When Hunter Sully first checked into a residential treatment program for addiction, she was only 13 years old.

She still remembers the pain that gripped her as the drugs in her system wore off — the uncontrollable shaking, sweating and vomiting; the feeling that her whole body was crawling. She also remembers the voices in her head, telling her she wouldn’t survive.

At the time, it was too overwhelming to stay.

“I just couldn’t manage the withdrawal,” she said. “I couldn’t fathom actually successfully making it through that and out on the other side.”

That was more than a decade ago. One of the things that saved her life, she said, was medical detox. 

Now, she’s been in recovery for more than a year, and works as a peer support counselor in Yakima helping youths in Comprehensive Healthcare’s multisystemic therapy program. 

Without the right help, the experience of withdrawal can create a seemingly uncrossable barrier to long-term treatment and recovery. Medically monitored withdrawal management facilities, sometimes referred to as medical detox facilities, offer a space where people can access medications that help manage their withdrawal and related symptoms and get 24/7 support from trained medical staff. The services are often a critical first step for recovery — but in the Yakima Valley, they’re missing. In fact, the closest facility is more than 100 miles away.

As overdoses surge, community partners are trying to change that.

Earlier this year, Triumph Treatment Services and Principle Allies completed a study looking at the need for detox in Yakima County, identifying a critical lack of medically monitored services. Now, the county has put out a call for proposals to open a facility in the community — a project that could open a new chapter for people escaping addiction.

A missing piece

Over the last five years, fatal overdoses in Yakima County have nearly tripled. In 2024, the county Coroner’s Office recorded 146 overdose deaths, representing a more than a 50% increase from the previous year. The state’s opioid and drug use data dashboard reflects a similar shift, despite a downward trend in fatal overdoses statewide.

“That’s pretty staggering, if you think about it,” said Dr. Jamie Simmons, chief medical officer for Triumph Treatment Services.

But it’s also just the tip of the iceberg.

What the figures don’t account for are the hundreds of other overdoses happening each year that are reversed with Naloxone, also called Narcan. In 2024, Yakima County saw nearly 700 overdose-related emergency department visits, and emergency medical services responded to more than 1,000 overdoses.

According to Triumph’s feasibility study, MultiCare Yakima Memorial Hospital also saw more than 5,000 substance-use-disorder-related admissions over a 14-month period, resulting in roughly $17 million worth of hospital charges. Of those admissions, 90% of patients were discharged without a connection to any further treatment.

Despite the growing need and strain on local services, medical detox is still missing from the equation.

The county does have a subacute withdrawal management option — sometimes referred to as “social detox” — at Comprehensive Healthcare’s Crisis Triage Center, which provides a safe place for people to go through supervised withdrawal. The center offers psychiatric relief, same-day mental health and substance use disorder evaluations and case management so people can get connected with other resources. People with acute withdrawal symptoms can also access medications across the street at Comprehensive Healthcare’s main building during the clinic’s regular hours, but the detox center itself doesn’t offer medical intervention for withdrawal.

For some people, that’s enough. But for others, it’s not.

When social detox isn’t cutting it, Simmons said people typically end up in one of two places: back on the street, or in the emergency department. Making a trip to the west side for medical detox is also an option — but often, it’s not a realistic one. Even if someone has the resources to get there, the next step isn’t easy.

“Then they’re more than 100 miles away from home while they’re going through (withdrawal), then they have to find a ride back to get into that residential bed,” for further treatment, Simmons said.

A person could also skip medical detox and go straight to treatment, but most programs only last 28 days. That means every day counts — and every day in withdrawal is a day that isn’t spent taking advantage of services. If someone leaves and starts using again, they’re also significantly more likely to overdose.

“When you’re at the point of leaving because you can’t handle the withdrawal, very rarely are you going to make it to get to another place,” Sully said. “This is also the very dangerous part, is (people) manage to stay there for two days or three days, then they leave and they don’t have anywhere else to go for services.”

Treatment providers aren’t the only ones with concerns.

Yakima County Human Services Director Esther Magasis said the county identified a medical detox facility as a priority in its five-year homeless housing strategic plan — a desire law enforcement partners have echoed. Often, people in her office will use the phrase, “If someone says, ‘Yes, I’m ready,’ you say ‘Yes, let me help you.’”

For the department’s outreach team, that’s easier said than done.

“If someone says, ‘I’m ready to detox,’ you can’t say, ‘Great, let me call around, see if I can find a bed somewhere that’ll open up in the next few weeks, come back, get you a bus, transport you to another community where they do that.’ All of that’s too much,” Magasis said. “By the time you’ve got all that done, that individual might not be ready to go through detox anymore.”

‘Time to heal’

Sully has lived in Central Washington for the majority of her life. When she went through medically monitored withdrawal management, it wasn’t at a detox facility — it was at the local hospital.

At this point, that’s the only way to access those services without leaving the county.

Local emergency departments will only assist with withdrawal if someone has already been admitted for another reason. In Sully’s case, that reason was to deliver her daughter. She said going through withdrawal in a hospital was completely different from her previous experiences.

