SEQUIM, Wash. — One morning last year, Brent Simcosky stepped out of a pickup truck in the middle of a sprawling field off Highway 101, stood in grass that brushed his knees and imagined an oasis from the scourge of opioids.
The epidemic had struck particularly hard here in Clallam County, where generations of families from the Jamestown S’Klallam Tribe live along the waterways of the Salish Sea. Simcosky, health director for the 537-member tribe, had too often seen the battered faces of neighbors and community members addicted to black tar heroin that sells for $5 a hit or to pain pills that for years saturated this remote corner of the Pacific Northwest.
Jamestown tribe leaders invested in schools, farming and aquaculture, spreading shells along the tidelands so that oysters could grow. Now, Simcosky had multimillion-dollar tribal and state commitments to finance a state-of-the art outpatient opioid treatment and healing center that would combine native practices with counseling, medical care and medications known to block the euphoric effects of opioids.
Standing in the 20-acre field, he pictured meeting rooms that faced the Olympic Mountains. A reflecting pool where patients could practice meditation. Activities that brought tribal traditions to the young.
In Washington, with 29 federally recognized tribes, Native Americans have died of opioid overdoses at a rate nearly three times higher than that of nonnatives. For heroin alone, it was four times higher, federal data shows. The tribe planned to offer treatment to residents — native and nonnative — across two counties.
“Indians,” tribe Chairman Ron Allen told Simcosky, “can be part of the solution.”
In May 2019, the tribe bought the land. The purchase initially drew little attention in Sequim, population 7,000, a town of retirees, artisan shops and an annual lavender festival that brings flocks of tourists every summer.
But a group of local residents rallied to block the project, arguing that tiny Sequim was no place for a regional drug treatment center. When tribe leaders called a public meeting to present their plan, more than 1,000 people spilled into a steamy room at the civic center and onto hundreds of folding chairs set up outside.
Scores came from a newly formed group: Save Our Sequim, a name that became a rallying cry.
Jodi Wilke, one of the founders of SOS, said the issue has never been about need, the importance of helping to root out addiction in the community. The problem, she said, is location.
SOS members worry a treatment facility would draw too many outsiders struggling with addiction into a small community without adequate law enforcement and social services. Tourism could falter. Housing prices could drop. Schools could quickly become overwhelmed, SOS members have argued.
The site itself, Wilke said, is too close to a neighborhood and senior housing.
“The thing that bothers me is that they would use us as if we are bad people trying to keep folks from getting care, and it is absolutely not what we’re about at all,” she said. “But [we are] looking at the picture of a small town without the ability to provide for the influx."
A year later and now embroiled in a zoning challenge by SOS, Jamestown tribe leaders say they’ve run smack into a classic not-in-my-backyard fight, one that has divided the community and raised uncomfortable questions about racism, the nature of addiction treatment and the intentions of a tribe that traces its roots on the Olympic Peninsula for centuries.
“The Native Americans want to get all of America back,” reads one comment on the SOS Facebook group page, which has about 2,500 members.
“They will buy the ... town and turn it into [an] Indian Reservation!” reads another.
Jamestown tribe leaders have been careful to sidestep conversations about race even though supporters of the center point out that nearly all of their opponents appear to be nonnative.
Instead, tribe leaders have stressed that many communities have woefully inadequate resources for addiction treatment and that helping those with substance abuse disorder will ultimately strengthen Sequim and the surrounding region. Though the neighbor vs. neighbor fight has played out with mixed results in other places across the country, tribe leaders say they intend to prevail.
“We want to be sure that they understand,” Allen, the tribe chairman, said of the center’s opponents. “We were basically born here before you guys ever showed up.”
A holistic approach to addiction
Between 2006 and 2014, opioid distributors shipped 2.4 billion prescription pain pills to the state of Washington. Clallam County received nearly 49 million — an average of 76 pills per person per year, enough to rival some parts of hard-hit West Virginia, according to a Washington Post analysis of a once-confidential Drug Enforcement Administration database. The Post and the owner of the Charleston Gazette-Mail in West Virginia obtained the data after waging a year-long legal fight.
