WASHINGTON D.C.—Representative Rick Larsen (WA-02) released a district opioid report on January 25 analyzing the opioid epidemic in Northwest Washington while presenting several federal policy recommendations he believes could address the issues facing local communities.
“It is time to regain the momentum to combat the opioid epidemic and save lives,” said Larsen. “Congress and the Biden administration must do more to coordinate with local governments, Tribal communities, law enforcement, health care providers and community partners who are on the front lines of the epidemic. This begins with understanding the challenges communities are facing and working together to break down barriers to lasting solutions.”
The report takes a “four-pillar” approach to tackling the drug crises in Washington centered on preventing individuals from turning to opioids, interdicting the flow of opioids into communities, expanding treatment options for those suffering from substance abuse, and supporting a long-term recovery for individuals while building resiliency in local communities.
Though the opioid epidemic has run rampant through the state of Washington for several years it was exacerbated by the recent COVID-19 pandemic. Between February 2022 and February 2023 Washington State had the largest percentage increase in the United States with most overdose-related deaths being attributed to synthetic opioids such as fentanyl. In 2022 more than 75% of all of Washington’s drug-related overdoses were linked to opioids. While the United States witnessed a 3% decrease in overdose deaths during this period, deaths in Washington State increased 21%.
Pillar one: Prevention
In Larsen’s report he argues that the United States must take meaningful action to prevent individuals from relying on opioids, instead of implementing stopgaps that simply mitigate the impacts of the crisis.
Larsen’s preventative strategy relies on the Drug-Free Communities (DFC) Support Program, which was created in 1997 and is the only national effort dedicated to helping communities fight substance abuse from the prevention stage. DFC grants help coalitions which coordinate local schools, law enforcement, local media, and other actors fight youth substance abuse.
Analytics in Larsen’s report find that adolescents are at a heightened risk of beginning to use substances with rates of drug usage rapidly escalating between the ages of 12 and 19.
In Snohomish County, Human Services contracts with 11 school districts, including 52 schools, to provide Student Support Advocates and curricula on youth substance use prevention for teachers and counselors.
Larsen says preventative measures should not ignore local Tribes, who traditionally struggle with gathering resources such as social workers for its Indian Child and Welfare Act (ICWA) system.
Larsen used the example of the U.S. Department of Veteran Affairs (VA)’s Opioid Safety Initiative (OSI) as proof of education-based preventative measures which has been proven to prevent Veteran’s relying on opioids for pain management.
Since its inception in 2013, the VA has reduced the number of veterans with opioid prescriptions by 67%, from 874,897 veterans in 2012 to 288,820 in 2023, and reduced the number of patients on high doses of opioids by 81%, from 76,444 in 2012 to 14,733 in 2023.
Pillar two: Interdiction
Larsen’s interdiction strategy revolves around cracking down on drug trafficking to prevent the spread of drugs entering local communities.
As it stands illicit drugs are almost entirely manufactured overseas and delivered to the United States via Transnational Criminal Organizations (TCO). The DEA Seattle Division reported that most fentanyl pills in Washington contain chemicals manufactured in China, for example. In addition to this most fentanyl pills in Washington were found to have been pressed into pill format by Mexican drug cartels before being smuggled across the U.S.-Mexico border.
The Biden administration launched the Global Coalition to Address Synthetic Drug Threats in July 2023, which includes more than 100 countries and 11 international organizations to employ coordinated approaches to prevent illegal drug manufacturing and disrupt drug trafficking.
Additionally, the Bipartisan Infrastructure Law (BIL), which Larsen championed for, invests in modernizing LPOEs at the U.S.-Mexico and U.S.-Canada borders through updating technology and infrastructure and enhancing capacity to screen cargo in vehicles.
In his report Larsen introduced the idea of implementing artificial intelligence and advanced technology to help the screening process and scan data for potential drug traffickers.
“Any time you do a law enforcement function privacy and first amendment rights, fourth amendment rights, and other rights comes into play,” Larsen informed the Lynnwood Times. “No matter what tool law enforcement is using it has to comply with the constitution and the courts have been clear that as technology has changed the constitution has not.”
As far as local law enforcement goes in interdiction efforts, Larsen applauded the work of local drug task forces but reported that these preventative measures are in dire need of more federal support and resources, particularly in tribal communities which are susceptible to drug trafficking given their remote location and traditionally insufficient law enforcement and resources.
“Because of longstanding tradition and history tribal law enforcement has relatively robust tools to enforce law on reservations against tribal members but as we found out during the Violence Against Women Act, for instance, enforcing law against non-tribal members on reservations gets really problematic,” Rep. Larsen told the Lynnwood Times. “The Parody for Tribal Law Enforcement Act would enable tribal law officers to enforce federal law.”
