A man who was just revived from a near-fatal overdose climbs into the back of an ambulance.
Kristyna Wentz-Graff / OPB
Earlier this year, Gov. Tina Kotek, Multnomah County Chair Jessica Vega Pederson and Portland Mayor Ted Wheeler declared a 90-day state of emergency to address what has become widely seen as a fentanyl crisis in downtown Portland. The idea was to bring more coordination and resources to bear on the crisis that is claiming lives through fatal drug overdoses and draining the resources of law enforcement, first responders, public health and medical professionals. The 90-day period ended April 29, and the official report on the progress that was made was released today. We talk with Multnomah County Health Officer Dr. Richard Bruno to get the details.
Note: 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. Earlier this year, Oregon Governor Tina Kotek, Multnomah County Chair Jessica Vega Pederson and Portland Mayor Ted Wheeler declared a 90-day state of emergency to address fentanyl. The big idea was to coordinate the response to the crisis that is claiming lives in fatal drug overdoses and draining the resources of health officials, first responders and law enforcement. The 90-day period ended a few days ago and a progress report was released today. Richard Bruno is board certified in family and preventive medicine. He is the health officer for Multnomah County and the Tri-County region, and he joins us now. Dr. Bruno, welcome.
Dr. Richard Bruno: Thank you, Dave. It’s so nice to be here with you.
Miller: It’s good to have you on. What do you see as the most important results of this 90-day emergency order?
Dr. Bruno: Yes. I think there are three main points that I’d like to highlight about the fentanyl emergency because it not only made a visible improvement downtown, but it allowed partners to discover new ideas and new ways of working together that will serve beyond the 90 days–a lot of new projects, pilots and initiatives that are breathed into life or continued as part of it. But I think one of the other important points is that it helps streamline a lot of the work that’s being done on the three governmental agencies that have been involved at the city and county and state levels. So now everybody’s harmonizing together [and] they’re collaborating in ways that they hadn’t before.
Miller: Well, if I could dig into that and then we can talk about some of the other specific things. But because that was one of the explicit goals, to break down organizational silos, what’s an example of a silo in the past that got in the way of public health?
Dr. Bruno: Yeah, absolutely. I’ll give you a great example. We launched a new overdose dashboard, a public dashboard that lets folks see exactly what the response to overdoses in our community has been. And for the first time, we’ve been able to connect with various other agencies to put all this data in one place. So we’re finally sharing data, we’re analyzing data and we’re presenting and visualizing data in ways that we haven’t done before. And so this new public overdose dashboard has really shown what we can do when we combine not only our 911 data, but our fire data, our ambulance data, our hospital data, and our medical examiner’s office data, all five of those into one dashboard that anybody can view.
Miller: And I viewed it this morning. I could see month-by-month things like overdose deaths, ER visits, 911 calls, fire calls in this dashboard. But on some level, that seems retrospective. I mean, I could see what happened month after month. How does that actually help in terms of the response?
Dr. Bruno: So what we want to understand is trends in public health. We talk about wanting to take a large look at large data sets and start to understand spikes and dips and changes, and be able to address and focus resources hyper localized into areas that are of high need. And so what this visualization does for us now is it helps us and in pretty good real time, especially on the 911 data side and the ambulance level side, what happened yesterday, what happened in the last few days? The medical examiner data takes a few more weeks or months to sort of get together. We’re working on streamlining that as well. So what it helps us do is create this larger picture that we can understand where we can start to present and focus these interventions in the community.
Miller: One thing the dashboard told me is that there has not been a reduction in the number of overdose deaths. In fact, so far, the 2024 average – which includes three months under the emergency order – as a whole, the year-to-date average is higher than last year’s average. What does that tell you?
Dr. Bruno: Some of this data is incomplete because, like I said, there’s been some lag in some areas. But what it says is yes, we’re still seeing an increase in deaths but it may not be rising as quickly. So we may not be accelerating as fast. There may be interventions that we’re doing in the community that are slowing this rise and decelerating it to some degree. So it’s a little too early to tell if this emergency declaration led to a reduction in deaths or the rates of overdose, but I think it helps us add to this picture and helps us start to streamline these data streams a little bit more clearly.
Miller: Can you help me understand how you might use this data? Because as you said, for example, the 911 or fire response data can be relatively granular and you can look at what happened yesterday or the day before. What might you do collectively differently now, because you can say there were – I’m making this up – four overdose deaths or 15 calls for service in this two-block area yesterday? What will you do with that?
