SPOKANE, Wash — It's difficult for Hallie Burchinal to even describe.
"I really thought heroin was the worst I'd ever seen and would ever see. I could not have comprehended what we're dealing with today," the Executive Director of Compassionate Addiction Treatment (CAT) said. "Never thought I'd say this but I wish fentanyl would go away and heroin would come back."
The fentanyl crisis has so impacted the clients and staff at CAT, located at 168 S. Division, that Burchinal says they're gathering regularly to process a loss. Last month, one client in his 20's who had completed treatment overdosed after using one time.
"That was really hard," Burchinal said.
It's a change CAT started seeing in 2021, when staff discovered one or two doses of Narcan, the opioid overdose-reversing drug also known as naloxone, wasn't having the same effect. It would sometimes take three or more doses to bring an overdosing patient out of it.
The change was fentanyl.
It's why last January when the University of Washington approached Burchinal and CAT with the opportunity to become the only drug checking site in Spokane County as part of a statewide program, they agreed.
"We were seeing such an increase in overdoses and having the opportunity to begin to identify what's on the street in real time," she said.
"Everything I have is something somebody brought in," said drug technician Bobbie Lee Moskaloff, pulling on a pair of black gloves.
She holds up a small vial containing the tiniest scoop of white powder; it's a crushed up fentanyl pill that was supplied by a drug user looking to find out what's actually inside.
In her small back office, Moskaloff tests donated drug samples every weekday. She's had people drop off bags of pills for testing.
For nearly a year now, CAT has been one of just a handful of such checking sites in the state through UW's Addictions, Drug and Alcohol Institute.
"Drug checking is a powerful tool to engage participants, especially when it is provided along with safer use supplies, overdose prevention education, harm reduction services, and referrals or linkages to care. Drug checking can also inform better public health, medical, and treatment responses," the ADAI reported.
Anecdotally and from very scant data, overdoses are on the rise in Spokane County in 2024. The Spokane Fire Department reported 249 overdose calls, an average of six a day, in just the first 38 days of the year.
The state Department of Health and, consequently, Spokane Regional Health District's numbers for 2023 aren't yet available. However, SRHD spokesperson Kelli Hawkins reports Spokane has seen higher overall drug overdose rates than the rest of the state, mainly in 2021 and 2022, which possibly continues in to 2023. That's mainly due to synthetic opioids like fentanyl and psychostimulants such as meth and MDMA.
The drug checking has also been a way for providers like CAT to see changes in the substances on Spokane's streets.
"So this is fentanyl powder," said Moskaloff, holding up a baggie containing a miniscule corner of purple dust.
This powder form of the opioid has become more prevalent, she says. It's more potent than the pills that used to be more common in the area.
She loads the powder onto her machine, places a small piece of foil on top to get a better read, then screws down a clamp. In less than a minute, she's generated a line graph showing what chemical compounds are in the sample.
"All these peaks match, so I know there's fentanyl in this," she said, pointing to a blue line that indicates the known makeup of fentanyl. A separate red line shows what's in the test sample.
However, it's what else Moskaloff is finding that's cause for concern.
More often, like in the sample she tested Monday, she's picking up carfentanil in the drugs donators may believe is just fentanyl.
The Department of Justice reports carfentanil is 10,000 times more powerful than morphine and 100 times stronger than fentanyl.
"That is a tranquilizer. So that's what they use in Africa in the darts to knock out rhinos and things like that," Moskaloff said. "Very dangerous."
She's also picked up samples containing xylazine, a non-opioid tranquilizer that can suppress breathing and can't be reversed with Narcan.
Recently she dealt with a man overdosing on a xylazine mixture. She says multiple doses of Narcan and chest compressions did nothing until first responders were able to give him oxygen.
"It was the first time I really thought he may not make it," she recalled thinking.
CAT will change how staff responds to ODs given this new data; they'll soon carry breathing equipment like EMTs.
"We're experiencing people die on a regular basis," Burchinal said. "It's absolutely getting worse."
Three years ago, she says, staff saw maybe two or three overdoses a week. Now they're dealing with multiple every day.
Burchinal would like to see more local low-barrier services, along with providers who understand the intersections of substance use, homelessness, and mental and behavioral health issues. She says people needing substance use treatment are often kicked out for behaviors that stem from untreated or misunderstood mental health conditions.
Moskaloff says they often see clients who want to go to detox, but there are no spots available anywhere.
She says Spokane isn't doing enough to address some of the more basic needs, like housing, which could help people ease out of addiction more successfully.
"Abstinence is like the end of all these other things that are needed. Housing, mental health. Many things," she said.
The non-profit is starting to share its findings with other providers, Burchinal said, including first responders, hospitals, and the health district. She says this way there's more collaboration and a wide-ranging understanding of the situation facing the community.
Drug testing, she says, doesn't just impact drug users. She has teenage children, so she wants a better picture of what's out there so she can educate them.
Moskaloff says even with so-called party drugs like molly or cocaine, unknown and dangerous others drugs can be inside that could lead to an overdose.
Once she's tested a sample, it doesn't go back to the anonymous donor. Instead, she sends it off to a lab at the University of North Carolina for even more advanced testing and confirmation of her findings. She says the donor can use a QR code to find out the results of what was in their supply.
"I want to save peoples' lives," she said. "That's what I do it for."
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