Inslee takes next steps to continue work on opioid crisis

‘We have a public health crisis on our hands. Opioid addiction is a state-wide problem and as such requires a state-wide response.’

Following up on his executive order in 2016 and legislation from last session, Gov. Jay Inslee is proposing next steps to fulfill a multi-pronged approach to combat the opioid crisis. His proposed supplemental budget and accompanying legislation will build upon substantial work already underway to treat more of those in need of services, not stigmatize people with a medical disorder, and prevent the epidemic from claiming more lives.

Shanni Jenkins, who lost her son to an opioid overdose, shared her story during an event with the governor.

“My son, Kyle, overdosed and died last October after being clean for 2 ½ years,” she said. “Kyle and his friends tried the drug OxyContin when he was younger, and it changed his brain. He fought the battle of this disease for 10 years.

“Kyle was open and honest about his struggles, which allowed me also to be.

“Addiction is nobody’s fault. I’m so proud of my son. We have to start talking. We have to change the stigma around this. People aren’t addicts, they have opioid use disorder.

“We have to have treatment available when they finally say they are ready, which is what Governor Inslee is doing. The people fighting this disease aren’t junkies, druggies, losers, nor do they deserve to die. They are our children.”

Gov. Jay Inslee and Shanni Jenkins, who lost her son to an opioid overdose, attend a press briefing on the state’s opioid epidemic on Jan. 15, 2018, in Olympia.(Office of the Governor photo)

“There are far too many people who are experiencing loss of loved ones. On average, two people a day in Washington die from overdoses. This is unacceptable,” Inslee said. “We all need to do more — we need health care providers to further reduce unnecessary prescribing of opioids and better treat people with chronic pain. We need first responders to help. And we need more tools for both. Most importantly, we need help for people who need treatment, and offer the wrap around services like housing and employment supports they need to stay healthy and get back on their feet.”

Discussing his proposals on Monday morning, Inslee was joined by Secretary of Health John Wiesman and his health cabinet; Department of Labor & Industries Medical Director and University of Washington Research Professor Dr. Gary Franklin; Health Care Authority Deputy Medical Director Dr. Charissa Fotinos; UW’s Alcohol and Drug Abuse Institute principal research scientist Dr. Caleb Banta-Green; Thurston County Prosecutor Jon Tunheim; Inslee’s senior health policy advisor Jason McGill; and Shannie Jenkins, who recently lost her son to an opioid overdose.

Gov. Jay Inslee discusses the state’s opioid epidemic and solutions Jan. 15, 2018, in Olympia. (Office of the Governor photo)

The governor has requested legislation that calls for a response to the opioid epidemic. The measures have drawn bipartisan support. Senate Bill 6150 was recently introduced by Sens. Annette Cleveland and Ann Rivers, and House Bill 2489 was introduced by Reps. Eileen Cody and Jay Rodne.

Inslee’s budget and bill focuses on treatment and prevention. It would:

  • Improve treatment options for people with opioid use disorder by setting up a statewide “hub-and-spoke” opioid treatment network;
  • Require the state to pursue a first-in-the-nation Medicaid waiver to allow medication assisted treatment for opioid use disorder for individuals in jail;
  • Integrate emergency medical service response data with public health data to ensure follow up on near overdose cases;
  • Use evidence-based, non-pharmacological treatments in Medicaid as an alternative to opioids for pain;
  • Establish a statewide standing order for naloxone, the antidote medication for opioid overdoses, so people can obtain it without a prescription from pharmacies and other health care facilities;
  • Require coordination with regional drug task forces to support rapid response teams to be deployed to communities that have a high number of fentanyl-related or other opioid-related overdoses;
  • Create new tools to train providers and track provider capacity to make it easier for individuals to obtain medication-assisted treatment from the limited number of health professionals who now offer it;
  • Provide direct prevention services, technical assistance, training and evaluation of local efforts to approximately 40 predominately rural communities across the state, serving 4,200 youth, parents and families;
  • Fund tribal health care provider programs to treat opioid use disorder and reduce overdose deaths;
  • Invest in a criminal justice diversion residential project in Snohomish County that aims to shrink recidivism, reduce the use of crisis and emergency resources, and decrease behaviors associated with untreated mental health and substance use disorders while increasing effective engagement with treatment providers, housing stability and employment;
  • Use data to improve services and establish performance metrics.
Click on the image above to read the policy brief.

