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After public outcry, Multnomah County Commissioners paused a new pilot program that would distribute safe smoking supplies, including foil and straws
Multnomah County Chair Jessica Vega Pederson abruptly paused a Multnomah County Health Department harm reduction pilot program last week before it began.
Multnomah County Health Department was set to begin distributing aluminum foil and clean straws this month to reduce the harmful impact of injection and the dangers of reusing implements, Willamette Week reported June 7. Near-immediate backlash spread online, and within days, Vega Pederson put a temporary stop to the program and county commissioners distanced themselves from the idea.
Multiple commissioners indicated a lack of support when questioned about the program or expressed shock, including one commissioner saying she’d never even heard of the program. However, a review of two recent county meetings show each commissioner was made aware of the plan to begin distributing smoking supplies as part of Multnomah County’s ongoing harm reduction programs. No commissioner raised a single question about the plan or voiced any opposition in either instance.
Fentanyl overdoses recently increased in Multnomah County, public outcry has reached a fever pitch and the county’s updated harm reduction efforts were a strategy to reduce overdose deaths.
“We’ve seen overdose deaths from fentanyl increase eight-fold since 2019, from 26 deaths to 209 deaths in 2022,” Vega Pederson said in a July 11 statement.
According to the Centers for Disease Control and Prevention, law enforcement encounters with illicitly made fentanyl overdoses sharply increased nationally as early as 2013.
While much of the political fracas focuses on a purported need for additional research, health experts understand the harm reduction approach to positively impact the immediate safety of individuals who use drugs and those surrounded by people who use drugs. Building trust between service providers and the people who use those services can also play an essential role in connecting people to treatment.
“The science proves that providing harm reduction tools doesn’t increase drug use. If seeing foil meant that you were going to do drugs, I’m guessing most of our kitchens would be triggering for people.”
— Haven Wheelock, harm reduction services manager
“This work is in alignment with an extensive body of public health research, as well as the American Public Health Association, Centers for Disease Control and Prevention, National Institutes of Drug Addiction, the Substance Abuse and Mental Health Services Administration, and many of our peer public health jurisdictions across the nation,” Multnomah County Health spokesperson Sarah Dean said.
The work also aligns with the strategy of local nonprofit, Outside In. Haven Wheelock, the nonprofit’s harm reduction services manager, said the clinic started providing smoking supplies, including aluminum foil, over a decade ago.
“It is safer to smoke drugs than to inject them,” she said.
Wheelock said she first bought foil with her own money for the Outside In harm reduction program when a young person who usually smoked said they wanted to learn how to inject drugs. They said they had no foil but knew they could get clean needles from Outside In.
“My answer was, let’s go to the store and get you some foil because it is so much safer,” Wheelock said.
Wheelock said decades of research around whether providing harm reduction services encourages drug use is so well established it is hardly studied anymore.
“The answer is just no, it doesn’t,” she said. “The science proves that providing harm reduction tools doesn’t increase drug use. If seeing foil meant that you were going to do drugs, I’m guessing most of our kitchens would be triggering for people.”
In light of the online controversy, public figures began questioning or downright attacking the idea of distributing safe use supplies as harm prevention, including fierce opposition from Mayor Ted Wheeler’s office.
“I adamantly oppose distributing paraphernalia to encourage using a drug that is the leading cause of death for Americans under 50 and responsible for 190 fatal overdoses a day in the US,” Wheeler tweeted within hours of Willamette Week’s story hitting social media.
Wheeler’s communications director Cody Bowman told Street Roots the community would benefit more if the county used its funding to increase treatment and sobering facilities to help save those suffering from the deadly drug epidemic.
“More research and data is needed before handing out crack pipes and tin foil can be validated as a true harm reduction approach,” Bowman said.
Commissioner Sharon Meieran said distributing safe use supplies facilitates hard drug use and did not know the health department’s program to distribute smoking supplies was in the works in advance, according to a July 12 interview with KATU. But at a May 23 budget meeting in which commissioners Susheela Jayapal, Lori Stegmann, Meieran and Vega Pederson were present, Multnomah County public health director Jessica Guernsey specifically noted the upcoming change.
“One of the changes that we’re making in our service delivery is expanding our supplies, including smoking supplies, to make sure that we’re reaching those people that are most at risk,” Guernsey said. “This is a significant pivot for us to make sure we are addressing overdose risk.”
Meieran, a medical doctor, did not ask any questions or voice any opposition. In apparent contradiction to KATU’s characterization of Meieran’s statements, Meieran submitted testimony supporting a harm reduction bill in the most recent legislative session, Oregon House Bill 2395, in a letter to the House Committee on Behavioral Health in January. Citing her role as a local government partner who implements state policies, Meieran said the bill was an important step to help save lives and reduce suffering.
