The first emergency call came in 90 minutes before midnight on New Year’s Eve at the Deschutes County Jail. An inmate was on the floor in Dorm 600, not breathing and blue.
Opioid overdoses are common enough that Steve Keith, a nurse at the jail, carries with him Narcan sprays to reverse the symptoms. In the past, one spray might have been enough. This man took four.
“Just as we finally got a breath out of him, I hear commotion behind me. Deputies are dragging another body off of a bunk,” Mr. Keith said. “I have seen dead bodies before, and I have never seen this shade of blue in somebody.”
By 2 a.m., five inmates had been rushed to hospital. Authorities believe they ingested fentanyl shared by an inmate who smuggled it inside his rectum and gave it out, some as powder mixed with juice, as a new year’s celebration behind bars.
In many ways, the shocking start to 2023 wasn’t terribly shocking. Bend is in Central Oregon, a sparsely populated expanse of grasslands and high-altitude pine forests where cowboys still move cattle on horseback. But even in the most remote corners of the United States, fentanyl is now everywhere – and stretching the capacities of a state that has the most progressive drug policies in the country, decriminalizing possession of even the most potent narcotics.
In Oregon and Idaho, authorities captured 700 dosage units of fentanyl pills in 2018. By 2021, that had risen to five kilograms of fentanyl powder and 1.5 million dosage units. Last year, that more than doubled: 55 kilograms of powder and three million pills, according to preliminary figures compiled by the Oregon-Idaho High Intensity Drug Trafficking Area. Overdoses have risen at a similar pace.
Oregon had the second-highest rate of substance abuse in the U.S. in 2020, and “six out of 10 pills that are seized contain a potentially fatal amount to somebody who has never used before,” said Chris Gibson, executive director of the two-state drug trafficking program.
In 2021, the last year for which figures are available, nearly 300 people a day died by overdose in the U.S.
The increasing intensity of the fentanyl problem in the more distant reaches of the country has fuelled arguments by the country’s conservatives that a clampdown at the southern border is needed to stanch the flow. In Oregon and Idaho, the fentanyl is “coming from Mexico,” Mr. Gibson said. In Washington, Republican leadership has seized on the crisis to push for more rigorous policing of the southern border.
“The fentanyl crisis has turned every community in America into a border community,” House of Representatives Speaker Kevin McCarthy said recently.
In Oregon, fentanyl has grown so extensive that it has displaced other opiates, entraining a new generation.
“I know 13-year-olds that use,” said Ember Meddock, who is herself 17. A heroin and marijuana user, she began using fentanyl last May when, she says, someone gave it to her by accident. “It makes you feel amazing,” she said. But it also “makes you become a heartless person. You don’t care what you have to do” to get more, she said. “Because the withdrawals are so bad. You throw up. You’re sweating or cold constantly. The body aches.”
Ms. Meddock has an allergic reaction to opioids that leaves her face spotted with acne. She is now in treatment, but as she speaks her legs and arms jerk in involuntary movements. “Fentanyl is just really bad,” she says. “It’s really addicting, though.”
And it seems to be everywhere.
“We have not seen a heroin-positive patient since March,” said Eric Geisler, a physician who specializes in addictions and who is medical director at Serenity Lane, an Oregon rehab centre. “Patients are telling us they can’t even find other opiates on the street.”
Compared with heroin, fentanyl hits harder and leaves earlier. It has what doctors call a quick half-life, a characteristic that encourages heavy use. Fentanyl levels in patients are “higher and higher to the point where the lab can’t even measure them,” Dr. Geisler said.
Jeremiah Messer knows how quickly dependency can build. He became a heroin addict as a teenager after his dad handed him Percocet at the age of 12. Now 30, he first sampled fentanyl two years ago. He quickly built a tolerance.
Many users consume blue pills that resemble oxycodone and are known as “blues” or “dirty thirties.” In years past it was common to pop five or 10 a day. Mr. Messer used 50 and more, before switching to fentanyl powder, which is more potent. “I had to start stealing cars and robbing people to support my habit,” he said.
Eventually he was arrested. He spent 30 days behind bars, a forced sobriety. For the first week, he barely ate or slept, defecating on himself and vomiting frequently. “Audio and visual hallucinations. It was the worst detox I’ve ever had,” he said.
He is now 90 days clean and working at a gas station in Bend.
But the drug is never far away. Two days before he spoke with The Globe and Mail, a co-worker died in the bathroom. “We suspect it was fentanyl,” he said.
In Oregon, the rise of fentanyl has coincided with Measure 110, which in 2021 made the state the first to decriminalize simple possession of illegal narcotics. Fentanyl has put that to the test.
The new drug regime is “disastrous. It’s not working the way it’s intended,” said Shane Nelson, the sheriff in Deschutes County, which sits at the heart of Central Oregon. Removing consequences from drug use removes an incentive to seek treatment, he said, a view that is shared by Shawnda Jennings, herself an addict who is now two years clean and working as a peer support specialist for Ideal Option, which offers medication-assisted treatment.
For drug users, “arrest” can often be better understood as “rescue,” she said. But with Measure 110, “law enforcement has kind of taken a step back. Not even dealing with drugs any more,” she said. “Their hands are tied.”
Oregon released an audit report on Measure 110 last week that found mixed results. Auditor Ian Green said it merited a C grade. “It is plain as day that Oregon’s drug treatment system is failing,” Secretary of State Shemia Fagan said. But, she added, “I want to see Measure 110 work.”
The measure has diverted marijuana revenues for treatment, including for Ms. Jennings’s job, which involves daily outreach to drug users. Without that, “I wouldn’t be able to do what I’m doing,” she said. (The jail, too, expects to hire two nurses to oversee medication-assisted treatment.)
People often don’t seek treatment until they hit bottom. With fentanyl, “unfortunately, some people’s bottom is nine feet under,” Ms. Jennings said.
That was the worry on New Year’s Eve at the Deschutes County Jail.
The second man to overdose had no pulse, so the group of people gathered in Dorm 600 began to administer CPR alongside Narcan. “I didn’t think he was coming back,” Mr. Keith said. But they continued compressions.
“We finally got him to breathe and got a pulse back,” Mr. Keith recalled. He took a moment to exhale. “And then I hear a commotion out in the hallway. They were dragging another guy down the hall.” Mr. Keith watched the third inmate stop breathing. It took three doses of Narcan to revive him. A fourth inmate admitted to using fentanyl, but did not lose consciousness. A fifth, the man eventually accused of supplying the drug, was found slumped over in his cell at 2 a.m. and sent to hospital.
None of them died, a triumph for Mr. Keith and the many colleagues who helped. “They prevented a catastrophe that night,” said Captain Michael Shults, who oversees the county corrections division.
But for others, what took place at the jail was sobering.
“How somebody could get that many people willing to take it – that really heightens to me how big of a problem it is,” said Roger Olson, who chairs the county behavioural health advisory board. “It just seems to be outpacing the resources that we have.”