The Columbian

Sobering center distributes antidote to opioid overdoses

The two-dose kits, if available on the scene, can save lives

To help curb opioid overdoses, Lifeline Connections is starting to distribute the antidote naloxone to clients of its sobering center.

The drug rehabilitation and mental health provider carries the injectable form of the drug, which is sold under the brand name Narcan; a kit includes two syringes, two doses of naloxone, a mouth protector, a pair of plastic gloves, an alcohol swab and instructions.

People can get it when they come to the sobering center, a 20-bed facility at the Center for Community Health off East Fourth Plain Boulevard.

The plurality of Lifeline’s clients, about 44 percent, say opiates are their primary substance. Within the sobering center, though, opiate users account for about 29 percent of the people who come in to sober up; methamphetamine users account for 43 percent.

The Centers for Disease Control and Prevention reported that more people died from drug overdoses in 2014 than in any other year on record, and most of those deaths involved an opioid. Heroin and prescription pain pills — as in morphine, codeine, oxycodone, methadone, Vicodin, Dilaudid, fentanyl, etc. — are all opioids.

Most new heroin users had already been abusing prescription opioids.

Preventing deaths

Nationwide, 47,055 people died of drug overdoses in 2014, including 979 people in Washington.

Naloxone can stop or reverse the effects of an opioid overdose, but cannot be used to get high and is not addictive.

The CDC surveyed facilities distributing naloxone kits and found that about 83 percent of people administering the drug are drug users — people who are on the scene and witnessing an overdose.

One of the first kits Lifeline gave out was administered by an addict to save the life of another addict, said Shannon Edgel, a spokeswoman for Lifeline.

Other sources

To start, Lifeline assembled 18 kits. It adds to other efforts around the county to increase access to naloxone.

Two years ago, Clark County Public Health began offering the drug through its syringe exchange program.

Local Fred Meyer stores sell both injectable and nasal spray versions of the drug without a prescription. In February, Walgreens announced it, too, will stock the drug prescription-free at more than 5,800 of its pharmacies, including all Washington stores.

And the Clark County Sheriff’s Office got a federal grant so deputies on the road could carry and administer the drug.

Patty Hastings: 360-735-4513; twitter.com/pattyhastings; [email protected]

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Mental health care explained from eye of storm

Reporter has studied issue since her husband’s suicide

The Columbia River Gorge, one of the most beautiful places in the world, draws crowds of people who want to hike and bike and kayak.

But some people go there to disappear, Sheila Hamilton said.

In October 2006, Hamilton’s husband of 10 years vanished into the Gorge after being discharged from what she now calls woefully inadequate psychiatric care. That was six weeks after he’d been diagnosed with bipolar disorder. Weeks after he disappeared, authorities found his body. The 50-year-old had committed suicide with a gun.

Hamilton, a leading Portland radio reporter and personality who’s heard daily on KINK-FM, was at Children’s Center, a Vancouver mental health clinic, Friday afternoon to sign copies of her new book, “All The Things We Never Knew.” It’s the story of her husband’s mental decline and suicide, interspersed with chapters detailing Hamilton’s subsequent four-year investigation of American mental health practices.

Hamilton’s talk at Children’s Center was a plea for mental health professionals to stop overmedicating what’s “wrong” with their patients and to start talking through the traumas and tragedies underlying their situations. When mental health patients are respected, equal partners in their own healing, she said, they do remarkably better than when they’re just medicated. That’s what happened to David, her husband, she said.

Hamilton described the man she fell in love with as brilliant, charming, handsome and a loving father to their daughter. But he had a tragic past and a dark side, Hamilton said, and no way to talk about it or ask for help. In the end, it overcame him.

He was born with a cleft palate and teased mercilessly about it as a young child, she said. He endured numerous surgeries to fix it. Then, before he was 10, he was shipped to boarding school and beaten just about daily. The result was “soul eating shame” — probably the environmental trigger for an underlying genetic predisposition toward mental illness, Hamilton said. That’s what doctors have told her.

When Hamilton met David, she thoughts his flips between energetic brilliance and dark withdrawal were just the signs of “a really brilliant man who needs a rest sometimes.” David always said he was just fine. But his successful construction business started to fall apart. When the couple’s baby was brand new, he started to have affairs.

