Substance use is a health issue, not a legal one

In 2021, 1,224 people died from fentanyl-involved overdoses across Washington state. This is more than a 10-fold increase from when illicitly manufactured fentanyl arrived here in 2016. It’s a national problem, with overdose death rates increasing in 42 out of 50 states in the last year.

Illegally made fentanyl is often sold as fake oxycodone pills (M30’s, blues) and sometimes in powder form. Because of its high potency and short duration of effect it has high addiction potential and high lethality. Because it’s often in pill form, the barrier to initiating use among young adults is low compared to heroin. The death rate is nearly as high for those under 30 as over 30 and racial disparities in overdose deaths are increasing.

The good news is that we have great new care models as well as newly approved policy and practice recommendations that could transform care, public health and lives across the state — if our elected leaders take action. The first step is a Senate Law & Justice Committee work session on Dec. 1, where I and others will be testifying about the recommendations of the Substance Use Recovery Services Advisory (SURSA) Committee created by a 2021 state law, ESB-5476.

In its 2021 Blake ruling, the state Supreme Court struck down as unconstitutional the long-standing state law that had made illegal drug possession a felony. The Legislature rapidly crafted Engrossed Senate Bill SB­­ 5476, which made drug possession a misdemeanor with the first two arrests subject to diversion to newly implemented recovery navigator programs. The current criminal status of drug possession as a misdemeanor expires in 2023. The SURSA committee was tasked with developing measures to help people access outreach, treatment and recovery support services.

A priority recommendation from SURSA is the creation of health hubs for people who use drugs referred by the newly created recovery navigator or other established programs. Health hubs have been implemented in New York and are a logical extension of the low-barrier care that my group at the University of Washington Center for Community-Engaged Drug Education, Epidemiology & Research has helped implement and evaluate here in Washington. They are supported by our findings that a vast majority of people who use drugs want services to help reduce harm and decrease their chances of dying or getting an infectious disease. Low barrier health hubs provide these services. People can also access highly effective treatment medications, or referrals to traditional treatment and/or recovery services at the health hubs.

Engagement with knowledgeable, caring people and desired services is what we all want. When King County launched the low-barrier Buprenorphine Pathways program in January 2017, word spread like wildfire and people lined up hours early to get treatment medications. Research found the program significantly reduced illicit opioid use.

The SURSA approved three other treatment-related proposals:

• Speed up the substance use disorder diagnostic process so that multi-hour assessments are not a precondition to starting care same day.
• Explore ways to expand access to the highly effective treatment medication methadone in communities across the state.
• Establish a work group to explore approaches to creating safer alternatives to the toxic illicit drug supply (e.g. prescription and dispensary models).

The need to consider models of safe supply became evident at the Sept. 12 meeting when the SURSA committee approved a recommendation to the Legislature that drug possession be decriminalized with no penalties. This is already the legal status of alcohol and cannabis, and society is clearly shifting to recognizing that substance use is a health issue, not a legal one. Safe supply also has been effective in several other countries.

Now we just need the Legislature and the governor to act so we can get to work saving lives, supporting recovery and making communities healthier by adopting the SURSA recommendations.