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North Sound ACH

North Sound Accountable Community of Health

Archives for June 2022

Why Do We Focus on Equity?

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Since 2018, when we first started contracting with clinical and community providers, we have asked for twice-yearly updates reporting on progress, challenges and how to mitigate them, and what aspects of innovative work can be sustained without Medicaid Transformation Project dollars. The past two years have been challenging for staff and the people they serve. 

Every six months one partner or another will raise the question of why we focus so much on equity when we could be looking for administrative or legislative fixes for reimbursement or access issues. I get an email from one of my staff, each reporting period, asking “what should I say to this partner in response?” I usually have a long-winded answer, but the crux of the matter is this – we cannot create a culture of belonging without advancing our understanding of communities around us, their history, and the structural barriers that have disadvantaged them over decades or centuries. We cannot work in true partnership to co-design or co-create new initiatives or projects unless we understand who gets left behind by common ‘one-size-fits-all’ approaches. 

The last couple of months have been brutal. People are struggling, suffering, and dying – violence, extreme heat and flooding, and limited or no access to basic needs. Our region’s two northern counties still have thousands who are displaced by flooding in the fall, looking for permanent housing and that is on top of those who were looking for housing already. This impacts all of us, which is why we all have to understand and see our roles in what happens next.

We have the contradictions of close to 20 mass shootings over Memorial Day weekend, coupled with the knowledge that Congress has been deadlocked on gun legislation for close to 30 years. While they are stymied, children were being killed on the streets and in school buildings. I wonder if Congress would be deadlocked if they were debating the best ways to nourish, feed, and educate children. I want to believe that well-intentioned, smart people represent us in Congress and I want to help them focus on the questions and issues that will make communities safer and healthier, and allow people to thrive. 

I collect photos of my family – we are a diverse collection of people connected by love. Perhaps for that reason, I also am moved by images that others create and share during these tough times and I want to share some with you. Not because I am trying to influence your point of view or politics, but because they are all asking questions that point to what I call ‘the creative tension’ in most decisions. Rarely is there a decision made where one solution benefits everyone; typically the choice made will advantage some and might disadvantage others, especially if we aren’t paying close attention to intended and unintended impacts.

I know that I gravitate toward images that affirm my viewpoint, but sometimes they challenge my thinking too, which I appreciate. I would also appreciate you sharing images or thoughts that have moved you and that you’d like to share. North Sound ACH has tried to stay in a nonpartisan space, which I also appreciate, but addressing gun violence and the public’s safety is a debate that will occur in many settings over the coming years. I have to believe that we will come out on the other side with a brighter future ahead, but it won’t happen if we stay within a debate designed by lobbyists from any side. We need to come at this as community members who actually care about the people in our communities – all the people, leaving no one behind. I hope you will join in those dialogues with an open heart and an understanding of our history of laws and policies that have left legacies of structural and systemic exclusion in many communities. 

We emphasize equity so that our team, board, and partners understand the past and present, and find ways together to make the North Sound region a place where all people feel a sense of belonging and find ways to thrive, leaving no one left behind. We believe we can craft new legacies to leave for future generations.

Washington Post Article to Link: More than 311,000 students have experienced gun violence at school since Columbine.

Responding to the Inequities in the Opioid Crisis

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Megan Tripp, Project Manager

In 2022, North Sound ACH partnered with the Department of Health for a pilot project aimed at getting naloxone into the hands of people in the community. The need for community naloxone distribution is greater now than it ever has been before. Over the past 15 years, opioid overdose deaths in the North Sound region have increased by over 126%, with a particularly rapid increase starting in 2020. San Juan, Skagit, and Snohomish counties have each seen an increase of nearly 150% in opioid overdose deaths.