“Infidelity is a hallmark” of bipolar disorder, Hamilton has learned since.

David always said he was fine, though. And his considerable smarts made him great at masking and denying his illness. Hamilton wanted to believe in him and wanted their daughter to have a dad.

“I missed the signs” because nobody really talked about signs of encroaching mental illness, Hamilton said. Since then, she said, she has hunted for books aimed at spouses and caregivers that describe those signs, and found nothing at all. That’s why she wrote her own book, interspersing David’s story with her own investigation and advice.

“Our care has been lacking,” Hamilton said. She said a mental-health system that’s tilted strongly toward the pharmaceutical industry winds up overmedicating people in desperate need of compassionate, therapeutic listening and healing.

Even schizophrenia has been recently shown to respond better to talk therapy with medication than just medication alone, she said. Hamilton said she wants to see medications used “as a screwdriver, not a jackhammer.”

David was eventually diagnosed with clinical depression and given antidepressants — which tipped him into full-blown mania and toward suicide, Hamilton said. The drive-by diagnosis was wrong. David wound up in a psychiatric hospital bed where he was drugged and treated to 15-minute bed checks, but never any concerted effort to unearth his traumatized past and emotions.

“He lost all hope,” Hamilton said. When he was released, he promptly went missing. His truck was eventually spotted, randomly abandoned by a roadside in the Gorge.

Humane care

It’s an oft-repeated statistic that one in five adult Americans contends with a mental illness in any given year. With the problem so widespread, Hamilton said, it’s good to note that progress is being made.

Compassionate, humane models of care — in which doctors and patients are equal partners — are being tested in places like Portland, she said, where a new Unity Center for Behavioral Health opened this year. Public school health classes are starting to take up emotional health. And young people now growing up in the world of social media are much more willing to share their secrets than previous generations. “They’ve grown up sharing everything,” she said.

The stigma of mental illness is starting to disappear just as the stigma of breast cancer has, Hamilton said.

Hamilton encouraged family members and friends to pay attention and speak up when someone’s behavior takes an alarming turn. They’re the ones who should go to doctors or even law enforcement for help. Hamilton added that she’s adamantly in favor of getting guns away from anyone with mental illness.

“David hated guns,” she said, and never understood why anyone would want one. Then, as his mental state worsened, he became obsessed with guns.

“It was all he could think about,” she said.

Scott Hewitt: 360-735-4525; [email protected]; twitter.com/_scotthewitt

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Whooping cough, chickenpox on the rise

Officials exhort public to get caught up on vaccines, boosters

Public health officials are urging immunizations as several vaccine-preventable diseases make a resurgence in Clark County and across the state.

So far this year, 52 cases of whooping cough, or pertussis, have been reported in Clark County — more than three times the number reported at this time last year. Statewide, 319 cases of whooping cough have been reported this year.

Health officials are also seeing increasing numbers of chickenpox cases at local schools. Chickenpox cases are not required to be reported to health officials, unlike whooping cough, but Clark County Public Health typically hears when case numbers are rising, said Dr. Alan Melnick, public health director and county health officer.

Elsewhere in the state, seven cases of measles have been reported. No measles cases have been reported in Clark County this year.

“We take all of these diseases seriously. They’re diseases that can kill people or make them very sick,” Melnick said. “And they’re preventable.”

Still below 2012 epidemic numbers

Clark County’s year-to-date whooping cough cases nearly total the number of cases reported locally in all of 2014, when health officials recorded 59 cases. Statewide, health officials recorded 596 cases of whooping cough in 2014, down from 748 cases in 2013.

Those numbers are still far below the record-setting number of cases in 2012, when a whooping cough epidemic sickened nearly 5,000 people. Still, the rising number is causing concern among health officials.

“This can be a harbinger of the cases’ going up even higher later,” Melnick said.

Whooping cough, like many communicable diseases, often experiences ebbs and flows in case numbers, he said.

“The reason behind all of this, is the pertussis vaccine is very protective, but the protection wanes over time,” Melnick said. “That’s why we’ve been doing boosters.”

Health officials recommend a pertussis booster for adolescents and adults. In addition, women should get a booster with each pregnancy, Melnick said.

