Despite a reported spike in fentanyl-related overdoses among teens and young adults, it's unclear whether students are learning about the hidden dangers of new counterfeit pills and street drugs in their health classes.
Multnomah County has seen a rise in such overdoses among linked to counterfeit street pills. Fentanyl is a synthetic opioid believed to be up to 100 times more potent than morphine.
Street pills known as "M30s" or "blues" meant to imitate oxycodone — a pharmaceutical-grade painkiller — contain unknown amounts of fentanyl, according to health officials. Those looking to buy "M30s" are often unaware of the danger fentanyl and other unknown substances in the pills pose.
"We're seeing some pretty significant and serious drug use with youth," Naomi Caster, director of Fora Health Youth and Family Services, said, noting a lot of them are "early youth, pre-high school and even pre-middle school."
During intakes at Fora Health, youth are asked when they first tried any sort of drug — including alcohol. Early exposure to drugs and a rough home life contribute to addictions among youth, Caster, a licensed marriage and family therapist, said.
"I would say elementary school," Caster said. "Fourth, fifth, sixth grade is when I'm seeing a lot of these youth are starting to experiment."
A tri-county report from 2019 found that in 2018, more than three people a week died from opioid overdose, 72% of which were in Multnomah County.
In fiscal years 2019 and 2020, Fora Health admitted 121 youth patients. Out of those, 23 were admitted with an opioid diagnosis, and 31 reported some sort of opiate use. Out of the 31, eight patients reported previous use of fentanyl.
The rise in use of counterfeit pills is a known problem among Multnomah County health officials.
Last spring, the county issued a warning about taking any non-prescribed prescription pill, noting counterfeit opioid pills containing fentanyl are suspected of "fueling an increase in fatal drug overdoses across the Portland Metro region." The overdose deaths include teens and others who didn't regularly use illicit drugs, a county press release noted.
"People should assume that any pill sold on the street contains fentanyl, no matter how authentic it might look," said Dr. Jennifer Vines, regional health officer for Multnomah County. "Taking any pill laced with fentanyl can be fatal."
The problem isn't limited to Multnomah County.
By late April 2021, Washington County's Westside Interagency Narcotics Team had seized more than 17,000 pills — more than the 14,000 seized the year before, according to a Multnomah County clinician alert. Most of the pills were believed to be counterfeit M30 oxycodone pills.
The Multnomah County Sheriff's Office's Special Investigations Unit reportedly seized more than 5,000 oxycodone pills suspected of containing fentanyl within the first four months of 2021.
"We used to run into blues here and there. When we were doing a meth or heroin investigation, we might find some pills," said Sheriff's Sgt. Tim Wonacott, assigned to the Special Investigation Unit. "It seems like all of a sudden we are more involved with pill cases. We're having cases with people who just sell pills."
Frequent users of street drugs are recommended by health officials to keep Narcan, an overdose-reversal drug, at the ready.
Signs of an overdose include pale or clammy skin, slow or no breathing, vomiting or foaming at the mouth, bluish or pale lips and fingertips and a limp body.
Severe drug use among young teens can affect not only their health and relationships with friends and family, but can often lead to them falling behind in school. To prevent any loss of education for teen patients seeking treatment, Fora Health implements daily schooling onsite through a partnership with Portland Public Schools, alongside therapy to repair those relationships.
Drug treatment experts say education is a key solution in drug abuse and overdose prevention.
Despite warnings about a rise in counterfeit street pills and fentanyl use among teens, school districts in the Portland Metro region have taken vastly different approaches to drug and health education.
Gresham-Barlow School District's health curriculum, doesn't include specific mention of fentanyl and the dangers of that drug alone. The district does, however, require a unit on drug prevention that covers both prescription and street drugs, according to district-provided curriculum.
"We do not have any drug prevention programs beyond what is taught in our health classes,"
said Tim Collins, director of research, assessment, and evaluation for the Gresham-Barlow School District. "While our teachers discuss fentanyl, it is not a primary unit of study but is rather part of a unit on drug abuse prevention that covers prescription drugs and street drugs."
Collins noted the district partners with local agencies to provide substance abuse prevention services for students seeking help.
Other districts have taken a much more proactive approach.
Beaverton School District has a public information component on fentanyl, called "Fake and Fatal" after the death of a recent BSD grad, Cal Epstein, in December 2020. Epstein's parents say their son likely sought out oxycontin and ended up with fentanyl. They discovered Cal unresponsive in his room while he was home visiting over winter break from college.
"These students thought that they were purchasing oxycontin or Xanax on social media," BSD Superintendent Don Grotting told Multnomah County health officials. "They had no idea that they were getting deadly fentanyl. They had no idea that one pill could kill them. Educating our students about this danger has become one of our highest priorities."
This story is made possible because of Amplify, a community storytelling initiative of Pamplin Media Group, Care Oregon and The Latino Network. Amplify supports internships for high school journalists in the Portland metro region and aims to elevate the voices of student journalists from historically underrepresented groups, such as communities of color, low-income residents and others.