Health
Scenes From a City That Only Hands Out Tickets for Using Fentanyl
For the past two and a half years, Oregon has been trying an unusual experiment to stem soaring rates of addiction and overdose deaths. People caught with small amounts of illicit drugs for “personal use,” including fentanyl and methamphetamine, are fined just $100 — a sanction that can be waived if they participate in a drug screening and health assessment. The aim is to reserve prosecutions for large-scale dealers and address addiction primarily as a public health emergency.
When the proposal, known as Measure 110, was approved by nearly 60 percent of Oregon voters in November 2020, the pandemic had already emptied downtown Portland of workers and tourists. But its street population was growing, especially after the anti-police protests that had spread around the country that summer. Within months of the measure taking effect in February 2021, open-air drug use, long in the shadows, burst into full view, with people sitting in circles in parks or leaning against street signs, smoking fentanyl crushed on tinfoil.
Since then, Oregon’s overdose rates have only grown. Now, tents of unhoused people line many sidewalks in Portland. Monthslong waiting lists for treatment continue to lengthen. Some politicians and community groups are calling for Measure 110 to be replaced with tough fentanyl possession laws. Others are pleading to give it more time and resources.
The following is a mosaic of voices and images from Portland today.
Working downtown
On her walk to work at Forte Portland, a coffee shop and wine bar that she operates with her brother in the sunken lobby of a commercial building, Jennifer Myrle sidesteps needles, shattered glass and human feces. Often, she says, someone is passed out in front of the lobby’s door, blocking her entrance. The other day, a man lurched in, lay down on a Forte couch, stripped off his shirt and shoes, and refused to leave.
“At four in the afternoon the streets can feel like dealer central,” Ms. Myrle said. “At least 20 to 30 people in ski masks, hoodies and backpacks, usually on bikes and scooters. There’s no point calling the cops.”
Despite the street turmoil, Ms. Myrle likes to go for strolls on her breaks. “But at 11:30 on a Tuesday morning, I walked to the block between Target and Nordstrom and in the middle of everything,” she said, she saw a woman performing an act of oral sex on a man.
She is keenly aware that she’s witnessing a confluence of longstanding societal problems, including mental health and housing crises. “But it’s so much the drugs,” she said.
Patrolling with a gun and Narcan
Officer David Baer of the Portland Police Bureau patrols downtown on a mountain bike, armed with a gun, a citation pad and the overdose-reversal drug Narcan. He spends his shift arresting street dealers carrying large quantities of blue fentanyl pills, writing $100 citation tickets for people injecting or smoking drugs in public and administering Narcan to those nodding out, an emergency he encounters at least once a day.
Such scenes are portrayed on the Portland Police Central Bike Squad’s Instagram account, which has generated intense reaction.
“I get a lot of feedback in the DMs: ‘You need to let the addicts die, they shouldn’t be Narcanned,’” Officer Baer said, adding: “That’s tough to read because we interact with these people every day. I’ve worked on the same person multiple times.”
One person Officer Baer has helped for years is a man named Justin. During night patrol shifts in North Portland, he would encounter Justin drunk from a night at the bars and drive him home.
“The other day I was biking around and I look over — ‘Why is that guy bleeding over there?’ I roll him over and it’s Justin!” Office Baer said.
“He had come downtown, and now he’s addicted to fentanyl. So I Narcanned him and he came back. Twice, now, I think.”
A big part of his job is writing Measure 110 tickets. “It’s like, ‘Hey, you can’t smoke meth or fentanyl on the sidewalk or on the playground.’ And the pushback we get? People can be really aggressive. They think they’re in the right because they think drugs are legal.
“I say, ‘Beer is legal, but you still can’t drink beer in public.’ So we cite them and give them the drug screening card. Then they’ll say they don’t want treatment or they’ll tell us, ‘OK, I’ll call the number.’
