A Rural Community Decided To Treat Its Opioid Problem Like A Natural Disaster

Oct 28, 2018
Originally published on October 30, 2018 5:07 pm

When he was police chief of Stanwood, Wash., population 7,000, Ty Trenary thought rural communities like his were immune from the opioid crisis.

Then, one day, a mother walked through his door and said, "Chief, you have a heroin problem in your community."

"And I remember thinking, 'Well that's not possible,' " Trenary recalls. "This is Stanwood and heroin is in big cities with homeless populations. It's not in rural America."

But heroin addiction and abuse are not just a big city problem, as Trenary had thought. While the bulk of fatal overdoses still happen in urban areas, the rural overdose rate has increased to slightly surpass that of cities.

Rural Americans say drug addiction and abuse are the most urgent health problems facing their local community, according to a new poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. In the poll, 48 percent of people said opioid addiction has gotten worse in their community in the past five years.

(Can't see the graphic above? Click here.)

Trenary now agrees. A few years ago, he was elected sheriff of Snohomish County and got a rude awakening. He toured the jail and found it had become a de facto detox center, full of "very, very sick, very, very sick people," he says.

"Detoxing from heroin is like having the worst possible stomach virus you can have. People are proned out, just suffering."

(Can't see the graphic above? Click here.)

At any given time, about half the inmates were withdrawing from heroin, making for a dangerous and expensive situation.

"It took becoming the sheriff to see the impacts inside the jail with heroin abuse, to see the impacts in the community across the entire county for me to realize that we had to change a lot about what we were doing," Trenary says.

A disaster response approach

So they did. Snohomish County in Western Washington is taking a unique approach to tackle the problem.

Last year, leaders declared the opioid epidemic a life-threatening emergency. The county is now responding to the drug crisis as if it were a natural disaster, the same way it would mobilize to respond to a landslide or flu pandemic.

Snohomish County Sheriff Ty Trenary. He wasn't aware of the extent of the opioid epidemic in his county until he became sheriff and realized the jail had become a defacto detox center.
Leah Nash for Finding Fixes podcast

The idea grew out of their experience with another tremendous disaster in the county: the massive 2014 landslide in Oso, Wash., which killed 43 people.

Back then, the director of communications for the sheriff's office, Shari Ireton, took reporters to see the landslide, and she ended up learning something, too.

"It was amazing to see Black Hawk helicopters flying with our helicopter and a fixed wing over the top of that," she says. "All in coordination with each other, all with the same objective, which is life safety."

Ireton thought, what if they used that same coordinated system, of everyone working together across government agencies, to tackle the opioid epidemic?

County leaders took the idea and ran with it.

It took becoming the sheriff to see the impacts inside the jail with heroin abuse, to see the impacts in the community across the entire county, for me to realize that we had to change a lot about what we were doing. - Ty Trenary, sheriff of Snohomish County, Wash.

Now, the response to the opioid epidemic is run out of a special emergency operations center, a lot like during the Oso landslide, where representatives from across local government meet every two weeks, including people in charge of everything from firetrucks to the dump.

The technical name for this group is the Multi-Agency Coordination group, or MAC group. It comes straight out of FEMA's emergency response playbook.

They talk through PowerPoint slides and rattle off numbers like 7.5 and 6.1, which refer to items on their to-do list. Seven big, overarching goals, which include reducing opioid misuse and reducing damage to the community, are broken down into manageable steps, like distributing needle cleanup kits and a project to train schoolteachers to recognize trauma and addiction.

This to-do list is over 100 items long.

"Some of these goals are really long term," Ireton says. "I mean they're going to take years, decades."

The key is to be realistic, says Ireton, who is also the spokesperson for this group. You are never going to be successful if your goal is just "end the opioid epidemic," she says.

"By breaking it down, it's like eating an elephant. You just can eat one piece at a time. Breaking it down into a piece that you can actually digest." Ireton says.

The county's program includes small steps, like making transportation easier for people in drug treatment. They train family members and others in the community on steps to reverse overdoses with medicine, and they send teams of police officers and social workers to help addicted homeless people.

Social worker Lauren Rainbow (right) meets a man illegally camped in the woods in Snohomish County. A new program in the county helps people with addiction, instead of arresting them.
Leah Nash for Finding Fixes podcast

In Marysville, Wash., the woods are full of homeless encampments surrounded by piles of spent syringes and trash. On a recent visit, rain drips through a cedar forest next to a strip mall. Officer Mike Buell is visiting the camp along with social worker Lauren Rainbow. Buell cracks jokes with some illegal campers and introduces himself using his first name.

Buell's job isn't to arrest the campers, but to help them get drug treatment and housing. He crouches next to the opening of one tent and explains that he and his colleagues will help the campers with food, coffee and transportation to and from appointments.

"We're basically your Uber," Buell says.

The new approach is paying off. The teams have helped hundreds of people find housing and drug treatment.

That's just one item in the county's plan, and problems with opioids are far from solved here.

Snohomish County will keep working on its large and small goals, one bite at a time.

This story was reported by Finding Fixes, a podcast about solutions to the opioid epidemic, which is a project of InvestigateWest.

