The Multnomah County Board of Commissioners on Thursday, Feb. 1 voted unanimously to declare a 90-day state of emergency in response to the ongoing public health and public safety crisis driven by fentanyl. The resolution is in conjunction with the emergency exemption authorized by Chair Jessica Vega Pederson that allows for the rapid procurement of goods and services for the effort.
With Thursday’s vote, the County joins Oregon Gov. Tina Kotek and Portland Mayor Ted Wheeler in declaring 90-day states of emergency. The joint action enables the quick deployment of resources to address pressing community needs related to illicit fentanyl use. Chair Vega Pederson had called for Board action during a Jan. 30 joint press conference with the governor and mayor.
The tri-government declarations follow a recommendation put forward by the Portland Central City Task Force, unveiled at the Oregon Business Leadership Summit late last year. Concurrent to the declaration, the State, County and City have established a unified command team to coordinate efforts and systems to address fentanyl in more collaborative and streamlined ways.
But while the state and city efforts are focused on the central city neighborhoods in Portland, the Chair and Health Department director said that the County’s efforts would extend across the County to address the suffering and overdoses being experienced in other neighborhoods.
Multnomah County will focus on preventing exposure to and use of fentanyl; reducing harm among people using substances; and increasing access to outreach, treatment, recovery and housing services.
Chair Vega Pederson explained that the County is not starting this work from scratch. Although the widespread availability of cheap fentanyl and sharp increase in overdoses is relatively recent, as the Local Public Health and Mental Health authorities, Multnomah County has a long history of connecting people who use drugs with treatment and services.
“With this declaration comes new opportunities for urgency, for partnership and for a response that meets the needs of our entire community,” said Chair Vega Pederson. “We also know that every approach to this work needs to address the inequity, trauma and despair that drives much of the substance use in our communities.”
The Chair expressed her goal that at the end of the 90 days, the County would have established new pathways for a long-term system of coordination to respond to the fentanyl crisis.
Overdose deaths from synthetic opioids increased by 533% in Multnomah County from 2018 to 2022. The sharp upswing in overdose deaths, County health officials shared in a June 2023 briefing to the Board, reflected the rapid and radical change in the local drug supplies beginning in 2019 toward fentanyl and other potent synthetic opioids.
Health Department Director Rachael Banks said that solving the fentanyl crisis requires a public health approach that engages every corner of the Health Department and the County, including its clinical, community-based and corrections services, as well as expertise in the fields of behavioral health, criminal justice fields and public health — “really knitting them all together for maximum impact and collective impact.”
“When I talk about a public health approach, I do not just mean the Public Health Division or just the Health Department. This is an issue that impacts the entire population and multiple different groups,” Banks continued. “Fentanyl is an issue that touches people that we love and all sorts of systems that we work in. Taking that population health approach is necessary because this is a challenge that we can not solve alone.”
The goal for the 90-day period and beyond is to slow the rate of overdose deaths, with the ultimate goal of ending overdose deaths through using a person-centered, trauma-informed approach. Banks acknowledged that substance use is an extremely complex disorder driven by personal, community and economic factors, family trauma, general addiction patterns, discrimination, oppression and colonialism.
“This issue requires a comprehensive approach because we are addressing the root causes of addiction and creating an umbrella of strategies and interventions,” said Banks.
During the 90-day state of emergency, the Health Department will launch two major public education campaigns: one that focuses on raising awareness about fentanyl risks — particularly for young people — and another that destigmatizes recovery. At the same time, the County will expand both its naloxone distribution and increase the number of naloxone trainings it offers. The Health Department will increase the visibility and coordination of its outreach providers, as well its mental healthcare work and harm reduction services.
“The 90-day emergency provides an opportunity for collaboration in a specific geographic area and allows us to partner with additional programs that have proven success and track records to work across the four areas of prevention, harm reduction, harm reduction and recovery,” Banks said.
Board comment
Each jurisdiction has appointed an incident commander to serve in a “unified command’’ that will work together daily to fulfill shared objectives. (Multnomah County’s Incident Commander is former Health Officer Dr. Jennifer Vines.) Several commissioners voiced their worries that the 90-day emergency is focused only on downtown Portland and asked how the declaration ties into a larger countywide effort to respond to fentanyl.
Leah Drebin, a policy advisor to the Chair, explained that while the tri-government unified command’s focus is on the Central City neighborhoods, the Health Department’s overdose prevention and response plan and other efforts will span all of Multnomah County, and not just the downtown core.
Commissioner Sharon Meieran expressed concern about the declaration’s goals and outcomes.
Both Chair Vega Pederson and Banks explained that the 90-day declaration’s goal is to have a visible improvement in the fentanyl crisis in the Portland central city and improve access to treatment. These overarching goals have been given to the unified command team to develop more specific goals and metrics that are measurable and timely to the 90 days.
Meieran also expressed skepticism about how effectively the 90-day declaration could create a visible difference in the central city and in increasing access to treatment.
A proposed amendment from Commissioner Meieran asking for specific metrics and the creation of a public dashboard for the 90 days and beyond failed to pass.
“We can’t just keep having meetings, declaring emergencies, saying we’re going to coordinate for 90 days and issuing press releases,” said Meieran.
Other members of the Board expressed support for the increased resources, interventions and coordination the emergency declaration is intended to spur.
“When you take fentanyl and drop it into a state that already has high addiction rates and the lowest number of treatment beds, I am not surprised we have what we have. We are not going to solve this crisis in 90 days,” said Commissioner Jesse Beason. “We have a lot of work to do. I believe the opportunity for us to go on is an opportunity we should take.”
“Fentanyl is the fire at our feet and this is the right step and the right direction,” said Commissioner Julia Brim-Edwards. “Fentanyl is ruining lives every single day in every neighborhood and not just downtown or in the central city. We have people in deep need of sobering, withdrawal management, detox and residential treatment across the County. I support this emergency action because it signals across the community that during emergencies, everything is on the table.”
“There are many commissioners that have been supportive of this emergency declaration for years, so finally, to see the County and the State and the City joining forces, it is past due,“ said Commissioner Lori Stegmann, “I think one of the easiest things to do is to criticize and blame others, and I think what’s really hard is to roll up our sleeves and do the work that's required of us when people are dying on the street.”
Chair Vega Pederson said “it’s important that we step forward with the State of Oregon and the City of Portland to quickly establish better systems of coordination to reduce fentanyl deaths and fentanyl activities on our streets and in our communities. It is only together as one County and side-by-side with our partners that we can address this emergency with the urgency and the coordination it deserves.”