.
And Narcan it reverses the overdose immediately.
It brings people back to life.
It's an opportunity for someone who is struggling
with the impact of their addiction
to have a second chance.
And we have some great programs in this county.
We have some great treatment options.
You can't get treatment if you're dead.
And you never know if that person that you're able
to save is, you know who that's gonna be.
It's someone's sister.
It's someone's mom.
It's someone's son.
And the idea is that, we worked really hard
in the beginning to make sure law enforcement had Narcan.
EMS has Narcan, but the folks that are most likely
to come across someone who's suffering
from an overdose is a partner or a child or a mother.
And so, the more households, the more purses that we can
make sure that have Narcan,
the more effective that we can be in our community.
- I was just speaking to a group of seniors earlier today.
And we're now, one of the results of the MAT group is we
now get almost live overdose incidents reported
to us using the dispatch system.
And, we have had this week already a 78 year old woman who
was found by her adult daughter, because she had messed up
with her medication and a 28 year old young
man who was found by his grandmother who had overdosed
on heroin and both were revived with Narcan.
So it's a pretty amazing drug.
How many, do you want to talk a little bit
about the trainings you've been doing
and how many we've trained this year?
- Yeah, you bet, so we worked
to offer a minimum of quarterly
trainings throughout the year.
So we've had four trainings for the public.
In 2018, we've trained over 200 members of the public
in how to use
and administer Narcan, which is just a nasal spray.
You stick it up your nose, and you push it.
And then you're done, nothing too major.
It's pretty easy to use.
And we're also able to provide some additional trainings
to larger groups that request if we have the capacity.
It's, Amy's just one person,
so we keep her pretty busy.
She travels along with our Nuisance Properties Team
to help intervene when there are folks there
who might be interested in treatment.
She goes along with the embedded social workers at times.
She's called by EMS
and law enforcement when they do have someone that they're
able to save, to administer Narcan.
She's able to intervene within 24 hours
with that person, sit down
with them, buy 'em a cup of coffee, talk to 'em
about maybe considering a different path.
And so, in her spare time, she does trainings
throughout the, throughout our county.
And we work to get as many people educated
about Narcan and get Narcan in as many hands as we can.
- And that's a great segue
into one of the things you mentioned
in your podcast which actually coincided
with that conversation we were having
in the MAT group which is, not all of our doses are taking
place out in the woods in the homeless encampment.
It's something we recognized just working
with our partners in EMS.
Obviously, those of us
and law enforcement do see more of the homeless encampments.
And what was the number you found that were
in home versus, was it over 50%?
- It was, there's a study that was done in Boston.
It was something like 60% of drug overdoses happen at home.
- So, again, we had been, seen that same statistic as well.
And one of the things we realized is okay we're really good,
well, we're getting better at reaching the vulnerable folks
in the homeless encampments.
What are we doing
for the grandmother who finds her grandson overdosed?
Sure, he goes to the ER and now he's gotta try
to figure out a myriad of very confusing,
which we're gonna tell ya later, resources and processes.
Do you wanna talk a little
about the MAT group's work Heather
to try to address that overdose, overdoses
in the home and providing support for folks?
- It's early stages.
I'd say one of the benefits of these MAT group
efforts is we've been able
to kind of take care of some of the low hanging fruit
and then identify some projects that if we had additional
resources we would be able to tackle next.
One of those opportunities came.
There's a CDC grant.
There's been a lot of money funneling
from the federal government.
And because of our efforts here
at the county, we were the second highest county funded
through the state for this grant.
It's a one-time, called a Surge Grant.
In one of those projects, we'll be working to try
to better understand the treatment and recovery pathways.
So for that grandmother whose grandson overdosed
and is now in the hospital.
You see these maps in a hospital or in a school
or a shopping mall, you are here.
Where do you need to go next?
We're trying to help identify, take a right
and then go down the hall and go to the left.
But that's different from each person.
As you said, what works
for one doesn't work for each person.
So, trying to make it as easy as possible.
Work with all of our treatment providers.
Work with law enforcement and EMS, the hospitals
to say if you have somebody,
what are your normal steps for referring them.
What are your obstacles?
Where are those gaps or pinch points?
And where is government best positioned?
Where could we put a pilot
in place, either geographically or time bound?
Is it an evening, is it a weekend?
Is it a certain spot in the county?
How can we help the families
and those individuals that have overdosed
to prevent a second overdose?
So that's what we're in the process of doing right now.
We're excited to see where this goes
and then also work with our partners
to figure out how providence can play a role,
how the treatment and recovery providers play a role.
So, you know government's not gonna solve this.
Public health's not gonna solve this.
It's really all of us coming together
to do our pieces, to get those naloxone kits
into the hands of people.
But ultimately, the goal's to prevent it
from even happening in the first place.
- Yeah.
This is, this project's remind me when we talked,
I said it's a lot like eating an elephant.
