A major West Coast city is in a state of emergency over fentanyl. Figuring out how to fight the 'demons' is its own challenge

Biking in one of the West Coast’s biggest cities, police Officer Donny 
Mathew spotted something out of the corner of his eye.

It was a glint, shining off a piece of aluminum foil in the hand of 
someone on the sidewalk.

Mathew knew the man was using it to cook. And he knew the substance in the 
small, makeshift pan was the same potent, intensely addictive, synthetic 
opioid that has torn through Portland, Oregon, and countless other 
American communities in recent years, leaving a stunning trail of 
debilitating addiction and death:

Fentanyl.

“He was still actively smoking right when we rolled up,” said Mathew.

The officer, his feet on the pedals, braked hard into a turn. He quickly 
dismounted his bike, approached the man and handed over a $100 citation.

But that wasn’t all. Mathew also handed him a card printed with a phone 
number that could help erase both his new fine and – in the longer term, 
civic leaders here hope – the sort of illicit substance abuse that’s 
escalated on these streets amid the nationwide opioid epidemic.

“They call this hotline, and they can get the citation paid for,” the 
officer explained – but only if they agree, with the trained substance 
abuse counselors on the line, to a medical screening that could serve as a 
critical gateway to addiction treatment.

The strategy is in place as the city’s mayor, its county chairperson and 
the governor – all Democrats – in late January declared at 90-day state of 
emergency to address the public health and safety crisis driven by 
fentanyl in Portland’s Central City.

State lawmakers, meanwhile, overwhelmingly approved a bill this week to 
reverse a 2020 measure that decriminalized possession of hard substances, 
including fentanyl, which now awaits approval by the state’s governor.

Plastic bags of Fentanyl are displayed on a table at the U.S. Customs and 
Border Protection area at the International Mail Facility at O'Hare 
International Airport in Chicago, Illinois, U.S. November 29, 2017. 
Picture taken November 29, 2017.

“Our country and our state have never seen a drug this deadly and 
addictive, and all are grappling with how to respond,” Gov. Tina Kotek 
said in a news release in late January, announcing Portland’s fentanyl 
emergency declaration, vowing “unprecedented collaboration and focused 
resources” ahead of a “roadmap for next steps.”

Off the bat, drug dealer arrests have increased, the fire department has 
launched an overdose rapid response team and outreach workers have begun 
“saturating” hot spots to help connect people with treatment, recovery and 
housing services, the city’s Community Safety Division Director Mike Myers 
said Thursday at a news conference.

Also expected under the emergency declaration are public health campaigns 
and a further effort by officials to pool and “use data to identify and 
respond to acute needs and gaps in service,” then figure out how to fill 
them quickly – and long after the three-month emergency period expires.

This formidable undertaking reflects the particular challenges of 
combatting fentanyl, which is up to 100 times more potent than morphine 
and very cheap to make and mix with other illicit substances.

“This addictive behavior is not something to be taken lightly and, not to 
be like, ‘Oh, just get a job,’ or ‘Just get help,’” said Portland Police 
Chief Bob Day. “There are demons there that I could never understand.”

The emergency mission, in fact, is nothing less than a race against a 
killer, said the head of outreach and treatment group Central City 
Concern. Fentanyl is “dirt cheap, it’s very dangerous,” Dr. Andy 
Mendenhall told CNN, and “it’s ubiquitous.”

‘An extremely dangerous spike’
As public health workers, outreach teams and police unite for the task, 
they forge ahead under Measure 110, a 2020 law enacted by statewide vote 
that declared a “health-based approach to addiction and overdose is more 
effective, humane and cost-effective than criminal punishments.”

“Essentially what has happened is drugs in Oregon are the same as a 
traffic ticket,” Portland police Officer David Baer told CNN.

Meantime, opioid overdose deaths in Oregon have increased from 280 in 2019 
to 956 in 2022, with 628 recorded so far for last year, state data show. 
“We’re on an extremely dangerous spike,” Multnomah County Health Director 
Rachael Banks told CNN.

Nationwide, the tally of drug overdose deaths involving fentanyl rose 
almost four-fold over five years through 2021, the US Centers for Disease 
Control and Prevention reported. And though early research, published in 
JAMA Psychiatry, suggests no link between Measure 110 and Oregon’s 
increase in fatal overdoses, critics have blamed the law for the mounting 
toll.

