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King County announces 5 new priorities in addressing fentanyl crisis

Seattle Times - 3/4/2024

Mar. 4—A new five-pronged host of efforts to stop the surge of fentanyl overdoses and expand substance use treatment in King County — including opening a residential treatment center — will soon be put into action, county leaders announced Monday morning.

The approach spans public health, social services, law enforcement and other departments, aiming to "attack (the fentanyl crisis) from many angles," King County Executive Dow Constantine said in a news conference. The plan includes steps to improve access to community-based treatment; increase the number of behavioral health beds and facilities; up overdose reversal medication and fentanyl testing access; broaden the county's behavioral health workforce; and reduce disproportionality in overdoses.

"While other communities may look at this and see an unsolvable crisis, King County is taking action," Constantine said. "Any effort to combat this threat to the lives and health of our residents must be coordinated, informed by experts, insights and efficacy. That's why today King County is sharing our strategies to prevent more overdoses, to get people treatment and, most importantly, to save lives."

The number of fentanyl overdoses has jumped significantly in Washington over the past few years. In 2023, fentanyl caused a record number of fatal overdoses, with 1,082 — a 51% increase over record-setting 2022. The Seattle Fire Department averaged about 15 overdose calls a day last year, surpassing the prior year's total by early fall.

State and local experts in policy, public health, education and law enforcement agree more needs to be done to address the growing problem, but many have differed in opinions about ways forward.

In King County, public dollars were used to offer treatment and resources to more than 30,000 people last year, including substance-use residential treatment for nearly 1,800 people. The county said it also added 22 walk-in buprenorphine sites and a mobile methadone van, and distributed 45,000 naloxone kits and more than 100,000 fentanyl testing trips.

"We need to have as many tools as possible," King County Councilmember Reagan Dunn said at the news conference. "There really are multiple pathways to recovery that exist out there. Not everybody does it the same way."

One new tool will be a 16-bed residential treatment center for those with mental health and substance-use disorders, which the county will open in Seattle in partnership with local nonprofit Pioneer Human Services. Constantine called the center, which is expected to open its doors in about six months, the "only one of its kind in the county."

Five crisis centers, funded by a property tax levy approved last year, are also expected to open in King County within the next several years. Each will contain a behavioral health urgent care clinic that could screen people and triage them to appropriate services, an observation unit where people could stay for up to 23 hours, and a short-term stabilization unit where people could stay for up to 14 days before being discharged or referred elsewhere.

While officials said Monday that programs at the upcoming Pioneer Human Services center are "still in development," there will likely be some overlap in clinical services between that and the crisis centers. The residential treatment center, however, will provide an opportunity for longer-term care, said Susan McLaughlin, director of the county's Behavioral Health and Recovery Division.

"The crisis care centers are set up to be an urgent, walk-in level of care," McLaughlin said. "When you think about a continuum of care, not everybody is going to need all three of those levels (at the crisis centers). Some people might need more than that."

Funding for the center comes partially from the $30 million investment the county made last year with five managed care organizations, which resulted in a 15% Medicaid reimbursement rate increase that "helps stabilize" providers in the region, Constantine said.

The county will also reopen a 24/7 sobering center, and work with local partners to open a post-overdose recovery center that provides medical follow-up and connection to other behavioral health treatment options following an opioid overdose.

In addition, the county has launched a 24/7 buprenorphine prescribing line, plans to introduce more mobile treatment teams for youth and adults, and will roll out a new centralized harm reduction supply center that includes vending machines for more naloxone kits and fentanyl test strips.

"The crisis of addiction knows no age or income limits," said County Councilmember Teresa Mosqueda. "It knows no race or ethnicity restrictions, and does not just touch the unhoused or the housed."

Still, attention to communities with disproportionately high overdose rates, including Black, indigenous and unsheltered populations, is crucial, Mosqueda said. The county plans to invest $2 million in overdose prevention grants from opioid settlement funds to community-based solutions.

A key factor that will allow these programs to thrive, he said, is a focus on behavioral health staffers, including peer counselors, substance-use disorder professionals and behavioral health technicians.

"That means appropriately raising wages for the dedicated professionals already doing this work," he said. "And it means expanding our behavioral health apprenticeship programs, making it easier, making it more affordable to become a provider treating substance use and growing that pipeline of trained providers."

The plan includes a goal of adding about 100 behavioral health apprenticeships statewide, with about half in King County.

Funding for the plan is already available through the King County Mental Illness and Drug Dependency (MIDD) tax, Medicaid and commercial insurance, state and federal funds and the crisis centers levy, according to the county.

The levy is expected to raise $1.25 billion over nine years, increasing property taxes by a rate of 14.5 cents per $1,000 of a home's assessed value. The first crisis center is expected to open in 2026, with all five expected to be up and running by 2030.

County Councilmember Girmay Zahilay, the prime county sponsor of the levy, expressed appreciation Monday for the number of shorter-term strategies worked into the new plan.

"We know that there's a need now and we can't wait until new buildings are built," Zahilay said.

Constantine said he was hopeful about the work planned this year.

"It's another step forward," he said. "And we have many more to come."


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