After ending the county’s administration of the needle exchange program in March and turning it over to a non-profit agency, Grays Harbor County Commissioners learned that they are not entirely out of the business of providing support for needle drug users in the county, and that public health officials continue to offer support staff and Naloxone (used to save people who are overdosing) at the needle exchange site.
Commissioners Kevin Pine and Jill Warne led the push to end the needle exchange effective April 1. That move put another grant-funded program at risk, the Naloxone distribution. A grant pays for the county to give Naloxone to the same people who come to the needle exchange. It also pays for distribution to first responders. The commissioners decided not to give up the Naloxone grant. “I’d like to see us continue to provide (Naloxone) to our law enforcement and jails,” said Commission Chair Vickie Raines at the time, concerned about losing the opioid overdose reversing drug for first responders.
When Commissioner Pine learned from a constituent that county staff was distributing Naloxone at the needle exchange site, he objected.
Each year, approximately 37.5 residents of Grays Harbor die of fatal overdose, many of those are preventable with the drug said Mike McNickle, Director of the Grays Harbor County Public Health and Social Services Department.
Fatal overdoses have been a consistent problem in Grays Harbor County for the past 20 years. The rate has been reliably 50% higher than the state average. Over the previous 10 years, the number of fatal overdoses in Grays Harbor County has increased by 13%
In April, after commissioners Pine and Warne pushed for an end to county participation in the needle exchange, the county ended theirs and the nonprofit agency Willapa Behavioral Health began their own. The public health department continued offering Naloxone and training as well as connection to services during those exchanges. The Naloxone program is funded through a separate grant than the needle exchange, which is also paid for by a grant.
Based on commissioners’ concerns, McNickle provided them with some options.
The first option would make no changes, public health staff would be on site during needle exchanges and both grants would continue to provide funding. The second option provided Naloxone kits but no care coordination services, and was more of a ramp down to hand off the Naloxone program to Willapa Behavioral Health. Funding would continue, but renewals would cease. The third option would stop allowing county employees at the site and would immediately end funding of the program. At the request of Commissioner Pine, the board discussed and reached consensus on an Option 4 — Public Health staff will be on-site to provide care coordination but Naloxone kits will be provided to Willapa Behavioral Health to distribute.
Healthy Places Division Manager Cassie Lentz added that option 4 would also, “allow us to distribute Naloxone kits to first responders as well as other secondary outreach that we’ve been building to get Naloxone kits out in the community.” The commissioners took no action on any of the options at the meeting. Lentz said public health will work with legal council to draft an amended resolution with a codified version of “option 4” for review at the next meeting of the commissioners.
Funding the program to inform the public
Two grants fund the Naloxone program at no cost to the county. A Prescription Drug and Opioid Overdose (PDO) grant from the University of Washington provides about $70,000 per year in no-cost Naloxone and staff time to distribute, train, collect data, and participate in regional/state work on overdose trends. A second component supported by a grant is called care coordination, which is funded through a CDC program called Overdose Data to Action (OD2A) and supports jurisdictions in collecting high quality, comprehensive, and timely data on nonfatal and fatal overdoses and in using those data to inform prevention and response efforts.
Naloxone or Narcan?
Naloxone is the generic name for the drug Narcan. Both instantly reverse opioid overdoses and both can be found in needle or nasal spray format. Naloxone is often distributed at needle exchange programs because it is where health officials find those people most likely to overdose or witness an overdose. The kits, which consist of two loaded needles and some information, require a few minutes of training. An anonymous tracking system is used to determine if someone has already been trained, and if they are returning for another kit they are asked if and how the previous kit was used. This information supports the CDC Overdose Data to Action (OD2A) grant.
Lentz said that 101 of the kits were reported used in 2020, and the health department has reported over the last five quarters that at least 37% of the kits were used to reverse a drug overdose.
An opioid overdose kills by muscle relaxation
When an opioid user is overdosing, important muscles like the lungs simply stop working, “If you’re in an overdose situation you won’t have the cognition to be able to reverse yourself,” explains McNickle. “That’s why we recommend that everybody, police officers, fire departments, emergency paramedics, even moms and dads who may have children who are addicted, carry Naloxone because you never know when you might come across someone who needs to be taken out of an overdose situation.”
From April 2020 to March 2021 local EMS responded to 95 overdoses in the county. However, McNickle notes that number is always an incomplete picture because not all jurisdictions report to the monitoring system, and not all overdoses are reported to 911.
Sometimes just having someone there with the drug user could be enough to save them during an overdose, “like Prince for example,” says McNickle. “He died using what he thought was oxycodone (it) was actually Fentanyl and there was no one around to save him. Had someone had Narcan he would have been saved or could have been, but that’s the issue; it’s about time.”