“You look at what has happened: open fentanyl, open drugs on the streets,” 
said Republican state Rep. Jeff Helfrich said, decrying Measure 110 as “an 
unmitigated disaster.”

While the governor would not “Monday-morning quarterback” the cause of 
Portland’s downtown drug crisis and Mayor Ted Wheeler said city officials 
have “been working on it,” public health and outreach teams said their 
efforts to beat back fentanyl’s scourge are continually challenged by its 
extreme addictive quality.

“It’s one of those things that even though you love your family, even 
though you love your friends and you want to be an outstanding member of 
society, all you really think about is your next use or your next high,” 
said Central City Concern Program Supervisor Dave Crosby, who once was 
unhoused and addicted to drugs.

The first need is housing, doctor says
Fentanyl’s potency “makes this battle a completely different fight,” said 
Mendenhall, whose organization annually serves over 14,000 people. That 
includes medical withdrawal management help for over 3,000 people each 
year, about half of whom use the drug, he said.

As for a common trope that fentanyl users should simply exercise personal 
responsibility and pull themselves out of their downward spiral, the 
solution is not so simple, Mendenhall said, pointing to myriad personal 
factors that can lead patients to substance use, including 
multigenerational poverty, job loss, mental illness, depression and 
anxiety.

“The first thing those folks need is shelter or housing in order to get 
stabilized enough to then potentially benefit from treatment resources,” 
Mendenhall said. As it stands, though, “there’s simply not enough 
resources for people who are seeking treatment and recovery.”

And while declaring a public health and safety emergency is an important 
step, it is not akin to flipping a switch and unleashing a flow of 
resources and funding, officials said. Rather, it starts with gathering 
critical information about the true nature of the crisis.

The emergency declaration in Portland’s Central City “allows many of the 
agencies to start to communicate and share data where we haven’t always 
done in the past,” said Dr. Richard Bruno, Multnomah County’s health 
officer. State, county and city officials are now operating under a 
unified command, officials said, to best determine what gaps in resources 
exist, what more can be done and where they should go.

Action will be taken, officials said, to increase public awareness of 
fentanyl’s addictive qualities, create wider access to overdose reversal 
agents like naloxone and expand access to treatment and recovery, 
including ramping up visibility and coordination among non-profits that 
provide housing and addiction services.

‘These are human beings’
On the same day the Portland officers tried to steer the man with the 
shiny fentanyl pan to treatment services, they pulled up on bikes to 
another man openly using the drug.

They gave him a citation – and a treatment card – as his friend Chelan 
stood nearby.

She had spent over two years in prison for delivery of methamphetamine and 
heroin, and she’d also tried – but failed, so far – to curb her own 
fentanyl use through treatment, Chelan told CNN, which is referring to her 
by one name to ensure her privacy after she shared details of her personal 
struggle with drugs. 

Asked to explain what it’s like to try to stop using fentanyl, Chelan was 
speechless: “There are not many words to describe how difficult that is,” 
she said.

Authorities discovered a trap floor and drugs hidden in the Bronx day care 
center where a 1-year-old boy died of a suspected fentanyl overdose, the 
NYPD said.

But locking up people who struggle to stop abusing drugs is not the 
answer, she said. “It doesn’t do anybody any good to go to jail,” she 
said. “It’s like a bunch of criminals get together to talk about how to do 
crime better. If you weren’t traumatized before jail, you will be 
afterwards.”

Even seeking help, though, can be a struggle: “People don’t know where to 
go, or who to call, or how to access the resources,” Chelan said. “There’s 
treatment facilities, but they’re all backed up right now.”

As Portland’s state of emergency leans hard into delivering tangible help, 
it is also vital not to lose sight of the humanity, said Crosby of Central 
City Concern.

“That’s someone’s daughter, that’s someone’s son, that’s someone’s 
parent,” he said. “And until we look at it from a person-centered approach 
– these are people, these are human beings, we need to help each other – 
the systemic change is not going to grow.”

https://www.cnn.com/2024/03/02/us/portland-oregon-fentanyl-state-of-
emergency/index.html?iid=cnn_buildContentRecirc_end_recirc