No other county in Washington saw more overdose deaths from pain pills per capita than Clallam. Black tar heroin has also impacted the region. In a restroom 50 feet from his office at the tribal medical center, Simcosky discovered a used needle still filled with the sticky, dark substance, which is primarily produced in Mexico.
Simcosky is not a tribe member, but after seven years as its health director and 20 before that working for other tribes in Washington and Alaska, he was emphatic.
“We needed to heal people,” he said.
In spring 2018, a year before the controversy began in Sequim, Simcosky and a small group of Jamestown leaders traveled more than two hours northeast to the city of Anacortes on the Puget Sound. On land once used to harvest camas flowers, the Swinomish Tribe in 2017 invested $4 million in tribal money to launch a medication-assisted treatment and recovery center, and the group from Sequim wanted to learn more.
Like a growing number of tribes, Simcosky and the Jamestown leaders planned to pursue a more holistic approach to addiction, combining medication with primary and dental care, job training, counseling, family support services and Native American customs and culture.
Many tribe members distrust nonnative medical standards, and programs integrated with local practices are critical, said Noa Krawczyk, a substance-use epidemiologist at the New York University Grossman School of Medicine.
“Every community wants to feel like they have ownership and they have a say in how they’re treated, especially a community that has a lot of history in being taken advantage of and doesn’t necessarily trust what outsiders come in and say,” she said. “These efforts need to come from communities themselves, from the leaders themselves.”
The group from Sequim spent a day and a half at the Swinomish recovery center, watching patients spill into a lobby with a carving of a hummingbird — which represents healing — fixed to the wall. About a half-dozen counselors offered behavioral therapy and support groups. Tribe members led talking circles. Signs above meeting and medical rooms were in English as well as the Swinomish native language.
Officials from the Jamestown tribe returned to the Swinomish recovery center three more times before announcing plans to open their own center in Sequim. The state provided $7.2 million, and the tribe put in $4 million, with an estimated $25 million more in tribal money committed over time to the development and operation of the center, as well as a broader campus of community health services.
“We will become the Northwest Mayo Clinic, with respect to this opioid challenge,” tribe leader Allen would say.
Fear and division deepens
The opposition organized at the Big Elk Restaurant just after the Fourth of July last year.
Wilke said she recognized the looks of distress on the faces of the 75 people who gathered to fight the tribe’s plans.
“They felt that typical powerlessness and despair when they find out they’re going to have something done that they don’t have any control over,” said Wilke, a licensed practical nurse, single mother and onetime Republican candidate for a state House seat. “David and Goliath for sure.”
Wilke, who recently announced a second bid for a state House seat, divided the group into committees to reach out to churches, homeowners and business leaders. Some members would visit and photograph the Swinomish recovery center, as well as other drug-treatment facilities in the region. Others would work to raise money so the group could hire a land-use attorney.
SOS signs appeared around town. One went up at a market near the center of town, with stacks of soda cans under a candy-red tractor, another on the fence of a nearby farm that sells organic eggs and kale.
SOS members say they believe the tribe is driven more by profit than the needs of the community, which Wilke said has more than enough drug treatment services. The proposed treatment center would receive as much as $455 per visit from Medicaid for some patients.
Simcosky said that by law, any excess revenue must be used for health-care-related services and that higher Medicaid reimbursement rates would go a long way toward covering costs for patients who may generate a lower rate.
At the Swinomish treatment center, officials noted, Medicaid money is used to pay for services that are not reimbursed by the federal government, including transportation, child care and case management.
“We’re treating the whole person,” said Dawn Lee, chief operating officer at the Swinomish center, which, with more than $10 million in new tribal money, is adding another 23,000 square feet. “We have so many extra services because that is the right thing to do.”
LEFT: Administrative assistant Nikki Force holds a baby at the Swinomish Tribe's center, which offers child care to parents in recovery while they receive treatment.. RIGHT: Certified nursing assistant Elizabeth Pranger watches over children at the center.
Allen said the Jamestown tribe’s proposed treatment center — like all health-care systems — must find ways to cover the costs of quality care.
“To accuse us of being business folks is a compliment,” he said. “We can only secure the best health-care providers if we’re able to generate the appropriate revenue to recruit them.”
As the opposition group grew, and the division in the community deepened, Wilke said she has struggled to control the message.