“In order to successfully address this problem we need to invest more in treatment and prevention — just as the governor has proposed in his budget,” Wiesman said. “We need to expand access to treatment so that it is available to all people who need it. Beyond treatment, we can’t forget about the health of those who use drugs. We need to prevent and reduce the spread of disease and distribute life-saving naloxone to prevent overdose.”

“We need to prevent the next generation from getting unnecessarily exposed and addicted to opioids and other substances by supporting evidence-based programs to prevent addiction in communities at highest risk,” Franklin said. “This is the worst man-made public health epidemic, and it’s incumbent on us to help the generation of people we’ve addicted. The governor’s proposal does just that, while making key prevention-oriented advances as well.”

“To fight this epidemic, we need to reach out to where people are, engage and retain them in care. This depends upon strong multi-disciplinary teams in every community in our state, which the hub and spoke opioid treatment network provides,” Banta-Green said. “People also need to know how to get treatment today. To that end, we are partnering with the Washingtong State Recovery Helpline to build a real time training and a treatment database, so that people can quickly get referred to care that meets their specific needs.”

“Partnership between the criminal justice and public health systems is crucial in this effort,” Tunheim said. “We cannot jail our way out of this issue. We must focus on what increases and improves public safety. We are unable to do that if we release someone from jail without treatment or medication for opioid use.”

Inslee issued an executive order in October 2016 that brought together state agencies, local public health organizations, law enforcement, tribal governments, and other partners to act on opioids. The executive order implemented key aspects of the state’s comprehensive opioid response plan.

A year later, Inslee convened agencies as part of Results Washington to discuss the data about the epidemic. This action today takes the next steps for the state with the goal to increase treatment options for people in need by 20 percent each of the next two years.

Medical and dental professionals support Inslee’s proposal

“Since 2016, our associations have worked with the governor to implement his executive order. We are proud of the work we have accomplished, including HB 1427 from the 2017 legislative session that promotes safe and appropriate prescribing while establishing the nation’s first overdose notification system. In addition to providing prescribers with the data they need to inform and update clinical practice, the bill requires the Department of Health to promulgate rules to ensure patient safety, including reasonable requirements for reviewing prescription monitoring program data and limits on prescriptions that also include flexibility for physicians to provide appropriate treatments to their patients.
“The governor’s legislation and budget request ensure that Washington state is taking a comprehensive approach to the opioid crisis by making critical investments in treatment capacity. Building out and sustaining the ‘hub and spoke’ medication-assisted treatment (MAT) model, raising MAT rates in the Medicaid program, piloting programs to pay for non-opioid treatment therapies and initiating a statewide standing order for opioid overdose medication are significant investments that will make a meaningful difference in addressing the opioid crisis.” — Washington State Medical Association and Washington State Hospital Association
“WSDA also supported the governor’s 2016 executive order, which continues to bring together state agencies, health providers, and other key stakeholders in a significant effort to combat Washington’s opioid crisis, as well as the Bree Collaborative in the 2017 creation of the ‘Dental Guideline on Prescribing Opioids for Acute Pain Management.’ These efforts, along with HB 1427 from last session, promote safe, appropriate prescribing practices. HB 1427 requires the commissions that oversee medical providers, including the Dental Quality Assurance Commission, to adopt rules establishing requirements for prescribing opioid drugs, including reasonable review of the Prescription Monitoring Program. WSDA supports, and is an active participant in, these rulemaking efforts, which have included an extensive stakeholder engagement process, garnering input across the state from prescribers, patients, and persons affected by the opioid crisis. 
 
“WSDA also supports the governor’s bills and budget proposal because of their investment in treatment, an area that remains in critical need. The governor’s legislation, combined with the other efforts already underway, create a well-rounded, comprehensive approach to combating this crisis. WSDA members are grateful that Gov. Inslee is working with the medical and dental community to find solutions, and we look forward to continuing to work with him, state regulatory agencies, and the legislature to address this important issue.Gov. Inslee is proposing a multi-pronged approach to combat the opioid crisis. His proposed supplemental budget and accompanying legislation will build upon substantial work already underway to treat more of those in need of services, not stigmatize people with a medical disorder and prevent the epidemic from claiming more lives.” — Washington State Dental Association