From May to June of this year, the number of 911-related overdose calls in Multnomah County doubled compared to last year. While many calls took place in areas such as Old Town and downtown Portland, data obtained by the Lund Report shows that nearly every residential neighborhood in the Portland area has a reported case. Emily Green is the managing editor of the Lund Report. She joins us to share more on the data she collected and what is happening in the county.
The following transcript was created by a computer and edited by a volunteer:
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. 13 overdoses at the McDonald’s on Portland’s West Burnside, 15 at the Stadium Fred Meyer, 23 at the corner of Southwest 4th Avenue and Washington Street. These are just a few of the details from the Lund Report’s recent analysis of 911 calls in Multnomah County over the last year and a half. There were nearly 7,000 such calls over those 18 months and about 3000 this year alone, meaning more than 16 a day. Emily Green is the managing editor of the Lund Report. She crunched this data and talked to experts about what’s happening and she joins us now. Emily, welcome back.
Emily Green: Hi, Dave. Thanks for having me.
Miller: Can you give us a sense for the scale of the increase in 911 overdose calls over the last year and a half?
Green: Yeah. So before this past May and June, Multnomah County was pretty consistently seeing between 250 and 450 calls reporting an overdose each month. But then in May and June, it shot up over 600 calls for each of those months for the first time since Boeck started recording data the way that it is now, which is in mid-2021. It was actually double the number of calls that they saw in May and June of last year.
Miller: Do we know what happened?
Green: Well, I think the increase that we’re seeing in Portland is really in line with national trends. We know that as fatal overdoses are going up, they’re going up in other parts of the country as well. As far as why there are so many more calls reporting overdose in those two months, I think it just indicates that there are likely more overdoses occurring.
Miller: And is there some sense for why that is?
Green: That’s a really good question. I think, well, fentanyl is driving most of these overdoses according to public health officials. Multnomah County has seen a 530% increase in fentanyl attributed overdoses - or I should say synthetic opioid, which fentanyl is - overdoses since 2018. It can send people into overdose a lot faster. It’s a lot stronger and just, as it’s really taking over the drug supply, it’s driving overdose rates up more and more.
Miller: And is it possible that the numbers you’ve mentioned are themselves an undercount? I guess I’m wondering about potential or overdoses that wouldn’t even show up as 911 calls.
Green: Yeah, figuring out exactly how many overdoses are occurring is really tricky. I mean, the data itself has limitations. Not every overdose is reported as an overdose. Some might be reported as a welfare check, or some other kind of call and then some calls that are reporting overdoses might actually be something else, when first responders show up. And then of course, you have many overdoses that are reversed, that are never reported. But I think that this data is really one of the best indicators that we have for how many overdoses may be occurring. When you look at the ambulance data where first responders are recording what they actually find when they arrive on the scene, half the time [when] they arrive, one paramedic told me, the overdose has already been reversed by a bystander. So they might not record that as an overdose response in their tracking system. How different paramedics record things can vary.
So this call data is probably the best measure of just the geographic spread of the overdoses that we’re seeing, which is all across the county in just about every neighborhood. And just the sheer volume, I mean, there are some locations that have more than 20 reports of overdose just to that location in the last 18 months.
Miller: Just to be clear, when you’re talking about reversed overdoses, meaning that somebody, a bystander or paramedics, would be administering naloxone, Narcan, to reverse the effects of the overdose. So, turning to the geography here that you were just mentioning, I’m curious what stands out to you in the patterns of reported overdoses?
Green: Well, some of the clustering isn’t too surprising. You see a lot around the open fentanyl market that Willamette Week did a lot of reporting on on 4th and Washington and you see a lot in Old Town. But I think what’s really striking about the data is that about half of the calls are made to public spaces. So, while there’s fentanyl trends in just about every state, what I think maybe more unique to Portland is just the rate at which it’s happening outside, in highly visible areas. Calls to businesses, street corners, parks, sidewalks, really made up a lot of the data.
Miller: That’s an interesting point. Because you know that at the beginning, that Portland is not necessarily an outlier in terms of overdose rates, but it may be that we are more of an outlier in terms of just how public this is as our version of a national emergency?
Green: Yeah, I mean, in Portland and other places where housing costs are high and rental vacancy rates are low, drug use and overdoses are happening out in the open in public spaces because so many people have kind of been musical chaired out of the housing market. Of course, Measure 110 took away some incentive to hide behind a bush or a building. So I think in places like Portland, it might be easier to encounter this right out in the open. But it’s important to note that states that have much lower rates of homelessness, such as West Virginia or Pennsylvania, actually have drug overdose fatality rates that are actually a lot higher than Oregon. So, while our situation might be more visible, it’s certainly not an isolated occurrence here.
