Seven Days of the Opioid Epidemic

A New Kind of Survey. The Snohomish Health District conducted its second point-in-time survey in July 2018, tracking overdoses and other impacts of the opioid epidemic in Snohomish County communities. This journal provides a behind-the-scenes look at each day during that week in July, and how opioid addiction affected families and neighborhoods.

TOTAL DATA FOR THE WEEK

Reported Overdoses

0

Overdose Deaths

0

Inmates Booked Into The Snohomish County Jail Who Tested Positive For Opioids (32% Of All The Week’s Bookings)

0

People Who Test Positive For Hepatitis C Antibodies At Syringe Exchange, Jail And Denney Juvenile Justice Center

0

Day 1 - Monday, July 9, 2018

12:01 a.m.

Point in Time Count begins

12:54 a.m.

Medics in Marysville are dispatched to treat an adult female withdrawing from heroin and Oxycodone. Patient is transported to the hospital.

2:22 a.m.

Medics in Edmonds are dispatched to a report of a male slumped over in his car. When they arrive, they find the man’s friend trying to wake him up. The male is in the driver’s seat, unconscious.  He has history of using Oxycontin for back pain. Narcan, also known as naloxone, is administered. Patient is transported to the hospital.

9:51 a.m.

The Office of Neighborhoods meet outside the recently-opened Diversion Center. It’s an unusual partnership, deputies and social workers, and an unusual assignment: go into the woods, connect with homeless people, and get them off the streets and into treatment.  But the team, which has been together since 2015, is making significant impacts in the community, one relationship at a time.

This morning, Sgt. Ryan Boyer briefs the team before heading out to visit a homeless encampment they’ve received complaints about from patrol and neighbors near Lake Stickney.

Sgt. Boyer and Deputy Bud McCurry and social workers Elisa Delgado and Lauren Rainbow arrive at a wooded area off of Admiralty Way. A couch and piles of garbage line the roadway. As they enter the woods, they run across several unoccupied tents surrounded by piles of garbage.

Office of Neighborhoods Deputy Bud McCurry, Social Worker Elisa Delgado and Sgt. Ryan Boyer review the list of homeless encampments they will visit today outside the newly-opened Diversion Center on July 9, 2018
Office of Neighborhoods Deputy Bud McCurry, Social Worker Elisa Delgado and Sgt. Ryan Boyer review the list of homeless encampments they will visit today outside the newly-opened Diversion Center on July 9, 2018
Office of Neighborhoods Deputy Bud McCurry surveys the garbage and debris at a homeless encampment in South Snohomish County.
Office of Neighborhoods Deputy Bud McCurry surveys the garbage and debris at a homeless encampment in South Snohomish County.

“We’ll leave a flier here, because the tent is unoccupied,” said Deputy McCurry. “We’ll come back. If the tent’s still here, we’ll gauge their level of interest. If they want some help, we will help them. If they don’t want help, they are going to have to pack up and move along.”

At every turn there are discarded needles.

The team contacts a male and female living in a tent. She says she’s in treatment. The male has a blue bandana hanging from his back pocket, but denies any gang affiliation. Deputy McCurry says they need to move out and they begin packing up.

“It definitely takes getting used to, and it takes different tools in our police tool box out here,” said Sgt. Boyer. “We have a different goal and a different end game versus a patrol response, so it definitely takes some heart to do this.”

A hypodermic needle – most often associated with heroin use – at a homeless encampment in South Snohomish County on July 9, 2018.
A hypodermic needle – most often associated with heroin use – at a homeless encampment in South Snohomish County on July 9, 2018.

Sgt. Boyer and Elisa make contact with Mike, who is also living in a tent at the location. Mike says he’s ready to get out of there. They make arrangements to meet up with him on Wednesday to discuss his options. One of those options includes moving in to the Diversion Center for a few days so he has a safe place to stay while they work out the next steps for treatment and recovery.

“So, the Diversion Center is somewhere we can bring someone out of the field, get them housed right away, get them a place to be where they’re safe, they have food, water," Boyer said. We can access their prescriptions, get their insurance. It’s also a spot where we know where they’re gonna be for their next appointment, so it’s not a constant re-schedule.”

