How some communities are tackling opioid abuse on Oregon’s fishing boats

A recent New York Times article shed light on how some fishing communities are grappling with opioid abuse and overdoses in fishing communities. Overdoses at sea are much more difficult to stop than on land. A program founded by Oregon State University in partnership with Oregon Sea Grant called “Fishermen First Aid and Safety Training” (FFAST) trains communities in general first aid including instructions on how to use Narcan, a drug used to rapidly reverse the effects of an opioid overdose. Upon completion of the training, boats are then supplied with a full first aid kit which includes Narcan. Angee Doerr, who works with fishing boats to implement these trainings, joins us to share more.

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. Commercial fishing is one of the most dangerous jobs in the U.S. According to the CDC, the fatality rate is more than 28 times higher than the national average. Now, fentanyl is having a disproportionate effect as well. The New York Times reported recently that fishing crews suffer rates of fatal overdoses up to five times that of the general population. A program founded by Oregon State University in partnership with Oregon Sea Grant was created to save fishermen’s lives, including from overdoses. It’s called “Fishermen First Aid and Safety Training” or FFAST. Angee Doerr works with fishing boats to implement these trainings and she joins us now. Angee, welcome to the show.

Angee Doerr:  Hi. Thank you for having me.

Miller:  Thanks very much for joining us. So as I mentioned, the New York Times had a really in depth article recently about this issue and noted that fatal overdoses in fishing crews are up to five times higher than in the general population. Do you have a sense for the severity of the crisis in Oregon?

Doerr:  Yes, absolutely. And thank you for mentioning that article. It was extremely well written, and featured several community organizations and partners that we actually work with throughout the United States. So I will say I’ve been working with the fishing community in Oregon for several years now. I’ve been teaching this program since 2019. I am fortunate that I have only heard of or met a handful of people who have been affected directly by opioids in Oregon. So it’s definitely an issue, more so on the addiction side and less so on the overdose side, from what we’re seeing so far for the commercial fishing fleet in Oregon.

Miller:  Why are people working in industries like fishing more susceptible to opioid misuse?

Doerr:  Yeah, that’s a great question. Commercial fishing is incredibly physically demanding. You have people working in harsh and extreme conditions. Our Dungeness crab fishing, most of that occurs in the months of December, January, February. You have people working 18 to 20 hours a day, lifting incredibly heavy pots, in cold conditions, in rainy, wet conditions. So it’s a very injury prone industry. And as I’m sure you and the listeners know, we’ve had a serious problem in the United States where people do go to a medical provider because of a work related injury and they get prescribed opioids for pain.

So we have an industry where people are trying to work through pain. They’re using opioids as pain management. And it is not uncommon in those situations for that to lead to addiction and a growing reliance on opioids.

Miller:  What makes an overdose on a fishing boat different from one on land?

Doerr:  So I would say a couple of things. One, we know people who have come close or had opioid addictions on fishing vessels who genuinely were just trying to keep working. They weren’t trying to get high. They weren’t thinking, in their mind, that they were going to cause themselves to overdose. Opioids can become less effective over time when you’re a habitual user. And they were just trying to keep going. So I think that’s one of the issues.

But I think probably even more importantly than that is what we call time-to-care or time-to-treatment. If you’re in a fishing vessel, you could be hours or even days from help. So it’s not like an overdose that happens in an urban situation, where if you did call for an emergency response, you could have somebody there in minutes. If you called for an emergency response because of an overdose on board a fishing vessel, the likelihood anyone would get there in time to save that person is extremely low.

Miller:  So let’s turn to your role in this. What is the idea behind FFAST?

Doerr:  So the idea behind FFAST is essentially just what I described. Fishermen First Aid and Safety Training was developed based on the principles of wilderness first aid. The idea was that for people on board fishing vessels, there’s a Coast Guard requirement that they have first aid and CPR training. But your average Red Cross course teaches you how to respond to a situation in an urban or near urban environment, where help is no more than 20 minutes away. So while a lot of the skills and topics were applicable, they weren’t necessarily useful or practical for the situations the commercial fishing fleet finds itself in.

We see different types of injuries in the fishing fleet. But more importantly, we see a longer time-to-treatment. So if somebody gets injured on board a fishing vessel, it’s important not only to know what to do immediately, but what to do over a longer period of time. The idea behind FFAST is that we provide those skills to the fishing fleet. It’s a two day course versus a four hour course. It’s very hands-on. We do a lot of skills training with the hopes that we are providing the knowledge and the skills and the muscle memory for somebody to respond to an emergency at sea.

Miller:  Has Narcan – the trade name for an overdose reversing drug – and training in administering Narcan been a part of FFAST from the beginning?

Doerr:  Yeah, it actually has. We teach the course throughout Oregon on the coast. We’ve also taught in Washington, California, and as I mentioned, we have community partners throughout the U.S. We’ve worked directly with our county public health partners in Oregon to be able to distribute the Narcan directly to the fishing community. They provide it for free and we provide it to the fishing community as part of these elaborate first aid kits that we put together for them to have on board the vessel.