Miller: It’s important that you just use the word drug overdose fatality rates. Does the data that we’re talking about here, that comes from your digging into 911 calls, include details about the outcome of these overdoses? I mean, specifically, the percentage that are fatal?
Green: The call data does not, I mean, the vast majority of these are non-fatal and I think we hear a lot about fatal overdose numbers, right, when we’re hearing about overdoses and news reports, and I think they’re still working through all the case loads from last year. The County Medical Examiner, but they’ve so far confirmed 334 overdose deaths in Multnomah County last year. But that number is likely to go up as they work through the backload of cases. But, just like we think about the human toll of overdose of fatalities, right? But a lot of these non-fatal overdoses come with a really substantial cost as well. I mean, oftentimes an overdose can cut off oxygen to the brain which can result in long term cognitive impairment, trouble processing, anxiety, depression - are some of the effects, according to public health officials. And you also have the cost of first response. Every one of these dots on this map represent a fire and ambulance response that, when police are available, are accompanied by police as well. So there’s a cost to taxpayers and a strain on the system here.
Miller: And also a call that they’re not responding to, potentially.
Green: All of the dots on this map are calls where first responders arrived on the scene. They might take a while because as you probably know, there’s been some reporting on ambulance response times recently, but they do come unless the call is canceled or it’s deemed to be a duplicate call.
Miller: Sorry, I meant that if by responding to that call, it means they can’t be somewhere else?
Green: That’s true. And I talked to a Teamsters Local 223 official who represents paramedics in Portland. And he told me that overdose response is contributing to an increase in calls for local ambulances. But the majority of calls are for other things. Overdose has made up about 6% of the calls this year.
Miller: What did you hear, though, from paramedics about this aspect of their job?
Green: I talked to Timothy Moman, who’s been a paramedic in the Portland, Tri-County area for decades. And he said there’s definitely been an uptick and it can contribute to burnout and it can be really difficult to respond to these calls over and over again. He says it’s not uncommon for him to respond to three or four a day. One time, he responded to the same person twice in one day to reverse an overdose with naloxone twice. And he hears similar stories from other first responders and it can be a little hopeless. He said they just feel like they’re not really able to do anything to help folks in the long term. They’re just showing up, reversing the overdose, offering to take them to the hospital for follow up, and about a third of the time they don’t. Now he’s taken it on himself to start carrying materials about treatment resources and handouts and flyers. And he said some other paramedics do that too. But other than that, I mean, there’s really no follow up and there’s no official program in place to connect folks to resources when this happens.
Miller: You note that people who’ve had an overdose are at a high risk of overdosing again. I mean, you just noted that this is a paramedic who’s actually brought people back twice on the same day, but there’s no official outreach program or sort of targeted system, to specifically help this population that clearly is so at risk.
Green: According to him, not in connection with the EMT response, no.
Miller: You also included some quotes from a woman named Haven Wheelock in your most recent article. She runs a nonprofit, Outside In Harm Reduction Services. Can you tell us what you heard from her?
Green: So Haven has been working in harm reduction, such as that with syringe exchanges and programs that help people use drugs safer. For a long time, well over a decade, and she carries naloxone, the opioid overdose reversing drug on her person at work and when she’s not at work. We were talking about public drug use and overdoses occurring in public and she told me that, just since fentanyl really took over in Portland, when she’s been off the clock she’s reversed four overdoses in public spaces, simply from being in the right place at the right time. Once at a bar, once at a bus stop, even once when she was getting groceries from a Safeway.
Miller: What are warning signs that people should be on the lookout for?
Green: So, signs of an overdose, if you see somebody who’s lying on the ground in an unnatural way, Haven suggested looking to see like, are they using something as kind of a makeshift pillow, like as if they’re taking a nap in a doorway or are they just lying haphazardly in the middle of the sidewalk, as if they just kind of fell there? That might be a sign of an overdose. People who are overdosing, they will start to breathe a little more heavily before they completely lose oxygen. It might be like the sound of gurgling or snoring. So you can listen to see if they’re breathing effectively and if they’ve lost oxygen, you might see that their lips and fingertips are starting to appear purple or pale blue or kind of an ashy gray. There might be vomit next to them and of course they might be unconscious.
Miller: As I’m listening to this description, I’m thinking that I don’t think very many Portlanders walking around through the city are likely to, first of all have Narcan on them and second of all, go up to somebody who is maybe sleeping, maybe in the middle of a potentially fatal overdose, and then check for all these things, check for vomit, check for breathing. How likely is it that just passers by are going to step in?