And there are some parts of the elephant that are harder
to eat than others.
This is gonna be one of those,
'cause it's such a challenge
to put all those pieces together.
I wanna transition into episode three, which is focuses
on the MAT group.
And I wanna start off by putting the Sheriff on the spot.
You talked about being shocked when you became the Chief of
Police of Stanwood, not
because you were the Chief of Police,
but because a mother came into your office.
I mean we were shocked, but.
- It's like winning the lottery.
(audience and panelist laugh)
- About, you know, that there was heroin in your community.
How has all of this changed your perspective
on law enforcement as CEO of this large law enforcement
agency and the jail.
- So the, it's the worst thing you can do is give a
politician a microphone, so I'm gonna apologize
the fact that I have one now. - We'll be here for a while.
- Yeah, so growing up here.
I actually grew up in Tacoma,
but growing up in law enforcement here in Snohomish County.
There's obviously always a lot of trends that you see
that are close tied to the Puget Sound reason.
When I had the opportunity as a lieutenant
with the Sheriff's Office to go up
to Stanwood and serve as their Chief.
It was really very selfish,
'cause my, I had my two daughters were
in school up there.
My wife at the time worked in the school system.
And so, it was just kind of a perfect way
to go to Mayberry and slow down a little bit.
And I'll never forget the lady, the mom that came
in to see me.
And it was very clear that there was a problem,
but I couldn't comprehend it,
because it was Stanwood.
I mean, it was just a little tiny town, where I, we walked
down and get the paper.
I'd read it three times throughout the day
and drink a cup of coffee.
It was a really slow town.
But it, I'll, the other part I'll share is I learned
a lot of lessons, because we decided hey, we gotta get
out in front of this.
We're gonna get the community involved.
We're getting the school involved.
And I don't know (mumbles) if any you remember,
but pretty sure it was President Obama had come
to Boeing to do kind of an interview.
And we were had advertised we were gonna have a big
parent night, community gathering
about heroin in our community.
And so, all of the media drove from Boeing
to Stanwood to participate
in this community meeting, which instantly turned
in don't move your children to Stanwood.
They're the heroin capital of the world.
So it was kind of this like oops,
that was probably not the way to go, but.
I went, I'll just end
with saying that heroin is not an inner city problem.
I, that's what I believed growing up
at my age that heroin was a homeless,
inner city issue that Seattle, LA,
New York had that we didn't have.
And clearly I was way wrong.
- So the reason we're all kinda here tonight is actually
because I'll take you back to 2016 when I was accepted
into a program for FEMA.
And I was asked to do a Capstone Project,
and I had to get approval from my supervisor.
And I said I have this great project I'm going
to do on child abduction.
Do you remember what you said to me?
- [Ty] I don't remember the exact words,
but I think it was no, that won't work.
- It was something like, okay that's fine,
but I really wish you could do something
about this heroin problem.
And it was that paper that kind of got us
to the MAT group in a way.
I would love to hear your take on the MAT group.
Where do you think we are?
Where do we, is it working?
- Well, I think so.
I mean, listen, I don't,
obviously I don't know everybody in the room.
I will just say here's the challenge for me.
I'm a cop.
This is my 33rd year in this business.
I grew up in the mindset that a pair of handcuffs
and a trip to jail solved just
about anything that I'm responsible for.
And I, I've got some colleagues in the room.
So I won't oversell myself,
but I thought I was pretty good at that.
And, I look back.
I was with, I happen to be with the FBI Director
and some national leaders and local leaders earlier today.
It was fascinating to listen
to everybody kind of say the same thing.
Why has it taken us so long
to figure out this pair of handcuffs
and a trip to jail doesn't work
for this addiction issue, because it doesn't.
And I, and so the challenge...
So the challenge is this isn't hug a thug.
This is what we're being hired to do.
Our responsibility is to make the community safe
and to create long-term solutions.
We're way outside our swim lane.
We're way outside on partnering with human services
and social workers and talking
about treatment and re-purposing facilities.
That is not what they taught at the police academy.
So, what MAP did was it gave us an opportunity
to take something that we know.
So, post-9/11, President Bush implemented the Incident
Management System, which was to basically teach federal
and local government how to work together
after a major event.
MAC is a piece of that.
That's the 21st century version of what ICS is.
And so, I will say that sitting down
and taking time to figure out how
in the world are we here.
And what's it gonna take to fix it has really been amazing.
Now we've got a long ways to go.
But in terms of finally being able
to go, well that's how we got here.
And that's, this is what it's gonna take.
It's gonna be slow.
There's going to be future sheriffs
after me that are still gonna be working on this.
But at least we're going in the right direction.
And we're seeing people get healthy.
And they're not coming back to our jail.
Shari is, I don't know whether you have this late
or not, so I don't want to steal this,
but I'll leave with this.
We, two major statistics for me that are important.
People that are arrested, 12 months later there's a 50%
chance, especially with addiction,
they're gonna get re-arrested.
