Effective treatment for substance use disorder (SUD) can reduce both crime and overdose deaths in a community, keynote speaker Brandon del Pozo said at the Lewis County Opioid Summit at Centralia College on Thursday.
“Fentanyl is the apex predator of drug policy. It is the apex predator of confounding variables. It is the apex predator of scientific analysis,” del Pozo said. “It is an extraordinarily potent drug that defies any policy change that you’re looking to implement, in many cases.”
del Pozo, an assistant professor of medicine and health services, policy, and practice at Brown University and a former NYPD police officer, told the audience that overdoses from opioids far outpace deaths, deaths from car crashes and the number of service members lost during the Vietnam War.
“If you’re in the lifesaving business, accidental death and injury, this is the major taker of lives,” del Pozo said. “It takes old, young, rich, poor, people who tried one pill for the first time versus decades-long users. Moms, fathers, sons, brothers, sisters, mothers, all of them.”
Across the country, research from the Centers for Disease Control and Prevention found nearly 70% of the overdose deaths in 2022 involved illegally manufactured fentanyl, a powder commonly smoked or ingested rather than injected through a syringe. According to the Washington State Department of Health (DOH), 28 people died of an opioid overdose in Lewis County in 2022, and 70% of overdose deaths in the county involved opioids.
In 2022, Lewis County had the ninth highest opioid prescription rate in the state. Change to: Between 2012 and 2022, Lewis County had the ninth highest opioid prescription rate in the state.
Still, del Pozo sought to dispel the myth that simply coming into contact with illegal opioids can be fatal.
“You do not die from just being around fentanyl,” he said.
Studies show that people without health insurance, people in poverty or those incarcerated face higher risks of opioid overdoses.
“I think we’re all in agreement that fentanyl has changed everything, and I think it will continue to change everything,” Caitlin Rogers, an outreach worker for the Lewis County Drug Court, said during a live experience panel at the summit “until it’s either gone, or it’s changed again.”
In his presentation, del Pozo also explored the impact of the Blake decision, a 2021 State Supreme Court case that found the felony drug possession law was unconstitutional. He suggested the state’s increase in overdose deaths resulted from the spread of fentanyl, rather than reducing the criminal penalty for drug possession.
“When your Blake decision decriminalized drugs, it looked like ‘oh my god, overdoses are going up’ and then you recriminalized drugs, and overdoses continued to go up,” del Pozo said.
As the Lewis County Commissioners consider potentially establishing a mobile clinic modeled after a unit recently opened by the Chehalis Tribe, del Pozo presented data showing the positive impact the medication methadone can have on crime rates.
In the study, heroin users given a supply of methadone reported up to a 90% reduction in crimes committed.
“If I was a chief of police fighting crime, and someone said, ‘There’s a little thing that you can make people drink and it’s going to reduce their crime by 70 to 90%,’ I’d be like ‘make everybody drink the thing,’ ” de Pozo said. “Not only is medication for substance use disorder public health, it’s also a public safety intervention.”
According to del Pozo, diverting those charged with minor crimes into treatment, as opposed to incarceration, can also effectively reduce crime. While it may seem counterintuitive, del Pozo said in his experience, “the revolving door to diversion and treatment is a more effective revolving door than the revolving door for misdemeanor prosecution.”
“Addiction is a relapse disease. It might take two, three, four, five, six times for the medication to stick and the person to get their life in order, for the circumstances to line up to get their life in order,” he said.