In an attempt to begin to address this crisis, we have supplied 105 kits of nasal naloxone spray (Narcan) to community partners, who in turn have distributed 44 kits to the people they serve. Each kit contains two doses of naloxone, which means we have gotten 88 potentially lifesaving doses of naloxone into our communities! Program participants have also reported training 48 people on overdose response and naloxone administration. Unfortunately, this program was limited by the funding available to DOH, and that funding has been depleted. We are actively seeking alternative sources for these life-saving supplies while we wait to hear from DOH about renewed funding. 

One of the organizations working with North Sound ACH is Health Ministries Network, an interfaith nonprofit which supports health ministry and works with faith community nurses (FCNs) in Whatcom, Skagit, Island, and San Juan counties by promoting preventive health care, health equity and spiritual well-being. Following a recent local health fair where Narcan was offered to community members, Executive Director Sarah Lane, shared with us, 

It was lovely to sit down with folks and have thoughtful conversations about Narcan distribution. As we let folks know that this was available, some felt called to tell us their recovery stories.  Others wanted to tell us that this was a futile effort—and we could hold space for good discussion.And others quietly came inside, learned, took the Narcan and know we are there for them, wherever they find themselves.”  

Sarah Lane

Fentanyl Awareness Day

The U.S. Senate passed a resolution declaring May 10, 2022 the first National Fentanyl Awareness Day in response to the increased impact of fentanyl in the opioid epidemic, and the sharp increase in overdose deaths over the past two years. The CDC estimates that as many as 107,000 people in the U.S. died as a result of drug overdose between November 2020 and November 2021, and an estimated 66% of those deaths are attributed to synthetic opioids like fentanyl.

Source: CDC

What is fentanyl?

Fentanyl is an FDA-approved synthetic opioid used legally for pain management and, according to the CDC, is “50 times stronger than heroin and 100 times stronger than morphine.” Because of its potency, illicit drug manufacturers have used fentanyl to create stronger, more addictive drugs more cheaply. Fentanyl is increasingly being found in counterfeit prescription pills (fake pills falsely marketed as prescription opioids, anti-anxiety medications, ADHD medications, etc.), cocaine, methamphetamine, and heroin, and many people taking these substances are unaware they are also ingesting fentanyl. The presence of fentanyl in other drugs cannot be identified by appearance, smell, or taste; it can only be detected using fentanyl test strips. 

Opioid overdose and equity

The opioid epidemic was put in motion in 1996 with the introduction and FDA approval of OxyContin as a “minimally addictive” pain reliever.1 For many years after that introduction, opioid use disorder and overdoses disproportionately affected white communities due to racialized opioid regulation, marketing, and prescription rates.2 Black, Indigenous, and People of Color (BIPOC) patients were frequently denied opioid prescriptions to manage their pain due to racial bias in the medical community. However, more recent data suggests a shift in who is most affected by opioid use disorder and overdose deaths. A study published in March 2022 showed that while all racial and ethnic groups had an increase in rates of overdose deaths in 2020, the increase was greatest in Black and brown communities.3 The mortality rate was highest in American Indian/Alaska Native populations, and the largest increase in the mortality rate was in the Black community. Previous studies have shown a correlation between frequency of opioid use and social determinants of health, including level of education, housing stability, and employment status.4 The inequality already faced by BIPOC communities further underscores the racial justice issues embedded in the opioid epidemic today, and the need to respond equitably.

What can I do?

Feeling overwhelmed or hopeless when faced with these facts is very real, but there are ways you can help. 

