# Council Hears Progress Report on Fentanyl Crisis Response — With Questions About Missing Accountability On a Tuesday morning in late April, Whatcom County's Public Works and Health Committee convened to hear an update that many had been eagerly awaiting: how the county's ambitious Fentanyl Operations Plan was performing nearly eight months after its launch. But what began as a straightforward progress report evolved into a pointed discussion about whether the county's response was missing a crucial component — accountability measures to complement its harm reduction approach. ## Meeting Overview The April 29, 2025 committee meeting brought together Chair Jon Scanlon and committee members Mark Stremler and Ben Elenbaas, along with several other councilmembers participating both in-person and online. The sole agenda item was a presentation by Carrie Holley, a program specialist with Whatcom County Health and Community Services, delivering the promised quarterly update on the operations plan that emerged from the county's fentanyl executive order. The meeting, held in the hybrid format that has become standard for county business, lasted just over half an hour but packed considerable substance into that time. What made this session particularly noteworthy wasn't just the data presented, but the philosophical tension that emerged about how the county should balance public health approaches with accountability measures in addressing the ongoing opioid crisis. ## The Data Picture: Mixed Signals on Progress Holley began with what has become the standard opening for health department presentations — a reminder of the department's mission to "advance equity and partner with our community to promote health, prevent disease and injury." But the data that followed painted a complex picture of where Whatcom County stands in its battle against fentanyl. Emergency department visits for opioid overdoses remained relatively stable through the first quarter of 2025, hovering around 30-33 visits per month according to data current through March. "So as you can see, the bottom blue line is opioid overdose, and the top black line is any drug overdose," Holley explained, pointing to charts that showed the persistent challenge of poly-drug use in the community. The EMS data told a similar story but with higher numbers, as Holley noted that "not everyone that has an overdose in the field ends up in the emergency room." Through April 22, EMS had responded to 175 suspected opioid overdoses out of 313 total overdoses, putting the opioid percentage at 56% — slightly lower than where 2024 ended. But it was a new slide that hadn't appeared in previous presentations that drew particular attention. Breaking down incident rates by zip code for 2024, the data revealed stark geographic disparities that were already driving targeted interventions. "This was data that was shared with the MAT group in February," Holley said, referring to the Multi-Agency Team coordination group. "But it breaks down the incident rates by postal code for Whatcom County for year 2024." The first two zip codes on the list were Bellingham neighborhoods, followed by Ferndale, another Bellingham area, and Blaine. The Blaine data was particularly striking to those working on the response. "As a Blaine resident, it really prompted some conversations in that community," Holley noted. When Councilmember Todd Donovan asked about trends compared to national patterns, Holley confirmed that Whatcom County wasn't far off from state and national trends, though with an important caveat about data availability. "But I will say that the overall death, we don't have death data. That is something that the medical examiner is not releasing," she said. This prompted a brief but illuminating exchange about data transparency. Deputy Executive Kayla Schott-Bresler stepped in to clarify: "That's not entirely accurate. The medical examiner does still release cause of death data. They're not releasing the data in the same way around preliminary overdose information prior to the finalization of toxicology reports." The distinction mattered. The new medical examiner, Schott-Bresler explained, "feels this is the more prudent and responsible way to release data, but it's in active conversations with the health departments and other medical examiners around the state around whether the value in releasing the data sooner outweighs the risks." ## Prevention Efforts: Media Campaigns and Community Partnerships The presentation moved into the concrete actions being taken under the operations plan, organized around the PETA model — Prevention, Intervention, Treatment, and Aftercare — that has guided the county's approach from the beginning. On the prevention front, the county has launched an ambitious media campaign funded by a Department of Health grant. "I don't know if you have seen the media campaign launched in April," Holley said. "Maybe on your social media, if you have that, you've been seeing the advertisements." The campaign includes multiple components: storyboards featuring a Bellingham police officer talking about field work, messages addressing stigma and youth education, advertisements in movie theaters, and wraps on city buses. The messaging was developed with extensive input from both the Opioid Task Force and the MAC group, using the stark zip code data to target areas with the highest overdose rates. Holley shared one of the bus advertisements with the committee — a simple but direct message reading "Opioid use disorder is preventable" that directs people to the county's wacomhope.org website. All messaging leads back to that central resource, allowing the county to track engagement and measure the campaign's effectiveness. A brief video clip intended for movie theater screening delivered an equally straightforward message about naloxone: "Naloxone reverses opioid overdose