DESC works to prevent and respond to overdoses

Naloxone procurement and distribution. We currently have streamlined widespread distribution of naloxone nasal sprays to staff and clients through all our programs, using a variety of funding mechanisms.

• We have created a mechanism to ensure that clients at risk of opioid overdose are regularly and recurrently obtaining prescriptions for naloxone nasal spray through a partnership with Kelley Ross & Harborview Long-Term Care delivery pharmacy, funded through existing health insurance programs.
• We are supplying naloxone to uninsured clients through a grant from the WA Health Care Authority
• We initiated a relationship with the organization Direct Relief in August 2023 through which we will receive additional naloxone supplies to be distributed to staff and clients.
• DESC led lobbying of the WA state legislature to increase the naloxone supply coming from the Washington Department of Health to community organizations as well as to remove restrictions on who could use and access the naloxone supplies coming through the DOH. The results of these changes are reduced administrative burdens, improved efficiency of processes and more flexible distribution of DOH naloxone (of which we receive hundreds of doses) to any staff or clients.
• We have improved infrastructure to ensure that naloxone is efficiently ordered through the funding mechanisms we have available and is regularly restocked at all sites from the above sources.

• We have added more training for staff on recognizing and responding to a suspected opioid overdose, including in the use of naloxone, rescue breaths and full CPR when indicated
• We are creating in-person training sessions, in partnership with colleagues from Seattle-King County Public Health, for both DESC staff as well as training for clients on how to prevent an overdose and recognize and respond to an overdose if it occurs.
• Outreach teams have compiled overdose prevention supplies to provide to clients, including an overdose prevention pamphlet, naloxone, xylazine test strips and other items.
• We have installed overdose response kits, containing naloxone and ventilation masks, on each floor of every permanent housing building, shelter sites and outpatient care buildings (alongside existing AEDs).

• We are researching overdose prevention systems, including personal monitoring devices for those who use alone, building add-ons or modifications to specific units.

Exploring a mechanism to offer sublingual buprenorphine in the immediate 30 minutes after an opioid overdose reversal with naloxone.

• Reversing an opioid overdose with naloxone, while lifesaving, often causes opioid withdrawal in the client who just experienced an overdose. Opioid withdrawal can be a reason for clients to decline immediate monitoring and engagement with staff or transportation to a health care facility. We are exploring, in partnership with colleagues from Harborview Medical Center, a mechanism to provide sublingual buprenorphine to clients in naloxone-induced opioid withdrawal within minutes of their overdose reversal. Buprenorphine would resolve the opioid withdrawal and may facilitate ongoing engagement in medication treatment. We are exploring the regulatory steps to create this program, which, if implemented, would be the first of its kind within shelters or housing to our knowledge.

• In partnership and with guidance from the UW Addictions, Drug and Alcohol Institute, Seattle Fire Department, Evergreen Treatment Services and King County Behavioral Health and Recovery Division and Public Health, we are planning to create an Opioid Recovery and Treatment Center.
• The Opioid Recovery Center would, in its current vision, receive non-critical, stable individuals who have just had an opioid overdose reversed in the field by Seattle Fire & Medics.  The individuals would receive ongoing monitoring, support and voluntary initiation of medication treatments.
• This center would also offer rapid initiations onto sublingual buprenorphine, extended-release buprenorphine, and methadone for individuals with opioid use disorder who have not recently experienced an overdose, but wish to initiate medication treatment.

The most effective and significant tool for preventing overdoses (fatal and non-fatal) is through evidence-based medication treatments for opioid use disorder.

• Continuing and expanding buprenorphine therapy, including sublingual and extended-release versions.
  • DESC’s Opioid Treatment Network (OTN) is a low-barrier buprenorphine program, offering same-day treatment intake assessments and buprenorphine prescriptions for individuals with opioid use disorder, and is a recipient of the WA State Opioid Response grants.
    • The OTN program can accept clients for care and medication treatment regardless of insurance and is a key provider in King County for treatment of individuals with current or former experiences of homelessness.
    • OTN accepts clients who are already accessing other DESC services as well as clients not previously affiliated with DESC.

• A multi-disciplinary, multi-sector team within DESC has created a dashboard and streamlined process to identify individuals who recently have had an opioid overdose reversal, deploy specialized staff to outreach and connect with these clients, and facilitate pathways to medication treatment and ongoing services. We will track data on the success of this program
• As noted above, outreach teams have compiled overdose prevention supplies to provide to clients, including an overdose prevention pamphlet, naloxone, xylazine test strips and other items.  These are targeted particularly for individuals who have recently had a non-fatal overdose.

Methamphetamine continues to be a key driver of non-opioid overdoses, nationally and locally, despite relatively less attention.

• In partnership with researchers at Harborview Medical Center, research is in progress on how to operationalize a contingency management and community reinforcement approach program for stimulant use (as well as potentially for other substances), widely considered as the current gold-standard in stimulant use disorder treatment.

• DESC Senior Risk and Safety Manager consults with UW and Seattle King County Public Health on opioid overdose prevention best practices.
• An agencywide integrated OD prevention and response work group meets twice a month to get updated on overdoses and to come up with solutions.
• DESC’s nursing director has joined a workgroup with the medical examiner to look at overdose deaths, investigating trends that will guide future responses and interventions
• Staff participate in overdose roundtables, conferences and learning opportunities such as Opioid Overdose Response Trainings through the KCRHA and health departments.
• DESC advocates for the Washington state legislature to appropriate funds for expansion of low barrier opioid use disorder treatments.
• We have expanded substance use disorder (SUD) treatment in permanent supportive housing to support clients in their recovery journey.