Brandi Fogle had already lost her fiance to a fatal opioid overdose when she almost died herself.
Just before the COVID-19 pandemic — Fogle isn’t sure exactly when — she overdosed while using heroin laced with fentanyl, a powerful synthetic opioid, in her RV near Grants Pass. Luckily, she said, she told friends where she kept naloxone, a medication that reverses opioid overdoses.
“It saved my life, and I did start turning my life around after a while,” Fogle said.
At that point, naloxone wasn’t easy to acquire in Grants Pass, she said. But that’s changed markedly in just a few years. The drug has become a focal point for Oregon’s efforts to reduce fatal opioid overdoses, which have skyrocketed in large part because of fentanyl’s widespread proliferation of the drug supply.
At the heart of those efforts is Save Lives Oregon, a network of health agencies and organizations serving people who use drugs that built a pipeline for supplies of naloxone and other so-called harm reduction materials, such as syringes and sharps containers for their safe disposal.
Experts say Save Lives Oregon has already improved Oregonians’ access to naloxone since it began distributing the medicine in late 2020. Since July 2021, the network has distributed about 180,000 doses of naloxone to community-based organizations, social service hubs, tribal health agencies and city governments, according to the Oregon Health Authority, which leads the project and handles its funding. The pipeline, which is officially called the Harm Reduction Clearinghouse, is also a key source of syringes provided to people at syringe exchange sites across the state. The effort has probably saved hundreds, if not thousands, of lives.
But two years after debuting, the project is running out of money.
The Save Lives Oregon clearinghouse was built on temporary allotments from Oregon’s General Fund totaling about $3.7 million over the last year. That money will dry up within three or four weeks, health authority spokesperson Tim Heider said in an email. The agency is “in the process of researching near-term bridge funding options, while we urgently seek long-term funding solutions,” he said.
Some experts involved in the project and close observers say the agency has struggled to find more funding, partly because it’s difficult to garner support for programs giving safety tools to people who use drugs.
“I think harm reduction is a little messier and a little harder to fund,” Haven Wheelock, a health service program coordinator with the Portland nonprofit Outside In, said. Wheelock helped form Save Lives Oregon and is a member of its advisory council.
Todd Korthuis, a longtime addiction researcher who heads the Section of Addiction Medicine at Oregon Health & Science University, said “it’s very much in question” whether Save Lives Oregon will find stable funding.
“And if it’s not funded, that’s a big problem,” he told The Lund Report.
The loss of funding would likely result in hundreds of preventable deaths each year, advocates say.
He called the supplies pipeline a “bright spot” in the state’s response to the opioid crisis. Advocates often criticize the state’s approach to combating addiction as disorganized and sidelined by officials. This is despite a voter-approved windfall from Measure 110, the state’s landmark drug decriminalization law, in 2020 that’s beginning to fund addiction services.
Jonathan Modie, another health authority spokesperson, said in an email that the funding constraints are limiting the agency’s plans to expand Save Lives Oregon and meet the demand for naloxone statewide.
That work will involve getting more naloxone into the hands of people who need it by way of organizations who work with them, while cutting red tape that advocates say is choking distribution efforts and threatening the state’s ability to curb overdoses. For example, many organizations in Oregon must independently receive approval from a health care professional before they can begin distributing the drug, creating wait times and paperwork while fentanyl continues to flood drug markets.
Naloxone is also expensive, costing up to $150 for a box of two nasal spray doses at retail prices, or about $50 for organizations like Outside In, according to the health authority and several advocates.
That’s part of Save Lives Oregon’s appeal: The state buys naloxone at reduced rates and provides it freely through the pipeline, freeing up organizations from fundraising for the medicine. Institutions like clinics, treatment centers, jails and tribal health agencies can simply fill out a form online to order naloxone and other harm reduction supplies. The state distributes naloxone nasal spray, as well a cheaper, injectable version of the drug.
The Oregon Health Authority also wants to build a public ordering system Oregonians could use to request the medicine free of charge or at reduced rates, akin to a similar system in Washington State.
To meet the huge demand for naloxone, distribution efforts like Save Lives Oregon “would need to be prioritized by local and state planning groups,” Modie said.
Stable Supply Of Naloxone And Syringes
While opioid use has long ravaged the U.S., fentanyl arrived in local drug markets relatively recently in Oregon.
The drug is much stronger than heroin and other opioids and helped fuel a rash of fatal overdoses in Oregon, which rose at a rate that was more than double the national average last year, according to the National Center for Health Statistics. Fatal overdoses involving fentanyl spiked about 600% in Oregon between 2019 and the first nine months of 2021, according to state data, killing 509 people.
In Oregon, law enforcement agencies are seizing illicit fentanyl products while prosecutors charge dealers. But on the public health side, experts have largely accepted that fentanyl and other drugs, including a devastating new variety of methamphetamine, are here to stay and require new strategies to help the people who use those drugs survive. Because, advocates say, a person can’t enter treatment and get better if they’re dead. One of those strategies: distributing massive amounts of naloxone, which blocks and reverses the effects of opioids such as heroin, fentanyl and oxycodone. Naloxone is commonly called Narcan, a brand of the drug.
“It’s not a magic bullet, but it’s as close as we have,” Korthuis said of naloxone.
