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Responding to the Inequities in the Opioid Crisis

June 13, 2022 by North Sound ACH staff Leave a Comment

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.

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.⁴The 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

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.
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
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
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

June 3, 2022 by North Sound ACH staff 1 Comment

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.

Find and strive for our ‘universal goal’

May 27, 2022 by Liz Baxter 1 Comment

Liz’s Note, May 2022 newsletter

Such tumultuous emotions this week …

I happen to live one block uphill from an elementary school, and every morning I hear the background noise of children arriving and entering the school building. On Wednesday morning I stood and intentionally listened to those sounds instead of leaving them in the background of a busy morning. After another unimaginable night for families, my heart continues to break for them, thinking of the thousands of times that I dropped off my sons at school, never fearing what could happen to them before the end of the day. Our children should be safe, allowed to live without fear of violence, especially in places meant to nurture them and help them grow. That is part of our obligation to them, and the people who surround them.

I spent time talking with partners this week about what targeted universalism is and how much setting the ‘universal goal’ matters, as opposed to identifying a universal strategy. I asked them to imagine how different it would be if our goal was to keep all children safe from violence and harm. Gun control and safety is one of many strategies but it is not the only needed strategy. We also have to think of all the elements that result in young people targeting other young people for death in such horrific ways. Young people are hurting, facing trauma and don’t have the needed support around them to make their way through alone.

I refuse to believe that we are powerless to make these circumstances change.

Two events come to mind for me – I joined many at Skagit Valley College last weekend for the Spring Powwow. In the wake of Buffalo and California, I was moved to tears watching four generations of dancers from one family as part of the Grand Entry in the afternoon, knowing that for too long, tribes were forbidden from practicing these traditions. Seeing young people as part of rebuilding these traditions is so impactful.

And on Wednesday evening I traveled to Shoreline to watch my grandson compete in a district track meet. I again found myself battling my own anxieties of having so many children gathered together, wondering whether some circumstance would put them in danger, and I felt I needed to be there, to make sure they do not feel alone. They are our future and worth every minute of our time to assure they have every opportunity to thrive.

I mentioned to one of my team that I remember the day when each of my boys began to understand that they could feel two conflicting emotions at the same time. Happiness and pain, fear and gratitude, hope and anxiety. That is where I am when each of these events rips through a community. I realize that while Buffalo and Uvalde seem far away from Northwest Washington, we had our own experience in Marysville not so long ago. Every community is just like ours, and what happens there happens to all of us too.

Hug your loved ones, and please wake up each day with a desire to change this world for the better, because we can do that work if we act together.

Be well,

Gratitude and reciprocity this Spring

April 28, 2022 by Liz Baxter Leave a Comment

April 22 was Earth Day and it was appropriate to spend part of the day standing with our colleagues and partners of Children of the Setting Sun as they modeled what it means to be stewards of this planet we call home – Mother Earth. There were two themes that stuck with me as I walked away – gratitude and reciprocity.

Gratitude for the reminder of all this planet provides for us – the warmth of sun on our faces, the ground underneath us, the ability to grow and harvest food, the air that sustains us. Taking a moment to use all of our senses to feel the earth around us. I don’t know about you, but I don’t take enough time to be still and feel all that surrounds me. I was grateful to stand with others doing the same and feeling out connection to each other.

One speaker at the event spoke to reciprocity – what the earth gives us, and noting our responsibility to give back, to care and nourish this place we call home. Another shared this quote – “the one thing we hold in common is the earth.” Imagine if we could carry that thought with us every minute of every day. Would we make the same decisions if we recognized our unbreakable connections to each other and this earth, and our responsibility to future generations?

Like you, we are moving out of our home offices and starting to be in spaces with real human beings again. It is both wonderful and a little anxiety producing. I want to wear a button that says “don’t forget that you still need to wash your hands, and keep some physical distance if you feel ill!” Plus, realizing that people I’ve met over the last two years are both shorter and taller than I thought. Zoom was a bit of an equalizer in that way, which I hadn’t thought of before.

And on April 23, our team received an award from the Center for Human Services, and we’re sensing that same theme of reciprocity again. Our work and their work are integrally intertwined. To be thanked because we were able to leverage resources so that a partner could continue to have such an impact is humbling, because our opportunities occur because there are such amazing partners doing great work. That plus the dress code was ‘business casual.’ Imagine what that could look like after two years of zoom attire!!