The team re-groups and makes a plan for the next encampment they are going to visit.

Mike never followed up with his desire to get out and move in to the Diversion Center. He is still homeless and using.

10:21 p.m.

Everett Police and medics are dispatched to a report of an unresponsive male lying near a thrift store. Police administer Narcan and the man responds, admitting to heroin use. He is transported to the hospital.

Data for Day 1

Reported Overdoses

0

Overdose Deaths

0

Inmates Booked Into Jail Testing Positive For Opioids

0

Day 2 - Tuesday, July 10, 2018

10:14 a.m.

The screaming and crying can be heard across the entire floor. 

 

“What you see here is a female who is not very cooperative,” said Booking Sgt. Dan Young. “We know she’s on something – maybe meth – but she won’t tell us what she’s using.”  

 

It’s a common scene at the Snohomish County jail, where over 30% of the inmates booked test positive for opioids, meth or both.  If they test positive for opioids, they are immediately placed on a withdrawal watch. Some inmates, if they meet certain criteria, can be prescribed Suboxone, medication which will help them with withdrawal symptoms.  Snohomish County was the first jail in the state to offer medication assisted detox and treatment.

 

Up in the jail’s medical unit, a young male inmate is being treated for opioid withdrawals, which can include fever, chills, vomiting, and diarrhea.

 

“Imagine the worst flu you’ve ever had,” said Nurse Supervisor Julie Farris, “and times that by 10."

 

Farris said when she first started working in the jail’s medical unit over 12 years ago, the primary concern was alcohol.

 

“And as the years have gone by, we’ve had more and more methamphetamines, and the introduction of heroin.  Then we had the Oxycontin problem that happened. It exploded. The company changed their formula … and then the heroin really took over,” said Farris.

 

Back down in booking, four female corrections deputies and a nurse are finally able to calm the hysterical inmate down. They get her dressed in a uniform, and carefully catalog and store her clothes and other property.  The nurse is able to get her vital signs. The inmate tests positive for meth and heroin.

 

12:26 p.m.

Everett Police request an aid unit to evaluate an adult male who admits to heroin and methamphetamine use. He is transported to the hospital.

1:05 p.m.

Snohomish Health District staff are on the phone with the Washington State Department of Health.

The topic: Neonatal abstinence syndrome, or NAS. That’s where a baby is born withdrawing from drugs that she or he was exposed to in the womb.

There are more cases of NAS in Snohomish County than there used to be, and the rate continues to climb. In 2017, there were 124 babies in our county born with NAS.

The team from Snohomish County and the team from the state talk about what can be done.

There’s no easy answer, but the Health District is working to map out a plan.

A nurse takes the blood pressure of a female inmate who is being treated for opioid withdrawal.
A nurse takes the blood pressure of a female inmate who is being treated for opioid withdrawal.
Male inmates waiting for medical services in the Snohomish County jail.
Male inmates waiting for medical services in the Snohomish County jail.
Buprenorphine, also known as Suboxone, is a medication used to treat opioid withdrawal symptoms. Snohomish County’s jail was the first in the state to offer medication-assisted detox and treatment.
Buprenorphine, also known as Suboxone, is a medication used to treat opioid withdrawal symptoms. Snohomish County’s jail was the first in the state to offer medication-assisted detox and treatment.

Nurse Alma Chenault talks to a male inmate in the jail’s medical unit on July 10, 2018

Data for Day 2

Reported Overdoses

0

Inmates Booked Into Jail Testing Positive For Opioids

0

Day 3 – Wednesday, July 11, 2018

12:26 a.m.

Aid units in East Snohomish County are dispatched to an overdose of an adult male. Witnesses on scene report the man has a history of opioid abuse. Narcan is administered and he is transported to the hospital.

8:30 a.m.

A man bought what he thought were “Perc 30s” – or counterfeit 30mg Percocet pills—from someone on the street.

Now he’s in the emergency department at Providence Regional Medical Center Everett being seen for an overdose, with his mom and girlfriend by his side.

