An Oregon bill expanding access to the opioid overdose-reversing drug naloxone passed the Oregon House on March 6 and is awaiting approval by the Oregon Senate. HB 2385 allows public buildings to keep naloxone kits; currently, individuals can carry naloxone but organizations have to have a medical professional on staff to keep and administer a dose. The bill also removes criminal and civil liability for teachers administering naloxone, would allow public safety officers like cops and firefighters to distribute naloxone and decriminalizes fentanyl testing strips — currently considered drug paraphernalia under Oregon law.
The Oregon Health Authority reported 745 unintentional overdose deaths in 2021. Just two years prior, 280 people died from unintentional overdoses. The data for 2022 isn't finalized, but OHA said the number of overdose-related visits to emergency departments and urgent care centers rose in 2022. Naloxone use, which reverses opioid overdoses, is also up, and OHA reported over 5,500 encounters where a dose was administered in 2021, up from about 3,800 in 2019.
Deschutes County Behavioral Health reported little change in the overdoses reported between 2021 and 2022. Both years the department found close to 700 overdoses reported to them both through emergency departments and self-reports at their syringe exchange programs. The number of boxes of naloxone distributed, however, rose sharply from 1,870 in 2021 to 3,006 in 2022.
Deschutes County Overdose Prevention and Response Coordinator Ana Woodburn said the data from 2022 is still coming in, and that all the data is underreported.
"These numbers are still an 'underreport,' because many people who reverse overdoses via Narcan/Naloxone do not seek medical care (which saves resources for the county via decreased first responder utilization and hospital visits, in short) and they also may not report them to us as they fear repercussion or giving out identifying information regarding whomever they use Naloxone on," Woodburn said in an email. "Data for 2022 is preliminary because we typically receive reports from overdoses in the previous year in the first few months of the new year. Additionally, in order to revive someone from an overdose it has taken between 1-8+ doses."
Opioid overdoses occur when someone uses enough opioids to coat receptors in the brain that cause a person to stop breathing. Naloxone pushes opioids off those receptor sites and blocks them for enough time to reverse an overdose. Stronger opioids like fentanyl often need more naloxone to reverse an overdose.
"Folks that are in active overdose are needing more supply or doses to reverse their overdose. And I mean, the correlation between increases in illicit substances, we haven't found that. I think it's just more the awareness of this as a resource for folks that are using drugs," said Colleen Thomas, the homeless outreach services team supervisor at Deschutes County. "Historically, some folks that are actively using drugs were afraid to access a service like Naloxone because they are afraid if they were carrying that could be a criminal offense."
DCBH's harm reduction department already distributes naloxone at its needle exchange events in Bend, Redmond and La Pine. People can also get free naloxone through the county's walk-in services. Naloxone is available at pharmacies, but it can cost as much as $130 for Narcan — a brand of naloxone that is administered via a nasal spray. An injectable version costs about $25. Though the county already offers naloxone for free, Thomas said the bill could help her department supplying the drug and increase awareness that it's available.
"It'll open up additional avenues for us in relation to funding to increase our supply. Historically, all of our access to Naloxone for our supply has been through grants that we've had to apply for. The passing of this bill, will, I think, open up avenues for increased access to the supply. And it might be more streamline access for different community members, or agencies or businesses and the community that might not necessarily have been aware of this before. I think it's going to raise the awareness and the need for this life-saving service," Thomas said.
Deschutes County's harm reduction program already does some of the practices laid out in the bill. The county hands out fentanyl test strips, which the bill decriminalizes and many local public health agencies consider to be drug paraphernalia. The state encouraged more harm reduction programs in 2019, and programs like the one in Deschutes County were the recipients of funding from Measure 110, the bill that decriminalized small amounts of drugs and funded addiction recovery services. Measure 110 funding allowed the harm reduction department to increase staff and introduce new outreach programs.
When new harm reduction programs are introduced, Thomas said some people accuse those programs of enabling drug users. Harm reduction was born out of the HIV crisis, but has expanded to more uses as needs arose and encompasses programs like supervised injection sites, needle exchanges and safer sex programs. Critics of harm reduction prefer full-on abstinence from drug use, but advocates say they should meet people where they're at.
"We know that people use drugs. So by providing life-saving services, just an aid, that isn't necessarily going to increase the amount of people that are using drugs," Thomas said. "If you show up to the doctor, and thinking of a harm reduction model is we are reducing harm for people that are actively using drugs, just like a seatbelt does for people that drive cars."
Bend's Rep. Jason Kropf (D-OR54) is among the sponsors of the bill.