Constantly.
We did a study and we looked
at, tell us, we asked our database, tell us people, give us
the names of the people that have been arrested more than 30
times in the last five years.
There were 53.
I would've never guessed 53 people had been arrested
more than 30 times over five years.
85% of those people addicts.
Why am I giving you those statistics,
because traditional policing and booking
and arrests, incarceration, does nothing
to attack the issue.
So, MAT gave me hope.
- [Shari] Thank you, and you.
- Want me to give the microphone away now?
- Yes please, somebody take that from him.
(audience and panelists laugh)
But it was a great tee off, tee up
for the next excerpt I'm, I'd like to have you play.
It's episode four.
It's the phone call,
because it tees up our Office of Neighborhoods.
Our hug a thug marshmallows and Kevlar.
- [Male Narrator] Lauren Rainbow talks tough, swears often
and wears a bulletproof vest,
not your average social worker.
She's on her phone a lot.
- [Lauren] I'm doing, here we go.
This is Lauren.
- [Male Narrator] Lauren works
for Snohomish County in Washington.
- [Lauren] Hey Sam.
I know, I heard.
Do you almost, you were almost on a year.
I know man.
You're not walking into a lecture.
It's all good, I was trying to.
- [Male Narrator] The person is on the phone, calling
to let Laura know he's relapsed
after not using drugs for a whole year.
- [Lauren] You've been kicked in the ass.
And it sounds like you are wanting
to get back into treatment.
And let's make this a stumble,
not a all out (faintly speaking).
- [Male Narrator] Lauren is answering this call
from the passenger seat of a police car.
Her co-worker who is driving motions
for her to hang up the phone.
- [Lauren] Hold on, hold on, nothing in McCurry wants
to talk to you.
Hold on.
(faintly speaking)
- [McCurry] Sam, Sam, Sam, what are you doing?
What are you doing man?
I heard.
Are you okay?
Yeah, yeah, alright.
Are we gonna fix it?
Okay, well let's fix it.
- [Male Narrator] All day long, this social worker
and cop drive around the county helping people struggling
with addiction and homelessness figure things out.
- So the stars of this episode are
Bud, aka, Marshmallow, and Kevlar,
I'm gonna say that all night long, and Lauren.
I would love for you guys to...
I know I've talked to you at length
about the strange roles you find yourself in.
Bud used to be one of our hard charging deputies, kicking
down doors and taking down felons.
And now he's a social worker.
And Lauren used to be a social worker,
and now somehow she's become a cop.
I'm kidding.
But I'd love to hear you guys talk about your perspective
and the work you do.
- Legally, I can't be called a social worker, just
to clear that up.
Yeah.
Yes, I used to be in a unit here
in the county called Directed Patrol.
And our direction was to go out
and find the most harmful criminals
in the county that were causing the most damage
to our citizens of the county, arrest them,
and book them into jail.
Back in those days, it was a meth epidemic.
We did see some success
by arresting our most harmful criminals that were addicted
to meth and putting them in jail.
We were able to affect the crime rate.
Heroin is a completely different story.
I like to call myself a good marine.
I get my marching orders, back then it was
to go arrest people and put them in jail.
Now, with this heroin epidemic, it's not methamphetamine.
And we've heard this over and over again.
That when our heroin addicts are detoxing they become sick,
and they will do anything they can to feel better.
I hear it's like the worst flu that you've ever had
in your life times 100.
I've never, the cancer, the chemo therapy,
same type of thing.
So this reverse in roles 180 to bring help out
into the homeless encampments was completely foreign.
But like a good marine, we took those orders
and we ran with it.
And we started to see successes.
It was one by one.
And I've said this before.
Our job, number one, is to go out
and make our community safe.
But, on a human level, on a humanitarian level, one
by one, I know for a fact, that we're saving lives out here.
And that's on a very humanitarian level.
So, me as a hard charging cop, former marine,
to actually step into this role of going
into a camp and earning the trust of a homeless addict
or mentally ill homeless
person was a complete role reversal.
I can tell you that
in my 20 years of doing this, this is the best,
most rewarding position I've ever had
to walk into somebody's camp, muddy.
I won't even tell you what we find in some of these camps.
Find them wet, sick, hungry, tired,
and to be able
to get them out of that tent, earn their trust.
Give them coffee.
Give them some food.
Get them started with detox treatment and housing
and eventually, that was our biggest problem.
What's our end game?
Do we high five them, 'cause we got him clean
and put him in a house?
Well that's traditionally when most people relapse is when
they lose that support that's been given
to them for the past 30, 40 days.
Our goal was to put people in houses
and continue to help them.
Am I talking too much?
- [Man In Audience] Not at all.
- Continue to help them with medical issues,
dental issues, legal issues.
Believe it or not, most of our clients,
and I do call them clients have some sort of legal issues
that we continue to help them with.
We'll go to court with them.
