When someone overdoses on opioids, they can sometimes be revived with a dose of naloxone. Often it is a friend, family member or fellow person with addiction who is administering the lifesaving overdose reversal drug. That means the overdose itself may never be counted by medical officials, leading to an incomplete understanding of how many people are nearly dying because of drug use. The Malheur County Health Department is trying to get a handle on the number of nonfatal overdoses taking place by using a survey. Hannah Woods, the health and promotion prevention supervisor for Malheur County, joins us to talk about the effort.
This 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. When someone overdoses on opioids, there’s a chance they can be brought back to life with a dose of Narcan. Often, it’s a friend, a family member or a fellow user who’s administering the lifesaving overdose reversal drug. But these nonfatal overdoses may never be counted by medical officials, leading to an incomplete understanding of how many people are nearly dying because of drug use. The Malheur County Health Department is trying to fill in these information gaps right now. Hannah Woods is a health promotion and prevention supervisor and a certified recovery mentor for Malheur County. She joins us to talk about their effort. Welcome to the show.
Hannah Woods: Thank you, Dave.
Miller: So as I just mentioned, the big idea behind this effort is to fill in gaps in overdose data. But what do you already know about ODs in Malheur County?
Woods: As everyone in the United States might notice, we do have an overdose epidemic happening. And if you don’t know where Malheur County is, we are a rural county on the Idaho and Nevada borders. There’s not a lot of effort that goes into tracking overdoses in a rural area because people might think that there’re no folks using drugs here or that we might not need the services that, say, Portland would. So the only overdoses that we currently track are those that are actually fatalities. And some of those numbers we aren’t even able to access because of confidentiality. Say, if there’s not as many in a month, then we don’t even have access to that data.
Miller: What do you hear from people, assuming that you are able to talk about this, about what it’s like to watch someone, say, a friend or a loved one stop breathing and then to bring them back with naloxone?
Woods: Yeah, it’s a traumatic experience, obviously. As you mentioned, I’m a certified recovery mentor, but I’m just one of many here in Malheur County. Our team goes out and we meet with people who are currently using drugs and they are the first responders to overdoses. They are administering naloxone to their friends, to people they’re using with, to their family, even to their children, and preventing them from dying. And we don’t have anywhere that tracks those overdoses. So it’s almost like, “Hey, I’m doing this huge thing. I’m saving my love’s critical life,” and oftentimes not calling EMS (emergency medical services) for fear of law enforcement involvement. And we’re not able to show that in numbers without the current database that I’m trying to start.
Miller: What exactly do you think those fears are? I mean, what are the specific reasons that somebody would not want a health official or a government official to know about what happened?
Woods: Oregon does have a Good Samaritan law which does prevent you from being charged if there are drugs on a scene when you’re actually saving someone’s life from an overdose. But a lot of people might not know that. And so they might have a warrant, they might be using drugs themselves, and so they’re afraid that EMS or law enforcement is gonna show up to help with that overdose and arrest them or get them in trouble. So I think that’s why a lot of people don’t call for medical help.
We also, as I mentioned, are a very large rural county and I actually worked in EMS prior to this and I know that response times are long. So even if somebody was calling EMS, it could be a couple of minutes to even an hour, in some parts of our county, before they’re there. So regardless of whether or not you’re calling EMS, it is important for families to have naloxone on board.
Miller: How would you say the availability of naloxone is right now in Malheur County, a sprawling enormous county that’s basically a big chunk of southeastern Oregon?
Woods: Yes, it is. I would say it’s OK. It’s not good, but it’s also not bad. That’s a lot of the reason why I want to track these nonfatal overdoses is to help with funding. We are very lucky that we are partnered with the Save Lives Oregon clearinghouse and we’re able to get Narcan from them. But we only get that in our cancer people who are using drugs or who are around those who are using drugs. We’re not able to give it in large amounts to businesses.
We do give it to law enforcement and [inaudible] as well. But if we are able to track these nonfatal overdoses and show that they are happening, we’ll be able to get more funding. Whether that’s for more peer support specialists that are helping, whether it’s for naloxone getting that in the hands of the people, we just wanna be able to have those numbers to show that we need it. Narcan is very expensive.
Miller: So basically, if you can show the Oregon Health Authority or state officials that you have this many more overdoses, nonfatal ones in this case, that is directly tied to the amount of state funding you can get?
Woods: Correct. In Oregon, a lot of programs and grants do come from the Oregon Health Authority. Of course, there’s many other grants from other agencies but specifically, what we are interested in is a position called an Overdose Response Coordinator. They’re in 11 different counties in Oregon and what that position does is it communicates with the public, with public safety. They get campaigns out to talk about that non-overdose and manage the ordering, the buying, the dissemination of Narcan. And we would love to show that we have enough overdoses to qualify for that position or other funding.
Miller: We do have some breaking news that is connected to what we’re talking about. Just within the last hour or so, the city of Portland, Multnomah County and the state of Oregon announced a 90-day emergency plan to work together on programs that crack down on fentanyl dealing and help people who are addicted to this synthetic opioid. They’re going to establish a command center where they’ll coordinate the response, including connecting people to treatment programs, to housing and to other social services.
There’s more detail about this development on our website opb.org. Hannah Woods, I’m curious, what goes through your mind when you see news like this about coordinated efforts in Oregon’s largest city and county with the state?
