While funds from Washington state’s $518 million settlement against three major pharmaceutical companies are yet to begin flowing into communities here, people familiar with the impact of the opioid epidemic in the Spokane area say addressing the problem requires communitywide awareness and response.

When the funds are distributed to communities through the state, Spokane County will receive a $19.1 million share of the settlement.

Lynden Smithson, interim city attorney for Spokane, explains that according to a memo of understanding, the funds will be divided between the county and four municipal jurisdictions: Spokane, Spokane Valley, Liberty Lake, and Cheney.

Jared Webley, public policy and communications manager for Spokane County, says funds will be subject to approval by an Opioid Abatement Council, and allocations will be considered in coming months.

Greg Dailey, project manager for Spokane Regional Opioid Task Force, says the task force was created four years ago to combat the opioid epidemic. Since fentanyl has started flowing into the community in growing amounts, he says, fatalities related to fentanyl overdoses have surged. 

“It was bad enough with (other) opioids that if you took too many, you could die,” he says. “With fentanyl, if you take any of it, you could die.”

According to the Centers for Disease Control and Prevention, pharmaceutical fentanyl is a synthetic opioid, approved for the treatment of severe pain.

Illicitly manufactured fentanyl is sold through illegal drug markets and is often laced into heroin or cocaine—with or without the user’s knowledge—to increase its euphoric effects, states the CDC.

Because there is no quality control with illicitly manufactured fentanyl, Dailey says ingesting any amount of it can be deadly. 

“Envision it as table salt,” says Dailey. “Just two grains of it will kill you.”

According to a Spokane County Medical Examiner’s Office annual report, in 2021 there were 108 fatalities involving fentanyl in Spokane County. In 2020, there were 28 reported fentanyl fatalities, up from 11 fentanyl fatalities in the county in 2019.

Dailey says that ways in which people obtain illegal drugs include online and social media platforms that promote prescription drugs, usually at a lower price. However, the drugs often are laced with other substances. The Opioid Task Force has responded by running its own educational ads on YouTube and other platforms to try to engage the community.

“I want Spokane to know it’s everybody. It’s your friends. It’s your family,” says Dailey. “Whether or not your family has had a tragedy, it’s your community and you should care.”

Dailey notes that fentanyl seized in Spokane County by the U.S. Drug Enforcement Agency increased by nearly 1,100% in 2021 compared with a year earlier. Additionally, according to the DEA’s Seattle Field Division, fentanyl seizures in Eastern Washington increased 2,700% from 2017 to 2021.

So far in 2022, the youngest person to die from a fentanyl-related overdose in Spokane County was 12 years old, and the oldest person to die from it was 91 years old, he adds.

Spokane County Chief Medical Examiner Dr. Veena Singh says the opioid epidemic has impacted every social demographic, from young children to senior citizens.

She adds consumers of illicit opioids can include someone’s grandmother who runs out of prescription medication for chronic pain before the end of the month and needs to get through to the next refill. They also can include a military veteran who self-medicates for Post-Traumatic Stress Disorder and depression, or a high school student who tried anti-anxiety pills and kept using them to sleep better or relax.

“Anyone can develop a substance abuse disorder, and anyone can overdose,” says Singh. “That means we all have to work together to keep people safe, develop prevention strategies, and reduce barriers to treatment and recovery programs.”

Singh says that removing the stigma associated with drug addiction, which often is viewed as a moral and criminal problem rather than a medical issue, needs to be addressed.

The stigma associated with addiction also has hindered research funding, she contends.

She adds that reducing barriers to drug treatment by diverting addicts into the medical system, rather than jail, would be a better way to help many of them.

Dailey notes that, as of this year, naloxone, often referred to by its brand name Narcan, can be purchased without a prescription for use in emergency situations to counteract opioid overdoses.

He recommends having it on hand even for people who aren’t directly exposed to opioids.

Dailey explains that often, because there is such stigma and shame surrounding addiction, it is kept hidden from spouses, children, and parents.

“Not speaking up can be deadly too,” he says. “In one case here in Spokane, a spouse was shocked when the medical examiner told them the cause of death was a drug overdose. The spouse didn’t know.”

He adds that because fentanyl is up to 50 times more potent than heroine and up to 100 times more potent than morphine, one dose of Narcan may not be enough to treat someone experiencing an overdose. In one case of a fentanyl overdose, 18 doses of Narcan were administered to keep the overdosed individual alive.

Singh adds that, while the narrative surrounding illicit drugs is focused on fentanyl, it’s important to know that illicit drugs are being laced with other substances including veterinary medications. Many of those substances don’t respond to Narcan.

To that end, the DEA has launched Operation Engage Spokane to address the drug epidemic through prevention strategies, facilitating conversations and collaboration with local partners. The campaign’s central message is: One pill can kill.

Marsha Malsam, CEO of Liberty Lake-based Rayce Rudeen Foundation, also agrees that prevention through educating every level of the community is a needed response to the epidemic.

“To me that (prevention) is the umbrella,” she says. “If you are funding education, then we are going to have less deaths, less addiction and issues.” she says. 

Malsam says that the Rayce Rudeen Foundation was founded in 2016 shortly after her nephew, Rayce Rudeen, died from an accidental fentanyl overdose. Malsam says she didn’t know what the cause of death was until she received the medical examiner’s report.

Since then, the foundation has worked to remove the stigma surrounding addiction and educate the community about the opioid epidemic. It launched SAFE, the Spokane Alliance for Fentanyl Education and have recently partnered with the DEA’s Operation Engage Spokane to increase awareness about fentanyl and provide education to all groups within the community, says Malsam.

Dailey contends that the origin of the opioid epidemic can be traced back to 1996, when the American Pain Society introduced the concept of treating pain as a fifth vital sign along with body temperature, blood pressure, heart rate, and breathing.

The same year, the narcotic oxycodone, a prescription opioid, began to be marketed as a safe nonaddictive painkiller, which was not the case, he adds.

“That’s why those lawsuits were done and won,” he says. “The pharmaceutical (companies) knew what was going on, they knew people were getting addicted.”