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Thursday, May 28, 2020

Decriminalizing the opioid epidemic

This story is one of a three-part collaborative report on the opioid epidemic by Melissa McCarthy, Rahwa Hailemariam and Katie Meier. They collectively obtained and analyzed data, and interviewed sources.

Editor’s note: Names of individuals suffering or recovering from drug addiction have been changed to respect their privacy and protect them from any possible legal ramifications.

By Rahwa Hailemariam 

Washington state has been leading the nation’s battle against the opioid crisis since the early stages of the epidemic.

On April 10, Whatcom County Council unanimously voted to join other Washington counties in the legal fight against opioid-producing companies such as Purdue Pharma, the maker of OxyContin, and Johnson and Johnson Pharmaceuticals.

Keller Rohrback L.L.P, a law firm based in Seattle representing King, Skagit and Pierce counties, reached out to Whatcom County Council looking to file a lawsuit on behalf of the county.

Whatcom County Councilmember Todd Donovan said the law firm will not be compensated by the county unless they win the case.

Depending on how much settlement the law firm is able to get Whatcom County, the agreed contingency fee ranges from 10 to 20 percent, according to the Whatcom County Council Agenda Bill.

Art by Sophia Greif

The county is spending $12 million building a crisis stabilization detox facility in response to the opioid crisis, Donovan said.

“We spend a lot of money in emergency medical responses to opioid-related issues and it has an impact on our criminal justice system,” Donovan said. “So the hope is to get resources to help fund those programs for the opioid addiction crisis that these companies, we think, are responsible for.”

In 2007, Purdue Pharma was faced with a lawsuit for misleading regulators, doctors and patients about the drug’s risk of addiction. The company pleaded guilty and agreed to pay $600 million in fines.

“They’re responsible [for the opioid epidemic] because they track every pill,” Donovan said. “They know how many pills end up in every single physician’s office in every county in the country.”

Donovan said these companies are negligent in the way they respond when doctors are massively overprescribing.

The opioid epidemic and how we got here

Greg recounts his dear friend turning purple while her body became unresponsive. Then, she stopped breathing.

Greg is a Bellingham local recovering from drug and alcohol addiction himself.

“I had to breathe for her,” Greg said. “She was going to die.”

Greg knew he had to get help as fast as he could. He took Trisha to the nearest fire department and left. He said he had to leave because he didn’t know the consequences.

He met up with her two days later. Before he could finish lecturing her on her heroin addiction, she asked him why he didn’t just let her die.

“It’s like a war sometimes,” Greg said.

The opioid epidemic is “the deadliest drug epidemic” in American history, killing more than 115 Americans everyday, according to Centers for Disease Control and Prevention.

Over 630,000 deaths were linked to prescription opioids and heroin in the past 17 years, according to CDC. The rate of opioid addiction rose by 500 percent in that same period.

In the 1990s, doctors were under pressure from advocacy groups, as well as the government, to treat pain as a serious medical problem. This was because hundreds of millions of Americans were suffering from chronic pain.

In the early 2000s, Gary Franklin, University of Washington school of public health research professor, along with University of Washington graduate Jaymie Mai, noticed people with back injuries dying while taking prescribed opioids such as Vicodin, Percocet and OxyContin for their pain.

They found that 44 people in Washington suffering from chronic pain had died of prescription opioid overdoses in just a few years.

They became the first in the nation to address the linkage between prescribed opioids and what were called “accidental poisoning” deaths.

While doctors were struggling to figure out better treatments for chronic pain, drug companies like Purdue Pharma began producing “safer and less addictive drugs than other painkillers on the market.”

“The drug companies and their surrogates lied to people about how safe and addictive opioids were,” Dr. Franklin said.

“They convinced people that they should be prescribing people opioids for chronic low back pain when it wasn’t indicated.”

Drug companies were marketing their drugs, such as OxyContin, based on a thought rather than science, David Tauben, UW Medicine’s chief of pain medicine said.

There was heavy marketing and promotion for opioids. The companies quoted insufficient data and made it sound easy, Dr. Tauben said.

“People [taking prescribed opioids] were addicted and they didn’t know it,” Dr. Tauben said.

Some switch to heroin because it is cheaper and easier to obtain than prescription opioids, according to the National Institute on Drug Abuse.

