Although that number may be staggering, it doesn’t necessarily encompass the full picture.

“Those are just the people who aren’t making it back from the overdoses,” said Trista Boudon, recovery services program assistant manager with Clatsop Behavioral Healthcare. “That 11 in the first six weeks are just the people who have passed away. That does not account for the massive amounts of people who are continuing to overdose every day and get brought back from the naloxone that is being handed out.”

Clatsop Behavioral Healthcare is the county’s mental health and substance abuse treatment provider. Increasingly, Boudon said they’re seeing people use naloxone on their friends and family, rather than calling emergency services to get the lifesaving medication. Those cases are never getting to the county level or being reported.

A troubling trend

Across Oregon, fatal overdoses have skyrocketed over the past five years, nearly tripling from 2019 to 2023, according to the Oregon Health Authority. For Boudon, there’s no question of what’s causing that trend.

In Clatsop County, she said, fentanyl is the key contributor to overdose deaths.

“We’re seeing fentanyl. We’re seeing carfentanyl. We’re seeing xylazine mixed in with the substances,” she said. “We’re seeing people whose main drug of choice is not an opiate, using stimulants, that are overdosing from opioids because they don’t know that the fentanyl is in their substances. It’s in everything.”

Elizabeth DeVisser, the county’s chief medicolegal death investigator, said the rise of fentanyl mixed with other illicit drugs like methamphetamine and cocaine has played a direct role in the increase in overdose deaths in Clatsop County. The drug is relatively easy to synthesize, and a small amount can be fatal.

The Medical Examiner Division at the Sheriff’s Office investigates all deaths resulting from both acute drug intoxication and from chronic drug use and communicates those deaths to the Oregon State Medical Examiner’s Office. However, DeVisser said long turnaround times on toxicology results at the state level can leave families waiting for up to six months on definitive results.

She hopes a new technology could help change that.

This month, the sheriff’s office medical examiner division began using a Randox Multistat Analyzer — a benchtop toxicology screening machine that can detect up to 29 drugs from a single sample and deliver on-site, quantitative results within about 30 minutes. The machine costs around $50,000, and DeVisser said Clatsop County is the first county in Oregon to use the technology.

“Our hope is that the Multistat Analyzer will change the landscape of drug detection in county deaths related to acute intoxication,” DeVisser said in a statement to The Astorian. “With rapid results, law enforcement agencies and Public Health can have access to real-time trends in the proliferation of specific drugs and their effect on populations. Rapid results will allow the county to monitor deaths and react quickly to help families, communities and prosecute dealers.”

Prevention and response

For Clatsop Behavioral Healthcare, overdose prevention involves touching base with anyone who walks through the door who reports using a street substance, educating them and making sure they have access to naloxone.

The nonprofit is also a partner with the county’s deflection program, which aims to redirect people found with small amounts of illicit drugs out of the criminal justice system and into treatment. A bilingual Clatsop Behavioral Healthcare Prime Plus Peer also attends weekly harm reduction events with Clatsop County Public Health and provides feedback on services.

One of Public Health’s goal is to reduce the stigma around overdoses, said Lisa Schuyler, the department’s health promotions supervisor. The harm reduction program offers a syringe exchange, hepatitis C screenings, resources and education and free naloxone kits, as well as trainings at community events, businesses and organizations, supported by funding from Save Lives Oregon, Columbia Pacific CCO and Measure 110.

The department’s health promotion program also collaborates with school districts and other community partners to focus on substance use and overdose prevention. In January, it partnered with the Seaside School District to host a panel and screening of “New Drug Talk,” a film that helps give parents resources on how to talk to their children about fentanyl.

Looking ahead, Boudon said she would love to see a more direct partnership with emergency responders, allowing Clatsop Behavioral Healthcare to more immediately provide resources once an overdose is reported.

“I would love to have an overdose response team that goes out on the back end of things after the emergency services are done, in order to connect them with the things that they need, and not find out about it three, four, five days — a week, two weeks, three weeks later — that this happened, and that person was kind of already back in their cycle of things,” Boudon said.

People can learn more about overdose prevention on Clatsop County’s harm reduction webpage, or through organizations like Save Lives Oregon. They can also access naloxone at their local pharmacy, or for free at Clatsop Behavioral Healthcare’s Bond Street Clinic in Astoria.

“You don’t have to agree with someone’s lifestyle to be able to save their life in a moment of crisis,” Boudon said.