We'll work with the defense attorneys, the prosecutors
and the judges to try and request leniency.
So now that we've got our client back
on their feet that they're not knocked back down
by our court system and put back
in jail, heavy fines, heavy probations.
I can tell you it's completely non-traditional policing.
But I can tell you, it's working.
We've got hundreds of people
out of the tents, off the street corners, off the sidewalks,
out of the storefronts, hundreds of people
through detox, treatment, and housing.
And I'll tell you this.
Yes, relapse is very real.
But the best part about our program
and the relationships that we've built
with our clients, when they relapse
we're usually their first phone call
to say I screwed up.
And you heard Sam call us.
And we don't beat him down.
We don't make him feel like crap.
Just like your own children,
that's the worst thing you can do is knock them
down into the mud and the dirt when they're already there.
So what we do is we build them back up.
- [Shari] Do you have anything to add?
- I think Bud covered everything.
(audience laughs)
- [Shari] Well you guys have some guests here tonight.
- We do.
- [Shari] I'm gonna let Lauren do this Bud.
It's okay.
- Thank you.
So my name's Lauren Rainbow.
I'm one of the social workers on this team.
And we do, there were two clients of,
they were on my case load actually.
They were heavily featured on the podcast.
And I think they did a great job of highlighting
a lot of the process that we take people through
from beginning to end.
And it, I'm happy that Dylan and Bernie could join us today.
I don't know if there's any specific questions for them,
but they are two individuals that I think we all highly
respect for all the work that they've put in.
I always tell my clients, people will say you saved my life.
And it's like, no I didn't.
We opened doors, you guys walked through them.
We give you opportunities
and you choose whether this is something you wanna pursue.
And if you don't, that's okay, there's no judgment.
There's no pressure.
This is your life.
We wanna find out what your goals are
and figure out how we can help in that process, if possible.
And that's exactly what these two decided to do.
- [Shari] Any milestones you'd like to share?
Number of days.
- [Man In Audience] Coming up on one year 24.
- [Shari] Awesome.
- [Woman In Audience] I have nine months and nine days.
- [Shari] Awesome, that's great.
(audience applauds)
(faintly speaking)
So don't be embarrassed, but we're gonna jump
to the next clip which features both of you.
That would be mac and cheese please.
- [Female Social Worker] Let's just go down all the aisles.
Any juice, you have breakfast
juice kinda (faintly speaking).
- [Female Addict] I don't know what I like.
This is new.
New to me.
- [Male Narrator] She needs a lot of help
just deciding what to buy.
- [Female Social Worker] Do you like tuna fish, or no?
Alright, we're gonna buy some cheese.
Everybody likes mac and cheese.
Try some of that.
- [Male Narrator] Now it's into the section
with personal items.
- [Female Addict] Mac and cheese, mac and cheese.
- [Female Social Worker] (faintly speaking)
So can you imagine coming from homelessness
to let's go down this aisle, get some
deodorant, all that stuff.
Been living on the streets for a few years.
They go to treatment where you're thrown
into a rigorous schedule.
Wake up at six thirty, eat breakfast, communal chores, go
to your first grade counseling.
Very different life that, wait, body washing, body wash.
There you go, get a loofah.
And then after that we drop them in a house.
Yeah, now you have a house, and you have this schedule.
Here's all your appointments you need to meet.
They don't have any bed sheets.
They don't have any food.
They don't have anything to take a shower with, no shampoo.
No, no, that's not part of re-entry
into the life that really hasn't been revolve for so long.
- Thank you for being here tonight
and for the progress you made.
That's amazing.
For the two of you, I know, I remember the very first time
I went out with these guys.
In 2015, it was October I remember,
because one of the homeless encampments they had a lovely
set of jack-o'-lanterns outside their tents.
And, walking into a homeless encampment
for the first time is definitely a life-changing experience.
And it's kind of why I'm passionate
about this, the work that we're doing.
Do you wanna share your experiences walk,
with walking through with the Office of Neighborhoods
and what you learned and saw and?
- I mean it wasn't my first time in a homeless encampment.
I'm a reporter in Seattle, so it's sort of a,
it's a place that we report the news a lot.
But, I think that, what I wanna sort of tease
out of what the Sheriff said and what Bud
and Lauren said is that if you, it goes back
to what is addiction
and how do we understand what addiction is
and how do we understand
and make sense of why do people continue to use drugs.
Well, if you think that people use drugs,
because they're bad or they're weak
or there's something wrong
with them, then of course, it makes sense,
let's just arrest them, throw 'em in jail.
Obviously that's gonna solve the problem.
But, that's not why people use drugs.
Drug addiction and alcohol addiction
and other forms of addiction, it's a medical condition.
And so, if somebody is doing behaviors
because of a medical condition, putting them
in jail, sending them to the courts, putting them
in to, in jail and then releasing them to the streets.
That's not gonna make anything better.