“The power is in HB 2395 and the opioid harm reduction package,” she said. “It will not magically solve the opioid crisis. But it will make a difference immediately. Harm reduction is an essential component of any holistic opioid prevention and treatment strategy.”
Meieran did not respond to Street Roots’ request for comment at the time of publishing.
In a fentanyl and overdose response briefing during a June 27 board meeting, Guernsey again noted harm reduction strategies utilized by Multnomah County Health, including a slide deck that showed “smoking supplies” as available services. Vega Pederson, Jayapal and Julia Brim-Edwards were present at that meeting, but no commissioners or staff asked questions or raised concerns about the change at that time.
In an email to Street Roots, Jayapal said she submitted questions to the health department July 9 (after Willamette Week published its story) asking if further data was available on the extent to which needle exchange visits translate into service referrals or naloxone distribution and if the county legal department had analyzed how the approach fits with House Bill 2395. Legal questions have become another sticking point for the burgeoning program.
Legal analysis
According to Dean, Vega Pederson paused the health department program to focus on expanding the legal analysis to deepen confidence and assurance in the scope of its operations.
“The Health Department remains confident that a robust harm reduction approach is essential to supporting our community, including people who use drugs, their loved ones, and individuals who experience the secondary and tertiary impacts of drug use in our community,” Dean said.
Current state law allows the provision of clean syringes by “syringe service programs” like Outside In and Multnomah County Health Department. The “affirmative defense” in ORS 475.757 means a person acting as an employee or volunteer of a syringe service program cannot be held liable for handing out equipment that might otherwise be considered unlawful possession of a controlled substance. The law also states sterile needles, syringes and other items provided by a syringe service program may not be considered “drug paraphernalia.”
The Oregon Legislature overwhelmingly passed House Bill 2395 during the recent 2023 session, and Oregon Governor Tina Kotek is waiting to sign the bill. The bill expands the scope of harm reduction efforts by allowing syringe service providers to provide pipes for adults over 18. It also dramatically expands syringe service providers’ right to distribute equipment for drug use and declassifies pipes as “drug paraphernalia” for those providers.
“The residents of this state acknowledge that a multipronged approach focused on substance use prevention, harm reduction and treatment must be adopted,” the bill stated.
In a July 11 statement, Vega Pederson cited the need for further legal analysis but doubled down on her support of harm reduction as a way forward in the long term. In the statement, Vega Pederson said her decision to pause the program was based primarily on a lack of communication and poor due diligence by the health department, saying the process of making these changes lacked community engagement, communications planning and a system to track outcomes.
“I am committed to efforts designed to reduce harm associated with the use of controlled substances, including fentanyl, and believe that they save lives,” she said. “But outreach, accountability, and proper implementation are also key to our success in addressing the fentanyl and polysubstance abuse crisis.”
Taking care
According to Wheelock, a common misconception is that people who use drugs don’t care about the associated dangers or the harmful effects of drug use.
“People who use drugs are human beings,” she said. “They feel pain. They feel shame and stigma, right? They feel the isolation and the judging eyes and all of that.”
According to Wheelock, the number of overdose reversal reports she takes each month has recently doubled. In many instances, the overdose was reversed by a drug user who administered the lifesaving overdose prevention drug naloxone to another person in their community. According to a 2018 study, when naloxone kits are distributed through syringe exchange sites, they can reduce deaths from overdose by 65%.
“The number of overdose reversal reports we get from drug users who have saved the lives of not only their friends and families but strangers in their community as well shows me that they do actually care,” Wheelock said.
Wheelock said the stigma around the use of certain drugs started with the war on drugs in the 1970s and continues today.
“We’ve been taught for decades that people who use drugs are somehow something other than just humans,” she said. “Do people really care? Yeah, actually, they really do.”
Changing the health department’s harm reduction techniques to include aluminum foil and straws is an adjustment to already operating programs. The harm reduction approach relies in part on stigma-free interactions between people who struggle with addiction and service providers who can connect them to resources for treatment or access to naloxone.
Providing aluminum foil and straws follows the same logic as providing syringes — adjusted to reflect a significant decrease in the use of syringe exchange services.
According to the health department, there has been a 30% decrease in unique clients accessing its syringe services and a 60.8% decrease in the number of visits between 2019–2022.
Wheelock said if people transition from smoking fentanyl to injecting it, she expects to see overdose deaths and HIV infections rise. She agreed better access to treatment and housing is also needed but said harm reduction is not a simple black-or-white issue.
“It’s part of a continuum of care for people,” she said. “If not for the harm reduction efforts that are happening, it would be worse — and it could be worse when people transition to injecting versus smoking.”
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