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Report on Clark County deaths tied to opioids in dispute

Officials at Clark County Public Health are disputing a presentation given to the Vancouver City Council on Monday evening that claimed the region’s opioid-related overdoses were dropping.

Deaths linked to opioid overdoses are not dropping in any sort of statistically significant way, said Public Health Director Dr. Alan Melnick, who said that they’ve been stable.

“I don’t have any evidence that opioid deaths are going down in Clark County or in the state,” Melnick said. “I wish the opioid death rate was going down, and we’re doing hopefully all we can to make that happen.”

On Monday, the Vancouver City Council heard an annual update from American Medical Response, the city’s ambulance contractor. That data were presented by Vancouver Fire Chief Joe Molina, AMR Regional Director Rocco Roncarati and Dr. Lynn Wittwer, Clark County medical program director.

During the presentation, Wittwer told the city council that between 2013 and 2017, “we have shown a steady decrease in the county from opioid deaths, unintentional opioid deaths.”

The number of unintentional opioid deaths did drop, Melnick said, but not in any kind of statistically significant way, or in a way that could point to a pattern. According to a 2018 report from Clark County Public Health, in 2013, 35 people in Clark County died of an accidental opioid overdose. In 2017, 33 people died.

The difference of two people, Melnick said, “is not statistically significant.”

“That’s the problem when you get into small numbers,” he added. “When you get into small numbers, it can look like a change even though statistically it’s not, really.”

Wittwer did not return an emailed request for comment Thursday.

Unreliable numbers

Not everyone calls 911 during an opioid overdose. Because of that, it’s an underreported medical emergency, and it’s hard to tally the number of actual overdose incidents with any kind of accuracy, Melnick said.

A spike might indicate more people actually using the drug, but it could also just point to more people willing to call an ambulance — not dissimilar from how an increase in reports of sexual assault is sometimes linked to more victims feeling empowered to come forward, rather than a change in the actual number of assaults.

“You hire more cops, and the number of arrests go up. It doesn’t mean the crime rates are up,” Melnick said.

Similarly, there’s only so much one can extrapolate from a drop in the number of overdose incidents, Melnick said.

Overall, EMTs are responding to fewer opioid overdoses this year compared with last year. Wittwer reported to the city council that first responders recorded 243 opioid-related calls in 2018, but only 76 for the first six months of 2019.

But ambulance numbers alone don’t paint a full picture, Melnick said. The increasing availability of Naloxone, a drug that immediately counteracts the effects of opioids, could be helping people stave off overdoses without the intervention of formal medical attention.

(Anyone who takes Naloxone to counteract an overdose still needs to go to the hospital, Melnick noted. The Naloxone might wear off before the opioid, and the user could still overdose.)

Clark County Public Health distributes Naloxone for free as part of its Harm Reduction Syringe Exchange Services Program. The drug saves lives, but it introduces yet another variable when trying to calculate the rate of opioid use in the county.

“I’m hoping it is going to get better. I don’t want us to rest on our laurels,” Melnick said. “I just want the public to know there’s a lot of good things going on around this, but we’ve got a ways to go.”



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