As the 90-day fentanyl emergency progressed past its halfway point, the Multnomah County Board of Commissioners received an update Thursday, March 21, from the Unified Command Center and the Health Department on the latest developments.
Abbey Stamp, a County agency administrator, shared that five new overdose data dashboards would launch Monday, March 25, on the County's Fentanyl State of Emergency website. Data will come from the County Medical Examiner's Office, fentanyl-related visits to emergency departments and urgent cares, the City of Portland’s Bureau of Emergency Communications, American Medical Response (AMR) ambulance responses, and Portland Fire & Rescue.
“We note the importance of sharing and being transparent about these processes as they emerge week over week,” said Stamp.
Stamp said the work of Unified Command also has resulted in week-over-week increases in the number of arrests and fentanyl grams seized by law enforcement; total contacts by the Behavioral Health Resource Center and other outreach staff; and the number of overdose reversals and substance use treatment referrals.
“We are having lots of successes during the day; we also know we need to continue to work in the nighttime, evening hours and on the weekends, and different spots that are continuing to challenge some of our coordination efforts,” said Stamp. “The Unified Commanders are working every day to identify ways to fill those gaps.”
Health Department updates
Communication campaigns
On Monday, March 18, the Health Department launched the first of three upcoming communication campaigns related to overdose response and prevention. "Recovery Is Possible", a media campaign that includes billboards, posters and digital assets, aims to inspire more people connect to recovery services and support.
The second campaign, which will launch in April, focuses on educating and raising awareness among youth about the risks of fentanyl, as well as providing resources, such as information on how to reverse an overdose. The third will be an addiction and recovery information website that explains the science and addiction and provides resources for people with a substance use disorder.
“I wanted to highlight the importance of painting a local landscape and focusing not just on the assets, but the stories we're telling,” said Diego Basabe, a communications and marketing team manager. “Our marketing approach is to focus locally in Multnomah County, grounding it in reality, and making sure the resources we provide and the assets we create speak directly to our residents and to our youth in particular.”
Fentanyl-related data
Epidemiology Manager Dr. Emily Mosites shared that her team's ongoing work to support the fentanyl emergency response has included increasing its analysis of fatal and nonfatal overdose trends, mapping fatal overdoses, and tracking substance use treatment offered through County services and County-funded organizations. Dr. Mosites' team has also convened agencies to inform the new overdose data dashboards.
Dr. Mosites also explained how nonfatal and fatal overdose data are recorded differently.
“There has to be an organization present to record a nonfatal overdose,” said Dr. Mosites. “About half of nonfatal overdoses may be reversed by bystanders who do not call 911, so those overdoses are not included in the data.”
Fatal overdoses are investigated by the Medical Examiner's Office and recorded on death certificates. However, Dr. Mosites cautioned, it takes significant time — about three to four months — to confirm overdose deaths. Nonfatal overdose data, on the other hand, can be available 24 hours to a week after the overdose occurred.
Dr. Mosites presented a graph showing the number of confirmed fentanyl-related overdose deaths each month over the past five years. Because of the time it takes to investigate and confirm a suspected overdose death, the data from 2023 are not yet complete.
“I want to take a moment and acknowledge this is not just a graph; this is a representation of over 860 people, community members and loved ones who have lost their lives to a fentanyl overdose,” said Dr. Mosites. “In 2023, it was more than one person per day. And if you know someone in these data, this can be hard to look at. It shows us the direction we do not want to keep going.”
Dr. Mosites presented a map of Multnomah County split into hexagons showing confirmed fentanyl-related overdoses over the past five years. Red hexagons that represented areas that had more overdoses than would have been expected by random change were concentrated in the downtown Portland area.
Health Department Director Rachael Banks concluded with an update on the fentanyl summit the Health Department hosted March 13. Over 150 providers, peers and community-based organizations came together to identify direct pathways into existing clinical addiction treatment services and provide insight into those different options, “understanding that one size is not going to fit all,” she said.
Banks explained that the summit facilitated a series of interactive conversations in breakout groups that covered a range of topics including prevention, harm reduction, treatment (including medically assisted treatment) and recovery.
As summit participants mapped where services are happening, they identified that a single database of services could help escalate those referral pathways. “Based on the data and the needs in our community, there is more of a need for culturally and linguistically specific, appropriate and responsive services.”
A theme that came out of the discussions was that while convening and collaboration are necessary to solve this very complex issue, it is not sufficient. “Yes, we need to be connecting, but really moving towards action,” said Banks.
Board comment
Commissioner Julia Brim-Edwards asked for data on how many people call Lines for Life or visit Recovery Network of Oregon's website, which are two of the metrics for the Recovery Is Possible campaign.
“When people call looking for treatment, they need to actually get treatment,” she said.
“Nothing kills hope like not actually being able to receive the service. We can have an amazing campaign, and we can get people to take action, but if we don't have a plan to actually have treatment accessible, then there's a huge missing gap in whether we're going to be successful.”
Commissioner Sharon Meieran asked if the Health Department communications team worked with the Office of Consumer Engagement, which works in part to ensure County services are informed and supported by peers who have lived experience recovering from mental health and substance use conditions.
“We have a director of consumer engagement [DeAndre Kenyanjui] who is incredible and tied into all the peer groups in our community. He has a team, how is that whole team, in particular DeAndre, included? And did they approve of the advertising campaign?”
Basabe assured that the department’s campaign will use digital assets and videos to tell stories that feature actual community members in recovery explaining why they chose recovery and the message they want to share.
“We're working with the Office of Consumer Engagement on those specific assets,” said Basabe. “We had a photo shoot with them with folks in recovery. All these campaigns have been informed by folks with lived experience and living experience in recovery.”
“There are known unknowns and unknown unknowns,” said Commissioner Jesse Beason. “On the epidemiology side, what are the things we wish we knew but don't have access to that would help us make better decisions?”
“Epidemiology is a bit like chasing a ghost, because there's always a time lag,” responded Dr. Mosites. “It works best in retrospect, looking at things that have already happened and the most severe outcomes. The unknown unknowns right now would be what is happening with people who are currently using, and what's happening with people who are currently at risk.
“Those data are very difficult to come by.… The way we're approaching that is by triangulating that information using the information we do have, focusing on what we can learn from the people who have unfortunately lost their lives to this.”
Allowing space for community wisdom even while gathering data and analytics is important, added Banks. “Because that lag, being able to listen, being engaged with people — that's going to tell us before we see in our data what's happening.”
Chair Jessica Vega Pederson noted the positive feedback from those closest to the work of the 90-day emergency reflected trends in the right direction. “We are working better together than we ever have before at building trust and safety. We're understanding our resources and gaps better today than we did on Jan. 30 and we're making progress. But as much as this emergency is helping us to see what's working, it's also exposing our gaps and helping us see what we need more of.”