The horizontal line at the bottom of the graph remains flat, indicating little change, until, abruptly, it veers upward to near vertical. This isn’t a chart of the latest Covid surge—it’s the number of confirmed fentanyl overdose deaths in King County since 2008. Five years ago, there were 33. In 2021, there were 396.
Illicit drugs are nothing new, but in the past few years, local public health experts have sounded the alarm about fentanyl, a synthetic opioid that’s 100 times more potent than morphine. “With opioid use disorder, what has happened is an actual rewiring of brain chemistry,” says Dr. Caleb Banta-Green, a principal research scientist with the Addictions, Drug, and Alcohol Institute at the University of Washington School of Medicine. “Opioids have literally hijacked the brain’s reward system, and opioids become more important than food, love, sex, water, all of those things.”
That chemical takeover, Banta-Green says, is why one of the most promising treatments for opioid use disorder, and fentanyl addiction in particular, is something that seems completely counterintuitive: more medication. Buprenorphine, or bupe for short, is a partial opioid that can safely regulate fentanyl cravings and withdrawals. It lowers the risk of overdose death by half. So why is King County already on track this year to blow past those 2021 overdose numbers?
“Many providers don’t get this or, emotionally, don’t believe it and won’t provide the care,” Banta-Green says, comparing the absurdity of that hypocritical stance to keeping insulin from someone with diabetes. But that bias about what addiction looks like and how it should be treated is just part of the issue. The other part is access.
Unhoused populations traditionally have a more difficult time obtaining medical care, and regular prescriptions even more so. In 2017, Banta-Green helped create a program that allowed those experiencing homelessness to receive buprenorphine at needle exchanges or community health clinics. Patients had an 83 percent return rate after their first prescription. “This is able to serve people who are the most marginalized and most disenfranchised,” Banta-Green notes. “That’s something we really strive for, and that’s something that the dominant culture and dominant health care systems are still really struggling with even though they’re trying to do it.”