Our hearts are with those who are struggling this month – looking for adequate housing, food, jobs, along with those arriving from Afghanistan, Ukraine, and other countries. They arrive here in the North Sound region every day, and our partners continue to have open arms to welcome them. Please reach out if you want to help support their work. We are raising funds for them, where 100% of what you donate goes directly to partner organizations.

Thinking of you as the sunlight in our days grow longer –

Car safety technicians trained in the North Sound

March 18, 2022 by Megan Stephenson Leave a Comment

Becoming a parent is an exciting and very busy time – there are many things to prepare for in order to keep your environment safe for a new baby. Car seats are an expensive but very necessary item to purchase, and the Region 11 Child Passenger Safety team helps caregivers prepare to carry their children safely in their cars, at no cost to the caregivers. Supported by a variety of funding sources, and often working out of local fire departments, law enforcement agencies, and social service agencies, these nationally-certified technicians meet with individuals and families, as well as groups and agencies like hospitals, to provide education and information on proper car seat safety.

Technician Erica Littlewood and expecting parent Tasha going over installing a car seat. Meg Stephenson / North Sound ACH

Morgan and Tasha are first time parents, and after buying a car seat, did an internet search to find who in the area could help them install and understand how to use the seat properly. For those who have not had to use or install a car seat, it may be surprising to learn how complicated it can be. Fortunately, trained technicians in this program are in each county in the North Sound.

North Sound ACH Project Manager Erica Littlewood is the Washington state Region 11 coordinator for the Child Passenger Safety program, and has been doing this work for 16 years. Region 11 consists of Whatcom, Skagit, Island, and San Juan counties. Snohomish County is its own region, and Region 11 and Snohomish County work closely together.

Technician Erica Littlewood demonstrates installing a car seat with expectant parents Morgan and Tasha. Meg Stephenson / North Sound ACH

After scheduling an appointment, Erica met Morgan and Tasha at the Geneva Fire Station in Bellingham. During the session, Erica explained how car seats should be properly installed, how to use the car seat’s harness (practicing on a baby doll), and an overview of the laws around the different car seats (when an older child can start using a booster, can sit in the front seat, etc).

“This is why we’re doing this, so we feel more powerful,” Morgan said.

Did you know: technicians recommend taking your baby out of the child safety seat every 1-1.5 hours – even though it may be tempting not to disturb baby if they fall asleep, it is better to take them out of that restrictive seat.

Hospitals will ask parents if they have a car seat installed before the birthing parent is discharged, but may not have a trained technician to go over the seat with parents at that time. Making an appointment ahead of time with a technician in your area is recommended.

Erica held a training for 11 new technicians who will work in Whatcom, Skagit, Island, and San Juan counties, as well as two technicians who will work in Snohomish and Pierce counties, in October 2021. Training the technicians, supplying the class with relevant equipment, and teaching space came from North Sound ACH, South Whatcom Fire Authority, and the Children’s Museum of Skagit County. The class was financially supported by the state Child Passenger Safety program.

Shawneri Guzman with South (Snohomish) County Fire is a trainer technician, with Trevor Bolton of San Juan Island EMS at the October training. Meg Stephenson / North Sound ACH

Shawneri Guzman works for South (Snohomish) County Fire and has been a child passenger safety technician for 20 years. She didn’t take this type of class when she had her own children, and when she was first trained it was an “eye-opener” for her. Whether the new technicians getting trained were there for their jobs or just as a community volunteer, they do it to help their communities, Shawneri said.

“It’s rewarding to know the family is leaving safer than when they arrived,” she added.

In her 20 years, she’s seen a lot of changes – car seats are more complicated but safer, cars are more complicated, families have changed.

“Culturally, a lot of people come to this country with no experience with car seats, [and] they just want to do what’s right,” Shawneri said.

Trevor Bolton of San Juan Island EMS at the child passenger seat training. Meg Stephenson / North Sound ACH

How can I find a seat or a technician?

The Child Passenger Safety program also has a limited number of car seats for donation to families who are referred by local agencies. For more information, contact Erica at erica@northsoundach.org.

You may search for technicians in your area by going to https://cert.safekids.org/get-car-seat-checked (it will include languages other than English if available).

Where can people donate?

If people want to support the program, they can donate to Safe Kids Northwest:
PO Box 764
Burlington, WA 98233
with “child passenger safety” on the memo line

Funds go to purchase new car seats for the donation program. It’s great if people can share a gently-used car seat with family or friends, but they should not resell a seat or purchase a used seat.

