In the span of six hours on Sept. 22, Springfield Police and Emergency Medical Services personnel responded to four suspected heroin overdoses.
That same evening, a fifth person was "dropped" — a method of avoiding encounters with law enforcement — at the emergency receiving area at McKenzie Willamette Hospital.
In one case, police responded to a 30-year-old woman seizing and struggling to breathe. Police administered IV Narcan, a drug that can help reverse an opioid overdose, saving her just barely from "what appeared to be the onset of death by heroin overdose," police said.
In a regular three-day period, Lane County averages seven overdoses that require hospitalization.
Related: How The Opioid Crisis Could Lead To More Cases Of Liver Cancer In Oregon
In a three-day period last weekend, there were 21.
It got so bad that the county began urging people to prepare for an overdose emergency, scrambling to get the word out to opioid users, and advising them to let whomever they've entrusted with naloxone, a medication designed to rapidly reverse opioid overdose, know when they are using.
Springfield Police issued a public safety alert.
"This volume is unusual and disturbing and public health officials urge caution for heroin users," the alert said.
Police suspected a granular black, white and brown heroin powder substance found in at least two of the cases that could be circulating the area. The 21 overdose patients were spread out between the county's three downtown-area emergency rooms: McKenzie-Williamette Medical Center Emergency Department and two Peacehealth Sacred Heart facilities.
But when Lane County's public health officer followed up with the emergency department directors at those three facilities, he found none of them had any idea the county was in the midst of an unprecedented spike in drug overdoses that tripled its average.
"Because they were split across three other hospitals, none of the doctors there thought that it was a problem," said Dr. Patrick Luedtke, Lane County's senior health officer.
"If all of those overdoses went to one facility, I suspect someone would've called the public health department."
The Oregon Health Authority has a real-time syndromic data surveillance tool for public health and hospitals to monitor what is happening in emergency departments across the state before, during and after a public health emergency.
But the opioid epidemic operates under the watchful gaze of multiple agencies, including law enforcement agencies who, in Springfield's case, were on the front lines administering the life-saving drug Narcan.
According to Luedtke, relevant agencies combating the opioid epidemic rely heavily on interpersonal relationships absent a uniform, real-time reporting system to track overdoses — and the substances that caused them.
"Data needs to be shared at the speed of the electron, not the speed of intercommunication," Luedtke said. "We don't have that right now. We're relying on these relationships and the ability to respond on a person-to-person basis, and that makes it fragmented."
Lane County has consistently seen overdoses that top state averages, said Dr. Elisabeth Maxwell, Lane County's substance abuse specialist. According to Maxwell, it's not entirely clear why.
In fact, Lane County has been designated by the state as a "high burden area" for opioid issues and receives federal money to fund positions like Maxwell's.
But even so, Maxwell said last weekend's spike in overdoses is not normal. It's also been days since the spike, and the county still doesn't know what exact drug is implicated.
"It's too early to say for us," Maxwell said. "It's not normal for our community."
Lab tests are underway to determine what drugs were involved in last weekend's spike in overdoses. Maxwell said similar incidents in other communities suggest drugs could be laced with fentanyl, or substance mixing could be involved.
According to Luedtke, lab tests are often sent out of state and can sometimes take weeks to return.
"From a public health standpoint, you really want to know what's in your community circulating," he said. "If we can find that out earlier, we could know earlier what's out there and help our legal people with data that is actionable in the court of law."
It would also allow public health officials to alert users who may be in a life or death situation.
"We could get the word out to the community of persons who use," Luedtke said, "and say, 'Look, it's out there, be very careful, do a test dose, don't use alone, don't use multiple drugs — stress that message and save some lives.'"
Jason Davis, a spokesperson with Lane County Health and Human Services, said the county plans to appoint someone to manually enter information about drug overdoses into the state's syndromic data surveillance tool known as Essence. Currently, it can take days before that information is entered. Davis said that would expedite the county's ability to recognize an abnormal surge in overdoses. He said that person could be appointed by the end of the week.