There’s been a surge in the ER in recent weeks as a result of overdoses from counterfeit Perc 30s laced with fentanyl, a synthetic opioid up to 50 times more lethal than heroin. Patients have reported taking the pills, which look different from authentic Percocet pills, and “blacking out” after taking them.

The man in the emergency department is released a couple hours later. He declines help for his addiction, and the mom says they have everything under control.

9:03 a.m.

Lake Stevens medics are dispatched to an unresponsive male who reportedly overdosed on pills. Narcan is administered. On waking, he admits to snorting fentanyl but denies needing or wanting treatment for drugs.

9:07 a.m.

The Snohomish County nuisance property team begins briefing.  The team is comprised of staff from the Health District, Human Services, Code Enforcement, Fire Marshal and the Sheriff’s Office.  Deputy Dave Chitwood distributes a list of properties they will visit today:

  • Sunset Rd, Bothell – The owner is in prison and patrol units continue to see and get complaints of people in and out of the property. The property is in foreclosure, but so far the bank hasn’t done anything to secure the property.
  • Little Bear Creek Rd, Woodinville – The property is for sale, but unsecured and neighbors are calling 911 to report squatters and unwanted foot traffic.
  • 199th Pl SW, Lynnwood – A former heroin house, a previous nuisance property investigation was closed. The team will see if they need to reopen a new investigation. The owner is a former user and says he’s clean, but has a reputation for renting out rooms to people to use drugs.
Deputy Dave Chitwood briefs the nuisance properties team about the locations they will be visiting today.  The team includes staff from the Snohomish Health District, Snohomish County Code Enforcement and the Office of Neighborhoods.
Deputy Dave Chitwood briefs the nuisance properties team about the locations they will be visiting today. The team includes staff from the Snohomish Health District, Snohomish County Code Enforcement and the Office of Neighborhoods.
Office of Neighborhoods Social Worker Lauren Rainbow talks with a woman living in a nuisance property in unincorporated Lynnwood while Sgt. Ryan Boyer keeps an eye on other residents.
Office of Neighborhoods Social Worker Lauren Rainbow talks with a woman living in a nuisance property in unincorporated Lynnwood while Sgt. Ryan Boyer keeps an eye on other residents.
The nuisance property team inspects a home in unincorporated South Snohomish County on July 12, 2018.
The nuisance property team inspects a home in unincorporated South Snohomish County on July 12, 2018.

“Can you imagine the rats that are probably around here? Just eating off of this stuff constantly."

9:36 a.m.

Everett medics are dispatched to a female not feeling well. She admits to using heroin and is transported to the hospital.

9:45 a.m.

At the Little Bear Creek property, Deputy Dave Chitwood is careful where he steps.

“There’s a pile of needles right there,” he says during a walk-through visit of the property.

The place has been taken over by squatters. They aren’t only using it to crash, it is also their outdoor toilet and garbage dump.

“This is ugly,” Chitwood said. “And as the weather gets warmer this week, can you imagine living as a neighbor next door, what you are going to smell?” He pronounces the situation “totally unacceptable.”

Chitwood and this multi-agency team focus on correcting conditions at nuisance properties. Hard experience has taught that arrests alone aren’t likely to have a lasting impact on places where drug-addicted people hold sway.

Health hazards need addressed. Property owners – often no longer living on site – need to be pressured into securing buildings. If they are amenable, homeless addicts need to be steered toward services.

This property appears vacant. Chitwood speculates it has simply become too foul for people to linger.

As he talks, hornets buzz around a broken dishwasher, rusting away under the trees.

10:03 a.m.

Everett medics are dispatched to an adult male who became ill a few days prior. Witnesses state the man had taken heroin the night before.  He is unresponsive and is transported to the hospital.

11:00 a.m.

Eric Korsmeyer is a registered nurse in the emergency room at Providence Regional Medical Center Everett, one of the state’s busiest. He sees the damage opioid addiction is doing to Snohomish County – one person at a time.

Some come to the ER seeking relief from withdrawal symptoms. Others are fighting infection from abscesses linked to their IV drug use. Most days, emergency room staff at Providence need to jump in to revive somebody who has overdosed and is hovering near death.