can save a life, your friend's life, your co-worker's life, your child's life, a stranger's life. Available free in Whatcom County for saving lives today." The campaign has already generated unexpected partnerships. Holley noted that after seeing the naloxone messaging on WTA buses, the transit agency "reached out to have naloxone on all their buses and to train their drivers." The county is working to connect WTA with state supply channels for naloxone access. Beyond media, the prevention work includes expanding the network of naloxone kiosks throughout the county. Currently five are in operation, with plans for more based on the geographic data analysis. When asked what the kiosks look like, Holley offered a surprisingly analog description: "It really looks like an old school newspaper machine. They've been refabricated, but it really just looks like that. It's just a metal box that we've wrapped in a logo, and you can just open it." The county has deliberately kept the program low-barrier for both users and hosting organizations. "We want to make it really low barrier for our community members and the organization hosting the kiosk," Holley explained. The county encourages organizations to connect with the Department of Health for naloxone supply but will provide it directly if needed. The geographic targeting approach led to concrete action in Blaine, where the community response to the overdose data prompted immediate conversations. "We just had a conversation based on that zip code data in Blaine yesterday with the food bank," Holley reported. "They are first in line for us to place a naloxone kiosk in Blaine." ## Intervention Challenges: Staff Turnover and Capacity Issues The intervention portion of the update carried sobering news about the persistent challenges facing the county's response. The much-anticipated response behavioral health specialist position, which had been filled and was taking referrals, became vacant when the employee "has taken a position elsewhere." "This highlights some of those barriers to the work that we're doing," Holley said with evident frustration. "So even though we can have this, this best laid plan, capacity continues to be an issue. And then this is just one of those indications that we'll look at part of the big overall storytelling." The position has been reposted, but the incident underscored the ongoing workforce challenges that plague behavioral health services throughout the region. It's a reminder that even well-funded plans can stumble on the basic challenge of finding and retaining qualified staff. On a more positive note, the Dijuali Wellness Center partnership has opened and begun seeing clients at its Division Street location. "It really is a beautiful partnership with our county and the tribes," Holley said, encouraging councilmembers who hadn't visited to see the facility. "They do a really good job of taking care of community members with such intention." The county has also secured additional grant funding to purchase naloxone, responding to what Holley described as "a recent uptick on the Whatcom prevention overdose prevention page for requests for naloxone in the community." Each request triggers not just naloxone distribution but connection to the broader network of community resources. ## Treatment and Housing: The Persistent Challenge When the presentation turned to treatment and aftercare, Holley didn't shy away from the fundamental challenge that underlies much of the county's work: housing. "I put this in here just to highlight the need for continued conversations around the housing crisis in our community and those broader systemic needs." The comment reflected a reality that permeates every aspect of addiction treatment and recovery. "Dr. Bostad is doing a wonderful job of talking about MOUD, getting it in the emergency room. EMS is working on getting that started out in the field, increasing providers that can prescribe that," Holley noted, referring to medication for opioid use disorder. "But if we can't interrupt that cycle of addiction and then have them change that environment that they're living in, it just becomes cyclical." The housing challenge represents one of those broader systemic issues that no single operations plan can solve, but which fundamentally shapes the success or failure of every intervention. Holley made sure to keep this reality "at the forefront that there are big, broader systemic needs in our community." On the employment front, the MAC workforce group continues meeting with employers to facilitate "second chance employment" conversations, helping justice-involved individuals find stable work. "Really helping those that have been justice involved get solid employment and really feel like they're an integral part of our community," Holley explained. ## The Accountability Question: A Philosophical Divide Emerges What had been a fairly routine progress report took a sharp turn when the presentation reached its conclusion and Councilmember Ben Elenbaas, participating online, raised fundamental questions about the plan's approach. As one of the original sponsors of the resolution that created the fentanyl executive order, Elenbaas had specific expectations about how the response would develop. "When I started with this resolution and working closely with the Lummi Nation, at least my view, my goal was a balance of harm reduction and accountability," Elenbaas said. "And I heard the word accountability there in your summary, but most of what I heard in the action plan was harm reduction type of things." The comment cut to the heart of an ongoing debate in addiction policy — how to balance public health approaches focused on harm reduction with accountability measures that might include consequences for drug use. Elenbaas pressed the issue: "So, I guess my question is, can you highlight how the plan balances