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Snohomish County taking new approach to opioid crisis

The opioid crisis has been a huge drain on law enforcement resources across the state, including jails.

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The Snohomish County Jail is taking a new approach to try to deal with the problem, becoming one of the first jail in the state to launch a Suboxone detox program for inmates.

Snohomish County Jail Chief Tony Aston says they’ve seen a huge increase over the past few years in people arrested who are addicted to opioids.

“We put people on withdrawal watch. You come in, you’re booked for whatever crime, you’re evaluated at the door by our medical staff and we examine to see if you are under the influence of alcohol, methamphetamine, opioids, anything … usually it’s a combination of all the abused substances. Currently, our withdrawal watches, about 35 to 40 percent of our population that we book daily gets put on a withdrawal watch. That’s a ridiculous number.”

So that’s up to 40 percent of all people arrested in Snohomish County who are addicted to drugs – mostly for opioids.

The jail’s medical unit has 24 beds that were meant to hold people suffering from regular medical issues. Instead, on average, the medical unit is at over 200 percent capacity. Nearly all of the people in those beds addicted to heroin or other opioids and going through withdrawal.

“What an individual when you are detoxing cold turkey off of heroin or an opioid is really sad. Imagine the worst flu you’ve ever had about times 10. That’s what these individuals are going through. Now, we do everything we possibly can to mitigate that, right? We’re giving them juice, we’re giving them the treatment that we can, but still, they get very very sick … very sick.”

Aston says most of these are people are caught up in a never-ending cycle of drug use, living in the streets, committing crimes to support their addiction and getting arrested over and over again.

But Aston and the county sheriff know they can’t arrest their way out of the opioid problem. In fact, for years because the jail’s med unit is always way over capacity they’ve been assessing people at the door and turning many away if they aren’t being arrested for felonies or other more serious crimes. For instance, Aston says, if a deputy makes a shoplifting arrest and that person is addicted to opioids and is going to end up on a withdrawal watch, they turn them away at the door, leaving the deputy with the option of citing the person and sending them to court.

These are the problems at the jail.

What they hope will be part of the solution: a pilot program launched Monday that will see a select group of inmates go through medically-assisted detox with Suboxone — a drug that can ease cravings and withdrawal symptoms in anywhere from 30 minutes to a couple of hours.

Alta Langdon is the health services administrator at the jail.

“Our goal is to really minimize their symptoms and try to get them out to the general population and feeling well. The other part to that is to give them some hope of what options there are for treatment out there. A lot of people come in and they don’t know what Suboxone is and how they can feel functional on anything other than heroin. So this helps them to get a picture of what treatment might look like as they leave.”

The Suboxone detox program is starting small. The program began Monday with five inmates selected by medical staff who will be treated with Suboxone and then completely tapered off over a five-day period. They’ll add five inmates a day until they reach 25, continually replacing people on the program as others cycle out.

The detox program will only be open to inmates who live in the county and who are not expected to go to prison over their case.

They also have to want to get clean.

The same is true for the Medically Assisted Treatment, or MAT, program at the jail. That program is for inmates who will be at the jail at least six weeks. The jail will start them on Suboxone treatment about 10 to 14 days before they’re released, and when they get out they’re picked up right at the door by one of the community providers that can continue that treatment long-term.

Providers who want to prescribe Suboxone have to get a special waiver and are only allowed to have up to 30 patients at a time.

The jail now has three providers who can prescribe Suboxone on site for both the detox pilot program and the MAT program.

Those chosen for the Suboxone detox will only get the medication for five days and then they’ll either be moved to the general population or released depending on what’s happening with their case. Either way, they’ll be referred to counseling and services to help them stay clean.

Langdon says she’s already seen what a difference the Suboxone makes in just the first few days of the program.

“They started their medication yesterday and within a couple hours were night and day difference. They went from vomiting, nausea, diarrhea, body aches to feeling well, eating, drinking and wanting to shower. So, big difference.”

Chief Aston says that not only helps get the inmate into general population faster, easing the strain on deputies, but it’s also more humane.

“If we can give you something that makes you want to eat and drink and take a shower within the first two or three hours as opposed to laying in a floor for three days wishing you were anywhere else but there, that’s a big deal to us. We want to be able to treat people with the decency that they deserve, regardless if they’re addicted to opioids or the life choices they make. The minute you hit this door until the minute you go out this door you are my responsibility.”

As for what success of the program looks like.

“We are going to start keeping data immediately. I want to know that if I put you on the detox program and you got out of here in three days. Did you connect with our MAT program? Did you connect with the educational services we gave you? And I want to check your recidivism. If all of a sudden I can say in 6 months, a year … I haven’t seen you again, and we can find out that there’s a success story and you’ve actually gotten off heroin or you have a job. From my end of it, you’re not in my jail anymore, that’s a big deal to us. So I’m going to see success in that sort of data keeping for me.”

In addition to the Suboxone detox pilot program and the MAT program for inmates expected to stay longer than 6 weeks, the jail is also starting to treat pregnant inmates addicted to opioids with a drug similar to Suboxone called Subutex, rather than Methadone. County officials say studies show Subutex works as good or better than Methadone in treating pregnant women addicted to opioids, with fewer signs of fetal withdrawal syndrome.

All of the efforts at the jail are part of Snohomish County’s coordinated response to the opioid epidemic, which the county is now treating similar to a natural disaster. In March, the county will open a 44-bed facility where people living on the streets and suffering from opioid addiction who want to get clean can go to be stabilized with Suboxone for up to two weeks and be connected to services.

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