We provide one first aid kit per vessel. But we also provide training on everything in the first aid kit. And that absolutely includes the Narcan or the naloxone as well. So they have been receiving the treatment itself, as well as training on how and when to administer it and what it does, for the entirety of the FFAST Program.

Miller:  Do you know if people take ownership of making sure that the Narcan on boats hasn’t expired, and it’s still there and hasn’t been used? It’s one thing to have this training; it’s another to have the kits be stocked.

Doerr:  I’ve actually had boat captains reach out to me because they got a kit two years ago and they’re going through it, and they’re trying to figure out how to replace Narcan. It’s easier now. You can get it over the counter without a prescription. Prior to that, I would either have them come by the Extension Office in Lincoln County, where I work and get it from me, or go by their county Public Health office, depending on what county they were in, and get it there. But we do try to make it as easy as possible for people to replace it when it has expired.

Miller:  Or if it’s been used?

Doerr:  Of course. Yes.

Miller:  Do you hear the stories about it being used after these trainings?

Doerr:  I haven’t heard any stories of it being used on our fishing vessels. But I have had fishing boat captains and crew reach out to say that they really appreciate the training because they’ve had to use it in an urban situation, or a situation on land with a friend or colleague or even a family member. I mean, the opioid addiction crisis is prevalent throughout our communities.

Miller:  A boat owner on the East Coast told the New York Times, in that article that we were talking about, that there is Narcan on his fleet. But it doesn’t seem like he likes it there. He says, “It says it’s OK to have a heroin addict on the boat. I don’t want to promote that.” I’m curious what you hear from boat owners or captains, when you say this is a training I’d like to provide?

Doerr:  Yeah, that’s a really fantastic question. We’ve had resistance to both the training and to providing the Narcan and the first aid kits. And we found it has been very effective to alleviate that resistance or that concern through conversation, both about what Narcan is and what it isn’t. There’s a lot of misconceptions. People think that it’s a drug in and of itself, which it’s not. People don’t necessarily understand why it’s used or when it’s used.

But we also really try to humanize the issue with addiction. We tell stories about how people get addicted, why people get addicted and why it’s a concern in the fishing fleet. And we are fortunate enough that we often have commercial fishermen who will step up and say, “You know, this is something I struggled with in the past. I’ve gotten over it now. But it would have made me feel great to know that that resource was there and that my captain, my crew were trained, if the situation arose where I ever needed it.”

So by really just putting faces of people they know and respect to the crisis helps a lot, but also just alleviating misconceptions about what Narcan is.

Miller:  What about misconceptions about opioid addiction itself? What do you hear from either crew members or captains?

Doerr:  There is absolutely a concern with having people that have drug addictions on board the vessel, which makes sense. It’s like I said earlier on, it’s a high stress job. It’s a high tempo job. And you’re heavily reliant on your crew members. The boats we have in Oregon tend to be pretty small. You might have a crew of three to five people, and you need every single person on that vessel to be contributing to both vessel safety and also, obviously, the fishing endeavor. So there’s absolutely concern with that. But what we try to remind people is that you can’t tell by looking at someone whether or not they have an opioid addiction, for the most part.

The opioid crisis in the United States has hit in a way that’s been very distinct from other overdose and drug addiction crises we’ve seen. It could be your 70-year old neighbor who’s a grandmother and bakes cookies, who got addicted to pain pills and is now trying to find a new way to meet that addiction. It could be the really hard charging crew member you have on board your vessel who injured himself and just couldn’t take the time off to fully recover from that. And just over time, has become addicted to a higher and higher dosage of pain pills.

But the other thing we try to remind people is that the issue with fentanyl is that people can get it without even realizing it. They can get synthetic opioids that they think are safe that contain fentanyl, where even if they took what they thought was a safe dose, just to use for pain management, it can still result in an overdose.

Miller:  As you noted, you’ve been giving out Narcan for five years or so now. Have you seen any shifts in perceptions about naloxone, about Narcan, in that time? Have things changed societally?

Doerr:  Absolutely. I think the fact that it’s now available over the counter, without a prescription, has made people feel a lot more comfortable with it and with having it available. Also, as I mentioned, we do training where we talk about what it is and what it isn’t. Early on there was a general belief that it was a drug in and of itself. That somebody who was addicted to opioids might choose to take it to get that fix. So really, providing the training about what it is does the opposite of that.

The magic of naloxone or Narcan is that it has a stronger affinity to opioid receptors within the brain than opioids themselves. And so it blocks the opioids from binding to the receptors. If the person on board the vessel, that they think needs it, doesn’t have any opioids in their system, it’s not going to do anything. It’s not going to hurt them. But if they have overdosed, it will save their life.

Making people feel comfortable with that, helping people to understand how it’s used, the fact that it’s safe to use, and that at the end of day, it comes down to saving a life and worrying about the value judgments later, I think has really gone a long way to make people more receptive to having it on board.

Miller:  Angee Doerr, thanks very much.

Doerr:  Thank you.

Miller:  Angee Doerr is an Extension Marine Fisheries Specialist at Oregon State University and one of the people behind the program known as Fishermen First Aid and Safety Training, or FFAST.

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