She said she has cringed at some of the public comments about Native Americans because they distract from the central SOS argument: Sequim does not have the capacity to support a regional drug treatment center. She and others have come to call the tribe “developers” instead of Native Americans to avoid accusations of racism.
“To me, it’s not at all about race,” she said. “It is about a developer and manager who wants to build this profit-making thing in our town without consideration of the impact.”
Wilke, herself a recovering alcoholic, said SOS has spent about $100,000 on legal fees. The group is appealing the permitting process and site design application; a hearing examiner brought in by the city is expected to weigh in on the issue. In the meantime, the group has filed a lawsuit in Clallam County Superior Court, saying the city’s permitting process denied SOS members their due process rights.
“We are for people getting treatment but appropriately sized to the community it serves,” Wilke said. “Treating addicts should not result in the demise of your community.”
NYU’s Krawczyk and other health experts say the fears are common.
“We have a lot of work to do with destigmatizing substance-use disorders and their treatment,” she said.
“If we win, you go away”
Three months after the Jamestown tribe announced plans to open the center, Wilke and members of SOS joined hundreds of others at a public meeting that tribe leaders had organized to discuss the development project. In a room at the civic center, the tribe put up a slide show entitled, “Community Collaboration and Hope.”
Allen stood before the crowd and talked about the health center the tribe already ran, treating 17,000 native and nonnative patients a year across two counties.
“We’ve always been here. We’ve always been part of the community,” Allen began, according to a video recording of the meeting. “I just want to say that to you guys. All health care, whether you have cancer, whether you have pneumonia, whether you have the flu, whether you have a broken bone or if you have an addiction. We want to step up.”
The tribe’s public health officer pointed out that Clallam County had experienced a series of opioid overdoses and that, nationally, an average of 130 people die of opioid overdoses each day. “That’s like a jetliner every two days of people that are dying,” Thomas Locke told the crowd.
County Sheriff Bill Benedict explained that he had visited the Swinomish recovery center to get a better sense of the clients and security measures.
“I was impressed first of all at how clean the clinic was, how orderly it was and how absolutely professional,” he said. “I did not see a criminal element in there.”
From the front of the room, Simcosky listened closely. Dozens of local residents stood behind two microphones, waiting to be heard.
Some praised the tribe for its efforts and called on Sequim to show compassion toward those who need treatment. An SOS leader apologized for hurtful comments attributed to the group.
Others thanked the tribe for its work in the community before outlining a case for moving the center outside of Sequim. “There’s probably not a single person in this room — if I’m wrong let me know — that’s against treating addiction,” one speaker said. “We’re united in purpose here. The scope of the project is concerning for me and concerning for a lot of other people. We’re talking about a huge facility.”
Soon, however, the comments grew bolder and louder.
“This is going to be a big bonus for the tribe as far as bringing in a fair amount of money somewhere down the road,” one speaker said to cheers and applause. “I think this is just a big smoke-and-mirrors thing.”
“You guys are trying to pull a fast one on us,” said another.
Questions flew. Will there be money to hire more sheriff’s deputies? How will Sequim survive if home values drop? Will addicts park RVs along the highway? Surely, one man said, drug peddlers will come to town to supply pills to the center’s clients.
“We know,” he added, “that the next step is halfway houses.”
One speaker challenged Allen to put the proposal on a ballot so voters could decide.
“If you win, you get your clinic and we go away,” the speaker said. “However, if we win, you go away.”
Another opponent pointed out that the tribe promotes gambling through its casino.
“You’re out there selling addiction and now you’re going to be in here profiting in a way that’s very burdensome to the community,” she said.
Later, county Commissioner Mark Ozias would remark, “We weren’t really aware that this sort of underbelly of hatred was so close to the surface.”
The meeting went on for four hours, and it was dark outside when Simcosky finally left. There was a building permit application to submit, design and architectural plans to finalize. With any luck, construction would start in a year.
Simcosky worried about the long-term impact of the dispute on the community, the tribe and the people most in need of help. But he was certain the plan needed to move forward.
He thought of the reflection pool the tribe wanted to put at the entrance of the new center, a place where those in recovery could sit and heal. A tribal elder had once told a story of how life could change like the flow of a stream.
All you have to do is pick up one rock.