In 2011, prescription pain pills were distributed at a higher rate than ever before. Working-class individuals were getting hooked on pills, eventually leading to a rise in deadlier, more easily available street drugs. Now, along with the U.S., Oregon is seeing unprecedented numbers of fentanyl use, a highly addictive synthetic opioid.
In September, The Washington Post released data showing the magnitude of prescription pain pill use in the U.S., providing numbers of prescription pills moving through states and counties.
The Washington Post worked alongside the company that owns the Charleston Gazette-Mail to obtain the extensive data held by the Drug Enforcement Administration. Reporters obtained the data after they began a year-long battle for access to the database.
The data, according to the reports, shows people the rise and fall of legal opioids entering their communities. The trends suggest the decline in prescription pills led to a rise in fentanyl, which ultimately bumped up the overdose rates in several states, including Oregon.
Teri Morgan-Urie, the program director at Springfield Treatment Center and the co-chair of Oregon Recovers, a statewide effort to address Oregon’s addiction epidemic, saw how opioid dependency affected individuals in the state.
“There’s a physical dependence and a psychological dependence and the physical dependency is brutal,” said Morgan-Urie. “If you’ve been taking them and you just get cut off, you are going to be insanely sick, and the solution to that is to use an opiate.”
Nationwide pain pills
The Washington Post reporters sifted through 760 million transactions from 2006 through 2019 that are detailed in the database.
The data found that from 2006 through 2019, more than 145 billion prescription pills were distributed across the country. In that same time frame, 2.5 billion pain pills were supplied to the state of Oregon.
The data proves to be a new look at the surge of pain pills that supported the prescription opioid epidemic. According to The Washington Post article, that resulted in more than 210,000 overdose deaths from 2006 to 2019 and “sparked waves of an ongoing and raging opioid crisis first fueled by heroin then illicit fentanyl.”
The Post’s interactive map details a closer look at county-wide numbers and pharmacies that saw the highest number of pills. According to the map, Curry County, on the southern coast of Oregon, saw the highest number of pills in the state, with enough for 77.8 pills per person per year.
Comparatively, the number of pain pills supplied to Deschutes County was enough for 42 pills per person. In Jefferson County, that number was 33 pills per person and in Crook County, 45 pills per person, per year. Wasco County saw a lot of prescription pills as well with 68 pills per person, per year.
Reporters received the initial data in 2019, spanning from 2006 through 2012, then 2014. The updated data, showing the years 2015 through 2019, was released on Sept. 12.
The data The Post obtained and posted focused on oxycodone and hydrocodone pills. The two opioids, according to The Post’s article, account for three-quarters of all opioid dosages shipped to pharmacies during that time.
Analysis of the data found that the number of pills reached its highest in 2011 and dropped almost 45% by 2019.
A rise in fentanyl
With the decline in prescription pain pills came a rise in other opioids like heroin and fentanyl. A report from the National Institute on Drug Abuse in 2018 found that in the 2000s, 75% of people abusing opioids reported that their first opioid was a prescription drug. At the time, nearly 80% of heroin users reported using prescription opioids prior to heroin.
“It’s less common for somebody to say, ‘I never used before and then I just started using heroin,'” said Morgan-Urie. “That does happen, but most people’s stories start with some sort of prescribed opiate.”
Jess Neuwirth, the health services supervisor at Deschutes County Health Services, noted that Central Oregon’s prescribing rates, on par with Oregon’s overall prescribing rates, have decreased significantly in the past decade. Oregon’s number of opioid prescription fills went from about 969,000 in 2013 to about 604,000 in 2023. “That’s really helping, in part because we’re reducing some of those risky prescribing practices,” she said.
As time went on, governing bodies began to understand the danger of over-prescribing and began to press providers to prescribe less.
Once people couldn’t get the prescribed pills anymore, however, they became sick and had to find something else. Most of Morgan-Urie’s clients reported opioid use starting at a very young age, in their teens, or because of an injury, where they were prescribed an opiate.