Dr. Bruno: Well, what it helps us do is it helps us coordinate with other agencies so we can let folks know on the ambulance side or the firefighters side, some of those first responders that, “look, we’re seeing a spike here and this may be something to keep a close eye on.” So if we’re seeing more calls, we need to devote more resources to be able to respond to those calls and be able to also provide better outreach to people in this area, help provide faster referrals for people who are looking for drug treatment, who are looking to stop using fentanyl. And all of this is a part of a coordinated effort that we’re starting to expand these days as well.
Miller: What does it mean to say that this emergency order is over in terms of what you’ve been talking about so far, such as the dashboard and the efforts to break down organizational silos? Is any of that stopping when the 90 days now have ended?
Dr. Bruno: Well, I’m happy to say that much of this work will continue, especially these pilot programs that have been breathed into life during the 90 days. A lot of this is going to continue to happen. We have efforts to continue coordinating with our various agencies. So for example, our chair of the county commissioners, Jessica Vega Pederson, is calling together a countywide operational oversight committee that will be run by her office. We’ll continue regular coordination, similar to our daily calls, on a weekly basis. We’ll continue monthly cross-disciplinary strategic planning calls with the tri-governmental agencies, other nonprofits and private industry as well. So we’ll be continuing to work together and also track and coordinate different policy and legislative efforts.
Miller: I’ve talked to your predecessors over the years a number of times a ton about COVID, obviously, but about all kinds of things, about nicotine, about other infectious diseases besides COVID. Where would you say that fentanyl sits in terms of your priorities as the Tri-County region’s top health officer?
Dr. Bruno: It is definitely one of our top priorities. If you look back at various public health emergencies in the past, when we look back into the 1950s when motor vehicle accidents were a top cause of death in communities, we developed an entire emergency medical system and highway system that helped provide ambulances to be able to address these large systems of care. And put those into place to reduce the number of cardiac arrests, strokes and heart attacks, and help get people [with] traumatic injuries to hospitals as quickly as possible.
Right now, we are not really building a system of care around the fentanyl crisis like we had done 60-70 years ago for other major catastrophes. So I think it’s really important that all of these processes are starting to align. We’re really starting to pull together different government agencies to create this new system of care so we can take better care of people and prevent that death.
Miller: The CDC talks about different waves of the opioid overdose epidemic over the last two decades or so. First came a wave of deaths from prescription painkillers, then came heroin when people turned to heroin because it was harder to access legal drugs like oxycodone. Then came where we are now, the synthetic opioids, especially fentanyl. Do you have any sense for what might come next? I mean, I’m just wondering how much health authorities can be proactive now as opposed to reactive.
Dr. Bruno: Yeah, absolutely. And the CDC is a tremendous resource for us to be able to connect the dots, not only within our own region but across the country, so we’re looking at other jurisdictions around the country. For example, on the East Coast, there is a rash of xylazine, which is an animal tranquilizer being cut into the fentanyl supply there. Luckily, we haven’t had very much of that here, but we’re having to prepare for it in case we do start to see more wounds caused by drug use that’s been – fentanyl specifically – cut with xylazine.
We also see most of the folks who are using fentanyl these days in an illicit form are smoking it, but some people are starting to inject it. And so that also raises red red flags for us. We want to make sure we’re preparing to help people reduce the harm of injecting. If people are starting to use needles again, we want to make sure that we are ramping up our safe syringe programs to be able to provide harm reduction for folks as well. So we’re keeping an eye out for a lot of different fires that could be coming around the corner.
Miller: Just briefly, in terms of harm reduction there, in terms of intravenous drug use, is it largely about preventing the spread of infections or is it that it could be an even larger dose if you’re taking it intravenously? And you have about 30 seconds for that answer.
Dr. Bruno: It’s an infection that can happen in the skin or in the heart. It’s hepatitis, it’s HIV, many of those infections that can be shared between people who are sharing needles. But essentially, yes, we want to provide clean and safe needles for people who are using and then also connect them with care, connect them with referrals to different drug treatment programs, if they want to stop using.
Miller: Richard Bruno, thanks very much.
Dr. Bruno: Thank you.
Miller: Richard Bruno is the Multnomah County health officer. He joined us to talk about the end, just a couple of days ago, of the region’s 90-day fentanyl emergency.
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