Last month, the public health department in Clark County issued a warning about an increase in suspected opioid overdoses last month. Ten people, ages 18 to 72, visited emergency room departments in Vancouver for treatment of suspected opioid overdoses linked to fentanyl during a four-day period, from April 15 to April 18. None of the overdoses were fatal, which the health department attributed to the administration of naloxone, an opioid reversal drug that is being made freely available at pharmacies and other locations in the county. Joining us to talk about this issue and harm reduction efforts to combat opioid overdoses is Dr. Steve Krager, deputy health officer for Clark County.
The following transcript was created by a computer and edited by a volunteer:
Dave Miller: From the Gert Boyle studio at OPB, this is Think Out Loud. I’m Dave Miller. Ten people with suspected opioid overdoses ended up in emergency rooms in Vancouver over a four-day period last month. Most of them were treated with the overdose reversing drug naloxone, and none of them died. But it was a big enough spike that the Public Health department in Clark County issued a warning. Steve Krager joins us to talk about this. He is the Deputy Health Officer for Clark County. Welcome to Think Out Loud.
Steve Krager: Thanks for having me.
Miller: So I mentioned 10 overdoses, or suspected overdoses, over this four-day period. That was above average. What is a more typical number?
Krager: For that four-day period, we usually see around two to three. So a pretty significant bump.
Miller: What are your theories for what was behind that uptick?
Krager: It’s a great question and something we obviously try to figure out ourselves. The main answer is that we don’t know. And there’s lots of reasons why this could occur. There is a little bit of seasonality to overdoses that we see, where we start to see a little bit more happen in the spring and into the summer. That could explain a little bit of it, but obviously there’s lots of other factors. We don’t know what types of drugs are out on the streets right now. We don’t know potency in regards to fentanyl. Unfortunately, [with] the kind of granularity of this data, we don’t know exactly how people were using, whether they were injecting or smoking or taking pills. Theoretically we could have [a] higher potency supply out there and that could be leading to more people [overdosing] as well. So, we obviously talk with our partners, law enforcement as well as community partners that work with people who use drugs, and try to see if they have any ideas. This is one where we’re not sure. So we have lots of theories. But in terms of getting a certain answer, right now, we don’t know.
Miller: From a public health perspective, I can imagine that that’s pretty frustrating. That the more you know, the easier it is, I suppose, to give people really useful information.
Krager: Right.
Miller: Are these questions that you’re likely to get answers to in the future, or might you never know the reasons for any particular spike?
Krager: Yeah. Sometimes, we never know. And that is frustrating, absolutely. Sometimes if these overdoses end up in deaths, which does happen sometimes, not in this case. We’re able to gather more data, right? We work closely with the medical examiner’s office and [we are] able to get specific drugs that are in people’s systems.
But oftentimes, yeah, it is very frustrating. And that’s part of the reason why we released this, is because we didn’t want – we didn’t know for sure, what exactly was happening, but we wanted the community to know that something was happening, and just to be a little bit more aware. So people could take more precautions if they’re using drugs. If you have a friend or family member that you know uses drugs, having naloxone on hand. There’s various actions that we wanted people to take, just to kind of remind people what is happening.
Miller: Did other counties in the region, I’m thinking about Multnomah, but other ones, in Southwest Washington also, did they report similar increases at the same time?
Krager: It’s not in this exact same time period, no. So none of the other counties in Southwest Washington have gotten a recent notification like this. We do work very closely with our partners across the river in Washington, Clackamas, and Multnomah [counties]. And we did hear about, not this large of a spike, but more overdoses happening towards the end of March into early April in Multnomah County. But again, it’s hard to know whether that’s connected to this or not. We certainly share a lot of the same supply, people cross the river. There’s no real clear geographic boundaries, people move all the time. So there’s certainly a possibility that there was a connection with that increase in Multnomah County. But again, we’re not sure.
Miller: What about basic things? I mean, do you know what drug, or drugs, were involved?
Krager: Yes. So the majority included fentanyl. We do know that. And then there was methamphetamine also seen in a few of the cases. And that’s been matching what we’ve been seeing when we look at our data overall, over the past couple of years, especially. Fentanyl is driving the vast majority of the increase in cases of overdose,
both in just overdoses in general as well as overdose deaths. But methamphetamine is also increasing, in terms of overdoses. So those were the primary culprits in this spike. And that matches kind of what we’ve been seeing.
Miller: I was struck by the ages of the people in this cluster, as young as 18. That’s not the part that surprised me – as old as 72. What does this age range tell you?
Krager: It’s a great question and unfortunately, it’s not uncommon to see overdoses in younger people, but also in older people as well. And to me, it tells me that people who struggle with substance use, with opioid use disorder, it really spans a lifetime, unfortunately. We think of it as a chronic disease, like we may treat other types of chronic diseases. Some people are obviously able to overcome addiction, in some manner, but for some people, it’s a lifelong struggle. We certainly see more overdoses in young people, but it’s certainly not uncommon for it to occur in the older population, as well.
Miller: As I mentioned, the good news here is that none of the 10 suspected overdoses in this four-day period, people who ended up in the emergency department, none of them were fatal. How do you explain that?
Krager: The biggest explanation, or the one that makes the most sense to me, is that most of these people were given naloxone, which is the opioid reversal medication that we have, also known as Narcan if you give it intranasally. So that is a very common way for people to treat an opioid use overdose, and that did occur in this scenario. And the other thing I would say is that these people ended up in the emergency department, right? So they were being monitored, they were getting health care treatment. And unfortunately, it’s not the case with every overdose that we see. So to me the lesson, one of the biggest lessons is having naloxone available. Somehow these people had naloxone available. Not in not every case. We don’t know whether it was given by a bystander, a friend, or EMS, or in the hospital. We don’t know that for sure. But we do know naloxone is widely available. It works really well in reversing overdoses, and we want people to be aware of that.
Miller: What is the availability of naloxone? Like you said, it’s widely available. What does it take for just anybody to get it?
Krager: In Washington, we’re fortunate that you can walk into any pharmacy and ask, and they should give you naloxone, which is great. We also have two naloxone vending machines in Clark County. It’s a newer program, but both at the Exchange Recovery Cafe and at Lifeline we have these vending machines. There’s also vending machines in Skamania and Klickitat County as well. And literally, you can just walk up, punch the numbers like you would on any other vending machine, and it will give you naloxone. So those are the easy ways. Obviously you can get a prescription from a provider. But we really want it to be widely available. We also offer training for anyone who wants to know how to respond to an overdose.
Miller: Around the time that this uptick in overdoses was happening in Clark County, Multnomah County health officials announced that xylazine, the horse tranquilizer also known as ‘tranq’ that has been showing up in combination with fentanyl all over the country, that it played a role in an overdose last fall. Even though that was last fall, it was just a couple of weeks ago that that was announced by Multnomah County officials. Have you yet found xylazine in Clark County?
Krager: That’s a great question. So there has been very low numbers of xylazine found in people overdosing. We can’t say the number. We haven’t seen a death, I will say that, from xylazine, but we know it’s around. We know other parts of the country certainly have much higher availability of xylazine, but it is something that’s concerning, right? Especially when being mixed with other drugs, it can cause overdose. And if it’s mixed with … xylazine is not an opioid. So if you take it, naloxone may not work. You should still give naloxone if you think somebody is overdosing because they may have overdosed on an opioid as well. But that’s something that’s really concerning about xylazine.
Miller: Steve Krager, thanks for joining us today.
Krager: Thank you.
Miller: Steve Krager is a Deputy Health Officer for Clark County.
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