What fueled much of the rise in other opioids was a combined crackdown on prescribing pain pills, pushing people toward more easily available drugs. At first, around 2018 and 2019, that was heroin. “We had a very high prevalence of combined heroin and methamphetamine use in 2018, 2019 and 2020,” said Morgan-Urie.
According to the Oregon Health Authority, fentanyl gained prevalence in Oregon in 2019. The amount of fentanyl seized in Oregon went up from 690 pills in 2019 to more than 2 million in 2022.
Oregon’s Good Samaritan Law protects both the person who is overdosing and the person who seeks medical help.
There are two different types of fentanyl; pharmaceutical fentanyl and illegally made fentanyl. Fentanyl is a strong synthetic opioid used to relieve pain. The fentanyl most are seeing on the streets is illegally manufactured fentanyl. According to the OHA, fentanyl is oftentimes added to other drugs, especially opioids, because of its potency, making drugs stronger, more addictive, more dangerous and cheaper.
Diana Everly with Ideal Option, a low-barrier treatment facility in Bend, saw people who were using prescription drugs in Oregon switch to heroin. However, she said, they aren’t seeing as much heroin anymore. “We’re primarily seeing fentanyl. It was always fentanyl pills, but here, in the past six to eight months I’ve been seeing more people on fentanyl powder, which is a more pure form of the drug, more deadly,” she said.
Morgan-Urie, who’s been working in the field for five years now, also saw the shift. “People are telling me that if they wanted to use an opiate or if they wanted to use heroin, they wouldn’t be able to find it. They use fentanyl because that’s what they can get,” said Morgan-Urie.
As a treatment provider, her organization conducts thousands of urine drug tests. A few years ago, she was seeing zero fentanyl. Now, she said, it’s everywhere. Out of 2,760 drug screens performed since the beginning of the year, 1,134 of them were positive for fentanyl, which comes out to 41.5%.
“Several years ago, we had about the same amount of people who were positive for both opiates and methamphetamine,” said Morgan-Urie. Now, the methamphetamine percentage is down to 28.2%. “Does that mean less people are using methamphetamine? I mean, it does. But, it also means that fentanyl is occupying everybody’s time right now.”
Under-represented overdoses
An OHA study from September 2022 summarizing opioid overdose data in Oregon found that while prescription opioid deaths have decreased more than 50% since 2006, deaths from synthetic opioids, including fentanyl and heroin, have increased exponentially in recent years.
The report noted that while the state has made significant progress over the last decade in decreasing overdoses related to prescription opioids, overdoses from fentanyl have increased.
According to the Centers for Disease Control and Prevention, fentanyl is 50 times stronger than heroin and 100 times stronger than morphine. Today, fentanyl and other synthetic opioids are the “most common drugs involved in overdose deaths.” Over 150 people die every day in the U.S. from overdoses related to synthetic opioids like fentanyl.
Opioid-related overdose deaths in Oregon, including fentanyl-related deaths, rose from 318 in 2019 to 765 in 2022, according to data from the OHA. Opioid-related overdose hospitalizations rose from 891 in 2019 to 966 in 2022. While these numbers certainly show a shocking spike in opioid-related deaths, the OHA notes that the majority occur outside of a medical setting.
“There’s a lot of barriers to providing treatment services in our communities. Then, fentanyl has come into our state and has just complicated everything.” — Teri Morgan-Urie
While the numbers are already troubling, Morgan-Urie believes there’s a big gap in the overdose numbers. “The overdose deaths are getting attention, which they should, but we’re also not giving attention to the actual raw numbers,” she said. “We’re talking about fatalities, but we’re not talking about the people who didn’t die.”
Morgan-Urie suggested that the number of overdoses is much higher than data shows. She noted the countless other overdoses that don’t get reported, especially in cases where Narcan, a brand of the opioid overdose treatment naloxone, is administered.