“And two hours later we run into them again, and they’re smoking or even overdosing. ”
Living on a sidewalk
“Portland is a homeless drug addict’s slice of paradise,” said Noah Nethers, who was living with his girlfriend in a bright orange tent on the sidewalk against a fence of a church, where they shoot and smoke both fentanyl and meth.
He ticked off the advantages: He can do drugs wherever he wants and the cops no longer harass him. There are more dealers, scouting for fresh customers moving to paradise. That means drugs are plentiful and cheap.
Downsides: Tent living is no paradise, he said, especially when folks in nearby tents, high on meth, hit him with baseball bats.
Plus, eviction notices for the tents had just been posted ordering everyone to be gone the next day by 8 a.m. He didn’t know where he would move next. But if he didn’t clear out, he said, the police would gather his stuff, store it for a month and then toss it.
Measure 110 also did not dial back the hatred and derision he gets from homeowners — people with jobs, full refrigerators, paid vacations. He feels those glares keenly, not least because for a time, his life resembled theirs.
Growing up in Detroit, he dreamed of becoming an English teacher and writing books. But in fifth grade, he started poking around his older brother’s sock drawer and found his weed stash. By high school, Mr. Nethers was smoking crushed-up OxyContin pills. Then he tried heroin.
He was in and out of rehab, five or six times. And prison.
During the years he was able to claw his way to sobriety, Mr. Nethers worked in construction, made rent and became a father.
He moved to Denver, but heroin found him again. For a long time he could shoot up and keep working. But after two big overdoses, he said, “My conscience was tearing me up, and I had to get out.”
Four years ago, he moved to Portland, where a sister lives. But drugs pulled on him. Then the pandemic hit. Finally, the streets summoned. “I was hanging on as long as humanly possible, trying to find the heroin dealers, but then they were gone,” Mr. Nethers, now 42, said. “So I got on the fentanyl roller coaster.”
Lately, he has been trying to take a hard look at his daily struggles.
“I want to pull up the plane before it totally hits the side of the mountain,” Mr. Nethers said. “I mean, please, please God, tell me there’s a way to make it out of this.”
Getting so many calls for help
Solara Salazar, a director of Cielo Treatment Center, which serves young adults in Portland, now receives about 20 inquiries a day about rehab services. “And the majority of them we can’t help,” she said.
Cielo offers outpatient therapy and sober housing. That is great for people who have already begun managing their addictions, but Ms. Salazar, who survived addictions to meth, OxyContin and fentanyl, keeps hearing from those in acute crisis who need a bed in a residential program right away.
She gets pleas from people leaving hospital detox, who have not yet gone through inpatient rehab. Oregon’s Medicaid patients can wait months for a treatment bed, she and others said.
“You just can’t skip a step and expect people to be successful,” she said. “We have a really low success rate that way.”
Funding for Measure 110’s promise of increased services comes from Oregon’s marijuana tax revenues. After a slow start, more than $265 million has flowed to programs that try to make drug use safer by providing clean needles and test strips, offer culturally specific peer support and provide shelter for people newly in recovery. But residential treatment for addiction has yet to be substantially expanded.
Yet critics of 110 say that few drug users who received $100 fines sought rehab.
Ms. Salazar rejects that claim. “The story out there is, ‘Measure 110 doesn’t work because people don’t want treatment.’ That is simply not true,” she said.
“I’m a strong advocate for harm reduction,” she continued. ”The model used to be ‘all treatment, no harm reduction’. But now there’s a push to ‘all harm reduction, no additional residential treatment’— with no happy medium,” said Ms. Salazar, who is on the board of Oregon Recovers, which lobbies for improved treatment and support.
“I talked to a woman the other day who’s living in her car, and she was sobbing and crying and so desperate for treatment. I’m trying to give her some hope and I say, ‘Just keep trying and you’re going to make it,’ but I know that’s a lie. She’s not pregnant, so she doesn’t meet the benchmark for an immediate bed. And I’m going to tell her she has to call every single day for four months and then maybe she’ll get a bed?”