: 10/30/18

A previous version of this story stated that Snohomish County was the first in the country to treat the opioid epidemic as a natural disaster. In fact, at least one other county — Montgomery County in Ohio — is taking a similar approach.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

LULU GARCIA-NAVARRO, HOST:

Rural Americans say drug abuse and addiction, including opioid addiction, are the most urgent health problems facing their communities. That's according to a new poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. Now one county in western Washington is taking a unique approach to tackle the problem. Anna Boiko-Weyrauch of Finding Fixes podcast reports how that works.

ANNA BOIKO-WEYRAUCH, BYLINE: Back when Ty Trenary was the police chief of Stanwood, Wash., population 7,000 people, he thought rural communities like his were immune from the opioid crisis until, one day, a mother walked through his door.

TY TRENARY: And basically said, chief, you have a heroin problem in your community. And I remember thinking, well, that's not possible. This is Stanwood. And heroin is in big cities, you know, with homeless populations. It's not in rural America.

BOIKO-WEYRAUCH: For decades, heroin was a big city problem but no longer. In the recent NPR poll, about half of rural Americans said the opioid problem in their communities has worsened in the last five years. Now Trenary agrees. A few years ago, he was elected sheriff of Snohomish County. He toured the jail and saw this.

TRENARY: Very, very sick, very, very sick people because detoxing from heroin is like having the worst possible stomach virus you can have. People are proned out. They're, you know, they're just suffering.

BOIKO-WEYRAUCH: The county jail had become a de facto detox center. At any given time, around half the inmates were withdrawing from heroin. It was a dangerous and expensive situation.

TRENARY: It took becoming the sheriff to see the impacts inside the jail with heroin abuse, to see the impacts on the community across the entire county for me to realize that we had to change a lot about what we were doing.

BOIKO-WEYRAUCH: So they did. Last year, Snohomish County - where Stanwood is located - declared the opioid epidemic a life-threatening emergency. Now they're responding to the opioid epidemic as if it were a natural disaster, the same way they'd mobilize to respond to a landslide or flu pandemic. Snohomish County is the first county in the country to treat it this way.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: State patrol also advised the road is flooded. Lines are down.

BOIKO-WEYRAUCH: The idea grew out of their experience with another tremendous disaster in the county.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: This is a major slide here.

BOIKO-WEYRAUCH: In 2014, the town of Oso, Wash., experienced one of the deadliest landslides in American history. Forty-three people died. Shari Ireton is the sheriff's director of communications. She took reporters to see the landslide. And she ended up learning something, too.

SHARI IRETON: It was amazing to see Black Hawk helicopters flying with our helicopter and a fixed wing over the top of that and all in coordination with each other, all with the same objective, which is life safety.

BOIKO-WEYRAUCH: Coordination, life safety. What if they used that system of everyone working together across government agencies to tackle the opioid epidemic? County leaders took the idea and ran with it.

(CROSSTALK)

BOIKO-WEYRAUCH: Now their response to the opioid epidemic is run out of a special emergency operation center, a lot like during the Oso landslide. Every two weeks, representatives from across local government meet - people in charge of everything from fire trucks to the dump. The technical name for this group is the Multi-Agency Coordination group or MAC group. It comes straight out of FEMA's emergency response playbook.

UNIDENTIFIED PERSON #2: Six ten is completed.

BOIKO-WEYRAUCH: They talk through PowerPoint slides.

UNIDENTIFIED PERSON #3: I think 7.5 is kind of...

BOIKO-WEYRAUCH: The numbers refer to items on their to-do list. There are seven big goals, like reduce opioid misuse and reduce damage to the community. Each goal is broken down into smaller pieces, like distributing needle cleanup kits and a project to train school teachers to recognize trauma and addiction. This to-do list is over 100 items long.

IRETON: Some of these goals are really long term. I mean, they're going to take years, decades.

BOIKO-WEYRAUCH: Ireton is also the spokesperson for this group. She says, the key is to be realistic.

IRETON: So if you set an objective for yourself to just end the opioid epidemic, you're probably never going to be successful in either - in any of our lifetimes. By breaking it down, it's like eating an elephant. You just can eat one piece at a time - breaking it down into a piece that you can actually digest.

BOIKO-WEYRAUCH: They make transportation easier for people in drug treatment. They train family members and others in the community on steps to reduce overdoses with medicine. And they actually send teams of police officers and social workers to help addicted homeless people.

(SOUNDBITE OF WALKING THROUGH WOODS)

UNIDENTIFIED PERSON #4: Thanks.

BOIKO-WEYRAUCH: In Marysville, Wash., rain drips through a cedar forest next to a strip mall. Officer Mike Buell cracks jokes with some illegal campers.

MIKE BUELL: (Laughter) Hi, Crystal. I'm Mike.

BOIKO-WEYRAUCH: The woods throughout this county are the sight of homeless encampments with piles of spent syringes and trash. Buell's job isn't to arrest the campers but help them get drug treatment and housing.

BUELL: We're your transport. We're basically your Uber. We'll get you to and from your appointments.

BOIKO-WEYRAUCH: The new approach is paying off. The teams have helped hundreds find housing and drug treatment. That's just one item in the county's plan. And problems with opioids are far from solved here. So Snohomish County will keep working on their large and small goals - one bite at a time. For NPR News, I'm Anna Boiko-Weyrauch.

GARCIA-NAVARRO: This story was reported by Finding Fixes, a podcast about solutions to the opioid epidemic. Transcript provided by NPR, Copyright NPR.