More Clark County street drugs include more than one illicit substance. Combination makes treatment more difficult (2024)

An annual report published by addiction treatment provider Ideal Option found substance use involving two or more illicit drugs has remained prevalent in Washington, making treatment for patients far more complex.

Ideal Option treated about 13,700 patients in Washington last year. Its two outpatient clinics in Vancouver treat an average of 60 patients a day.

The clinic’s annual report highlighted rapidly evolving trends in street drug blending, including the combination of synthetic opioids such as fentanyl and cutting agents such as xylazine. The report revealed 68 percent of patients in Washington were using multiple substances at the time of enrollment to the clinic, and 30 percent tested positive for three or more substances.

Lindsey Barnett, registered nurse and advanced practitioner at Ideal Option’s Vancouver locations, said polysubstance use has risen alongside the presence of fentanyl in Clark County’s drug supply. Barnett said she is surprised when a patient is only using one kind of drug.

“I’ve noticed it, especially as fentanyl has come into our community in the last few years,” Barnett said. “They’re cutting other drugs and putting fentanyl in other substances because it boosts the high and makes it more addicting. It’s also cheaper for them to make and so it’s extra dangerous.”

Polysubstance use complicates treatment because each drug has different withdrawal symptoms. Many patients don’t know they’ve been taking multiple substances until they begin treatment and are tested, Barnett said. If a patient is on multiple substances, Barnett will start by treating opiate withdrawal, since it is often the strongest.

“Maybe it’s not just a pure opiate withdrawal. Now we’re dealing with the anxiety and all the horrible withdrawal from having stimulants in the drugs,” Barnett said. “Withdrawal from different substances present in different ways. We need to tackle all those different things so that they feel well enough to get over the worst part so we can keep them in treatment.”

Continued support

Fentanyl use has overrun consumption of heroin and prescription pain medications in recent years, Barnett said. In 2023, an increased number of street drugs contained synthetic opioids, including fentanyl and fentanyl analogues, which are blended in random combinations and potencies, the report said.

Additionally, the report found roughly 1 in 6 patients starting treatment at the clinic tested positive for xylazine, a dangerous, highly addictive animal tranquilizer often used to extend the high from fentanyl.

The presence of xylazine has almost doubled in Clark County’s drug supply since November, according to Columbia River Mental Health Services. The drug, also known as “tranq,” contains a sedative that rots human tissue, causing painful open wounds.

Barnett said treatment for opioid use disorder doesn’t end with medication; it is often also necessary to address the root causes preventing patients from seeking treatment, such as housing, transportation and financial factors. More than half of patients pay for treatment through Medicaid, said Olivia Roe, Ideal Option marketing director.

“We think it’s much more than just writing them a prescription and sending them on their way,” Roe said. “We want to treat the whole patient because that’s going to give them the best chance of success and sustaining recovery.”

According to the study, 85 percent of Washington patients returned for a second visit in 2023. Of those patients, 69 percent continued to attend treatment visits after at least six months, 62 percent continued after at least nine months and 56 percent continued after at least 12 months.

As a result of working on the frontline with patients, Barnett believes visibility and education can positively impact treatment. The stigma surrounding addiction, specifically opioid use disorder, is still present, Barnett said. But she works to combat that stigma by educating her peers.

“I try to educate the family and the people closest to them,” Barnett said. “As a nurse practitioner, whenever I’m dealing with other doctors and physician assistants, if the subject ever comes up even in my normal everyday life, I just try to get the word out and really educate so that we can change the narrative in our community about addiction and the treatment of addiction.”