And so, with this understanding, this program is based
in understanding of you can't,
you're not gonna solve the problem
by treating it like a moral failure.
You're gonna help people
by getting them the services they need
and by treating it as a the medical condition that it is.
And so this is why,
but how we've always treated it is like the Sheriff said,
pair of handcuffs, trip to jail.
Lock 'em up.
And there we go, we've solved it.
So, we're, as a society we're already very equipped
to send cops into a situation,
but, so this is really flipping the script
and turning it around.
- I would say, yeah, it was intense
to walk into the homeless encampment.
But, I got more, I found more richness in just hanging
out with you guys
and following them around day to day,
because also the dichotomy of a police officer
and a social worker.
Already that's so funny and out of the box.
It's a great story already.
You're like or it draws you in.
People are like what.
So it's, I already have so much to work with.
And then just seeing them (mumbles).
We were in the grocery store in that clip that you her.
Just being in the grocery store, right.
Or meeting people at the coffee shop
or being in the cop car, driving
around, answering the phone,
those really regular day to day things were
so revealing to me.
And that's where I thought the storytelling got rich.
- The more I look at both this and mental health, addiction
and mental health, one of the key words that keeps coming
up over and over again is relationships.
I mean, what works
for the Office of Neighborhoods is the
relationships they build with their clients.
And in a way that's kind of what we've done
here in Snohomish County as well is it's our relationships
with each other, cross agency, cross jurisdiction,
being able to have that conversation.
We have to kinda go where people are at.
And sometimes it's up here and sometimes it's not.
But I think that's what's been driving all of us
to keep moving forward.
I'm gonna switch over, I wanna be cognizant of time,
and switch over to our last episode
which focuses on the jail.
And do you mind Ken playing the last clip?
- [Female Narrator] That's the sound of a
jail door closing behind me.
I'm in the Snohomish County jail in Everett, Washington.
Folks from the county are leading me on a tour.
I'm seeing how they handle
so many inmates addicted to heroin.
(slow paced music)
(faintly speaking)
In the medical ward, we run across a young man
with thick, black wavy hair.
His face looks unnaturally ashen.
He sits slouching forward on the bench.
He's wearing a green and white striped uniform.
He's an inmate and he's really sick.
A nurse, Julie Ferris, leans over.
(faintly speaking)
She asks him how much heroin he usually does.
- A couple grams a day. - A couple grams a day.
Have you gone through (mumbles) detox before?
- [Male Addict] Yeah.
- [Female Narrator] He tried the program that uses medicine
to replace heroin, Suboxone.
His voice is hoarse.
- [Male Addict] I stopped doing it two weeks ago.
- [Female Narrator] But he stopped.
- [Julie] How come?
- [Female Narrator] He looks up and sort of shrugs.
- [Male Addict] Heroin (faintly speaking).
- [Julie] I can, because, okay.
- [Female Narrator] Heroin, a one word answer
that explains everything.
Nurse Ferris takes the stethoscope from around her neck.
- [Julie] We have 130 over 90.
So what's that saying is your blood
pressure has gotten pretty good.
But we need to get your stomach taken care of.
That make sense?
- [Male Addict] (mumbles).
- [Julie] I know, I know.
That's to repeat his temperature.
- Okay. - Alright.
So, what we (mumbles) is we make a little dehydrated.
We can adjust the fluids
and you're start cooling down, okay.
So because you're throwing up, we need
to put it in your bottom.
- [Male Addict] So (mumbles).
- [Julie] I know, I know, I get that.
I get that.
So we give another 30 minutes
after that, then we'll try some sips (mumbles).
We'll give you some chicken broth to help your stomach.
And then get your guts to hold bit of a rest.
Does that make sense?
- [Female Narrator] He starts crying
and slowly droops forward.
The young man is puking everything up.
So they have to give him a suppository with medicine
to stop him from vomiting.
- [Julie] I know, I know, hang on a minute.
- [Female Narrator] Nurse Ferris helps him stand up
and grabs a fistful of his uniform on his back
to keep him standing up.
- [Julie] Come on.
We'll go this way.
- [Female Narrator] They walk into a cell and out of view.
Withdrawing from heroin is like the
worst flu you've ever had.
You be a bad out of both ends.
The Snohomish County jail has been flooded with people
in just this situation.
People addicted to opioids are getting arrested, booked
into jail and then withdrawing.
Some inmates were even dying.
They weren't getting the medical care they needed.
From 2010 to 2014, over a dozen inmates died, two
from drugs, many from medical complications
and some from suicide.
The families of these inmates sued.
And the county has paid millions in settlements.
The jail has turned things around,
and inmate deaths are rare now.
And recently the jail is handling inmates
with addiction differently than they used to.
We're going to tell you how.
(slow rock music)
- We're gonna actually have, Alta's gonna tell us how.
I have to tell this quick story.
I recently went to a public health conference
with Heather here which is very odd
because I work in law enforcement,
and I have a background in communications.