Fifty-seven percent of those who inject heroin said they were hooked on prescription opiates before they began using heroin, according to a Washington statewide survey.

Recent research shows four out of five heroin users were first using prescription opioids.

For Bellingham, heroin became more of the issue, especially for youth and young adults.

According to Whatcom County Council 2017 data, two percent of Whatcom County eighth graders and three percent of 10th graders reported using heroin at least once. The 10th graders reported using prescription meds to get high.

The data reported 66 percent of adults in Whatcom County felt prescription drugs are a “moderate to serious” problem for youth.

The relation between crime and opioids crisis

Though Matt has been doing drugs such as ecstasy and cocaine since middle school, he always managed to go to work on time, see his children and stay out of trouble.

When he was 29, he started doing heroin.

“That was when I got messed up. I started going to work late and was just out of it,” Matt said.

He is 32 years old and has been to jail almost 30 times since he was 29.

He said he had to find a way to get the heroin he needed, and stealing became his way. He would get caught and then sent to jail.

When asked if he thought going to jail for theft had anything to do with his recent heroin addiction, he quickly agreed, nodding his head.

“Oh yeah, completely related,” Matt said.

He said he became more willing to step over boundaries for it.

“I have always wanted to want to stop,” Matt said. “But the more you do it, the more your morals start to loosen.”

The opioid epidemic has played a role in Bellingham’s crime rate. The number of people in Bellingham arrested for illegal possession of opioids has increased significantly from five arrests in 2005 and one arrest in 2006 to 125 arrests in 2016, according to data provided by the Bellingham Police Department.

Possession of illegal opioids were only part of the crime. Prescription fraud and forgery for opioids were among the crimes reported.

According to an affidavit from Whatcom County District Court, in 2016, officers responded to a prescription fraud report at a pharmacy in Bellingham. The pharmacist who reported the fraud said he had received a prescription via fax machine for 30 Oxycodone pills.

The pharmacist believed the prescription to be fraudulent when he noticed the prescriber’s signature appearing to be stamped.

The officers called the clinic where the prescription was supposedly prescribed from and verified that the prescription was illegitimate.

Treating it as a Public Health issue, not a criminal one

Due to the failed drug policies of the 1990s, communities and public officials have increasingly called for an approach of a public health issue that looks at harm reduction principles rather than a criminal justice issue for drug abuse, according to an article in Vera Institute of Justice.

Washington is among the states adopting the public health approach.

In 2007, Washington became the first state to legislate opioid-prescription limits by publishing the nation’s first guidelines. Dr. Tauben and Dr. Franklin were a part of the group that introduced the idea of prescribing limits.

Dr. Tauben said the reason the pharma companies were advocating for opioids to treat pain was for their own profit. The more they got doctors to prescribe opioids, the more they profited and that amount of overprescription is what led to this epidemic.

The legislation for opioid-prescription limits was in hopes of preventing overprescription, which was supposed to help reduce the chances of addiction to opioids. Which would have also prevented the rise of heroin addiction.

Dr. Tauben was sued by advocacy groups for his idea of opioid-prescribing limits.

“They said we were trying to prevent people from getting treatment for their pain,” Dr. Tauben said.

States were focusing on preserving costly prison space for more serious offenses such as violent crimes, and began authorizing “treatment-based alternatives” for most drug-related offenses.

As of now, states including Washington have lowered penalties for possession of small amounts of drugs. They however maintain stricter penalties for larger amounts and drug-trafficking offenses.

Sgt. Jay Hart supervises Bellingham’s drug-related units and investigates people involved in drug dealing.

“We’re not looking for drug addicts, we are looking for people who are breaking the law by selling drugs,” Hart said.

Sgt. Hart’s department works undercover along with informants to investigate drug dealers. Informants are usually people who were arrested on suspicion of drug-related crimes and were able to work out a deal with the police department. Some are those who approached the department asking help after seeing a relative overdose.

Hart said they are picky about who they select to make sure the informants don’t start using the drugs for themselves. Informants are valuable because they are already involved with that culture and know their way around.

In 2016, Gov. Jay Inslee signed Executive Order 16-09, “Addressing the Opioid Use Public Health Crisis,” which directed actions of state agencies to follow the Washington State Opioid Response Plan.

