How Multnomah County overdose deaths are trending amid nationwide decrease

After years of steep increases, overdose death rates appear to be dropping nationwide. Data compiled by the Centers for Disease Control and Prevention show a 10% decrease in the number of deaths from drug overdoses across the country between the 12-month periods ending April 2023 and April 2024. That number varies significantly by state — while many Eastern states saw double-digit decreases, Oregon saw a 22% increase in that same period.

Still, some local health officials say they’re cautiously optimistic. Teresa Everson is the deputy health officer for Multnomah County. She joins us to talk about what overdose death numbers look like in the county and what they could tell us about the ongoing drug crisis.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. After years of steep increases, overdose death rates appear to finally be dropping nationwide. Data compiled by the Centers for Disease Control and Prevention show a 10% decrease in the number of deaths from drug overdoses across the country between the 12 month periods ending April 2023 and April 2024. It is worth noting that in that same period, Oregon bucked that positive national trend with a 22% increase in overdose deaths. Nevertheless, some local health officials are cautiously optimistic.

Teresa Everson is the deputy health officer for Multnomah County. She says that more recent data shows that Oregon’s largest county is now also seeing a decline. Teresa Everson, welcome back.

Teresa Everson: Thanks for having me here, Dave.

Miller: Before we get to Multnomah County, just how does it feel to see that 10% drop nationwide after years of seemingly unstoppable increases?

Everson: Oh, I’m not sure I can find an appropriate adjective. Exhilarating is the first thing that comes to mind. Relieving. We have been fighting so hard for so long and continuing to see some really sobering data for several years now. It was really exciting to see nationally that we’re starting to see a decline.

Miller: I have read that 12 months is a really short time to see this kind of decrease. Has this been on the horizon or did it take health officials like you and your counterparts around the country by surprise?

Everson: It did not take us completely by surprise. We had suspected that we were starting to see a plateau late last year and some jurisdictions were seeing it even earlier than that. But we suspected that we were reaching a plateau as the rate of increase was slowing down. So I’m not completely surprised here.

Miller: OK. But let’s turn to the Oregon side, because as I noted for the two 12-month periods that were the heart of this national data – where when you average all the states nationwide, you see a 10% decrease – Oregon, as I noted in my intro, saw a 22% increase. Only Alaska saw a bigger increase in the 50 states. Why did Oregon buck that national trend for those two time periods?

Everson: Yeah, that’s, that’s the question of the hour. What I would point out to folks that we probably forget, because it’s been a while since we looked at this data, was at the other side of this really large spike in overdose deaths that we’ve been seeing nationally, Oregon was one of the latest states to start that rapid increase. And a lot of that is due to when fentanyl was introduced into our area. So we may be one of the last to see that dramatic decrease, but we also benefited from being one of the last to start on that rapid rise.

Miller: But as I noted, you are more hopeful now than you would be if the data ended in April of 2024. What has happened since then in Multnomah County?

Everson: Yeah, so I can speak to what the data has been showing us and then I can speculate as to what’s behind the data that we’re seeing. Although really the answers are complex about what drives overdose, both fatal and nonfatal in our area. So what is giving me hope right now is some of the data that we collect that’s a little bit more real time than this April to April, ‘23 to ‘24 data that the CDC was able to release … and that includes data that we get from our EMS partners in Portland Fire. It includes data that we get from our medical examiner’s office, data that we get from our emergency departments, 911 data about calls for overdose. There’s a number of different sources of data that we use to determine what the trends may be locally. And those data are pointing to potentially a decline for this year. Again, I’m cautiously optimistic about that, but at the very least a plateau in our data. So over the summer, we’ve really seen a change in what our numbers look like locally.

Miller: I mean, it’s dramatic if you look at month to month, say, July of this year compared to July of last year, or August as well – it’s a huge decrease. How much stock do you put in comparing one month, say, to that same month the year before?

Everson: Not much stock in a single month. I start to feel better about a trend being real if I’m seeing three or four or five months in a row and to be fair, some of that cautious optimism is knowing that our data is not final for some of these pieces that we’re tracking. Medical examiner data can take months to be finalized, so some of those numbers we know will change by at least a little bit. But the trend across all of those different sources of data that we watch is that there is a legitimate decline happening.

Miller: And I should say that all of this now is publicly available on the county’s dashboard. So folks can look at confirmed fatal overdoses, ER visits, EMS contacts. All of that is available.

Let’s turn to the possible reasons behind this, starting with the work that people like you do. How much do you think nationwide, or if you want to just focus on Multnomah County, is attributable to public health campaigns or advocacy workers?

Everson: I would put a lot of the success behind advocacy, but I’m not going to give the credit to a single agency, ours or another agency. The first thing that I talk about, when I talk about what might be driving this decline that we’re seeing, is continued efforts by people who use drugs in our county to keep themselves and each other safe. And there’s a number of different ways that they do that. It may be keeping naloxone on hand, making sure that they’re using with other folks when possible, paying attention to changes in the local supply and adjusting their practices, maybe using fentanyl test strips, if they’re not intending to use fentanyl, but want to make sure it’s not in what they are using. So I don’t think we give enough credit to people who use drugs to try to make sure that they’re staying as safe as possible and that their friends and neighbors are also staying safe.

Miller: That’s an important point. And I should say that when NPR covered this story, they talked to a fentanyl user in Vermont who said that he and others that he knows have learned to deal with overdoses better. He specifically mentioned some of the things you just talked about. He said that more users carry naloxone and they’re more likely – he too – to use with other people around when they’re ready to offer aid.

