Spike in Rogue Valley fentanyl deaths points to ‘fourth wave’ of the opioid crisis

Illicit opioid use has been a growing issue in the region for years, especially with the increasing use of the exceptionally potent synthetic opioid fentanyl. Jefferson Public Radio’s Roman Battaglia recently spoke to Jackson County’s Chief Medical Officer, Dr. John Mahan about this phase of the opioid crisis.

Roman Battaglia: The big reason I wanted to talk with you right now is that we recently saw this string of overdose deaths in the last few weeks, there were 10 overdose deaths in five days. I’m just wondering what’s happening here? I mean, why are we seeing so many, such an increase or such a dramatic rise in overdose deaths?

John Mahan: Sure, not only are we seeing year-over-year increases, occasionally we’ll see a large number in a short period of time, like this, and it is especially tragic for everyone involved. You know, why this happens, usually is related to a change in the supply, the illicit opioid supply that people are using on the street. So if there’s a new kind of a new batch, it’s coming through the area of higher potency, people may use the same kind of physical amount, but because it’s more potent in that batch, unexpectedly to them, it’ll be stronger in effect and lead to more overdoses, unfortunately.

Battaglia: So it could be because there was a different batch of opioids that has come through that had been at a higher potency. And because people are used to using it at some certain level, it might have just been more potent, and that’s what has created an increase in overdose deaths.

Mahan: I think that’s most likely.

Battaglia: And so that’s one thing I’ve always wondered a little bit about. So are a lot of these dangerous opioids that we’re seeing right now, a lot of this is coming through the illegal drug market then. We’re not seeing as much being prescribed by doctors, like we saw with the main part of the opioid crisis, right?

Mahan: That’s a good question. And as the opioid crisis has evolved in the last 5-10 years, that’s what we’ve seen. People often talk about it now as being the fourth wave of the opioid epidemic. The first wave really being prescription opioids that were either used in higher amounts than prescribed or used by people they weren’t prescribed to. The second wave really being the use of heroin. Third Wave starting to see some contamination with the illicit opioids like fentanyl, illicitly manufactured fentanyl. And then the fourth wave now we’re really seeing it characterized by fentanyl as well as stimulant use. So not necessarily meaning that the stimulants are contaminated with fentanyl, but that people are using street opioids with illicitly manufactured fentanyl, and using stimulants like methamphetamine or in some places cocaine.

Battaglia: In terms of the opioid crisis we’re seeing in Jackson County, what has Jackson County Public Health been doing to address this crisis?

Mahan: We do the best we can to gather as much meaningful data as we can from our partners, from law enforcement, from the state, from local emergency departments and urgent care centers. From EMS, understanding how many times is 911 being called for overdoses? How many times are law enforcement responding? How often are ambulances headed out on these types of emergencies? And how often are people being transported to ERs, people being seen in ERs for overdoses? And we try to bring that data together. And when we see an uptick in that number, issue an alert, just hopefully to get a little bit ahead of this when it’s happening to get that information out to the public to be extra careful.

Battaglia: Do you feel like those alerts help then, that they do something? Because I do see the alerts all the time. I’m just wondering if you see them ever having an effect?

Mahan: I don’t think they’re hurting, I sure hope they’re helping. Yeah, it’d be hard to quantify what the exact impact is, right? We need to know we’d have to have two different identical communities. I think in one community, we issue them, in one we don’t and then compare and I don’t think we’re going to do that. I think that it’s reasonable enough to think that this might be helpful and to go ahead and do it.

This transcript has been edited for length and clarity.