Oregon opioid overdose deaths increased nearly three-fold. Why?

The coronavirus pandemic has been devastating for people in recovery from opioid use nationwide, and Oregon has been no exception.

For months, people struggled with isolation, diminished access to treatment and a nearly overnight evaporation of the support networks critical to maintaining sobriety or starting on the path toward it.

That, in combination with a “stunning” supply of fentanyl, likely drove a nearly three-fold increase in opioid overdose deaths from 2019 to 2021, experts say. While Oregon’s overdose death rates are relatively low compared to other states, the growth in deaths during the pandemic was among the highest of the states for which comparable federal data is available.

State health officials are cautiously optimistic 2022 won’t show such dramatic increases and that state and local efforts to mitigate deaths will have a visible impact. But whether that optimism is warranted has yet to be seen.

Oregon’s top opioid treatment official, John McIlveen, hesitated to make any forecasts, especially with so little data available for 2022. But the data he does have indicate potential good news.

“It looks like there’s some stabilization,” McIlveen said, though he said what he sees as the core issue – overwhelming supply of fentanyl – does not appear to be changing. The hope, he said, is that the multitude of Oregon Health Authority and local efforts to mitigate opioid overdose deaths will continue to have an impact.

“Time will tell in terms of what the exact outcome is on a year to year basis,” McIlveen said.

So far, the numbers have been shocking.

Overdose deaths from opioids such as heroin, fentanyl and prescription medications climbed from 280 in 2019 to 745 last year, according to the Oregon Health Authority. Available data indicate 2022 could be about as bad as 2021, with 332 known opioid overdose deaths through May.

“It’s highly concerning,” said OHA expert Dr. Tom Jeanne, who oversees analyses of statewide drug overdose trends. “And it’s a really, really complicated issue.”

For the boots on the ground – the thousands of counselors and other health care workers trying to help people get into and stay in treatment – state data only confirm what they have now witnessed for several years firsthand.

Solara Salazar has been in the field for 15 years, first as a counselor, then as founder and owner of Recovery Boulevard and, as of November, founder and owner of Cielo Treatment Center. She has seen what she said was a virtually overnight change in deaths. The flood has changed her.

“I really believed that I could make a difference, you know, that I could help people change the world for the better,” Salazar said. “Now, there’s so many days that it does feel hopeless.”

The key change she has seen, Salazar said, is that before, if someone relapsed, that wouldn’t be the end of the road for them. They would “dust themselves” off and try again, because recovery is a work in progress. Now, she said, a relapse too often means death.

“There’s no comeback from it,” she said. “There’s days that, it’s just, it feels very dark and it feels very difficult to navigate and it’s hard.”

The key difference, she said, is fentanyl. As much as 50 times more powerful than morphine, the synthetic opioid is cheap to get and increasingly is found contaminating non-opioid drugs, such as methamphetamine. As a result, people who have no built-up tolerance for opioids at all could unintentionally have their first contact be with among the most powerful opioids known.

“It’s different from the things that have come before, because it’s more potent, it’s more addictive, and it’s cheap and easier to get,” said Dr. Todd Korthuis, an Oregon Health & Science University addiction specialist.

Of the more than 730 opioid deaths last year, at least 512 involved illicitly manufactured fentanyl, according to federal overdose data. That amounts to about 70% – up from less than 50% of all opioid deaths in 2020.

And because the drug is more potent, it is also more addictive, Korthuis explained. That means more people who try it are likely to become hooked, compared to people who try other drugs.

Oregon ranks first in the country for the percent of people who need substance use disorder treatment but can’t get it, according to the most recent federal survey. And the state ranks second for the highest percent of citizens with substance use disorder in the last year.

“I’ve devoted most of my career to expanding treatment access and developing new treatments for addiction,” Korthuis said. “And I feel like all of our best efforts right now aren’t up to the task.”

An OHSU study this fall found Oregon would need to double its addiction services to adequately meet the needs of Oregonians struggling with addiction, including prevention, treatment and harm reduction. Korthuis lamented what he said was insufficient legislative action on substance misuse primarily to a culture that puts the onus on individuals to treat themselves.

“It’s a combination of stigma (and) of our cultural bias toward individualism and individual responsibility over community responsibility,” Korthuis said, explaining why other priorities might get first pick when resources are limited.

Jeanne, the Oregon Health Authority official, said it will take a multipronged attack to address a societal and systemic problem that has many causes. The agency is running a panoply of programs to help reduce overdose deaths.

It is training employers how to administer naloxone, a medication that almost instantly reverses the effects of opioids. It’s helping provide the medicine to community organizations and tribes. Agency funds help get clean syringes to intravenous drug users. But how soon these and other programs will make an impact is unclear.

“It can take a while to actually see those efforts reflected in the numbers,” Jeanne said.

McIlveen said he hopes the current attention on opioid overdose deaths could help make a dent in the stigma surrounding drug use and addiction.

“Hopefully it makes people stop and sort of think a little bit about people that struggle with these issues, that struggle with use disorders and are in different stages of recovery,” McIlveen said. “And that helping them helps our society as a whole.”

Salazar recalled a former client who died in November as a hard worker who was funny and well-liked by staff and the other clients. He had periods of doing quite well and, most recently, got a job making decent money.

But when he got his first big paycheck, he purchased fentanyl, overdosed and died, Salazar said.

“Some of them just stick with you, you know? I’m not sure why. But I think because he just, he was so sweet,” Salazar said, starting to cry. “And, you know, when they’re young, you think about these lives that they’re supposed to have or could have had.”