On May 9, medical response units in Tumwater responded to a person believed to have overdosed. Despite efforts to reverse the effects of the drugs, the person died.
Shawn Crimmins, fire captain in Tumwater, said there was a 40% increase in overdose cardiac arrests in Thurston County from 2020 to 2021. Much of that can be blamed on the growing presence of fentanyl circulating here, as it is in cities across the country.
Even a city as small as Tumwater can't escape the drug's grasp. Crimmins, who spoke during the city's Public Health and Safety Committee meeting on May 10, said the person who died the day prior had fentanyl in their system.
Fentanyl is a synthetic opioid that's 50-100 times stronger than morphine and often mixed with other substances sometimes unknowingly.
At least 36 people died from overdosing on fentanyl in 2021, according to data presented by Thurston County Opioid Response Coordinator Katie Strozyk to the Thurston County Board of Health last Tuesday. Meanwhile, at least 45 people died from any opioid overdose that same year.
"The biggest concern is that fentanyl is lethal in very small amounts, and it can be hard to detect when mixed in other substances," Strozyk said.
Data for overdose deaths in 2021, including those caused by fentanyl, are based on death certificates as of March and are still being finalized, according to Thurston County Public Health and Social Services. The Olympian has requested the Thurston County Coroner's Office share final data when it is available.
For comparison, fentanyl overdoses caused 14 deaths in 2020 when there were 33 total opioid deaths, according to finalized state Department of Health data. In 2019, there were 10 fentanyl deaths and 22 total opioid deaths.
Data on fentanyl overdoses for 2018 and 2017 were hidden in the DOH data set because they were in the single digits. However, the data does show there were 26 opioid overdose deaths in 2018 and 19 such deaths in 2017.
The Board of Health declared the opioid epidemic a crisis in Thurston County in June 2018 and later created an Opioid Response Plan. Nearly four years later, state and county data indicate the problem has only gotten worse.
Thurston County Emergency Medical Service providers saw 22 overdose-related cardiac arrests in 2021 compared to 13 in 2020, said Ben Miller-Todd, Advanced Life Support Program Manager at Thurston County Medic One.
In all, there was a 29% increase in the number of cardiac arrests treated by EMS in Thurston County. To help save lives, Miller-Todd called for EMS and 911 systems to be activated quicker.
"I want to point out that there is a very, very clear increase in survival related to any form of cardiac arrest with earlier activation of EMS and earlier arrival on scene from point of need," Miller-Todd said.
Miller-Todd also shared data on Narcan administration during the Tuesday BOH meeting. Narcan, generically known as naloxone, is a medicine used to rapidly reverse an opioid overdose.
Emergency medical service workers recorded 302 incidents when Narcan was administered in 2021, according to Miller-Todd. Overdoses were confirmed in 57.6% of cases, suspected in 24.4% of cases, and unknown in 18% of cases.
In 65.6% of charted outcomes, Miller-Todd said a person was transported to a hospital. About 16.2% were treated and released, 10.9% died in the field, and 4.6% left the scene.
Administering Narcan improved patient condition in 65% of cases, he added.
Notably, EMS from Lacey Fire District 3 administered the most Narcan with 117 instances, Miller-Todd said.
The Olympia district administered 91 and the Tumwater district administered 30. However, he clarified these numbers are based on where the medic units are coming from rather than where the emergency occurred.
"One of our medics that is managed by Lacey Fire District 3 is just about on the border between Olympia and Lacey," Miller-Todd said. "So, they responded to the City of Olympia quite frequently."
Sheriff John Snaza said the Thurston County Narcotics Task Force investigated 25 cases involving fentanyl in 2021, resulting in 14 arrests and about $167,000 worth of individual doses being seized.
The task force, which is made up of federal, state and local agencies, investigates and arrests people involved in mid- to upper-level drug trafficking. Fentanyl has become a priority for this task force, Snaza said.
"Unfortunately, what we're seeing in the law enforcement community is that fentanyl is really affecting our youth," Snaza said. "They say the average user is 18-44, but what we're seeing is, in our youth, 18-24 is our main user of fentanyl and opiates."
In addition to fentanyl-laced opioids, Snaza said the task force has found fentanyl on marijuana and methamphetamine.
Most illicit drugs are coming from organized drug cartels, Snaza said. Some also have been purchased through the dark web, encrypted internet sites that are not conventionally accessible.
"We're on the main I-5 corridor but we're also on the 101 corridor, so (cartels) are getting it out to the coast," Snaza said. "That's why we're seeing a big distribution hub here in the Olympia area."
To address this wave of fentanyl, Snaza called for increased availability of facility-based drug treatment with an enforcement mechanism and more teamwork among local law enforcement agencies.
He also called for simple drug possession to be criminalized more strongly than it is in the aftermath of the State v. Blake decision. In State v. Blake, the Washington state Supreme Court ruled that Washington's simple drug possession law was unconstitutional because it did not require the state to prove intent, in this case knowledge of possession of a controlled substance. That ruling overturned many simple drug convictions.
Thurston County Prosecuting Attorney Jon Tunheim spoke on how his office has responded to the illicit drug trafficking and use.
Tunheim said his office has seen an uptick in referrals for controlled substance homicide. In these cases, a person dies due to an overdose and their dealer faces liability.
"We have not seen that kind of crime much in the past, but with this lethality of fentanyl, that's also increasing," Tunheim said. "We're taking those cases very seriously."
The major focus for his office will be prosecuting drug traffickers, those who sell drugs for profit to "feed their own greed," he said.
As the courts open back up, Tunheim said he expects to focus more on non-violent property crimes that have been linked to substance abuse disorder. Such crimes have fallen into a backlog amid the COVID-19 pandemic.
On the street level, Tunheim said his office is focusing on programs such as the Law Enforcement Assisted Diversion Program to help people avoid jail and receive treatment.
A new program
In Tumwater, Crimmins said the county is hoping to start planning a Narcan administration program called Narcan "Leave Behind." He said the idea is to update current protocol for what city departments and other groups can do to help people.
The plan is to open up who can provide services to people suspected of overdosing or those with substance abuse issues. This way it's easier for people to build support networks with people outside of law enforcement.
"A lot of the time what happens, our guys go out and wake them up and they want nothing to do with us," Crimmins said. "So we end up trying to have them sign a medical agreement and we leave a Narcan kit with them, a friend or family member."
Crimmins said protocol and a general work plan will probably take about a year. It will also require training for emergency medical service teams across the county, which will need to be funded along with supplies for kits.
Tumwater City Council member Angela Jefferson said during the meeting that she would like to know how people can get access to Narcan administration training now, since it's an obvious current and concerning problem. Council member Leatta Dahlhoff said she received training from the county's Opioid Response Task Force and keeps her Narcan kit readily available.
Dahlhoff said kits are usually available at pharmacies and are covered by insurance.
The state Department of Health has a list of instructions and resources on its website, as well as a search engine to help people find naloxone near them. Thurston County's Public Health & Social Services department also offers a clean syringe program and naloxone training; more information can be found on the department's website.
Those in need of help for substance abuse or mental health concerns can call the Washington Recovery Help Line at 1-866-789-1511.
Education on how to prevent opioid overdose can be found at stopoverdose.org.