It’s Korsmeyer’s job to track those overdoses in partnership with the Snohomish Health District . He tries to talk with the patients, to learn more about how they wound up in the ER. He and social workers attempt to connect them with options for fighting addiction.

“Unfortunately, some of the people that come to the ER aren’t necessarily interested in getting off of opiates,” Korsmeyer said “You know, we are kind of fortunate in that we catch people at a vulnerable time. If they are having to go to the hospital, they obviously are having some consequences to their opiate use. But it is not for sure that they are wanting help at that time.”

“It is a population that is hard to deal with, that gets forgotten about and doesn’t always get treated the best. And so, it can be discouraging. Not everybody wants help. And sometimes – frequently – people that get help end up relapsing. So, when you find somebody that you can get through to, it is definitely rewarding.”

2:41 p.m.

Lynnwood medics are dispatched to the report of an elderly female found unresponsive by caregivers. Narcan is administered and she is transported to the hospital.

3:12 p.m.

Deputy Chitwood stops by a residence on Lerch Road in Snohomish and confirms that the property has been cleaned up, all squatters evicted and the owner has taken back control to keep it clean.  This nuisance property is now closed.

4:32 p.m.

Arlington medics dispatched to an adult female lying unresponsive on the floor.  Narcan is administered. When she’s revived, she explains she may have taken too much Oxycodone and is transported to the hospital.

Data for Day 3

Reported Overdoses

0

Inmates Booked Into Jail Testing Positive For Opioids

0

Day 4 - Thursday, July 12, 2018

9:00 a.m.

The 11 women are quick to welcome a new member to their group.

She looks exhausted. Her baby is 2 weeks old. And like all of the other moms in the room, she’s in recovery for opioid addiction.

This is her first time joining the weekly group at Therapeutic Health Services for pregnant and parenting women in recovery. They start by sharing their names, the names and ages of their children (or their due dates), and how long they’ve been clean. They check in, cheer each other on and commiserate over shared struggles.

Each meeting also includes a class; today’s topic is toddler behavior. The moms are particularly interested in how toddlers test boundaries and rules as they learn independence. One mom notes that her youngest child is the most difficult of four siblings, constantly pushing boundaries.

Felicia Cain, a public health nurse with the Snohomish Health District, presents to the class twice a month. But the moms often learn more from each other than from any presentation, she said.

Mothers in treatment attend a support group with their babies at Therapeutic Health Services.
Mothers in treatment attend a support group with their babies at Therapeutic Health Services.
THC-Addicted-Moms-2

“I’m consistently impressed by their knowledge and wisdom of parenting, and humbled by their resilience,” says Cain. “They are among the hardest working moms I know. Because of their hard work and social support they are breaking the cycle of intergenerational trauma and honing a new path for their children so they can thrive.”

2:00 p.m.

Cheri Speelman, program director with the AIDS Outreach Project/Snohomish County Syringe Exchange, turns on the “OPEN” sign.

The exchange works like this: bring in used syringes and you can leave with an equal number, sterile and still in their packaging. The one-for-one swap is anonymous and free. It aims to help intravenous drug users better protect their health and also to reduce the spread of HIV/AIDS and Hepatitis C.

The program launched in 1996. It distributed 124,000 syringes that first year. In 2017, roughly 2.2 million syringes were exchanged, Speelman said.

On an afternoon like this, it is common to swap out anywhere from 35,000 to 50,000 syringes brought in by 150 or more people in just under six hours. Today, Speelman collects 41,200 used syringes and provides 40,500 clean ones. She won’t give people more syringes than they bring in – it’s a one-to-one exchange. However, she will take extra dirty syringes. Sometimes people turn in syringes and ask for fewer, or none, in return.

As she exchanges syringes and clean supplies, Speelman talks with visitors about how they’re doing, whether they’ve followed up on a referral, or if they want to see one of the resources available in the clinic.

A woman, 26, says she’s been using heroin since 16. She’s interested in learning more about Naloxone, the compound that can save a life when an overdose tells the lungs to stop breathing.

Anybody can become addicted, Speelman says. And everybody matters.

