Responding to the Fentanyl Overdose Crisis With a Tri-Government Incident Command Structure in Portland, Oregon, 2024

The increasing use of illicit fentanyl has contributed to a drastic increase in drug overdose fatalities throughout the United States. The rate of fatal fentanyl-related overdoses in Multnomah County, Oregon, was 1.6 times higher than the United States' average in 2022 and continued to rise in 2023. In January 2024, the Governor of Oregon, the Multnomah County Chair, and the Portland Mayor declared a 90-day tri-government emergency to augment and enhance the ongoing response to fentanyl use and overdose in Portland city center.

Between January 31, 2024, and April 30, 2024, an Incident Management Team (IMT) that unified the state, city, and county jurisdictions was stood up in accordance with the emergency declarations. The response objectives included coordinating access to naloxone and substance use disorder treatment, creating an accessible fentanyl data dashboard, visibly revitalizing urban areas, and developing a long-term plan that includes policy planning to address the fentanyl crisis in Portland.

During the 90-day response period, daily coordination occurred between approximately 55 Oregon State and local public health agencies, law enforcement agencies, community-based organizations, and first responders. The IMT aligned substance use response activities in the operational area, supported a fentanyl-focused community summit, and enhanced data systems for increased accessibility. A dashboard that visualized 5 sources of interagency data on fatal and nonfatal overdose also resulted from the IMT and was made publicly available.

Although the efficacy of using an Incident Command System to respond to fentanyl overdose mortality is difficult to ascertain, the approach allowed for cross-agency results in ways that might not have otherwise been possible. Future emergency declarations to address public health issues should define specific, health-related and equity-oriented objectives ahead of time to have the most impact on health outcomes.