In 2021, the Legislature asked the Health Care Authority to help emergency departments more easily prescribe methadone and buprenorphine as part of the state’s response to the Washington Supreme Court’s ruling in State v. Blake that voided all drug possession convictions by ruling the state statute unconstitutional.
The new program, ScalaNW, works with the Washington Department of Health, hospitals and providers, and its services are provided free across the state. Liz Wolkin, ScalaNW program manager, said the goal is to ensure accessibility to these medications at all stops in the healthcare system, from the EMTs who first arrive on the scene to practitioners in emergency rooms.
ScalaNW is also partnering with the University of Washington Psychiatry Consultation Line to make a live chat available 24/7 for clinicians, and with the WA Recovery Help Line to help patients set up follow-up appointments after they leave the ER.
National data show the need for this new program. According to the National Library of Medicine, from 2017 to 2021 drug treatment medication was prescribed only once for every 12 patients who visited an emergency room after an opioid overdose.
To prescribe these medications, doctors were required to apply for a waiver from the Drug Enforcement Administration. Beginning in 2024, those requirements were removed after Congress passed the Mainstreaming Addiction Treatment Act; now doctors and hospitals are able to prescribe these medications.
Dr. Christopher Buresh, associate professor of emergency medicine at the University of Washington and a practicing doctor at Seattle Children’s Hospital, has had a waiver for more than a decade.
He still remembers an opioid overdose case he treated nearly two decades ago, when he started as a physician but before he knew about the treatment drugs. Buresh was treating a woman going through opioid detox. He prescribed her ibuprofen, Tylenol and nausea medication for the symptoms and told her to hang in there.
“And then she killed herself. Not even about half an hour after walking out of my exam room. That really drove home to me how lethal opioid dependency is,” Buresh said. He was taught in medical school that opioid overdose withdrawal wasn’t as dangerous as alcohol or benzodiazepine (also known as Xanax) withdrawal, since those can result in seizures.
Buresh said that when he’s on call at the UW Harborview emergency department, he sees about five or six people come in every night for opioid overdoses.
“People with overdoses are almost as likely to die as somebody with a heart attack,” Buresh said. A person who comes in for an opioid overdose has a 5% chance of dying that year, compared to a 7% chance for a heart attack victim, according to Buresh.
From 2019 to 2022, more than 30% of all deaths in the state were from overdoses: nearly 8,000 people, according to the Washington State Department of Health. Non-fatal overdoses also account for about 10% of hospitalizations; and 6% (39,848) of all emergency-service injury responses were for suspected opioid overdoses.
Seattle Fire Department medical director Michael Sayre said SFD responds to about 15-20 people every day who have issues with drugs, and a majority of those cases aren’t related to fentanyl overdoses. He said these calls started to increase significantly in March 2021, and that areas with the most overdose events are in the core of Seattle: Pioneer Square, Belltown and Capitol Hill.
Medication can cut those overdose deaths in half. Most of his colleagues did not get the medication waiver because of the extra training hours it required. Medication can be administered as a pill or film strip that is absorbed once placed under the tongue, and more recently it came out in injectable form, Buresh said.
Buresh worked with ScalaNW to create protocols here in the state. Wolkin also said they reached out to those with lived experience of substance use, either themselves or family members.
“I have been on both sides; I’ve been a nurse in the emergency department and I’ve also been someone who is in the emergency department related to my own substance-use disorder,” Wolkin said.
