Relapse vs Recovery: Oregon's reality of new street drugs

Editor's Note: This is the first of a 6-part series about the overlapping addiction and mental health crisis in the state: Breaking the cycle, Oregon's attempt at recovery

PORTLAND, Ore. (KOIN) -- Fentanyl first showed up in Oregon in 2018. By the fall of 2021, counterfeit pills had taken over the drug market. The Oregon Health Authority said law enforcement confiscated about 700 fake fentanyl pills that first year. In 2022, police seized more than 2 million pills.

"The proliferation of illicitly produced fentanyl, that's deadly. It's a public health emergency," said Joe Bazeghi of Recovery Works Northwest. "I think what's important for folks to understand is the change in our street drug supply. It's is overwhelmingly crowded by counterfeit pills. We are seeing death at rates that have never been experienced before."

Fentanyl has now surpassed methamphetamine as the most deadly drug in Oregon.

Overdose deaths in Oregon nearly doubled from 2019 to 2022.

The National Center for Health Statistics reports overdose deaths in the US rose about 30% following the pandemic -- but in Oregon, the increase was about 90%. Washington, Nevada and Wyoming also saw record increases.

Bazeghi said meth users report more powerful meth is immediately inducing psychosis.

"There's also been a change in our methamphetamine supply. It is significantly more neurotoxic than previous iterations of methamphetamine on the street," he said.

All of these problems are compounding.

Central City Concern CEO Dr. Andy Mendenhall, who is board certified in addiction medicine, said he's found fentanyl addicts who use it around the clock.

"We know that the drugs are more potent, they're cheaper, they're more readily available and they're more dangerous," Mendenhall told KOIN 6 News. "We have folks in our community that report to us that they're using fentanyl every 30 to 60 minutes, which is making medical withdrawal more complicated."

Because the level of physical dependency of fentanyl is so strong, substance use disorder experts are finding fewer people successfully completing medical detoxification. That means more are relapsing, compared to people who use heroin and other pharmaceutical opioids.

"The detoxification process from fentanyl is across the board being reported as more difficult. There are physiological reasons for that," Bazeghi said. "It is 100 times more potent than morphine. It is 50 times more potent than heroin."

He said tools they've used that work well for heroin, OxyContin and other traditional opioids "are becoming less effective. And we're seeing more people dying."

What makes it even worse is how cheap fentanyl is -- about $1 per dose.

"We'll see folks coming in smoking 60 or 80 of these pills a day," Bazeghi told KOIN 6 News. "This wasn't even a figment of imagination 10 years ago."

Stakes are very high

Dr. Mendenhall said the more potent drugs of today mean people now require a higher level of care, such as residential treatment before they can benefit from lower levels of outpatient addiction services.

"We need to innovate. We need to work even harder to help individuals be successful," Dr. Mendenhall said.

"I'm confident that we're going to be successful in closing these gaps. It's going to take time. But the right people at state, county, regional coordinated care organization levels are having conversations. They're committed to informing themselves with data," he said. "The challenging part for our community is it's just going to take a couple of years to bring that capacity, to bring that inventory online."

For significant change to be felt, he said, it will require additional investments in residential treatment, housing, a behavioral health workforce and employment services to re-integrate people into society.

"I'm hopeful that our public will continue to be patient, and I believe that folks are going to see a tangible change in the next 12 months based on a couple of things," Dr. Mendenhall said.

First, he believes the noticeable difference on the streets will be because of the ongoing expansion of temporary alternative shelter capacities. There is also promising news about deeply affordable and supportive housing units on the horizon within the next 2 years, offering hope for a more stable future.

"There is a build plan over the next 24 months for a ton of different resources, inclusive of residential treatment, bed capacity, skill, partnerships, secure residential treatment and residential treatment, home capacity," he told KOIN 6 News. "I believe all of these things are going to make a difference."

We know what to do, he said. We just need to do a lot more of it.

The next part of this series looks at personal and public safety concerns. There is a small group of people facing a dual diagnosis -- a substance use disorder and severe mental illness, such as schizophrenia. Two fathers talk with KOIN 6 News -- one will share his relentless struggle to secure help for his daughter while the other will recount the day when his daughter's safety hung in the balance. Their stories intersect.