About this series: Fentanyl is having a deadly impact on Malheur County, and one not well understood. The Enterprise reporting team of Mac Larsen, Isaac Wasserman and Cynthia Liu spent weeks learning about this threat. This is part of a series of their findings. Share your comments and thoughts with an email to Editor Les Zaitz ([email protected]).
Nathaniel Stringer worked for the Malheur County Health Department as a substance use peer recovery mentor when he overdosed on fentanyl last fall, at 35 years old.
He had been in recovery from his own addiction for six years.
“It was an out-of-the-blue situation. You live your recovery every day,” said Hannah Roy, health promotion supervisor at the health department and a life-long friend of Stringer.
The loss of Stringer is still felt in the health department and a sense of loss felt across Malheur County with the rising prevalence of fentanyl-related overdoses and deaths.
“It really is critical that every single person in the community knows that this is a public health crisis,” said Sarah Poe, Malheur County Health Department director.
The spread of fentanyl use in Malheur County has affected almost every corner of the community. From young to old, high income to low income, the prevalence of counterfeit pills and the potency of the drug make fentanyl-related overdoses a danger to everyone.
Stringer’s death last October underscores the risk. He never intended to take fentanyl, but the illicit synthetic opioid was cut into a different substance.
Born and raised in Nyssa, Stringer joined the health department in 2020 at the launch of a new program to provide peer support to those affected by substance use and harm. Last year, he received an award for his service to the recovery community.
He had also coordinated the first needle exchange program in the region because of his own experience with how clean supplies can save lives.
Fentanyl use surges
Fentanyl is a synthetic opioid that is 50 times more potent than heroin. It is driving a rise in overdoses and related deaths across the United States.
The intensity of fentanyl means that a drug overdose can occur faster than other opioids or illegal drugs. According to the National Institute on Drug Abuse, fentanyl causes an overdose by slowing a user’s breathing and cutting off the flow of oxygen into the bloodstream.
Signs of overdose include slow or no breathing, cold, clammy skin, a greyish or blueish hue of the skin, and choking or gurgling sounds.
“It really is critical that every single person in the community knows that this is a public health crisis.”
Sarah Poe, Malheur County Health Department director
Oregon had the highest rate of fentanyl poisoning on the West Coast in 2021, according to federal data. Since 2019, fentanyl has overtaken heroin as the leading cause of drug overdoses in Oregon.
Assessing the true number of fentanyl overdose deaths is difficult because so many go unreported. This can stem from a fear of arrest, the stigmas surrounding drug addiction, and the partial reporting process of public health databases.
“We’re looking at trying to get more agencies to use OD mapping. We would actually understand the number of overdoses that are being reversed or that people are getting help,” said Poe.
Between January and March of this year, Oregon logged 51 fentanyl overdose deaths – nearly three times as many from the same period a year earlier.
Among fentanyl overdose deaths last year were 11 Oregon teenagers, often taking pills they believed to be pharmaceutical Oxycodone or Percocet that were, in reality, fentanyl.
“There are situations where younger adults who are in the party scene or just taking things from their friends that they might even think is ecstasy or just a random pill not knowing that it’s fentanyl,” said Roy.
An estimated 40% of all counterfeit pills contain fatal amounts of fentanyl, according to the federal Drug Enforcement Administration. Even for users seeking fentanyl as a cheaper alternative to meth or heroin, the risk of taking fentanyl is high.
The Russian roulette factor
“It’s like playing Russian roulette with a firearm,” said Detective Sergeant Bob Speelman of the Malheur County Sheriff’s Office.
Public health experts use a chocolate chip cookie metaphor to explain the dangers of counterfeit pills.
Like the amount of chocolate in a cookie, the amount of fentanyl in a pill isn’t consistent, and even a small dose can result in an overdose. Fentanyl accounted for six out of 10 drug overdose deaths in the U.S. in 2020, according to Song for Charlie, a national nonprofit combating fake pills containing fentanyl.
“In Ontario, we’re averaging about two or three overdoses a week,” said Ontario Police Chief Michael Iwai.
Ashley Corder, a Malheur County 911 dispatcher, said the number of drug overdose calls in July seemed “countless,” and Poe said the numbers are “seriously under-reported.”
Mark Keele, clinical supervisor at Altruistic Recovery in Ontario, described the struggle against fentanyl in the younger population as almost as bad as among adults. For Keele, it’s an ongoing battle and the danger of overdose never goes away.
“Fentanyl is on the rise everywhere, especially in Malheur County. I think what a lot of people don’t realize is because we are such a poor county, fentanyl is the drug of choice for a lot of people because that is the only choice,” said Roy.