accountability in to it? Or since you're, you know, the health department, are you relying on the criminal justice system or the sheriff's department to hold up the accountability in?" Holley acknowledged the limitation of her perspective: "And that is a great question. And my lens is through the health department. So, I'll let the executive's office discuss your question further." Deputy Executive Schott-Bresler stepped in with a response that revealed the complexity of coordinating across multiple systems. "I would just want to reiterate what Kerry has said, which is the health department's looking at this through a public health lens. The executive's direction to them was to do so. And then I think it is the rest of the system that would need to take up the accountability measures that you're thinking of." But Schott-Bresler also emphasized that the work isn't happening in isolation. "We have sort of these multiple overlapping efforts. We have all of our justice project work, as well as the MAT group work, where we are coordinating very closely with other systems, including EMS, law enforcement, the prosecutor's office, the courts." She outlined several specific examples of this coordination: a kickoff meeting scheduled for the following week with the prosecutor and sheriff to discuss the behavioral care center and prosecutorial diversion, recent travel with the prosecutor and a councilmember to examine King County's out-of-custody diversion program, and daily coordination with the sheriff's office on jail facility construction. "So I think that coordination is happening and it's the reporting back to Council on that coordination that is perhaps lacking and we can think about how to do a better job," Schott-Bresler concluded. ## The 22 North Example: What Accountability Looks Like Elenbaas wasn't satisfied with the explanation, and he offered a concrete example of what he meant by accountability. "Let's think about how many overdose deaths we saw at 22 North until council held them accountable by threatening to take away their funding," he said. "And then all of a sudden, the performance was much, much better." The reference was to a transitional housing facility that had experienced multiple overdose deaths before the county intervened with funding consequences. "So I don't know what they did, but it sure appears that there's some accountability that happened," Elenbaas continued. "So accountability doesn't, because we haven't seen the type of, we haven't seen the type of, I guess, death rate there that we saw before." The example illustrated Elenbaas's broader point about accountability: "Because I do understand that your authority only goes so far in most of these situations." He wasn't necessarily talking about criminal justice accountability, but about building consequences and expectations into service delivery systems. Interim Health and Community Services Director Charlene Ramont acknowledged that she needed to better understand Elenbaas's vision: "That example that you just gave helped me get a better understanding of what you're referring to. So I don't know if there's a way that we can sit down and I can learn a little bit more from you so that we can make sure that we address Council's desires around this work." ## The Business-as-Usual Critique As the discussion continued, Elenbaas's frustration became more apparent. He had helped craft the original resolution in partnership with the Lummi Nation specifically to move beyond existing approaches. "I was hoping rather than laying out a plan for the future, integrating what we're doing now to get a better outcome. And it just appears that we're doing things in silos, business as usual." The comment reflected a deeper concern that despite all the planning and coordination, the county's response was falling back into familiar patterns rather than achieving the integration he had envisioned. "I have, you know, I'm just on the calendar quarterly and I come in here, but I'm happy to share any other information that needs to be shared if that's something that would be beneficial and we could do that communication." Carrie Holley offered to sit down with Elenbaas and others to "paint a clearer picture about that," acknowledging that her quarterly presentations might not capture the full scope of integration happening across systems. When Chair Scanlon asked about the role of the Multi-Agency Coordination group, Holley provided insight into how the ambitious collaborative structure had evolved in practice. Initially formed in 2023 with "a lot of excitement around it and people were ready and willing," the MAC had organized into working groups around policy, communication, prevention, intervention, treatment, and aftercare. "And then as we started to get out there and do the work, capacity, right?" Holley explained. "You know, not everyone can come to a meeting every single month or things come up." The reality of implementation had required adjustments to the original collaborative vision. "I think the work is happening and those conversations are, you know, being done. They're just not being done in that big sense anymore because we really are in the meat of getting doing the work, right?" Holley said. "We've identified what needs to be done and there's barriers to that." ## The Evaluation Plan: Measuring What Matters Before the accountability discussion dominated the meeting's conclusion, Holley had presented an ambitious evaluation framework designed to assess both the fidelity and effectiveness of the operations plan. The 16-page evaluation report provided to councilmembers outlined a comprehensive approach to understanding what's working and what isn't. "A lot of energy time, man hours has gone into, you guys worked on that resolution or Mr. Ellenbaugh," Holley said, acknowledging the investment of political capital. "And we want to make sure