  • Educate yourself on who is susceptible to opioid overdose – it is not only a risk for people with opioid use disorder or substance use disorder, but can happen to anyone taking opioid medications or illicit drugs.
  • Fentanyl testing strips can be ordered online and should be used to test any substance that was not obtained at a pharmacy or dispensary.
  • Learn to recognize the signs and symptoms of fentanyl and other opioid overdose:
    • Loss of consciousness
    • Slow or stopped breathing
    • Gray or bluish pallor to the skin in light-skinned individuals; ashy skin in darker-skinned individuals
    • Constricted pupils (looks like a pinpoint)
  • Overdoses caused by fentanyl may strike more suddenly, and require additional doses of naloxone to reverse. 
  • Carry naloxone and know how to use it. Naloxone can be purchased at many pharmacies without a prescription, and the cost may be covered by insurance. 
  • Advocate for additional funding from the state to continue vital naloxone distribution programs and fentanyl testing programs.
Sources
  1. Products – vital statistics rapid release – provisional drug overdose data. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm. Published May 11, 2022. Accessed June 10, 2022.
  2. Hansen H, Netherland J. Is the Prescription Opioid Epidemic a White Problem?. Am J Public Health. 2016;106(12):2127-2129. doi:10.2105/AJPH.2016.303483
  3. Friedman JR, Hansen H. Evaluation of Increases in Drug Overdose Mortality Rates in the US by Race and Ethnicity Before and During the COVID-19 Pandemic. JAMA Psychiatry. 2022;79(4):379–381. doi:10.1001/jamapsychiatry.2022.0004
  4. Albright DL, Johnson K, Laha-Walsh K, McDaniel J, McIntosh S. Social Determinants of Opioid Use among Patients in Rural Primary Care Settings. Soc Work Public Health. 2021;36(6):723-731. doi:10.1080/19371918.2021.1939831

Sadness and anger on racial violence – we must speak up

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Shanon R. Hardie, Board Chair

The tragedy in Buffalo still weighs heavy on my mind and heart alongside the shootings in Tulsa, Laguna
Hills, Uvalde and 14 other sites over the Memorial Day weekend. I know it is not new; acts of violence
and racism are inflicted upon our Black friends, neighbors, co-workers, families, and communities every
day and traumatize them further. What is hitting me so hard is that despite so much more focused
attention on racial injustice, there continues to be such regularity of it; the cumulative effect, the
seeming acceptance of it as ‘normal,’ and that in the Buffalo case, it was an 18-year-old that carried out
this evil act. How does an 18-year-old develop such hatred and bias? We accept that we have so much
work to do with older generations raised in an environment with biased and racist cultural norms. But
how, in this day and age, are we still raising children with that hatred? I guess I have been naïve in
thinking that we are raising a new generation that is more aware, more tolerant, more empathetic,
more inclusive. My hope for the future was in the next generation. Expecting they would help us lead
REAL change. I know this is just one young person but if there is one, there are others.

Life is hard and there are so many risks out in the world that can harm and devastate any family. Every
parent worries about their kids. However, I can’t imagine the kind of fear, stress, and anxiety that Black
mothers and fathers have to live with and manage each and every single day. Beyond worrying about
the things all parents worry about – stranger danger, car accidents, being hit by a car, drowning, etc. –
they have to worry that any person their child interacts with will harm them solely because of the color
of their skin. A worry that those of us with white privilege never have to think about. Never having to
ask ourselves…Will they see and appreciate how important my child’s life is? Will they see my child as a
person of value and worthy of kindness and respect? Will they see that my child is as loved and precious
to our family as their own children are to them? Will they see that my child has hopes and dreams just
like their children do? Will they understand and have empathy for my child’s wariness and fear because
of a pattern of inequities, bias, violence, and trauma that they’ve seen happen time and again?

I struggle between heartbreaking sadness and full-on outrage. As a white woman of privilege, I am still
on a learning journey and am committed to increased awareness, adding my voice and taking action. I
am still not always comfortable in sharing my message and voice. I know what I feel in my heart and
what message I want to say but can’t always find the right words to say it. I know many of us of privilege
are in the same boat. However, if we stay silent for fear of saying it “wrong,” then nothing will change.
So, I am working at taking the risk of saying it anyway and knowing that I will get better at it through
humility, owning my missteps and doing better next time. I also know that I will be extended grace for
having my heart and intentions in the right place. I encourage you to join me in taking the risks…. for
that is the only way toward REAL change.