Unifying divided neighbors
For months, a beat-up van with a duct-taped storage box on the roof has been parked across the street from SS. Peter and Paul Episcopal Church in southeastern Portland, doing a brisk business at all hours. The Rev. Sara Fischer thinks the owners are dealing drugs; she recognizes some customers, who also show up in the parking lot of her church, which hosts a county needle exchange program.
Many people in the church’s congregation have expressed frustration with the pervasive, public drug use in the neighborhood, a diverse, scrappy and gentrifying area called Montavilla. But suggestions for how to respond are divisive.
Some want the drug users evicted: They are angry that their kids must dodge tents on their way to school, and witness overdoses, frenzied fits and public defecation. But others, she said, worry about how to get the tent dwellers better and more constant care.
On Sundays, the church sponsors a potluck dinner for everyone in the community, whether they live in tents or comfortable homes. Here, the better-off do not serve food to those without. Instead, all diners eat together. They share life stories, play music and make art.
“Once we know people’s names and stories, they’re not so scary,” Ms. Fischer said. “They cease to be the ‘they’ out there.”
She can’t predict the fate of Measure 110 but firmly believes that criminalizing addiction to drugs is the wrong response to complex problems.
“I think Measure 110 needs more time, “ she said.
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You’ve likely felt your heart beating in your chest after strenuous activity — or have taken your pulse by placing your fingers on your wrist or neck.
A less common — and sometimes startling — sensation is to actually hear the “whooshing” sound of your heartbeat in your ears.
Fox News Digital reached out to two doctors to learn more about what causes this and whether it’s a cause for concern.
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Hearing your heartbeat in your ears — also known by the Latin name “pulsatile tinnitus” — isn’t always a sign of a medical problem, but it could warrant a discussion with your physician, according to Frederick James Meine, M.D., an interventional cardiologist with Novant Health in Wilmington, North Carolina.
Hearing your heartbeat in your ears — also known by the Latin name “pulsatile tinnitus” — isn’t always a sign of a medical problem. Still, it could warrant a discussion with your physician. (iStock)
“Many people hear it at one time or another, especially when they are lying down on their side,” Meine told Fox News Digital.
What causes the condition?
Hearing your heartbeat can be related to ear issues such as wax buildup, fluid in the ear or other hearing issues, Meine said.
The most common cause is Eustachian tube dysfunction. This is usually due to allergies, according to Jesus Lizarzaburu, M.D., a family physician with TPMG Grafton Family Medicine in Yorktown, Virginia.
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“The Eustachian tube connects the middle ear to the back of your nose, and when it is blocked or doesn’t open and close properly, it can cause the sound of your heartbeat to be heard in your ears,” he told Fox News Digital.
Another culprit could be earwax buildup, which can also cause a seal in the ear canal that makes the heartbeat easier to hear, Lizarzaburu added.
Elevated blood pressure is another cause, though less common.
Hearing your heartbeat can be related to ear issues such as wax buildup, fluid in the ear or other hearing issues, a doctor said. (iStock)
On rare occasions, medications like non-steroidal anti-inflammatories (NSAIDs), antibiotics, diuretics, chemotherapy medications, aspirin, certain antidepressants, quinine and antivirals can cause tinnitus, a ringing in the ears that is in rhythm with the heart rate, noted Lizarzaburu.
“Extremely rare causes would be an aneurysm (a bulge in a blood vessel in the brain) or a vascular tumor, which is made up of a collection of blood vessels,” he added.
When to seek medical attention
A thorough physical exam, including a blood pressure check and an examination of the carotid arteries in the neck, is an important part of gauging overall cardiovascular health, Meine advised.
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“In addition, ruling out anemia or hyperthyroidism, both of which could cause increased blood flow and possibly contribute to pulsatile tinnitus, could be evaluated with simple lab tests,” he said.
If someone experiences the condition intermittently, it is likely less worrisome, the doctor noted.