That’s part of the motivation behind Save Lives Oregon. Addiction experts and advocates created the Save Lives Oregon pipeline in 2020 as a way to streamline the distribution of naloxone and other harm reduction supplies, while educating the public, said Tony Vezina, chair of the state’s Alcohol and Drug Policy Commission.
The organizations at the network’s core include 4D, a treatment network that Vezina leads, as well as the Multnomah County Health Department, Oregon Health Authority, Max’s Mission, NW Instituto Latino, the HIV Alliance and Outside In.
Studies, including a recent publication co-authored by Korthuis, suggest that people who use drugs want naloxone and are willing to use it. Wheelock helped lead the first naloxone distribution program in the state almost a decade ago. She said the vast majority of opioid overdose reversals involve people who use drugs together administering the naloxone to each other. But the retail price of naloxone is too expensive for those in poverty, she said.
To reach them, and respond to overdoses themselves, organizations like school districts, police departments, health agencies, tribal governments and social service hubs all say they need an abundant supply of the medicine.
That effort has always been short on funding and supplies, especially in rural parts of the state, Wheelock and other advocates said, because policymakers tend to prefer putting money toward treating drug addiction. Federal funds and some state government grants also restrict which organizations can provide harm reduction supplies, creating another layer of barriers for programs like Save Lives Oregon, she said.
In 2013, Julia Pinsky’s son died of a heroin overdose in Ashland. Pinsky said no one she knew was aware of naloxone at that time.
She quickly educated herself and founded a nonprofit, Max’s Mission, which became a key source of naloxone for communities across southern Oregon. The group currently serves Jackson, Josephine and Klamath counties with harm reduction supplies, syringe exchanges and outreach, supported in large part by Save Lives Oregon. She called the pipeline a “game changer” that’s allowed her team to ramp up distribution.
Before Save Lives Oregon debuted, Pinsky said the norm was cobbling together grants from various donors, including other nonprofits and the state health department, to keep her programs running. She said donors are also wary of funding naloxone because of its high cost, so the supply to Max’s Mission was usually in question.
But Save Lives Oregon offered stable supplies, Pinsky said. With the clearinghouse’s help, between July 2021 and July 2022, the most recent data Pinsky keeps, Max’s Mission gave out more than 12,000 doses of naloxone. From those doses, she documented 337 overdose reversals. She suspects there were more.
“It’s a little scary,” she said. “Those are only the ones we hear about.”
Save Lives Oregon became the largest supplier for the HIV Alliance, which operates clean syringe exchanges in seven Oregon counties. Together, those sites exchange about 2 million used syringes, which are a source of HIV transmission and other viruses, for clean ones each year, according to its Executive Director Renee Yandel.
She said it can take a huge amount of time and energy to find grants for the programs. It’s “stressful and disappointing” that the state is struggling to fund Save Lives Oregon, she said.
“There will be impacts if we have to go backward,” Yandel said.
Controversy Is Still A Factor
It’s unclear where the Oregon Health Authority might tap more funding for Save Lives Oregon.
State Rep. Rob Nosse, D-Portland, who chairs the House Interim Committees On Behavioral Health and Health Care, said in an email that the health authority could ask the state Legislature’s Emergency Board for more funding in September.
Nosse said he’d need more information before considering whether to support Save Lives Oregon. But he also acknowledged the controversial nature of harm reduction programs.
“Honestly if I stand up for this idea, I bet I would get a lot of blow back from voters and maybe some legislators,” Nosse said.
He added that support might appear to condone hard drug use and create “a tough conversation politically and culturally right now with some of the voters in my district.”
Another avenue the state could pursue to fund the program may be to seek federal dollars, which have already supported separate harm reduction programs in Oregon. But federal funds can’t be used to purchase syringes for syringe exchanges, according to Yandel, only accessory supplies, so some exchange sites could run out in a worst-case scenario.
Another potential source of funds: a recent $333 million settlement with four companies found culpable in the opioid crisis. That’s expected to help fund drug policy and treatment in Oregon over an 18-year period. On the health authority’s settlement webpage, access to naloxone and harm reduction supplies tops a list of ways the agency says the funds could be spent.
Some organizations in Save Lives Oregon, including 4D Recovery, have turned to other sources in case the pipeline runs out of money. The Measure 110 Oversight and Accountability Council is stewarding $265 million in grants during the current biennium and has already funded harm reduction supplies for individual organizations across the state. Recently, the committee made an allotment of $131,000 to 4D for harm reduction supplies, according to Vezina.
Although Vezina looked elsewhere for funds, he said he isn’t worried about the future of Save Lives Oregon.
“It’s not that there’s a lack of will to do it, they’re just trying to figure out where the resource will come from,” he said of the health authority’s fundraising plan. “I think they’ll figure it out.”
Pinsky hopes the tap stays on for her own organization and others. She says she still hears of people overdosing because they didn’t have naloxone on-hand. But she said it’s rewarding to make a difference. Now part of her staff is Fogle, who entered recovery in 2020 after overdosing in her RV. She has since become a peer support specialist at the nonprofit.
Recently, while meeting with drug users in a park, Fogle discovered a woman overdosing in a tent after she smoked fentanyl.
“She looked dead,” Fogle said. “Gray and lifeless.”
Fogle said she gave her several doses of naloxone, likely saving her life.