Whooping cough is an illness spread through respiratory secretions such as coughing and sneezing. The illness is especially problematic for children younger than 1, who have a whooping cough mortality rate of 1.6 percent, Melnick said. Immunization of older children and adults protects infants who are too young to receive the vaccine, he said.

Of this year’s local cases, 80 percent have been in people 18 or younger. Two cases were in infants, Melnick said.

Health officials are also concerned about the chickenpox in schools. Chickenpox, or varicella, can be problematic for pregnant women, newborns, adults and people who have immune system problems. One complication of chickenpox, varicella pneumonia, can be fatal, Melnick said.

“I really do want people to take chickenpox seriously,” he said.

Health officials have seen increasing numbers of chickenpox at Camas High School and Helen Baller Elementary School in Camas. The high school is also experiencing pertussis transmission, according to health officials.

Both schools have immunization exemption rates higher than the county average of 6.8 percent. The exemption rate at Camas High School is 7.1 percent; Helen Baller’s exemption rate is 10.7 percent, according to state health department data from the 2013-14 school year.

Countywide, 22 public schools and four private schools had exemption rates in the 2013-14 school year at 10 percent or higher.

“It scares me that you have some schools with exemption rates in the 10 to 20 percent range,” Melnick said. “It’s kind of like having kindling for a forest fire.”

Marissa Harshman: 360-735-4546; [email protected]; twitter.com/MarissaHarshman

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County to consider passing e-cigarette ordinance

The Clark County Board of Health will consider an ordinance to prohibit electronic cigarette use in public places where tobacco products are banned.

The board — county Councilors David Madore, Tom Mielke and Jeanne Stewart — will hold a public hearing on the ordinance during its monthly meeting at 9 a.m. Wednesday at the Public Service Center.

The proposed ordinance would extend the regulations under the statewide Smoking in Public Places law, formerly the Washington Clean Indoor Air Act, to include "inhalant delivery systems." The ordinance defines inhalant delivery systems as devices used to deliver liquid nicotine, or other liquids or solids, in the form of vapor or aerosol to a person inhaling from the device. That includes electronic cigarettes, e-cigars, e-cigarillos, e-pipes and e-hookahs.

The Smoking in Public Places law prohibits smoking in public places, places of employment and within 25 feet of exits, entrances and windows of buildings. A handful of other local jurisdictions across the state have passed ordinances to extend the state regulations to vapor devices.

The board of health declares in the ordinance that new and unregulated inhalant delivery systems "present a threat to public health."

Clinical studies about the safety and efficacy of the products have not been submitted to the Food and Drug Administration for the hundreds of brands of devices on the market. That means customers have no way of knowing if the products are safe, what types or concentrations of harmful chemicals the products contain, the dose of nicotine or other chemicals in the products and the toxicity of the vapor emissions, according to the ordinance.

The board of health asked Clark County Public Health staff to bring forward the ordinance after hearing from business owners who want direction on the use of the devices — businesses can legally prohibit the devices — and growing concerns that people are using the devices for marijuana.

This isn't the first time the board has considered restrictions on electronic cigarettes and other inhalant devices.

In June 2011, the board of health passed an ordinance that banned the sale of electronic vapor devices to minors. At that time, the public health department also proposed extending restrictions under the Smoking in Public Places law to include the electronic devices.

The board, however, decided not to take further action.

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Patients seek cure for medical pot dilemma

Critics of medical marijuana often note that most of the people using the system aren’t actually sick — they’re just using it as a way to get cheap, untaxed pot.

And the critics aren’t entirely wrong. Even those in the medical marijuana community admit that there are likely more people gaming the system than there are people using it as intended.

But that’s not the entire story.

For seriously ill patients, the drug and medical access to it can be a lifesaver, life-extender or at least make life bearable — but because others abuse the system and because of the drug’s federally illegal status, medical marijuana can also be a patient’s nightmare.

“The system just isn’t set up for people that really need it,” said Katie Zinno, a Vancouver medical marijuana patient suffering from rare illnesses. “I have so many different problems, (traditional) medicine isn’t set up to treat me.”

