During a Monday afternoon meeting of the Board of Health, Lewis County’s new Health Officer Dr. Joseph Wiley gave commissioners an update covering one of the area’s most pressing public health concerns: illicit narcotics.
Presenting to Commissioners Lindsey Pollock and Lee Grose, with Sean Swope having to leave the meeting early before the health officer update, Wiley relayed a warning he was urged to deliver by a local school district superintendent. The health officer meets with school administrators frequently, he said, and in the last meeting, the educators expressed concern over fentanyl getting into candy bowls.
Illicitly manufactured fentanyl, he said, can resemble other power drugs, be pressed into pills, consumed as a liquid on paper or through nasal spray, and can be placed in candies.
“They want their kids to be aware that candy could be laced,” he said.
Also of concern for the superintendents, he said, was the potential for school children to overdose on campus.
Narcan
According to GoodRX, the average retail price of Narcan — generic naloxone, an opioid overdose reversing medication — is $93.18.
For institutions that, unlike individuals, don’t have health insurance, the cost is typically higher.
In a recent event in a Lewis County school, Wiley said the school nurse got to the point of opening the school’s only dosage of the medication.
“They actually came to the point of opening the Narcan and prepared to give it when the emergency services team arrived and it wound up not needing to be given. And I'm not sure that after the package is opened it can be used — and they may have wasted their investment,” Wiley said.
He reported on Monday to the Board of Health, which is made up of the county commissioners, that the school had purchased its Narcan at a Rite Aid for over $100.
Earlier this month, Washington’s Attorney General Bob Ferguson announced $518 million is expected to flow through the state due to a settlement with companies Ferguson said “played key roles in fueling the opioid epidemic,” as previously reported in The Chronicle. Over $2 million of those funds are set to be available for Lewis County.
Wiley recommended the county look into spending some of that money on getting at least two doses of Narcan into each school district in Lewis County. He said Patty Howard, co-pastor with Gather Church, which has a grant to provide Narcan to individuals, expressed a willingness to visit every school district offering training on how to administer the medication in the event of an overdose. Wiley reported Howard said it only takes about 15 minutes to train folks on the administration of the medication.
The scope of Gather’s grant does not allow the church to distribute Narcan to institutions such as schools, Wiley said, but he mentioned there may be an opportunity for reduced costs if the medication is purchased in bulk.
Narcan comes in an injectable version along with a nasal spray, Wiley said, and neither version of the drug is proven to be more or less effective at reversing the symptoms of overdose.
Pollock said it’s frustrating that “from the private side,” it’s over $200 for her to purchase the medication for her veterinary practice. She said she keeps it on hand, but it often expires before it’s used. She reported only having to use it once on a dachshund that inadvertently swallowed a fentanyl patch.
Wiley said in his previous practice delivering babies, he’s used the medication on infants born to mothers on narcotics, calling it “remarkable” to watch babies go from barely breathing to “crying right away” after the drug is delivered.
Harm Reduction Programs
At the last Board of Health meeting, Wiley said, a question was raised regarding the health officer’s role in regulating needle exchange programs. Exchange programs are meant to reduce the spread of bloodborne illnesses such as HIV among people who inject drugs, according to the state Department of Health.
Since that meeting, Wiley said the Public Health and Social Services department has received nine emails requesting the programs be stopped in Lewis County.
“We’re looking at the cost to the state for the needle exchange program and the cost savings to the state for cases of HIV and hepatitis C prevented,” Wiley said.
The cost-benefit assessment has just begun on the subject in the county and he said he will have a recommendation on the program in the near future.
Withdrawal Treatments
Wiley recently toured a Suboxone clinic on North Tower Avenue in Centralia, which is run by Gather Church. Suboxone is a medication meant to reduce the negative effects of narcotic withdrawals with the hope of reducing a patient’s desire to use illicit drugs. It is also used in the Lewis County Jail.
The doses administered at the clinic are sublingual and last about six to eight hours, Wiley said. Doses are usually distributed in amounts meant to last one week, he reported.
“And if you’re successful and don’t have dirty urine with each week’s check for a while, then they can go to a two week’s (supply) and then even to a month prescription at a time,” he said, later adding he was “very impressed” with what he observed at the clinic.
He said the clinic is exploring a new injectable medication that can reduce or stop withdrawal effects and that it could have doses as early as next week. He is investigating the possibility of getting that treatment for inmates at the jail as well.