“It’s a big difference when there are nurses at your side that are able to look at you and say, ‘OK, you’re not doing well,’ and you’re able to vocalize that: ‘I’m not comfortable right now with how I’m feeling. These are the feelings that I’m having, and I don’t know if I can continue to handle feeling like this,’” she said. “It’s completely different in an outpatient setting.”

Dr. Gillian Zuckerman, the medical director for addictions at Comprehensive Healthcare, has observed that contrast, too. She was by Sully’s side after she was admitted to the hospital.

“I kind of get to see in real time the difference between a situation in which I have a nurse at bedside evaluating a patient, looking at the patient and saying, like, ‘Here’s what they look like, what do you want me to do with them?’” she said. “And in that setting, as a doctor, I get a lot more flexibility, right?

But Zuckerman said filling up hospitals isn’t the ideal solution. Not only are there capacity limitations, but hospital staff aren’t necessarily specially trained to work with people going through addiction.

Zuckerman wants to see a medical detox center in Yakima with staff who are trained in addiction and want to be there, including nurses onsite 24/7. Just as important, she said that facility needs to be patient-centered and treat people with dignity and respect.

Sully shares those desires. For her, getting through withdrawal wasn’t just about having the right medical resources — it was about being in an environment free from judgment, where people were listening to her and pushing her to succeed.

“I think that that would be the hope for a medical detox, is that that is a space where people have time to heal,” Zuckerman said. “And, I mean, there’s never enough time, right? We’re going to be looking at medical detox stays that are just a few days, but it’s something, and it’s a step in the right direction.”

A new opportunity

For as long as Magasis can remember, Yakima County has been talking about the need for medical detox in the community.

Now, it’s moving forward with a process that could help turn the page.

In October, the county released a request for proposals to establish a medically monitored withdrawal management facility. According to the request, it’s looking for a provider that can offer both withdrawal management and crisis stabilization beds with 24/7 drop-offs within Yakima County. The facility would need to have the capacity to provide services to people on Medicaid experiencing opioid and alcohol withdrawal. 

The request doesn’t specify a number of beds, but Triumph’s feasibility study proposes a 16-bed facility with 12 withdrawal management and four crisis stabilization beds. The county plans to make $6 million total in mental health sales tax revenues available on a reimbursement basis over the next five years to whichever applicant is selected.

“Our hope is that this is going to help make it possible for folks to move on to long-term treatment,” Magasis said. “But until we can get that medical detox component, there’s always going to be people who can’t cross that threshold to be treatment ready.”

The mental health sales tax is a 1/10th of 1% tax that can be used by counties for chemical dependency and mental health treatment services. While the exact amount collected each year varies, Magasis said the county takes in between $4 million and $6 million annually. The county is still spending reserves that it accumulated during the pandemic, but will reassess long-term funding goals once those funds are depleted.

Commissioner Kyle Curtis, who serves as the chair of the Yakima County Homeless Coalition executive committee, has been involved in the medical detox conversation for the last few years. He said the goal is for the project to become self-sustaining — but he recognizes the value in helping with the startup costs.

To him, the request represents a trial opportunity.

“It’s not cheap, but when you do the math of, ‘OK, if I have one person and I can get them sober and get them on the right track, and they’re not now not using illicit drugs for five months,’ all of a sudden, you see the tremendous return on our dollars, because this person is no longer using emergency services,” Curtis said. “So, I mean, it’s something that I feel comfortable going all in.”

Proposals were due on Nov. 17. From there, county commissioners are expected to review and deliberate on applications on Nov. 24. If commissioners choose to move forward with an agreement, a contract could be in place by the first of the year.

One piece of the puzzle

Community partners are excited about the process — but they also recognize that detox is only part of the solution.

If a person goes through medical detox but doesn’t have a treatment bed and support system to continue in recovery, their odds of success only go so far. If they finish treatment but don’t have a place to stay when they leave, they’ll be fighting an uphill battle.

Zuckerman and Sully said one of the biggest needs they see is housing — and then housing again. People tend to think homelessness is a consequence of drug addiction, but often, it’s the other way around.

“I just think the housing piece is huge,” Sully said. “Because even if you’re making it through the detox, you’re making it through the inpatient, if you’re going right back out to the same environment, it makes it 10 times harder to abstain from those drugs.”

Often, Zuckerman said, recovery is viewed through a medical model, where a person goes from detox to inpatient to outpatient care.

To her, it’s more nuanced than that.

“The opposite of addiction is not sobriety, it’s a meaningful life,” she said. “And so really, what we need is not just this concept of, ‘We’re going to walk you through these treatment things that kind of progress downward.’ It needs to be a full spectrum approach to, ‘What’s your housing going to be? How are we going to get you a meaningful career or meaningful purpose?’”

With a potential medical detox project on the horizon, she hopes people keep asking those questions.

“Community partnerships are how we’ve gotten this far,” she said, “and what is going to lead us further.”