“You’re important. You’re important to us,” she tells visitors. “We don’t want you to die. There’s a way to prevent it. Until you can decide that you want to do something different, let’s keep you safe and alive.”

“Nobody grows up wanting to be an addict. Nobody starts using heroin or starts using meth saying ‘Oh, I’m going to be homeless and I’m going to hurt myself and my family.’ That’s not how it happens.”

Today, the exchange has a medical team from MercyWatch on hand for a few hours. Dr. Tim McNamara and his wife Judy come most Thursdays to help out with basic medical needs. Whether it’s wound care or giving prescriptions for antibiotics, the street medicine team from MercyWatch try help keep clients out of the ER while they find a path to treatment.

Another regular on Thursdays is Jordan, a disease investigation specialist from the Health District. Jordan performs free Hepatitis C testing for clients, recommended every six months for IV drug users. That afternoon, Jordan tests four people. Two of the tests come back positive for the presence of Hepatitis C antibodies, meaning those people who have been exposed to the virus.

Since the Snohomish Health District doesn’t have funding to perform the next level of testing, those clients are referred to one of the community clinics for confirmatory testing. Most never go because they’re worried what doctors may think of them when they admit to IV drug usage.

7:48 p.m.

Everett police and medics are dispatched to a male acting erratically.  The man admits to using meth, heroin and another substance half an hour before the 911 call. He is transported to the hospital.

10:26 p.m.

Everett medics are dispatched to a female with complications due to heroin use who was found by her mother. She is transported to the hospital.

Disposal of needles following the needle exchange.
Disposal of needles following the needle exchange.
Dr. Tim McNamara and his wife Judy helping out with basic medical needs.
Dr. Tim McNamara and his wife Judy helping out with basic medical needs.

Data for Day 4

Reported Overdoses

0

Inmates Booked Into Jail Testing Positive For Opioids

0

Day 5 - Friday, July 13, 2018

2:20 a.m.

Medics are dispatched to the Lynnwood jail for an inmate who claimed to have ingested a large amount of heroin before being booked. Lynnwood Police had arrested him earlier that night for outstanding warrants. The man was transported to the hospital for evaluation.

9:30 a.m.

It’s the first meeting in the new house. But this isn’t just any house; it’s a dream coming true for many local nonprofits and agencies.

The Homeward House steering committee gathers in the living room. The members pull in chairs from other rooms. They review intake and assessment forms, and talk about referrals. Practical stuff. Logistics.

But the house is the exciting part.

Funded by United Way of Snohomish County as one of five community “collaboratives,” the Homeward House is a partnership involving the YWCA, Snohomish Health District, Snohomish County Superior Court and more than a dozen other partners.

After months of work, this house was secured and the team is working on finishing touches before it opens later this fall.

The home, located at Broadway and 37th in downtown Everett, has five spaces where mothers who are separated from infants during active dependency cases in the courts will be able to bond with their babies. The moms will sit down with parent allies to work through what they need to do to gain custody. They can hold their babies while they work to get connected into treatment and other support services.

The program is about trying to keep families together and keeping moms on the path to recovery. The house is about hope.

3:45 p.m.

Superior Court Judge Joe Wilson has two big rules for people enrolled in the county’s Adult Drug Treatment Court.

Show up. Be honest.

It was time for honesty.

The man standing in the courtroom was a new arrival. Odds were against him staying clean. About half of the people in drug court wrestle with addiction to heroin and other opioids. The court team had arranged admission at an in-patient treatment center.

"Will you do that for me?" Wilson asked. "Will you do it for you?"

Now?

Now.

Wilson kept talking, making the case. It was time. The man stared at the floor, his jaw muscles bunching. As the seconds stretched, all eyes were on him.

Finally, a nod. A shrug. OK, he’d go.

The courtroom erupted in applause.

Earlier, two young men graduated from the court. They joined more than 800 others since the program began in 1999, opting for court-supervised recovery in exchange for dismissal of their non-violent felony charges.

They showed up and were honest about their addictions.