that our actions align with what our purpose was." The evaluation will use a results-based accountability approach to examine both process and outcomes. "Did we implement the plan as attended? What worked and what didn't? Are there specific strategies showing early signs of achieving their goals?" The framework promises to generate "actionable insights to improve overdose prevention, treatment access and recovery support, both during this response and beyond it." The timeline calls for finalizing the evaluation plan in April (accomplished with the current presentation) and publishing a year-one monitoring and strategy update report in August. That report will examine which strategies are showing signs of improvement and which might need reevaluation within the current timeline. Data collection begins May 14, with Holley and colleague Hunter conducting qualitative interviews with stakeholders involved in various strategies. "Part of this is that story," she explained. "We will have some data, some raw data, but a broader picture is the storytelling of the work individually." The evaluation will also examine sustainability questions in light of the evolving funding landscape. "Have priorities shifted based on the current funding landscape?" Holley asked, noting that a million dollars has been earmarked for a 24-hour crisis facility while just over a million remains available for other priorities. ## National Recognition and Looking Ahead Before the accountability debate consumed the meeting's final moments, Holley shared news that the county's approach was gaining national attention. She and colleague Joe Fuller were scheduled to present on a CDC webinar the following Thursday, sharing their experience with other local health jurisdictions. "The health department was who was designated to hold the keys of the opioid funds," Holley explained. "And so, they were really impressed with the work that we've done to develop a community plan to reach out to those stakeholders, the task force specifically, and then the MAC and how we've continued to come and educate you as council members." The recognition highlighted something unique about Whatcom County's approach — the ongoing effort to keep elected officials informed and engaged rather than simply implementing a plan in isolation. "Your job is very unique in that sometimes after we present, you'll listen to a presentation on disposable waste," Holley noted with a smile. "And so, you have to hold all of these pieces and decide what's the best use of all of these funds." ## The Path Forward: Integration vs. Silos As the meeting drew to a close, Chair Scanlon suggested bringing in representatives from the sheriff's office and prosecutor's office to discuss their response to the operations plan — a signal that the accountability questions raised by Elenbaas had resonated with other committee members. Councilmember Barry Buchanan, who had co-sponsored the original resolution with Elenbaas, made sure his perspective was recorded: "I do agree with everything he said. I just wanted to make sure to get that on the record." The brief statement underscored that the accountability concerns weren't isolated to one councilmember but reflected broader expectations about what the fentanyl response should accomplish. Elenbaas's closing comments captured his essential frustration: "I think that is exactly the conversation that we had was we don't want to kick harm reduction to the curb, but we would like to incorporate some accountability into it." The challenge, as he saw it, wasn't choosing between approaches but finding ways to integrate them effectively. "I think the intent of that was to say, hey, we don't want to do business as usual. We want to do something different because business as usual hasn't been working," he concluded. ## A Crisis Response at a Crossroads The April 29 committee meeting revealed a fentanyl response that is both making measurable progress and grappling with fundamental questions about approach and integration. The health department's presentation demonstrated significant activity across prevention, intervention, treatment, and aftercare — from media campaigns and naloxone distribution to workforce development and evaluation planning. But the pointed exchange about accountability exposed tensions that go beyond operational details to fundamental philosophy. How should a community balance public health approaches with accountability measures? When does harm reduction become insufficient? How can multiple agencies and approaches integrate effectively rather than operating in parallel? These aren't just policy questions but practical ones with immediate implications for how the county spends opioid settlement funds and structures its ongoing response. The discussion also revealed the challenge of translating broad political direction into specific operational changes across multiple departments and systems. For Elenbaas and others who crafted the original executive order, the quarterly update represented both progress and frustration — progress in implementing specific interventions, frustration that the integrated, accountability-enhanced approach they had envisioned hadn't fully materialized. The suggestion to bring in law enforcement and prosecutorial perspectives signals that this conversation will continue. How the county resolves these tensions may determine whether its fentanyl response becomes a model for other jurisdictions or a cautionary tale about the challenges of coordinating complex, multi-system responses to public health crises. As Carrie Holley prepared for her national webinar presentation, she would be sharing not just Whatcom County's successes but its ongoing struggle to balance multiple priorities and perspectives in addressing one of the most complex public health challenges of our time. The conversation was far from over.