So why I'm at a public health conference.
It was, there were times I thought what am I doing here.
And I wore my office regalia with the shirt on
with the patch, and the funny thing was is that
I could not find five minutes to myself
between sessions, because people would chase me
around this room of 800 people.
You're from Snohomish County.
You have embedded social workers.
You have Medication-Assisted Treatment in the jail.
How did you do it?
So, how did we do it Alta?
- Before I start, I just wanna say, I heard somebody mumble,
I didn't get chicken broth.
(everyone laughs)
And, I just wanna say I'm sorry
you didn't get chicken broth.
Next time ask for chicken broth.
It's tough, it's really, it's tough
to get chicken broth.
It's a tough position to be in.
Medication-Assisted Treatment.
So, I'll start with the detox part of things.
We're using Suboxone to help alleviate some of the symptoms
that are associated with withdrawal.
It's the worst flu.
It's the worst flu ever.
And I can't say that Suboxone's the miracle pill,
but what I can say is you would be wanting the cheeseburger
and not chicken broth the minute after you take it.
Not the minute, but
about four hours later you'd be feeling a whole lot better.
So, basically when people come
through we do a medical screening.
We do a mental health screening.
Anybody who is withdrawing from heroin goes
into our medical unit where we monitor their vitals.
When their COWS Score which is a screening that looks
at withdrawal reaches a certain level,
then we can start Suboxone.
And we do a five day taper.
And they're usually better within about four
to six hours after taking the first tablet of Suboxone.
And they're not suffering.
The hardest thing for me as a practitioner is seeing
someone suffer and seeing someone
sick and being powerless.
So for me Suboxone is a miracle pill in that sense.
But that's only one part of the problem, one part of
the solution I should say.
The other part is connecting people when they're released.
And if I'm only taking them off of this
for a certain period of time, how am I connecting them
to Geoff as they leave?
So, the thing about withdrawal is
and using Suboxone is it gives them an opportunity
to know what it's like
to take a medication that can actually help them
for a longer term.
And what we started doing was working
with Ideal Balance and having screens done
so that they can be connected with Ideal Option
and receive the treatment they need as they leave.
- [Shari] And you're seeing success?
- We are. - Yeah.
- It's baby steps, and it's not perfect.
And much like the addict, we stumble.
And we do, we learn from our mistakes
and we move forward.
It's not perfect and some people don't get chicken soup.
Sorry.
But, I think that we're getting better.
And every time...
I've had two people call me,
because I give out my business card.
And two people call me and tell me that they're doing well.
And that's two people, two people that are doing well.
And now that's four people that are doing well.
So, yeah, I think we're doing okay.
- Yeah, thank you.
I wanna be, I wanna be respectful of people's time,
and I wanna make sure we have a little bit of time
to talk about resources.
As you walk out of the room, you'll notice a lot of material
out there, particularly there's a huge list of reading
material put together by we are in a library.
And it is a great place for having librarians do research.
And Anna and Kyle also put together some resources as well.
And there's also a publication called 10 Things
to Know About Opioids.
It was produced by Heather here
in the health district as part of some of the work we've
been doing in the MAT group.
And that's a great resource
for people who aren't, haven't gone
through the process, who don't understand
what addiction looks like.
It's for parents and clergy and grandparents.
There's a lot of great information in there.
I'm gonna do two things.
I'm gonna turn it over to Anna and Kyle for a minute
to talk about the resources you found the most useful
and also ask you if you do have any questions, this is the
time to write it on your card and raise it up.
And we'll gather those and make sure we have a chance
to get those answered, so resources.
- Yeah.
I love reading books abut addiction.
I happen to generally my strategy is I have one book
about addiction, one book about that has nothing
to do with addiction, just to balance it out.
But, so the front page there are books that, not the whole
thing, but just the front page are books that
I've personally read and I recommend.
There are a number of books
by people who have addiction, who talk, who have then gone
on to study addiction or have some sort of expertise.
And so, they really bring a very interesting perspective
of this is what it was like for me,
and here's what the research says.
So the one I'm reading right now is at the very bottom.
It's called Unbroken Brain.
It's fantastic.
There's also another one
in that genre is Realm of Hungry Ghosts, also
by a man who has addiction but is a doctor
and treats many people with addiction as well.
Clean is a book that's by the author of Beautiful Boy,
the movie that's now coming out.
And it talks about, it was one of the first
books that I read and had a lot of inspiration
in there for me, because he talks about solutions,
about solutions to addiction.
- And I have to interject.
The producers of that movie actually contacted me
after your NPR piece came out, so.
- What, what did they wanna know by the way?
- That the movie was coming out.
Probably that we should buy tickets and go see it.
I don't know, but.
(everyone laughs)
I was skimming the email,
I think it's Brad Pitt that's involved
in the production company.
And then I stopped, and I read it again.
I thought maybe he was coming here or...