It’s hard to know exactly how to read this long-term. It’s not necessarily evidence that the use of potentially deadly drugs is going down, just that harm reduction messaging, to some extent, has been working and people who are using are doing it in a safer way. How do you think about this long-term?

Everson: Yeah, that’s a really tricky question to answer. So, I do think that there has been just a really great push at the education about staying safe. But I think that it’s also been timed with a change in our local drug supply. And we know that the drug supply changes fairly regularly. If this were 10 or 15 years ago, we’d be talking more about heroin than we’d be talking about fentanyl. So we can anticipate that the drug supply even five years from now will probably be different.

The other thing that’s making this complex is, I think you’re right. I’m not sure that use has actually decreased very much. I think overdose has been decreasing. But what has made it constant, if not then increasing our area is methamphetamine use and the prevalence of overdoses that include more than one substance, such as stimulants. So we are seeing a rise in polysubstance. That’s the word that we use to describe more than, more than one substance. Those polysubstance deaths have been on the rise over the past several years.

Miller: If, as you’re saying, one of the, maybe the single biggest reason for this increase in overdose deaths nationwide is chemistry. The fact that fentanyl is so much more powerful than opiates or opioids that were widely available on the street before. Is it possible that the decrease we’re seeing now around the country is also tied to chemistry? It is tied to, I don’t know, on average, a slightly weaker version of fentanyl that’s on the street.

Everson: It is and there’s a couple of different ways that we can validate whether those anecdotes are true or not. And we do hear anecdotes from people who use drugs that what they’re experiencing is that the fentanyl seems to be either a weaker version or that there’s less of it in what they’re using. But we also keep in close touch with other partners who do testing of drugs, whether that’s testing of drugs that people who use drugs have brought in, to try to keep themselves safe, or testing of drugs that have been seized, either by local police or by DEA partners.

So I think there is a very real change in the potency of the drugs that are out there and it’s a tricky thing to talk about because we don’t want to over-sell that current drugs are weaker than they used to be because things can change. A specific source may be more potent, so people may have it in their minds that the drugs aren’t as strong. Maybe I can use more, when in fact what they picked up is still very strong. So we’re trying to be really cautious with that messaging so that people aren’t overconfident in the safety of what they’re using.

Miller: When we talked last year, you said that traditional medication treatments for opioids and narcotics are not as effective against super powerful drugs like fentanyl – something we’ve heard from medical professionals as well. Do you think that medical practices have caught up somewhat, though, in the last year or so?

Everson: I do. We are in close touch with partner organizations, as well as the clinical colleagues within our health department that are on the front line, supporting people with medications for opioid use disorder. And I know that there has been a shift in practice to be open to using higher doses of medications such as buprenorphine to help people with cravings and withdrawal symptoms. So I really do think people have adjusted their practices to try to be responsive to folks' needs. The last thing that we want is for folks to have ongoing severe cravings or severe withdrawal symptoms because we know that’s correlated with the likelihood of disengaging from treatment. So people have really tried to flex to help people who use drugs be as successful as possible.

Miller: We mentioned naloxone earlier. The director of overdose crisis response in Seattle told NPR that they had tripled the amount of naloxone available in the community. Do you have a sense for the availability of naloxone now compared to previous years?

Everson: Yes and no. I’m not sure I can give you a doubled or tripled or quadrupled. I can share that since April 30 of this year, we passed out almost 39,000 doses of naloxone through the health department. We now have a dedicated staff member who is focused on improving naloxone availability and distribution in our area. So we’ve been working hard at this naloxone distribution for the past several years and our amount of effort put into this has certainly increased. But 39,000 is even a hard number to wrap my head around. It’s so much naloxone that we’re trying to get out into the hands of folks that need it.

Miller: The hands of folks who need it – who needs it? I mean, as a county’s deputy health officer, who do you think should have naloxone on them right now?

Everson: I love that question. I don’t think there’s anybody who can’t have it. I think there are people who we prioritize more and certainly the folks who are the highest priority are people who are using drugs. They need to have it on hand, or people who are around other folks while they’re using need to have it on hand. People who live with, work with, are neighbors with, love or otherwise regularly interact with people who use drugs should have this on hand because, while I think the numbers are slightly better, there’s still a lot of overdose out there.

So, if you can anticipate that you may be around someone who overdoses or who might overdose, I would encourage having naloxone on hand. But really, it’s never wrong to have it. Like you might be prepared for any other kind of health emergency that might happen around you. So there’s no one who shouldn’t have it, but we certainly have some priority folks that we try to get it out to first.

Miller: We talked last year about the heightened risk of overdose for people leaving incarceration because they may return to using and their tolerance may have gone way down. With the recriminalization of hard drugs and more people possibly winding up in jail or prison, what are you going to be doing at the health department to prevent an increase in post-lockup ODs?

Everson: So, one of the things that we’re working on in addition to our long standing provision of medications for opioid use disorder is we’re working on expanding our ability to start and then continue medications for opioid use disorder for folks who are released from custody. And we applied for and received a grant from the Bureau of Justice for specifically that, for enhancing our support of people who use drugs around those times of transition. And it includes hiring an additional clinician who will both care for folks while they’re incarcerated, but also will see them after they’ve been released in an outpatient setting and can follow up with them there. So, just in the past year, we have started working on this grant and hired some folks to bolster that transition, to make that smoother for folks.

Miller: Teresa Everson, thanks very much.

Everson: Thank you so much for having me.

Miller: Teresa Everson is the deputy health officer for Multnomah County. She joined us to talk about a drop in overdose deaths all around the country, according to CDC data and according to recent preliminary local data in Multnomah County as well.

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