It’s been difficult to even get a doctor to discuss marijuana as a treatment option, much less support it, said Zinno, who suffers from a serious connective tissue disorder and seizures.

“It’s the one thing that actually works, out of years of trying other treatments,” Zinno said. “But to get access to it, I basically have to give up everything else (including pain medications and traditional treatments).”

Zinno’s primary doctor declined to talk to The Columbian about this story because of the controversy around the drug.

“She says she wants to but she can’t because of hospital policy,” Zinno said of her doctor.

Dr. Alan Melnick, director of Clark County Public Health, said medical marijuana is not something he generally deals with, but broadly, as a medical expert, he said the drug is too poorly studied for most doctors to feel comfortable prescribing it.

“It’s hard to do the studies because it’s still federally illegal,” Melnick said. “If you look at the research, it’s mixed. The other issue is (unlike other drugs) the feds don’t regulate it — dosage, what’s in it — and that’s a problem.”

It might be easier to study if it were federally reclassified from its Schedule I status as a drug with no medical benefits to a Schedule II drug, but that hasn’t yet happened, Melnick added.

“Marijuana’s been around for a long time,” Melnick said. “It does have addictive potential, and it’s a problem for kids. It’s not all roses.”

Washington’s largely unregulated medical marijuana system, which traditional doctors often don’t want to be involved with, is also rife with problems.

The lack of organization and structure can leave patients in a limbo where they have to find their own treatment methods and medications. And the federal ban and stigma means there’s not much in the way of financial help or pharmaceutical guidance for those who want to look into the treatment.

The state system also doesn’t require testing of medical marijuana products — it’s up to individual growers or dispensaries to decide whether to test or not, adding more concerns for patients who are already suffering.

On the recreational side, testing includes screening for mold, some chemicals, and the percentages of THC (the component of marijuana that gets people high) and CBD (a non-psychoactive component used to treat pain and seizures).

Many medical advocates think testing should be even more strict for their patients than it is for recreational users, and the problem is something that even growers and medical dispensaries say needs to be fixed.

“Everything needs to be more tested from now on,” said Tom Lauerman, a medical marijuana grower in Vancouver who works with between 20 and 25 patients. “They really need to set standards across the board. And illegal dispensaries, you need to get rid of them and only have legit ones. We need to weed out the blatant drug dealers.”

The state Legislature is debating whether to add structure to the system by rolling it into the recreational marijuana network. But if that happens, will recreational growers and stores want to make medical products like suppositories or concentrated oils designed for a very small number of patients?

Some say they are willing to do that, but patients remain justifiably concerned that their medications may no longer be available if the medical and recreational systems are merged.

“I don’t think it’s a good idea to mix the two,” said Lauerman, who is also a patient. “One is health related, the other is not. They need to be separated.”

One patient’s story

Katie Zinno’s medical nightmare began when she was 14 and a student at Oregon’s Hillsboro High School.

“I was hanging out with friends at Red Robin and I just passed out on the pavement outside,” Zinno said. “I had no idea what was going on, but I just started passing out randomly after that.”

Zinno, 24, used to love playing in the school’s wind ensemble, but the strange illness made her so short of breath she had to quit.

After going through several doctors, she learned she had Ehlers-Danlos syndrome, an incurable connective tissue disorder that affects her skin, joints, muscles and internal organs.

“I also make too much spinal fluid,” Zinno said of her secondary disease, intracranial hypertension. “That’s why they put a shunt in my head. But that makes me have seizures.”

At 18, she went on the road to see doctors in California and Maryland, hoping to find some relief. But everything she tried just seemed to make things worse.

“Two years ago, I was on 22 medications and I weighed 220 pounds from fluid retention,” Zinno said. “I came back to my family in Vancouver after I heard that pot had just been legalized. I was ready to try anything at that point.”

Zinno grew up a conservative Republican with a strong anti-marijuana stance, but after a host of traditional medical strategies failed to help her, she found herself willing to reconsider her ideas about the drug, she said.

When she returned to Vancouver, she was on a combination of methadone, fentanyl and morphine sulphate to treat her symptoms. She spoke to doctors at Oregon Health and Science University about medical marijuana as an option.

“They said I could do that, but I would have to stop taking all my pain medications,” Zinno said. “I wanted to go through the proper channels. I wanted to communicate with everybody.”

