Local medical panel warns Spokane County overdoses remain steady; counterfeit pills highlight youth risk

Dr. Velasquez, presenter for the Fentanyl Roundtable, told the Spokane County Behavioral Health Advisory Board that overdose deaths tied to synthetic opioids have continued to rise in Spokane County through 2024, and that the county has not shown the plateau seen in some other jurisdictions.

"We have not really seen that plateau in Spokane County," Dr. Velasquez said, citing recent medical examiner data. He told the board the county's medical examiner, Dr. Singh, had shared updated numbers in the weeks before the presentation.

The presentation summarized national and state trends and localized data for Spokane County. Dr. Velasquez said fentanyl is the most commonly detected drug in recent overdoses, but that many fatal and nonfatal events involve multiple substances — most commonly methamphetamine and, to a lesser extent, cocaine and prescription drugs. He warned that the composition of street pills and powders is increasingly unpredictable: "About, 6 out of every 10 counterfeit pills has a potential lethal dose of fentanyl at this point in time." He also noted that some adulterants observed elsewhere, such as xylazine, are not yet widespread in Spokane.

Why it matters: Dr. Velasquez emphasized three practical priorities the roundtable will pursue: (1) improving reimbursement pathways so nontraditional providers can be paid for care, (2) expanding recovery housing and post-crisis housing supports for youth and young adults, and (3) intensifying youth-prevention work that the roundtable is extending to pre-K populations because of early exposure risks.

The roundtable, which Dr. Velasquez said began after a community conversation in 2023, includes public health, tribal partners, law enforcement, judges, emergency medical services, nonprofit providers and people with lived experience. He said the group is focused on narrowly defined, measurable actions that avoid duplicating existing services.

Board members and attendees asked questions after the slide deck. Gail Coble, identified in the meeting by name, asked whether pills could be formulated to prevent injection use (a reference to past efforts to deter intravenous use). "Is there any way that you can do that with ... the counterfeit ones won't even care," Coble asked. Dr. Velasquez replied that counterfeit pills are not constrained by pharmaceutical manufacturing standards and that some street products are formulated or cut in ways that make predictable countermeasures ineffective.

Dr. Velasquez said the roundtable maintains an archive of presentations and materials and that Madison Johnson coordinates invitations and meeting notes. He encouraged interested community members to contact Madison to join the open roundtable list, which he said contains roughly 75 invitees who receive notes and materials even if they do not attend meetings.

The presentation covered supply channels, including social-media–facilitated sales and the prevalence of visually appealing counterfeit pills aimed at younger people; Dr. Velasquez warned that small quantities of fentanyl can be lethal and demonstrated visual comparisons to show how little drug can cause fatal overdoses.

Ending: Dr. Velasquez closed by inviting further questions and offering to share medical examiner substance-detection details on request. He and Madison Johnson said they would provide follow-up materials to board members and interested attendees.