A thorough physical exam, including a blood pressure check and an examination of the carotid arteries in the neck, is an important part of gauging overall cardiovascular health, a doctor advised. (iStock)
“However, if it is persistent or new-onset, we would perform a complete history and physical exam,” he said.
From a cardiovascular perspective, if someone is experiencing pulsatile tinnitus or hearing their heartbeat in their own ears, Meine said it’s important to rule out any potential cardiovascular issues.
The doctor would also make sure the patient does not have a blockage or narrowing of the neck arteries, which could contribute to louder heart sounds in the ears and head, he said.
“I do want to stress that most of us occasionally hear our heartbeats in our heads and ears, especially when our heart rate is increased during exercise,” Meine said.
For more Health articles, visit www.foxnews.com/health.
- Nicotine alternatives like 6-methyl nicotine in vapes may be more addictive than nicotine, according to the FDA.
- These synthetic substances are not regulated by U.S. tobacco and vaping laws that control traditional nicotine.
- Traditional nicotine is derived from tobacco leaves, while 6-methyl nicotine is synthesized in labs using chemicals.
Nicotine alternatives used in vapes being launched in the U.S. and abroad, such as 6-methyl nicotine, may be more potent and addictive than nicotine itself, though the scientific data remains incomplete, according to the U.S. Food and Drug Administration (FDA) and independent researchers.
The synthetic substances – which have a chemical structure similar to that of nicotine – are not subject to U.S. tobacco and vaping regulations that are designed to control traditional nicotine, a highly addictive drug.
That means manufacturers can sell vapes containing synthetic nicotine analogues such as 6-methyl nicotine in the United States without seeking authorization from the FDA – a process that can be costly, time-consuming and is often unsuccessful.
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Big tobacco firms like Altria Group and British American Tobacco have already lost substantial U.S. sales to an influx of disposable vapes containing traditional nicotine that are being illegally sold without FDA authorization.
Various vapes, nicotine products and the new Spree Bar, which contains a chemical that mimics nicotine, line the shelves at Sultans’ Smoke in Arvada, Colorado, on May 21, 2024. (REUTERS/Kevin Mohatt/ File Photo)
Altria, the maker of Marlboro cigarettes in the United States, highlighted the emerging use of 6-methyl nicotine in vapes and other smoking alternatives in a May 9 letter to the FDA, according to a copy of the correspondence posted on its website.
It urged the agency to evaluate the compounds and establish what authority it had over them, warning they posed a “new threat” to regulation of the sector.
“The introduction and growth of chemicals intended to imitate the effects of nicotine, if left unchecked, could present unknown risks to U.S. consumers and undermine FDA’s authority,” the letter said.
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It cited SPREE BAR, a vape launched in October by Charlie’s Holdings Inc that uses 6-methyl nicotine.
The FDA does not comment on its correspondence with individual firms.
In response to Reuters’ questions about 6-methyl nicotine and other nicotine alternatives, the FDA said in a statement: “Although more research is needed, some emerging data show these nicotine analogs may be more potent than nicotine – which is already highly addictive, can alter adolescent brain development and have long-term effects on youth’s attention, learning and memory.”
Traditional nicotine found in many vapes and pouches is extracted from tobacco leaves. 6-methyl nicotine, in contrast, is made entirely in the lab using chemicals.
The FDA said it was considering the use of such synthetic compounds from an “agency-wide perspective” and would use all of its resources to protect youth from products that may harm their health. As well as tobacco products, the FDA also regulates drugs, foods, cosmetics and more to ensure safety and efficacy.
“The FDA is a data-driven agency, and we’re in the process of reviewing the available data to inform potential actions in this space,” it said in response to Reuters’ questions.
Three academic researchers told the news agency that current studies of 6-methyl nicotine are too limited to draw definite conclusions on the health impact or to what degree it is addictive.