Eric Brossard speaks with family and friends at his graduation from Snohomish County’s adult drug treatment court on July 13, 2018.
Eric Brossard speaks with family and friends at his graduation from Snohomish County’s adult drug treatment court on July 13, 2018.
Eric Broassard’s family and friends look at photos documenting how far he has come while a participant in Snohomish County’s adult drug treatment court.
Eric Broassard’s family and friends look at photos documenting how far he has come while a participant in Snohomish County’s adult drug treatment court.
Shane Larson gets a hug and applause as he graduates July 13, 2018 from Snohomish County’s adult drug treatment court.
Shane Larson gets a hug and applause as he graduates July 13, 2018 from Snohomish County’s adult drug treatment court.

They’d each earned a new life. “Go live it now,” Wilson said.

8:12 p.m.

Marysville medics are dispatched to a man with an abscess who admitted to using heroin three hours prior. He is transported to the hospital.

Data for Day 5

Reported Overdoses

0

Inmates Booked Into Jail Testing Positive For Opioids

0

Day 6 - Saturday, July 14, 2018

1:31 a.m.

Medics respond to a Bothell residence for a female who overdosed after smoking Percocet. She is transported to the hospital.

 

1:45 a.m.

Everett medics are dispatched to check on a female for possible overdose after she smoked heroin. She is transported to the hospital.

 

2:34 a.m.

Everett fire and police are dispatched to a male who was lying in someone’s yard. He admits using heroin earlier and refuses any medical care.

 

2:33 p.m.

Medics are dispatched to a female found lying outside a Lynnwood business with drug paraphernalia around her. She admits to using heroin and meth and is transported to the hospital.

 

4:03 p.m.

Stanwood police and medics respond to an intoxicated male lying on the porch. Male states he is under the influence of meth and heroin. He refuses to be transported to the hospital.

 

7:30 p.m.

Medics are dispatched to an unresponsive male lying near a walking trail in Everett. He admits to taking heroin and meth a few hours earlier and is transported to the hospital.

 

8:27 p.m.

Monroe medics are dispatched to a residence for an elderly male complaining of abdominal pain. The man is taking several opioid pain medications following a recent surgery. Narcan is administered and the patient is transported to the hospital.

10:54 p.m. Bothell medics are dispatched to a male who was vomiting after smoking heroin and taking a “dab” of a controlled substance. He is transported to the hospital.

Data for Day 6

Reported Overdoses

0

Inmates Booked Into Jail Testing Positive For Opioids

0

Day 7 - Sunday, July 15, 2018

3:20 a.m.

Marysville medic units are dispatched to find someone doing CPR in the roadway on an adult male. Narcan is administered and the man regains consciousness. He refuses treatment or transport to a hospital and leaves the scene on foot.

10:29 p.m.

Everett police and aid units are dispatched to a female who was assaulted with a hammer. She admits to using heroin earlier in the day and is transported to the hospital. Police are investigating the assault.

12:00 a.m. Monday, July 16, 2018

Point in Time Count ends.

Needle-in-Camp-2

Data for Day 7

Reported Overdoses

0

Inmates Booked Into Jail Testing Positive For Opioids

0

*Not all reported overdoses are reflected in the narrative.

Journal entries compiled by Shari Ireton, Scott North, Kent Patton, Kari Bray and Heather Thomas. Photos and video by Scott Hopson, Scott North and Shari Ireton. Special thanks to the Office of Neighborhoods (Sgt. Ryan Boyer, Deputy Bud McCurry, LEESW Elise Delgado, LEESW Lauren Rainbow), Snohomish County Jail booking and medical staff (Sgt. Dan Young, Health Services Administrator Alta Langdon, Nurse Supervisor Julie Farris), Snohomish County nuisance property abatement team (Deputy Dave Chitwood, the Snohomish Health District, Human Services, Code Enforcement), Providence Regional Medical Center Everett (Eric Korsmeyer, RN), Snohomish Health District (Felicia Cain and Jordan Bower), AIDS Outreach Project/Snohomish County Syringe Exchange (Cheri Speelman, Matt Standerfer), Mercy Watch (Dr. Tim McNamara and Judy McNamara), Snohomish County Drug Court (Judge Joe Wilson).