- I'll see a movie with Brad Pitt,
with Brad Pitt (mumbles) go together, yeah.
- Sorry anyways other resources that are good.
- I watch a lot of documentaries.
So PBS has some great documentaries, even
on Netflix, just googling the topic of addiction.
But that was my go to for learning about stuff.
- Yeah.
Any go to resources, Heather or Angie, Geoff, Alta, no.
- [Geoff] I kinda use the NIH a lot,
but I think it's a little bit of dry reading.
- Yeah.
- Well, talk more about it.
What's the NIH?
Talk about, use the mic.
- National Institutes of Health have
the National Institute of Drug Addiction.
And then there's also SAMHSA and ASAM.
ASAM is the American Society of Addiction Medicine of
which I'm a part of.
And they're daily putting in new bits of research.
We need everybody out there to start reading
and figuring out what's going on.
And so, I like the dry read once in a while.
It helps me sleep better.
And then Alta you had a couple of things that you read
and told me about.
- But the National Institute
for Drug Addiction, NIDA, right.
- NIDA, right.
- They have, actually I found a lot of their stuff
to be very easy to understand for the public
about the neuroscience of addiction,
what happens in your brain.
Useful treatment (faintly speaking).
- They have great pamphlets that you can.
If you get on NIDA, I think it's NIDA.gov.org, I think, or.
- A lot of dots. - Lot of the dots and.
- SAMHSA has a lot of resource booklets too.
- Right, substance abuse, mental health.
- SAMHSA's S-A-M-H-S-A, yes. - H-S-A, right.
- I use them a lot as well for research.
- They're quite good to get pamphlets if you have a group,
church groups, school group, community group,
parent group, whatever you want.
They have wonderful one page briefings that you can utilize.
- While you have the microphone, I'm gonna pass one of these
questions off to you Geoff
or maybe Alta can answer this as well.
This is from the audience.
Why can't you be treated
at a regular medical facility for Suboxone?
If addiction is a disease like diabetes, why isn't this
the medical profession handling,
why isn't the medical profession handling this?
What do we need to do to make this happen
with 72,000 people a year dying?
- [Alta] Go for it.
- That's a great question.
And it kind of pierces my heart, right.
Why aren't we all the docs
around here getting the data waiver?
Well, because the drug is controlled drug.
It's new, it's a lot, I mean,
when I first started prescribing it I could prescribe as
much opiate as I wanted to, basically.
And that got us into the trouble.
So, when the drug Suboxone comes
around, now everybody's, crud,
it's another controlled opiate substance.
So, we're gonna really control this one.
And so right now, you have to go
through if you're a mid-level, a PA
or a nurse practitioner, it's 24 hours of study
before you can get your data waiver.
It's called the data waiver.
And drug abuse and treatment, what's the last a stand for?
I can't remember.
But, it's a certification that you get your first year.
You can only see 30 patients.
And then your next year after that,
after you've done successfully
with 30 patients, you can go up to 100.
If you're a doctor, you start with 30, move
to 100 and then go to 275.
But because there is still that stigma and it's scary.
And many family practice guys say
I'd rather send them to a specialist.
I don't feel well versed.
And so that's such a great question.
Why don't we all treat?
I would love to see every single doc graduating
from med school now studying for their data waiver.
So, we can all do it.
Yes ma'am.
- [Woman In The Audience] So I asked that question.
So what can we do?
How can we demand that this tablet (faintly speaking)?
- Well, that's a personal choice.
Demanding, I don't know.
- [Woman In Audience] But they're treating diabetes.
We've talked about chemotherapy.
Why is this different?
- So my background is in primary care.
And I, what, part of what drove me to apply
at where I'm at now and very thankful to be is.
I had a patient that came to me four years ago
and said I'm a heroin addict.
Can you get me some help?
I got him into treatment.
He was doing really well.
He came back to me four months later
and said I'm really struggling.
I'm having really bad cravings.
I'm really afraid I'm gonna use.
What do you think about Suboxone?
I said don't do it.
Don't, whatever you do, don't do it.
It's just replacing something for something else.
And, I look at that now.
And I think about what I know about withdrawal.
And what I know about overdose
and how sick people can be.
And it breaks my heart that I gave that recommendation as a
provider working in family practice.
And I, if I could go back four years, whatever it was,
five years and change the answer that
I gave him, I absolutely would.
But to answer your question about why is it not being used
in primary care, I think a lot of it has
to do with the workload in primary care.
If you think about the pressure on the providers
in primary care and the number of patients that they have
to see in a day and the push to see more
and do more and answer more, that would be one more,
honestly, that would be one more piece,
because you have to really closely track how many people
you have and you have
to have, see them every so often and you (mumbles).
It, it's another pressure.
And I could see that being a big barrier
from a primary care perspective.
There was one other component here.
They are using it in specialty care.
OB, a lot of OB providers are waivered,
and they're using Subutex for pregnant women.
So, some orthopedics will use it.