“We ask the public just to be aware that if you use fentanyl, it could be your last,” warned Malheur County Sheriff Brian Wolfe.
According to Wolfe’s office, most illicit fentanyl comes from Mexico and reaches Malheur County along drug trafficking routes that follow Interstate 84.
Illicit fentanyl is often sought by heroin and meth users because it produces a greater high at lower cost.
Wolfe links part of the rise in overdoses to the decriminalization of drugs in Oregon from Measure 110, but it mostly stems from the drop in price of illicit fentanyl in recent years. The price of these “fentapills,” as they’ve been named, is half of what it was at the beginning of the pandemic -– now $4 or $5.
Malheur County is part of the Oregon-Idaho High-Intensity Drug Trafficking Area jurisdiction. In the 2023 drug threat assessment, HIDTA stated emphatically that fentanyl distribution had increased in the region. According to HIDTA, a little more than half of all police agencies surveyed in the Oregon-Idaho region reported that the amount of fentanyl increased. These agencies also said that counterfeit pills were the main way the drug was being sold.
Wolfe believes that expanding the county’s focus on fentanyl will help combat its prevalence in the community. By December he hopes to have a county task force in place with partners from Oregon State Police, Idaho State Police, HIDTA, Ontario Police Department, and neighboring sheriff’s offices.
In the meantime, sheriff’s deputies in Malheur County and officers in Ontario have been trained to administer naloxone, a prescription antidote to prevent opioid overdose better known by its brand name Narcan.
Fighting overdoses with Naloxone
Narcan can be administered as a nasal spray or injection during an overdose to save the user’s life. The federal Centers of Disease Control and Prevention advises on its website that it may be necessary to administer more than one dose of Narcan to an individual overdosing from fentanyl because of the strength of the synthetic drug.
Iwai has presented a drug prevention program in recent months to school administrators, road crews at the Oregon Department of Transportation who can encounter emergency situations, and community organizations like the Rotary Club. The program teaches the signs of an overdose and how to administer Narcan.
Iwai believes that collaboration across the county will help drive down the number of overdoses.
“I think that we’ve got the commitment from the agencies here to actually make an impact that’s going to benefit the communities that are involved,” said Iwai.
The difference that Narcan interventions can make during an overdose is significant.
Speelman noted that some drug dealers and users carry Narcan as a precaution.
Recently, a sheriff’s deputy saved the life of a young woman overdosing during a routine traffic stop because the deputy was carrying Narcan and was trained to administer it.
“We’ve pretty much doubled our amounts of giving out Narcan from last year and we’re only halfway through the year,” said Roy.
The health department doesn’t charge for any of the Narcan it distributes to the community and funds the life-saving drug through the peer mentor and safe syringe programs. As long as they have it in supply, anybody looking for Narcan can get it at their offices or go to one of their syringe exchange pop-ups.
“We need a lot of Narcan in our community. I would love to see it in every business, in every public space,” said Poe. “I think it’s important that you would have it with you. It’s something that can save somebody’s life. But at the same time, it’s not the long-term solution. The solution is that we get people into treatment and recovery.”
Malheur County agencies can provide medication-assisted recovery but lacks a medical detox facility for those going through the severe withdrawal symptoms of opioid addiction. The closest such facility is more than an hour away in Baker City, and for a county hit as hard as Malheur, a medical detox facility would make a big difference.
“Why aren’t we talking about this? Hey, why are we turning our backs on all this when, you know, the people that are involved with this part of the community? You know what a nightmare it is and how hard it is to get off. But we’re not talking about it,” said Keele.
In the meantime, the health department provides peer recovery services and needle exchange programs.
The Ontario office of the Oregon Department of Human Services also provides resources for families dealing with substance abuse. By working with treatment programs such as Altruistic Recovery and Lifeways Recovery Center, parents can get help and reunite with children removed because of the risks.
“I think a key piece of our job is giving people hope, right? Like it’s never too late,” said Melissa Phillips, a state addiction and recovery team caseworker.
Poe and Roy also emphasized the importance of non-judgmental communication in combating drug abuse. Deadly overdoses can be avoided when family and friends intervene.
“It’s recognizing that people are hurting, and how can we make sure that they get the help that they need, so that they’re not harming themselves,” said Poe.
Roy thinks Stringer would’ve wanted his experiences with opioids to be shared.
“He wouldn’t have wanted it to be a scary thing. He was about harm reduction,” she said. “This can happen to anybody at any time. Watch people and make sure they’re OK.”
Next: Sneaky Killer – Local people affected by the surge of overdoses.
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