Pillar three: Treatment
Larsen write that a holistic approach is needed to overcome the main barriers to treatment which includes normalizing harm reduction treatment such as Naloxone (“Narcan”), ensuring there are enough beds for recovery treatment, improving reimbursement rates and coverage for Medicare and Medicaid, investing in a robust health care workforce and personalizing care for patients, leveraging the justice system as an incentive to seek treatment, and meeting patients where they are.
Snohomish County, specifically, must grow its number of outpatient treatment facilities to meet the increasing need and future expected demand, Larsen says.
Although Snohomish County has the largest number of outpatient treatment facilities in the Second District, per-capita availability for outpatient services ranks below the other counties in the district and the state average. Snohomish County officials have argued that Medicaid’s Institution for Mental Diseases (IMD) Exclusion, which clarifies that inpatient facilities with more than 16 beds cannot reimburse services through Medicaid, has disincentivized them from building OUD treatment facilities with greater capacity, the report states.
What’s more, people with substance use disorders are overrepresented in the criminal justice system with 63% of jail inmates and 58% of prison inmates suffering from these disorders, compared to 11% of people between 18–25 years-old and 6% over age 25 in the general U.S. population. As a result, corrections facilities are often used for detoxification, despite having limited and insufficient resources and treatment programs.
Snohomish County counters this with its Law Enforcement Assisted Diversion (LEAD) program which diverts people with OUD or behavioral health issues who have committed low level crimes away from the criminal legal system and connects them with treatment and other resources. Participants in LEAD work with case managers to address their underlying behavioral health needs.
Pillar four: Recovery
Lastly, as a long-term solution Larsen writes in his report that ongoing supporting services are needed for people suffering from chemical dependency to ensure their long-lasting recovery, including continued MOUD medications and ongoing therapy to address underlying issues.
Providence Regional Medical Center Everett and Swedish Edmonds to gather data on non-fatal overdoses and support patient follow-up, and Washington State’s Arms Around You program which helps individuals in recovery reenter the job market.
People who have previously been incarcerated due to drug charges or who have large gaps in their employment history due to their addiction often struggle to get hired for jobs. An analysis by the Prison Policy Initiative found that the unemployment rate for formerly incarcerated people is nearly five times higher than the rate for the general population, the report states.
Larsen concludes his report with several policy recommendations he believes are necessary in order to combat the opioid epidemic in Washington State, and the nation at large.
In general, he recommends the passing of President Joe Biden’s supplemental budget request, which includes $1.55 billion to strengthen addiction treatment, overdose prevention measures and recovery support services across the country, and more than $1.2 billion to combat drug trafficking.
For his prevention pillar Larsen recommends increasing funding for the Drug-Free Communities Support Program and establishing other funding opportunities to support K-12 schools and youth organizations, implement a national opioid abuse prevention plan, increase access to integrated pain management programs for veterans and increase funding for OUD research, and support the reintroduction of Rep. Gottheimer’s Student and Student Athlete Opioid Misuse Prevention Act of 2023.
For interdiction Larsen recommends establishing a dedicated funding source which states can distribute to multi-jurisdictional drug task forces or other law enforcement agencies to stop narcotics trafficking, fully fund modernization and advanced screening technology at U.S. borders, pass Rep. Newhouse and Senator Cantwell’s Parity for Tribal Law Enforcement Act, establish a dedicated funding source that law enforcement could use to update their technology and equipment, and pass Rep. Vasquez’s Joint Task Force to Combat Opioid Trafficking Act.
For treatment Larsen recommends increasing funding for Harm Reduction Grant Program, increase Medicaid reimbursement for inpatient and outpatient care, pass Rep. Barbara Lee’s Improving Access to Mental Health Act of 2023, pass rep. Norcross’ Modernizing Opioid Treatment Access Act, and establishing a Behavioral Health and Substance Use Workers Retention Fund.
“One challenge we have in Washington State, really the country, is the lack of good pay for behavioral health and substance abuse counselors,” Larsen told the Lynnwood Times. “They do good work, but they get burned out and they leave. One of the things I want to do is develop legislation that would provide an annual bonus to health care workers in those fields to make it more attractive for them to stay. This could be tuition waivers for their education, student loan repayment forgiveness, or any additional incentives that would be our role to play at a federal level.”
And lastly, for recovery, Larsen recommends establishing a grant program to fund educational and workforce development opportunities for people in recovery, increase funding for opioid peer support programs, increase funding for sober living homes, invest in child care and family support programs, support local organizations providing wraparound services for people in recovery, and provide long-term access to MOID to ensure people receive continuous care in recovery.
In addition to the several federal policy recommendations listed in his report, Larsen plans to soon introduce legislation aimed at creating a dedicated funding source for multi-jurisdictional drug task forces and helping communities that have been economically dislocated by the opioid epidemic recover.