- But I think it comes back
to what we've been talking about is education.
It's education of the community
to ask for it and the medial community to do it.
But there's also the counseling piece which is a heavy lift
for a practice that's very busy already.
- Explain the logistics of, if you're providing the drug,
you also need to provide the mental support
and the obligational support.
And that just takes time.
- It takes time and it also takes, it's not as simple as
just seeing somebody one time, giving them a medication.
It's teaching 'em all those components of overdose
and the resources and the tools,
but also really making a connection
with your patient, because you have
to establish some rapport with them.
And for me the hardest part of my job right now is I have
up to 12,025 people is our max.
Up to 1,025 people at one time.
And how do you connect with each and every one of them
on a level to give them the, that individual care
and education that they need?
It's such a challenge.
And it's the same challenge that we face
in primary care as providers as well.
- Okay, (faintly speaking).
- I think one other piece Debbie's getting
at is the next generation of doctors.
So, I know locally CMAR has residents that come
through their program, and they, we've worked
with them to (mumbles) some modules.
So when residents come through they spend a day
at the health district to get to know the data
and from the public health standpoint.
They also spend a day
at the syring exchange, observing what happens there.
They, I think go to Ideal Options.
Don't the CMAR residents go to Ideal Options.
So we're starting to get more of a well rounded rotation
for the new doctors coming up.
As far as requiring them to sit
for that, I mean that would be, I would say start
with the Washington Medical
Association and family physician.
Start with the associations and talk with them
to see what they can try to move
from there recommendation, policy level.
- I'm gonna, yes go head.
I can never say no to Alta.
- One other area that I'm seeing Suboxone being used
is in long-term care.
And the interesting thing with that is that
for every patient that they have
on opioids right now,
they're giving a prescription for Narcan.
So, that's huge.
- Thank you.
I'm gonna end with these.
There's two questions.
I, it's a magic trick.
I'll make him appear again in a second.
What was the hardest part of telling the story?
- So, the way that we went about creating this podcast,
so there a number of different ways
to make a podcast, one is you and your buddies get together
and talk like this, and you make a podcast.
Another way is to do the hardest way which is what we did,
which is you follow people around for months
and you go to where they are.
And you talk to, we tried to count it up.
It was like over 50 people who we talked to
in the course of creating this podcast.
And most of those people informed us very much,
but they, they're voices didn't make it in the podcast.
And so, so then we collected something like
over 30 hours of recordings.
And so you go, I have to go through that amount.
And it's not, if people aren't talking
about fluffy bunnies, they're talking about addiction
and overdose and all of these very intense topics.
So it was just like, it was hard.
It's just a lot of stuff to go through.
- So when will season two come out?
- I don't know yet.
(women laugh)
We're working on that.
And so for season two, something that we didn't get
to that I, that is really, really important is talking
about prevention, the prevention side of it.
And there, for all of the topics that we did address of the
first season, there are
so many more topics that we didn't get to.
So I'd really like to get into what works
to prevent addiction, especially among adolescents.
What's the best way to treat chronic pain.
Right now there's a big debate,
because doctors are now prescribing fewer opioids,
but there are people who rely on opioids.
So what do you do?
What's the best way to treat pain?
And then another big issue is trauma.
When people have traumatic childhood experiences
for example, leads often times to addiction.
So how do you, what's a better way than illegal drugs
to deal with the pain of trauma?
Do you wanna repeat the questions for.
- Sorry the question was, two questions what was
the hardest part of telling the story.
- It was intense.
It was heavy.
We would finish our day and eat and drink.
We had to go eat and drink right away,
just do something else and not think.
It was very heavy reporting.
We wondered if anyone would listen.
We're like, what are we, is, who wants to listen to this?
It's really heavy and sometimes sad and not hopeful.
So we worried about that.
Do we need to make jokes to be fu,
or where we can find a lightness to it too?
That was the hardest part.
- Yeah, and that's a good point is that I want people
to listen to this and to be and to feel hopeful
and not feel depressed.
But we're also talking about heavy subjects.
So, it's a very fine line to walk there.
- I know those of us who are in the MAT group.
We meet every Monday, and some of us have meetings
before those meetings, and I've told my colleague Courtney,
well it's heroin Monday,
and boy at the end of those long days,
there's such a daunting list of things to get through.
But I wanna, especially again, thank everybody
in the front row here for the work you're doing
for being a leader for going out into the field,
for partnering, for finding new ways to connect
with people in the county and finding solutions.
And I also wanna thank the two of you
for again bringing Snohomish County into the spotlight
in a positive way with hope.
And thank you so much for everything you did.
- Well thank you to Shari
and thank you to all of the people
in this room who have spent so much time talking
with us and sharing your stories and your experiences.
So thank you so much for that.
- Thank you.
Okay.
(audience applauds and panelist applauds)
Thank you.
- Yeah, thank you.
How are you?
(audience chatters amongst themselves)
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