Woods: Yeah, it’s needed. I’m a person with lived experience. I used to use drugs. I’ve overdosed myself. I’ve seen a lot of overdoses and my friends and family are dying because of them. And I really think it is an epidemic that we need to put a lot of focus towards, especially after COVID. We had all this time that we’re working towards that pandemic and we kind of put other programs, such as overdose, on the back burner. And we can see in the numbers that there’s just more and more overdoses.
Of course, being on the complete other side of the state, I definitely always push and ask for those same resources to be given to other counties. We might not be as big as Portland, but we do have a lot of people coming in and out of our county. We have a lot of drug use, and those resources are just as valuable here or in rural counties like Lake or Klamath as they are in Portland.
Miller: Do you feel like you get sufficient resources per capita? Do you feel like you get as much attention for your residents as Multnomah County does for its residents?
Woods: We don’t, and a lot of that is also our population. If you’re not familiar with Ontario, Oregon, we’re right on the Idaho border. And Oregon has these benefits that Idaho might not. So people can come and shop here tax-free. We have legalized marijuana, which isn’t available in Idaho. We are actually doubling our population of Ontario every day, with people coming in and out to work, to shop, to do recreational activities. So when you look at our population, it might not look like we have the numbers. But we have way more people coming into our county daily than a lot of other places.
Miller: I want to go back to the survey that you and others are working on right now to try to just get this data to find out a fuller picture of nonfatal overdoses. Because you’d mentioned earlier the real reason…some of them tied to misunderstanding or a lack of knowledge about good Samaritan laws. But regardless of whether they’re grounded in legal reality or not, there are entrenched ideas that are preventing people from reporting these nonfatal overdoses.
So how do you get people to open up? Where do you find them? And what do you say?
Woods: I think it’s their syringe exchange programs and having peers, people with that lived experience, able to talk to you. You know, someone might not open up to a doctor and tell them that they’re using substances. But if somebody walks out into your camp on the street and they’re dressed just like you, they appear like you, you might even know them in a small town like this, to be someone who used to use drugs and has now gotten into recovery, they want to talk to you. They trust you. They want to tell you about this extremely hard, traumatic situation that’s going on in their life. And they want help from you. So I think it’s important to have people with lived experience be the ones connecting with people who are using drugs, giving them Narcan, teaching them how to use it and helping them save their friends and family.
Miller: What are the questions that you ask to try to fill in this data?
Woods: Our peer support specialists are around town every week. And weekly, we’re asking the people we’re in contact with if they responded to an overdose or if they heard a run or swing in their camp. We ask them where the overdose took place, whether it’s an apartment, a camp, or a street name. That way I can kind of look through the data and make sure we’re not getting duplicates. Obviously, if they administered naloxone and if so, how much they did. And the biggest one right now is just that they knew fentanyl was in the drug, and if not, what drug they thought they were using. Because we are experiencing fentanyl in pretty much every drug in Oregon.
Miller: And how many previously unknown nonfatal overdoses have you now heard about and verified, to the best of your ability, and entered into some kind of official database?
Woods: I just now launched this survey at the start of this month so it’s very new. Prior to that, and the reason I did launch it is because we are hearing about three to five overdoses a week that were not calling EMS or law enforcement. Since we launched the survey just a couple of weeks ago, I have had four overdoses reported that we have entered into OD maps. And we’re still getting the word out. A lot of people who live outside might not have access to our website or to our email list. And so our peers are bringing paper surveys around as well. So if you don’t have internet, you can still fill that out. Obviously, we don’t want people to be overdosing, but if they are, we wanna be able to track that. Hopefully, we’ll get our funding to help with the crisis.
Miller: A coalition has been meeting in Malheur County in recent months to put forward drug abuse prevention techniques and an overdose response plan for the county. It includes health officials from the county and the state, school folks, law enforcement from both the sheriff’s office and the police department in Ontario. What do you hope is going to come from that collaboration?
Woods: I was very lucky enough to be one of the people who was on the planning committee for a community conversation for overdose. We worked very closely with the University of Oregon to help start that. And so far, we’ve made great progress. We’re meeting again in March. We meet every other week online. For example, right now, we’re working on a task force where it’s law enforcement, anyone serving people in the community who use drugs, whether that’s substance use disorder agencies, our team here at the health department we have on probation, to kind of talk about all of our individuals who we all work with together and kind of plan. Like, hey, this person just got out of jail so what can we do to connect them to medication assisted treatment, give them Narcan, make sure they’re not gonna go out and overdose. So I’m excited for that.
We also have other resources where we’re trying to build prevention in the community,
the activities for children and teens in our community that might not have anything to do but use drugs. So I’m just really proud that we are able to have all these different leaders in our community and even senators and people from across the state come and help us with our overdose prices here in Malheur County.
Miller: If you see somebody on the street and you want to convince them to actually report an overdose, what would you tell them right now?
Woods: I would just say, “Hey, talk to me. Just tell me about it.” It’s not even the fact that they’re reporting it to me. I would just want to get that off their plates. Help them with the stress and the trauma that they experience and help them save more lives.
Miller: Hannah Woods, thanks very much.
Woods: Thank you.
Miller: Hannah Woods is the health promotion and prevention supervisor and a certified recovery mentor for Malheur County. She joined us to talk about the county’s efforts to better track nonfatal overdoses and to prevent all overdoses in the first place.
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