Green: I think it depends on the passer by. I mean, we know that a lot of these calls are reversed by people passing by. So it is happening that folks are carrying naloxone and reversing these overdoses and of course, depending on the situation and the person, they might not be comfortable approaching somebody. But I think that’s where, really looking at how they’re laying and if it looks like they’re taking a nap versus just fell. If ever someone is suspecting that it might be an overdose, whether they wanna check on the person or not, it’s recommended that they call 911 and report it as a suspected overdose, so that first responders can come out and make sure.
Miller: You mentioned that Haven Wheelock works in harm reduction and has for a number of years now. Do the incredibly high dosages of fentanyl change longstanding ideas about harm reduction? I mean, things like safe injection sites, for example, when most people now, as I understand it, they’re not injecting fentanyl, they’re crushing it and smoking it on a piece of foil.
Green: Well, safe injection sites are now starting to be referred to as overdose prevention sites, because it’s true. I mean, people are starting to really inject fentanyl on the east coast and harm reduction folks believe that’s probably gonna be a trend that reaches Oregon in a matter of time. Right now they’re primarily smoking it here. But at an overdose prevention site, they could potentially smoke or use drugs in whatever manner they choose, in the presence of medically trained professionals who know how to reverse an overdose, should it occur.
Conversations about overdose prevention sites in Portland have been happening a long time. Even at the county, it’s something that they’ve been talking about for almost a decade. But as public drug use has really increased and all these calls to public spaces, where overdoses are occurring, are becoming so frequent, those conversations have really been revived. According to Multnomah County’s Interim Health Officer, Dr. Teresa Iverson, overdose prevention sites are one of the many tools the county is looking at right now in terms of getting at this issue and fentanyl does have a role to play because an overdose can occur so much faster with fentanyl, and getting that quick response becomes that much more critical in order to prevent somebody from having really devastating long term health impacts from the overdose or of course, potentially dying.
Miller: It does seem like politicians, elected officials, at the county level and at the city level are approaching this issue in very different ways in recent months. Can you give us a sense for what you’ve heard from the city?
Green: Yeah, I mean, the city and county have really been offering solutions from opposite ends of the spectrum. Whereas the county is talking about overdose prevention sites and potentially handing out tin foil and straws as a way of engaging with people using drugs. At the city, they tried to ban public drug use. Of course, that proposal was revoked after there were some questions around the legality of it. And that’s actually where I started looking at this reporting, was when the city was considering that public drug use ban. I was talking to harm reduction officials and officials at the county, just about what would that mean for all of these overdoses that are occurring in public spaces if we were to recriminalize drugs or ban public drug use. And of course, what that would do is just push people kind of into hiding, they said, and then there’d be a lot less chance of somebody being able to see that overdose when it’s occurring and calling 911 or responding with Narcan.
Miller: Before we say goodbye, I just want to ask you about this recent burst of national coverage that’s focused on Portland, Oregon, as a whole and Measure 110, where voters decriminalized drugs in the state. You’ve been covering these issues here, based in Portland, for a number of years now, and I’m curious what you think outside journalists have gotten right, taken as a group and, or gotten wrong?
Green: These stories from national outlets have painted a really colorful and in many ways, very real picture of what’s taking place in Portland. And I think it’s clear a lot of good reporting went into putting these pieces together, but they’re all very, very street level focused and a lot of it is framed around drug decriminalization. I think it’s human nature to want to point a finger somewhere to find an answer to what has caused what we’re seeing on our streets. And I think it’s intuitive to a lot of people to kind of point to Measure 110. But to see what’s really happening, I think you need to pull back from the kind of microcosm of events taking place on the street level and look at Oregon, both in the context of what was happening here before we decriminalized drugs, and then also in the national context.
And I spoke a little bit about this earlier, but we are in line with national trends here. Fentanyl isn’t an Oregon problem. It might be a little more public here. But I mean, before voters decriminalized drugs with Measure 110 in 2020, we had a long failing behavioral health system treatment that was hard to access, issues with chronic street homelessness. So it kind of created a perfect storm, but it’s not unlike what you’re seeing in other places that have taken a more, less criminalization approach to drugs and where you also see high rent and low vacancy like San Francisco, Seattle. Portland, it’s very visible here, but it doesn’t mean it’s not happening in a lot of other places.
Miller: Emily, thanks very much for joining us.
Green: Thanks for having me, Dave.
Miller: Emily Green is the managing editor of the Lund Report.
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