Imad Damaj, a professor in the Department of Pharmacology and Toxicology at Virginia Commonwealth University, said his research showed 6-methyl nicotine may be more potent than nicotine, but more extensive tests were needed to say what impact it has on humans.
The limitations of existing research included that some papers were industry funded, while others focused on the short-term impact on animals or cells and were insufficient to understand 6-methyl nicotine’s effects on human bodies, the researchers said.
Charlie’s Holdings calls the 6-methyl nicotine solution used in SPREE BAR Metatine. SPREE BAR’s website says Metatine “may have a toxicity profile similar to nicotine”.
SPREE BAR promises users 6,000 puffs from each device and offers fruity flavors including “blue razz ice” and “creamy melon”, according to its website.
The FDA has yet to approve any flavored vape using traditional nicotine for sale in the United States, saying companies have not been able to show that the health benefits they offer to smokers outweigh the known risks to young people, who may be more attracted by the flavors.
Charlie’s Holdings co-founder Ryan Stump told Reuters that the company only targets adults, adding that flavors played an important role in its mission to help smokers quit cigarettes.
Stump said Charlie’s Holdings respects and abides by laws in every market where it operates. He acknowledged that more research is needed on 6-methyl nicotine, adding that the company dilutes it in its products.
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Anes Saleh sells SPREE BAR in his vape shop in Denver, Colorado, called Sultan Smoke. He said he has some customers who only buy Spree Bar instead of a nicotine vape and he hasn’t had any negative feedback on the product.
“The only… protest I would hear about people not wanting to try this is that they don’t know what Metatine is or does,” he said.
Stump said that Charlie’s Holdings is working on new varieties of SPREE BAR and new products using 6-methyl nicotine. It will launch SPREE BAR internationally this year. He declined to say where.
The company buys the 6-methyl nicotine solution used in SPREE BAR from another U.S. firm, Novel Compounds, according to Novel Compounds’ founder Samuel Benaim.
Novel Compounds imports 6-methyl nicotine from overseas and alters it to make it easier for manufacturers like Charlie’s Holdings to use in their products. It sells this solution under the trade name imotine.
Tests commissioned by Novel Compounds have found 6-methyl nicotine to be no more harmful than nicotine, Benaim said. But he also said that more research was needed into the chemical.
Benaim added that Novel Compounds had received legal advice that its product is not classified as a tobacco product or drug in the United States. The company is committed to legal compliance, he said.
MORE POTENT THAN NICOTINE?
Sven Jordt, a professor at Duke University, who has authored papers on products like SPREE BAR, said 6-methyl nicotine could me more addictive and toxic than its traditional cousin.
“Do we want to have such a chemical as a recreational product, available to anyone?,” he asked. “That’s really questionable.”
Neither Jordt nor Damaj – the professor at Virginia Commonwealth University – have received funding from tobacco or vape makers.
As well as the United States, Novel Compounds also sells its 6-methyl nicotine solution around the world, including in the United Kingdom, Indonesia, India and Japan.
Another company, Aroma King, sells 6-methyl nicotine in the United Kingdom in pouches, which users insert under the lip to get a buzz. The pouches are sold in cans emblazoned with graphics of gorillas in suits and sunglasses.
It said in a February blog post that its 6-methyl nicotine products were “less toxic”, “less harmful”, and “less addictive” than regular nicotine products.
In a statement to Reuters, Aroma King cited existing research, its own toxicology and other tests and its supplier, which classifies 6-methyl nicotine as less toxic under the European Union’s Classification, Labelling and Packaging of Substances and Mixtures (CLP) Regulation.
Aroma King said 6-methyl nicotine was self-classified by its supplier. It declined to say who supplies it with the chemical.
Four Chinese companies hold patents in China related to the production of 6-methyl nicotine, including Zinwi Biotech, a company that makes the liquid used in vapes.
Zinwi Biotech confirmed it is researching 6-methyl nicotine but did not answer further questions, including on whether it has sold any 6-methyl nicotine so far. Reuters was unable to find contact details for the other firms.
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