Oregon Business Magazine July August 2023

they’re no longer breathing. The first thing that I do is give naloxone, because no matter who it is, it’s safe. It quickly revives people if they are suffering from an overdose. It’s just part of our urgent response to an arrest, and I know it’s safe. I know that it is effective. And we need it everywhere in our community to make sure people are, you know, kept alive long enough to get into recovery, if at all possible.” House Bill 2395 passed out of the House of Representatives in early March. But for much of the spring its fate was uncertain, due to a six-week walkout by Republican senators that left the Legislature without the quorum required under the state’s Constitution to pass new laws. That hamstrung legislative business until mid-June, leaving observers concerned that testing strips would remain in a legal gray area until the next session. But an amended version of the bill passed out of both chambers June 24, the day before the Legislature adjourned. “Oregonian lives will be saved through this bill,” Shold says. He is originally from Portland and recently moved back but had previously worked as chief technology officer at Alameda Health System, a public health care system in the San Francisco Bay Area. Fentanyl is a synthetic opioid that is sometimes prescribed for patients in extreme pain — such as patients recovering from surgery or for advanced-stage cancer patients — but that’s also manufactured and sold by black-market dealers. The Centers for Disease Control describe the drug as 50 times stronger than heroin and 100 times stronger than morphine. It’s also lethal in smaller amounts than other drugs: Shold says just 2 milligrams can be a lethal dose. He says in his previous role, he started researching the opioid epidemic and learned that one of the contributing factors is an increase in other illegal drugs — like cocaine and heroin — laced with fentanyl. Shold doesn’t believe that’s intentional. “Killing customers is not high on their list,” he says of drug dealers. Rather, he says dealers are often handling, measuring and bagging multiple types of drugs using the same equipment in the same facilities. But because fentanyl can be so dangerous in such small quantities, the results can be devastating. “The audience we really wanted to focus on was people who were effectively ingesting fentanyl nonconsensually — meaning they didn’t think they were going to be ingesting it. They thought they were doing cocaine or they thought they were getting a Percocet pill off the street,” Shold says. “Those are the people that we are trying to help find a way to check their drugs, to make sure that they don’t contain fentanyl if they don’t want to be consuming fentanyl.” He and Alison Heller created FentCheck in 2019 because, at that time, fentanyl testing strips existed but were difficult to find. Prior to the passage of HB2395, the easiest place to get fentanyl testing strips was through syringe-exchange programs. But, Shold points out, not all drug users know about or regularly visit such locations. His organization has done outreach to nightclubs, dive bars and strip clubs, and he says a number of business owners have expressed interest — but have been reluctant because of the legal issue. (For his part, Davis says law enforcement have left him alone.) The CDC estimates that about 150 Americans die every day from overdoses related to synthetic opioids. The Oregon Health Authority’s data dashboard on illicit fentanyl overdoses ends in 2019 but shows a slight drop in the number of deaths that year from the previous year — 62 deaths versus 73 in 2018 — after years of steadily increased deaths from 2015. The OHA says fentanyl is the most frequent drug involved in overdose deaths in Oregon, and that the amount of fentanyl seized by law enforcement in the state increased from 690 counterfeit pills in 2018 to more than 2 million in 2022. Haven Wheelock has run Outside In’s syringe exchange for 17 years and has worked in harm reduction for more than 20 years, starting with HIV-prevention work in high school in 1998. She holds a master’s in public health from Johns Hopkins University, focusing on overdose and addiction policy. “I love people who use drugs a lot,” Wheelock says. Outside In’s needle-exchange program was one of the first in the United States, modeled on programs in Europe that were developed to curb the transmission of HIV through intravenous drug use. Fentanyl “really has become dominant” in use in recent years, Wheelock says. In late 2021, there was a decline in the number of people coming in for injection equipment. The nonprofit has begun to offer pipes — partly to encourage people to smoke fentanyl rather than inject it, because the risk of overdose is much lower with smoking — as well as fentanyl testing strips. “Fentanyl test strips are a relatively new intervention in the world of harm reduction. I mean, we’ve been using them for about 10 years as a harm-reduction community, but that’s still pretty new, right?” Wheelock says. “I don’t think when they were drafting [the drug paraphernalia law], they were thinking, ‘Oh, we’re going to keep people from inadvertently using substances that are dangerous, right? I don’t think their intention was to bar people from having fentanyl test strips. But it’s how it’s playing out today.” Davis says the fentanyl epidemic has hit home just recently, with news reports that eight people in Portland overdosed in a single weekend in May and stories from friends working at other bars. And a little less than a year ago, he says, a regular customer who he considered a friend had a girlfriend who overdosed, and then overdosed himself the following day. “Drug use has happened, to the best of my knowledge, ever since bars existed, and I’m just providing another tool for people to make an informed decision,” Davis says. “I’m not saying ‘Yeah, go ahead and do it’ or ‘No, don’t do it.’ It’s more, ‘You’re going to make your own decisions. Be safe about those decisions.’” 19

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