By Andrew Clevenger • The Bulletin

WASHINGTON — Just like the rest of the country, Oregon has seen its rate of deaths due to heroin overdoses increase dramatically over the last 15 years, but a new protocol being used in Portland is helping to reverse the trend.

Between 2000 and 2012, Oregon saw its rate of fatal heroin overdoses more than triple, from 0.8 per 100,000 people to 2.9, with a high of 3.2 in 2011, according to a 2014 report by the Oregon Health Authority.

In 2000, the West and Northeast had the highest rate of heroin overdose deaths of any region in America, with 0.9 per 100,000, compared with 0.4 for the Midwest and 0.5 for the South, according to figures released earlier this month by the Centers for Disease Control. By 2013, rates in the West had doubled to 1.8, the South rose to 1.7, while the Northeast jumped to 3.9 and the Midwest skyrocketed to 4.3, an elevenfold increase.

“It’s a fairly complicated landscape, and we’re just now really studying what the drivers” are behind heroin-related fatalities, said Lisa Millet, OHA’s Injury and Violence Prevention section manager.

Conventional wisdom has largely settled on one narrative to explain the rise in heroin-related deaths: As painkillers containing synthetic opioids rose in prevalence, widespread abuse of prescription drugs followed. When federal law enforcement began cracking down on prescription pill abuse, users craving an opioid high often turned to heroin when painkillers were unavailable. This often resulted in fatal overdoses, particularly when black tar heroin, a particularly strong narcotic imported from Mexico, was involved.

That’s part of the story, said Millet, but there’s not as much crossover between prescription painkillers and heroin as people think. Yes, the medical community in Oregon has reconsidered the appropriate doses and lengths of time for people to take opioid painkillers, but other factors have helped reduce Oregon’s heroin fatalities, she said.

First, Oregon removed methadone as a preferred drug administered during heroin detox for Medicaid patients, and saw a quick drop in fatalities, she said. Particularly when used as a prescription painkiller, methadone can build up in the body and lead to slowed breathing and disrupted heart rhythms, according to the CDC.

Second, Multnomah County, where heroin abuse rates are very high, has started a program where naloxone, an opioid antagonist used to counter the effects of heroin during an overdose, is made available. The heroin-related overdose rate in Oregon dropped to 2.6 per 100,000 in 2013, and the total number of heroin-related deaths in Oregon for 2014 was 72, down from 101 in 2013 and 124 in 2012, according to the OHA.

“With the heroin-using population in Portland, a lot of those people can be rescued” with naloxone, said Millet. “We’re working right now on a study to examine why the prescription drug overdose rates and heroin overdose rates in Oregon have dropped.”

Still, heroin has made inroads in Central Oregon that may be difficult to reverse, said Rick Treleaven, executive director of BestCare Treatment Services, a drug rehab center in Redmond.

Until recently, there was no tradition or history of a serious heroin problem in Central Oregon, Treleaven said.

“About five years ago, we really began to see heroin have a solid foothold here. Before that, you never had a steady supply of heroin in Central Oregon,” he said.

Heroin addicts in Central Oregon tend to be young and unaware of the long-term consequences of abuse and addiction, he said.

“You have a lot of kids who were recreationally using prescription drugs, and they were kids who were from decent families, should be going to college or community college,” Treleaven said. “They were playing with a set of drugs that they were largely unaware of the consequences.

“It’s been so long since heroin was a big deal in this country, they were basically clueless (and) picked up a very big-time addiction.”

The emergence of younger addicts mirrors the national trend. In 2000, the group most likely to die from a heroin overdose was non-Hispanic blacks between the ages of 45 and 64, at 2.0 deaths per 100,000 population, according to the CDC’s national figures.

By 2013, the top group was non-Hispanic whites between the ages 18 and 44, at a rate of 7.0 deaths per 100,000 population.

Now that there’s a demand for heroin in Central Oregon, the supply has become steady, and users can count on heroin that is cheap and effective, Treleaven said.

“The concern is that Central Oregon has never had this underlying culture of heroin addicts, and now it does,” he said. “I’m not sure it will ever be able to put the genie back in the bottle.”

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