Other resources:

Region 11 Child Passenger Safety Program

National Highway Traffic Safety Administration

Safe Kids Coalition

Collaborative Action Network Cohorts – next steps

March 3, 2022 by Megan Stephenson Leave a Comment

Creative tension is common when a group is in liminal space. And it is exactly what is needed for co-creating something new.

During our February learning session, we held space for diverse perspectives to share their hopes, concerns, and questions about the emerging Collaborative Action Network (CAN) Cohorts.

Together, we:

Sought clear answers AND recognized we need more time for partner input
Experienced discomfort with uncertainty AND excitement for creating something new
Acknowledged the need for pragmatism AND the desire for reimagining solutions (and better future for all people and places)

The new cohorts offer a tangible opportunity for partners to create a just and inclusive culture and the necessary conditions for all community members to thrive. The trust and commitment of the North Sound ACH partners is rare – and it will be exciting to see how partners bring this to life over the course of 2022.

FAQs

What do we mean by “cohort” and “focus area”?
A cohort is a grouping of Network selected focus areas that have a strong affinity or common theme. It is also a way for North Sound ACH staff and partners to organize and manage the Focus Areas. We have five cohorts:

Equity
Vital Conditions
Emerging Focus Areas
Practice Transformation
Care Coordination

Focus areas are the more discrete, actionable areas that Network participants have identified for collaborative learning and action. For example: food security, oral health, or mobile integrated health.

How were these cohorts and focus areas identified?
The North Sound ACH team identified these cohorts and focus areas based on reports from contracted partners, requests and reflections from leaders across the region, and an environmental scan. These topics are driven by our network members and will continue to be shaped by network members.

Can we change our commitments to cohorts or focus areas?
We anticipate that our network will grow and evolve over time. Partners who have signed contracts committing to a particular level of participation in a cohort can amend their contracts if another focus area emerges as an organization priority.

We also hope that additional people will join us over time, sharing their expertise and experiences. Organizations that are not currently engaged with North Sound ACH may join the network and cohorts at any time.

What could the work look like?
Our partner-based workgroups are a forerunner to the Network cohorts, such as the Regional Opioid Collaborative (ROC) and the Oral Health Local Impact Network (LIN). At the February partner learning session, Yuki Yang of Ideal Options shared that the ROC is like a “beta version” of the cohorts.

We come across different funding sources, and we can’t apply for it because we’re for-profit; having this space in these cohorts, to identify these situations, we’re always going to our community partners and saying, there’s this opportunity [for funding], do you want to apply for it and we’ll help support your efforts?
But it’s not always clear what those organizations want or need he money for, so these having cohort discussion to identify what are the solutions we’re searching for, or what are the things we want to try, and then also knowing what funding sources are available, we can say, there’s this opportunity, let’s apply or have a lead organization apply who is a non-profit and we will all deliver on whatever the solution is … that is what we’re talking about: coming together, finding funding, delivering a solution, and being in action.”

Hear more from Yuki at the February meeting recording, starting at 44:59.

What do partners say so far?
Mike Parker of Opportunity Council recognized there is comfort with “prescriptive contracts with defined measurement,” such as the Medicaid Transformation Project. However,

Those things don’t afford a lot of creativity, and so while this may feel unsettling and a little bit new it also can be a spark of creativity. For us, working regionally is one of the great benefits, has been one of the great benefits through [the Medicaid] transformation program. The problems we deal with are so regional or wider than that even, so I just look for more creative opportunities to do out of the box solutions, because obviously what we’ve been doing hasn’t been creating the thriving conditions we want.
So this type of model is maybe exactly what we need to do because it’s different, because it will afford opportunities for us to connect across our different organizations, service territories, you name it, languages… so I’m hopeful.”

Nicole Picknell of South (Snohomish) County Fire said its taken time for her and colleagues in her line of work to get comfortable with creative thinking.

Its super hard for us to be ok with being comfortable with the uncomfortable,” she shared. But working with others, “With the north sound ACH, we did start bringing the community resource paramedics together, and that really started us to find a space that we could feel comfortable in talking about, and there’s value in listening to other people, cause theres things I’ve learned on here that I’m like, oh I had no idea that we actually have a connection.”

Hear more from partners by watching the February learning session on our YouTube page.

We invite you to bring more questions to the team – you can always email us at Team@NorthSoundACH.org – and at the next partner learning session on March 16. There, we will break out the attendees into the cohorts they are participating in, to get started together!