Washington state’s response plan funds programs such as drug courts and lays out goals and  actions that stakeholders, such as police departments and school districts, could implement to help the crisis.

In 2017, the Washington state attorney general’s office partnered with law enforcement, public health experts, prosecutors and medical professionals for a summit to develop and recommend strategies for reducing the supply of illegal opioids in the state. As a result, seven goals and recommendations were set to reduce the supply of illegal opioids.

Whatcom County specifically implemented harm reduction programs such as the Syringe Services Program, which will allow people to access clean needles to prevent infectious diseases without getting in trouble with the law.

Even though there are some issues with the criminalization of opioids, it is the most normalized drug issue in U.S. history.

“Anyone can become addicted to opioids. ANYONE” Those are the first words that are read on the Whatcom Has Hope website.

The opioid epidemic has been declared a public health issue. However, when crack was an issue in the country, it was met with “War on Drugs,” with more people being arrested for it than any other crimes. 

It is not people of color dying from opioids, it’s young white men and women, and socioeconomically distressed areas around the country, whereas crack was targeting African Americans, Dr. Tauben said.

“Crack cocaine was someone else’s problem as far as this country was concerned,” Dr. Tauben said. “Lock them up, put them in jail.”

Taking New Jersey, for example, cannabis is still illegal there and the usage rate is the same among both white people and people of color, but the people who are punished are people of color, Tauben said.

Whatcom County equips police officers with Naloxone, an opioid antidote that can reverse an overdose so that officers are able to reverse an overdose if they get to the scene before first responders.

According to the Whatcom County’s prevention and response plan, the strategies are made up of three work groups.

The safety workgroup aims to prevent opioid misuse and abuse. The naloxone workgroup educates community members about access to naloxone, as well as the Good Samaritan Law, which protects civil liabilities when trying to help in a medical emergency. Lastly, the marketing workgroup works on making sure effective coordination of efforts are conducted between the rest of the workgroups.

The Whatcom County Opioid Response Task Force launched a community education campaign, Whatcom has HOPE (Heroine and other Opiate Prevention & Education)  to provide information about opioid addiction and prevention.

Another program in Whatcom County is the Drug Court.

The role of Whatcom County Drug Court

The drug court is a center designed to address drug-related crimes by directing people to treatment instead of jail.

If people are arrested for drug-related offenses, they qualify for the Whatcom County’s Drug Court. The next step is for the person’s attorney or public defender to request for the case to go through the drug court.

The prosecutor would approve or deny the request. If approved, the client goes through a preliminary screening with the drug court to see if they are in need of the court’s assistance by looking at their history of substance abuse, physical and mental health, Chris Furman, therapeutic courts coordinator at the Whatcom County Drug Court, said.

The program is a minimum of 52 weeks, each phase with a minimum of 13 weeks. They are expected to participate in substance use disorder treatment, maintain sobriety and gain GED/high school diploma, expected to either get a full-time job or enroll in a college full-time.

They are also expected to pay a fee of $800 over the course of their participation, according to the Whatcom County Drug Court participant handbook.

Shoshana Paige, senior deputy public defender, works with Whatcom County’s Drug Court to represent clients who make it to the drug court.

There is a stigma around small-time dealers being unable to get into the drug court. Those dealers are usually selling to feed their addiction and they make up the majority of the people facing criminal charges, Paige said.

“There are about 35 people here, but there is room for 80,” Paige said. “That is a huge barrier because of the cases I had, 90 percent of them were addicts who were excluded from the drug court.”

In Bellingham, there is a lot of energy being put into criminalizing someone for drugs rather than getting them treatment, Paige said.

“What we are doing isn’t working,” Paige said.

The justice system is doing a horrible job at handling this, Matt said.

“When you send drug addicts to jail with other drug addicts, they only learn how to do drugs better,” Matt said.

Matt is recovering from heroin addiction, hoping to finish school and work with kids sometime in the near future.

“The lowest for me was when I chose drugs instead of seeing my kids,” Matt said. “And I don’t want to do that anymore.”

Greg’s friend Trisha is now clean, married with kids and a job.

“The only victory I have seen… was her,” Greg said.

 

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