FEATURE
All Time High By Jack Harvel
O
verdose deaths exceeded 100,000 for the first time in United States history in 2021, driven largely by an estimated 71,238 estimated deaths from fentanyl, a synthetic opioid that is 100 times more potent than morphine. Opioid overdoses accounted for 25 deaths per 100,000 people in 2021, up 15% from the year before and several times higher than the rate of 2.9 measured in 1999, when the Centers for Disease Control says the first wave of the opioid crisis began. That first wave was pharmaceutical. About one in five Americans experience chronic pain, leading to a push in the late 1990s and 2000s to treat it using semisynthetic opioids like oxycodone and hydrocodone. In 1991, American pharmacies distributed about 76 million opioid painkillers; by 2016 it was around 289 million. As doctors doled out more doses, patients got used to it. In 2002, one in six patients took pills more powerful than morphine, and by 2012 it was one in three. Recognizing the growing number of patients forming substance abuse disorders, health care regulators started issuing stricter guidelines on prescribing opiates, and between 2012 and 2017, first-time prescriptions fell by 54%. This led to the second wave, when fewer prescriptions corresponded to an uptick in heroin overdose deaths starting in 2010 – from a death rate of one per 100,000 people to about five. A 2016 study found that four of five heroin users had migrated from prescription pain medication. “The first five years of my career as a counselor, I basically watched exactly that,” said Josh Lair, community outreach coordinator at Ideal Option, a medical provider specializing in addiction treatments. “Their story pretty much starts with prescription pills, and then they get cut off by their doctor. They start buying them on the streets, it’s way too expensive, they get introduced to heroin because it’s cheaper, and then they are heroin addicts.” It wasn’t long before synthetic opioids like fentanyl surfaced on the market, leading to the third surge and cementing overdose as one of the leading causes of death in the United States, claiming more lives than car crashes and firearms combined in 2021. Oregon’s overdose death rate is the twelfth lowest in the country, and the state has been able to avoid the more acute epidemics of addiction seen in Appalachia, New England, and the Rust Belt. But it is trending in a dangerous direction. Oregon overdose deaths jumped from 462 to 656 between 2020 and 2021, a 28% increase. In 2019, the last year county-level overdose data are available, nine people died of opioid overdoses in Deschutes, Crook, and Jefferson Counties. “Typically, we are lower than state averages in Central Oregon, but we’re following state trends. So, we are seeing a downtrend in certain indicators around prescribed overdoses, or overdoses with prescribed opiates, and an increase of those around fentanyl,” said Katie Plumb, public health director of Crook County and Chair of Central Oregon Overdose Crisis Response Taskforce.
Courtesy of the National Institute on Drug Abuse
The Unique Danger of Fentanyl Fentanyl differs from prescription opioids and heroin in its strength, needing just three milligrams to make a dose fatal, compared to 30 milligrams for heroin. In Central Oregon, fentanyl mostly takes the form of mass-produced counterfeit pills that resemble oxycodone, but sometimes mimic other opiates, and even benzodiazepines like Xanax. Courtesy of the National Defense University
The couple of miligrams of fentanyl shown next to this penny could be fatal.
“The tablets are so well made that even experienced users say that they can’t tell the difference between a counterfeit pill and a pill manufactured by a pharmaceutical company,” said Sgt. Kent van der Kamp, a member of the Central Oregon Drug Enforcement Team. “To be clear, these are not pharmaceutical-grade
painkillers; they are ‘basement’ pills made by the drug cartels. There is no quality control. Pills in the same batch can have wildly varying levels of fentanyl.” Besides pills, fentanyl can also take the form of powder that can be snorted or mixed with other drugs. Van der Kamp said fentanyl is usually sourced from Chinese-produced chemicals that are processed into pills by criminal drug networks in Mexico, who then traffic the drugs up the I-5 corridor. It’s not clearly understood why fentanyl is mostly sold as pills, but van der Kamp said it could be a way to market to people seeking prescription drugs, because pills are less stigmatized than street drugs. Also, the bright colors and various sizes could better attract teenagers. Despite fentanyl’s prevalence, local officials report the drug is not popular, even among its users. “Anecdotally people are not necessarily seeking out fentanyl for use,” said Plumb. “I think it’s still scary to people because of its potency and unpredictability.” Heroin is often laced with fentanyl to augment its strength. It has also been found in stimulants like methamphetamines and cocaine. “Folks are reporting overdosing, but they swear they’ve never used an opiate. They solely say that they use methamphetamine, and yet they’ll overdose and be revived by Narcan (a nasal spray that reverses overdoses),” Plumb said. “And so that is telling us that fentanyl is being cut into these other drugs, unknowingly to folks. And even in the instance of heroin, I think what our law enforcement is reporting in what they’re seeing is that more often there is fentanyl, either in heroin, or in place of heroin.” (Cont. on page 17)
VOLUME 26 ISSUE 26 / JUNE 30, 2022 / THE SOURCE WEEKLY
Overdose deaths increase in Oregon as fentanyl flourishes
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