Washingtonians need greater access to medication and treatment for opioid use disorder in the state, according to health officials.
Representatives from various health agencies discussed opioids and their impact on residents during a Washington Children and Youth Behavioral Health Work Group meeting on Thursday.
Dr. Tao Sheng Kwan-Gett—chief science officer at the Washington State Department of Health (DOH)—said drug overdose death rates for people of all ages in the state continue to climb, although the overdose death rate among children and youth has leveled off a bit, and could be decreasing.
The statewide overdose death rate for residents of all ages jumped from 33.4 in 2022 to 43.6 in 2023, Kwan-Gett said. But the death rate for youth (up to age 24) dropped from 9.3 in 2022 to 7.5 in 2023. The 2023 data is preliminary, however, and is still being updated. The overdose death rate for youth could be decreasing, but it’s too early to say whether this represents a true decline between 2022 and 2023, Kwan-Gett said.
The rate for overdoses involving synthetic opioids (fentanyl) among youth (up to age 24) was higher in 2023 than the national average, however.
“One of the most important things we can do to decrease overdose deaths among infants and (young) children is to improve the care we give to pregnant and parenting individuals who use drugs,” Kwan-Gett said.
That is the goal of the new Center of Excellence for Perinatal Substance Use, a birthing hospital certification program developed by the DOH, the Washington State Health Care Authority (HCA), and the Washington State Hospital Association.
“The program is based on recommendations from the Maternal Mortality Review Panel, which found that the most common causes of maternal mortality in Washington are due to substance use and mental health disorders. The purposes of this program are to implement strategies that have been proven to lead to better health outcomes for parents as well as babies.”
— Kwan-Gett
The program includes strategies to screen parents for substance use, mood, and anxiety disorders when admitted to a hospital; to ensure there are hospital providers with expertise in starting medications for opioid use disorder; and allowing birthing parents and infants to room together, Kwan-Gett said.
“These are evidence-based strategies that have been shown to result in shorter hospital stays, as well as fewer babies on medications to treat withdrawal symptoms,” he said.
Three hospitals have been certified by the program: the University of Washington Medical Center-Northwest in Seattle; Providence Sacred Heart Medical Center in Spokane; and Providence Holy Family Hospital in Spokane.
Lauren Kula, opioid treatment quality improvement officer at the HCA, cited a 2018 JAMA Pediatrics study that examined a multistate cohort of 4,837 youths with opioid use disorder (OUD). It stated that one out of 21 adolescents (younger than 18), and one out of four young adults (age 18-22) received medication for opioid use disorder within three months of their OUD diagnosis. Kula noted that there are only 38 opioid treatment programs in the state.
“They are the only treatment facilities that can dispense methadone and provide methadone to individuals. They can also provide buprenorphine products. They can provide all three medications for opioid use disorder (MOUD). There is a lack of prescribers/providers that will provide MOUD, specifically for youth. We need aggressive efforts to make MOUD more accessible to youth and young adults. It’s a needed and clearly effective option. Any provider that has (Drug Enforcement Administration) approval to prescribe Schedule III drugs are able to prescribe buprenorphine products.”
— Kula
Washington overdose deaths increased by nearly 24 percent between February 2023 and February 2024, according to the National Center for Health Statistics. And the median monthly overdose deaths among people age 10-19 increased by 109 percent from July-December 2019 to July-December 2021.
Dr. Kym Ahrens—medical director at the Washington State Department of Children, Youth, and Families’ Juvenile Rehabilitation System—said providers need training in respectful, evidence-based shared decision-making models.
“If we teach providers how to do shared decision-making with patients and families when the adolescent wants to, that’s something that can help a lot, and we try to do (it) when we can,” Ahrens said.
Other ideas that could help include increased provider/parent support for pediatric prescribing; advocating for evidence-based inpatient models that include MOUD; virtual, mobile health models that meet patients where they’re at; and focusing on harm-reduction efforts until an individual is ready for treatment.
“When someone’s not ready to stop using, harm reduction is really important. And being willing to still meet with them, and be compassionate, even when they’re not willing to stop using yet is really important.”
— Ahrens
Harm-reduction efforts include informing individuals to never use drugs alone; designating a sitter each time they use; and encouraging them to carry naloxone and consider using fentanyl test strips to test their drugs ahead of usage, Ahrens said.
Those interested in learning more about health initiatives in the state can register to attend the 2024 Washington State of Reform Health Policy Conference on Oct. 17 at the Spokane Convention Center. An “Examining the Evolving Behavioral Health Landscape” panel will discuss recent work to address substance use disorders at 2:15 p.m.