Neuwirth saw a rise in fentanyl-related deaths in Oregon, but noted that Deschutes County is not seeing the same increase as other parts of the state. Deschutes County Health Services has been working alongside Crook County and Jefferson County to better identify and collect data of overdose fatalities.
Their goal is to improve data collection to be able to respond more efficiently and effectively to addiction in Central Oregon. DCHS is also attempting to combat overdoses with harm reduction and treatment, offering free overdose prevention kits to whoever needs them. Lawmakers approved a bill, HB 2395, in March to widely distribute the life-saving medication, improving access to the drug across the state.
An ongoing battle
Julia Pinksy is the co-founder, along with her husband, of Max’s Mission, a nonprofit in Medford dedicated to saving lives through opioid outreach and Naloxone education and distribution.
She started the organization after her son died from an opioid overdose in 2013. Pinksy found out about naloxone online and felt it needed more attention.
“If we’d known about it, we thought, maybe we would’ve been able to save our son,” Pinksy told the Source Weekly. “We lived in a rural area, it took emergency services a while to get there.”
When Pinksy found out about the overdose prevention drug, she realized it wasn’t widely known or available. Some people in the field of recovery didn’t even know what it was in 2016, she said. “It’s a very different world, every year things change rapidly in the world of drug treatment and overdose.”
Pinksy believes that, like many states, Oregon needs more treatment beds and detox facilities. “More people than ever are using drugs, and it’s really because we haven’t addressed the problem soon enough,” she said.
In her mind, efforts to help the crisis shouldn’t be seen as an either-or situation, it’s a complex situation with many different answers.
A report from the National Institute on Drug Abuse in 2018 found that in the 2000s, 75% of people abusing opioids reported that their first opioid was a prescription drug.
“I think with Measure 110, we’ve seen a lot more services out there, but I do think that it takes time,” said Pinsky. “The fulfillment of that is going to take time, you are not going to get everybody off the streets and in treatment in a year.”
In 2020, Oregon voters passed Measure 110, the Drug Treatment and Recovery Act. The measure, which decriminalized most unlawful possessions of controlled substances, attempted to keep people out of jail in order to prevent barriers for them to get clean, and to expand drug treatment and recovery services.
Morgan-Urie with Oregon Recovers believes that the state still has a lot of work to do in terms of helping people get into treatment. As an opiate treatment provider, Morgan-Urie works to provide methadone or buprenorphine for opioid use disorder, two drugs that help with withdrawal management and stabilization.
Still, she thinks there’s not enough being done in Oregon to combat addiction. “If the drugs are everywhere, then treatment needs to be everywhere,” said Morgan-Urie.
Morgan-Urie herself is in long-term recovery from substance abuse and is 10 years clean. Fighting to get clean for her daughter, she agreed to go to treatment, but there was no treatment available.
It took her almost four months to get a spot in residential treatment. “Part of that process that is so challenging for people that struggle with substance use is that the window of opportunity for somebody to be motivated to go to treatment is very small,” she said.
Morgan-Urie recalls having to jump through a series of hoops to get to treatment. “There’s a lot of barriers to providing treatment services in our communities,” said Morgan-Urie. “Then, fentanyl has come into our state and has just complicated everything.”
Neuwirth at DCHS hopes to see Oregon work together to combat overdose deaths in the state. DCHS works to educate and encourage the public to call for help if there is a chance of an overdose. Oregon’s Good Samaritan Law protects both the person who is overdosing and the person who seeks medical help. “We would like folks to know it’s always OK to call for help.”
This article appears in Source Weekly October 19, 2023.
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I’ve never seen a television commercial or magazine ad for an opioid despite the fact that the media is inundated with pharmaceutical advertisements. And I’ve never heard of a pharmaceutical company prescribing medication. Those who are addicted have my sympathy but your beef is with the prescribing doctors.