She also tried going through Providence Health & Services in Portland, but because cannabis is illegal, she was told that if she wanted to try it, she’d have to look elsewhere.

“A lot of doctors won’t even treat you when they find out you have a complex illness,” Zinno said. “At that point, I qualified for hospice care. They sent me home basically to just die.”

But she didn’t die.

Instead, she found J.B. Creel, who runs Cannalogics, a medical marijuana center in Portland. Creel looked over her records and said he thought medical marijuana could help.

“I did not know at the time that it would be this effective,” Creel said. “I don’t take patients on unless they’re really sick or dying. But she’s done remarkably well. This is the first treatment of anything that has actually worked for her.”

Despite all her problems navigating the system, Zinno said her pain tolerance is far greater with medical marijuana, her seizures are far less frequent, and she’s out of the hospice and living mostly on her own, albeit with a roommate, in Vancouver.

“Even my parents, who are also conservative Republicans, are on board with medical marijuana at this point,” Zinno said. “They’re just happy something is working.”

And that’s not to say she isn’t still sick. So far, she’s had five brain surgeries. Her shoulder, knee and other joints often dislocate randomly and have to be popped back in place. And she still has seizures, just fewer of them.

But the medical complications aren’t the only thing she has to deal with. Like many seriously ill patients with complex diseases, she also faces poverty.

Medical marijuana doesn’t fall under any health insurance plan. And Zinno’s treatment requires an oil made from about two pounds of marijuana a month. That costs about $65,000 a year to keep her going, much of which is donated, she said.

At the beginning of March, she had to choose between paying her rent or helping to pay for more medication, she said, adding that she chose to pay her rent.

“The people that really care about the medicine, they’re going broke,” Zinno said. “They’re spending so much every year on my medicine and they have to eat most of that cost.”

It’s a frustrating situation, and yet her quality of life on medical marijuana has improved so much that it’s worth it, she said.

“It’s not curing me, but it’s certainly making my life a lot better,” Zinno said. “I was told I’d be dead by 25, and I’m celebrating my 25th birthday next month. I couldn’t be happier to prove everyone wrong.”

Seeking a solution

It’s likely that the plight of medical marijuana patients won’t ease unless the federal government reclassifies the drug and makes it easier to study.

The legal recreational marijuana system in Washington hasn’t so far been a big help for patients, who have different needs and sometimes very specific medication requirements.

Merging the recreational and medical systems in Washington may eventually help patients. But in the short term, it’s likely to lead to even more uncertainty as patients wait to see what changes the Legislature makes and how it affects their access to the drug by the time the session finishes in late April.

“My hope is that people will see this is a really complex issue,” Zinno said. “It seems like medical patients will lose out, because the recreational side is run by people that want to make money.”

Money is also a factor at universities and medical facilities that might otherwise like to study cannabis. If those organizations work with marijuana on their own, they put their federal funding at risk. And not many groups, or doctors, are willing to do that.

“What we need to do is get doctors to lose their fear of losing their jobs if they talk about this,” Creel said.

Those problems aren’t likely to change soon, even as legalization of both recreational and medical marijuana continues to spread in states across the country. Ultimately, the ball remains in the fed’s court, Lauerman said.

“As long as this is a Schedule I narcotic, it’s going to have to be this grass-roots type of medicine,” Lauerman said. “There’s so much to it. Patients need a place where they can feel safe; they need better information. But I think they’re going to have a really hard time until the feds do something.”

Sue Vorenberg: 360-735-4457; http://www.twitter.com/col_suevo; [email protected]

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Vancouver Medicaid Provider CUP to File Lawsuit Against State

The Lund Report

Republished courtesy of the Vancouver Columbian

March 2, 2012--Columbia United Providers will file a lawsuit against the state Health Care Authority in federal court Monday afternoon.

CUP will also request a temporary restraining order to prevent the Health Care Authority from issuing contracts to the organizations selected to provide Medicaid services to Washington residents, said Dr. Lisa Morrison, CUP’s medical director.

The hearing was initially scheduled for Thursday afternoon in U.S. District Court in Tacoma but was delayed until 2:30 p.m. Monday.

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