Late afternoon on a Wednesday in Portland, Oregon’s downtown core, the fire department’s Community Health Assess and Treat Overdose Response Team — a pilot program known as CHAT — were dispatched to a call: A man was on a sidewalk, unconscious and not breathing.
CHAT paramedics began breathing measures for the man as they waited for the initial dose of naloxone, the overdose-reversal drug, to work. They administered another dose and the man gasped back into consciousness.
This was the fifth such call the team had that day.
“Sometimes we're noticing we need more Narcan, and sometimes we're noticing we're able to go with, with less. It all depends on the strength of whatever it is that they use,” said Mandy Boyton, a CHAT team member.
Last year, Portland Fire responded to 7,000 overdose calls. The month-old CHAT program aims to streamline the response to opioid overdoses.
Firefighters believe it’s already making a difference.
Instead of sending a big red fire truck, a more nimble team in a pickup responds with focused tools like naloxone. They also help overdose victims find recovery treatment, freeing up firefighters for other duties. Portland Fire and Rescue is also in the midst of another pilot program that distributes buprenorphine to overdose victims on scene. The pilot is scheduled to run for 18 months with potential to be permanent if funding can be secured.
“Overdose deaths have increased 600% since 2019. So that is incentive enough to get stakeholders in the right place at the right time to try and create some innovative solutions to the problem,” said Michelle La Vina, the CHAT community health nurse manager for Portland Fire & Rescue.
For those working in harm reduction, the rise of fentanyl in the drug supply post-2020 changed everything. In 2019, Oregon saw 280 overdose deaths. Three years later, in 2022, that number skyrocketed to 956. That’s more than the number of people who died in car accidents across the state that year.
While finding outside-of-the-box solutions like CHAT to a problem such as opioids is important work, it’s complicated, and no one program is going to be the complete answer.
“There’s a lot of amazing human beings doing amazing work and working really hard to try and ease some of the suffering, but denying the suffering is there isn't something that anyone should be doing,” said Haven Wheelock, who runs harm reduction at the Portland nonprofit Outside In. Her organization provides safe use supplies like naloxone and clean needles to people in Portland living with drug use and addiction.
Last month, Oregon Gov. Tina Kotek and Portland Mayor Ted Wheeler declared a state of emergency in the city due to the fentanyl crisis, marking a condensed period of collaboration and resources to try to tackle the epidemic.
In 2020, voters in Oregon decriminalized possession of hard drugs under the belief that the issue was a health problem, not a crime problem.
But now, state lawmakers are working to reverse that law as part of a bill to slow the state’s drug emergency.
Wheelock says returning to treating users as criminals would be regression.
“We were in an addiction crisis, an overdose crisis, a housing crisis long before we decriminalized drugs. Right? I don't want to go back to how it was in 2019. Because it was bad in 2019,” she said.
Third-party early research released last month found no association between decriminalization and overdose deaths. Regardless of the findings, many in Oregon now believe it was the wrong strategy in general, or was implemented the wrong way.
“What we're learning is that decriminalization took a tool away from law enforcement that I think they should have,” said Oregon Rep. Jason Kropf, co-chair of the Joint Committee on Addiction and Community Safety Response.
In what its sponsor says would add “some accountability,” one proposed measure would boost hard-drug possession to a misdemeanor with possible jail time and make it easier to prosecute those who sell drugs. There are other proposals that suggest possession should be a Class A felony.
Rep. Kropf’s committee is currently hearing debate during Oregon’s short 35-day session over drugs — not only about decriminalization, but how to create more pathways to recovery.
A coalition of health care organizations called Oregon Recovers says the state is 50th in the nation in access to drug treatment.
“I'm working as hard as possible as I can on this. And I realized when this session gets done, I have a lot more work ahead of us,” Kropf said.
“It's been gasoline on the fire. It didn't create the problem, the problem already existed,” said Mike Marshall, co-founder of Oregon Recovers. He says the state’s mistake was decriminalization without ensuring enough treatment infrastructure.
State data says Oregon needs 3,000 treatment beds to get the addiction crisis under control.
“ We shouldn't be arguing about a criminal justice definition. We should first be arguing about how to intervene and engage people in getting better,” he said.
In the meantime, at street level, people continue to work on solutions to save lives in the midst of the current crisis.
“I'm not going anywhere, right? I am. I'm going to show up and serve our people as best I can,” said Wheelock.
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