Every Monday, Dr. Luke Rosen with PeaceHealth St. John’s clinic in Longview, Washington, opens his phone line for new patients.
On the average week, he gets 16 people looking for opioid addiction treatment.
“This disease impacts everyone," he said. "And to think otherwise, you’re a fool."
Cowlitz County is rural and has one of the highest overdose death rates in Washington state. Seventy-one people died here over a four year period. Rosen said he thinks that's because there aren’t enough clinicians and he fears the number will only grow.
Rosen's concern comes even as President Trump has declared a federal emergency to deal with America's opioid crisis.
Tri-county health officer Dr. Paul Lewis of Portland said he’s heartened by Trump's declaration.
“I think there is great reason for hope. If nothing else it’s symbolic," he said.
The declaration directs agencies to use all appropriate emergency authorities to tackle this problem. What that actually entails could be complicated, in part because opioids can be distributed in many ways.
The most obvious way is when someone gets injured and they get a prescription for pain.
Lewis said for most people, the drugs aren’t a problem. But for some, it lights-up their brains and they’re easily hooked. So, he said, prescriptions need to be limited and the declaration could help.
Another way opioids are abused is by people traveling from one clinic to another, collecting the drugs to sell. Lewis said both Oregon and Washington have computer systems that track these "doctor shoppers." Those systems appear to be reducing demand.
“Since a peak around 2015, we’ve come down about 25 percent of the amount of pills prescribed," Lewis said. "We feel like legal pharmaceutical excess is beginning to decline.”
But Oregon Republican congressman Greg Walden isn't so sure. In a recent call about the opioid crisis, Walden said one small town in West Virginia, with a population of just 400, had nearly 9 million pills delivered over two years.
That’s more than 900 pills per person, per month.
“Why are so many pills flowing into so many communities? Is it the manufactures? Is it the prescribers? Is it the distribution chain? And why is it we can’t just shut that down?" asked Walden.
Opioids also come in the form of cheap black-tar heroin.
President Trump has said 90 percent of heroin comes from south of the border and his solution is to build a wall.
But Steve Harris, an addiction counselor from Beaverton, said a wall isn’t going to fix the problem.
“This is an epidemic that was really caused, I believe, by pharmaceuticals, by this idea that thinking opioids weren’t addictive if you have pain," he said.
Perhaps the most deadly way opioids have affected communities in recent years is through fentanyl. Lewis said some people will buy pills without realizing they’re cut with the drug — a much more potent opioid that can be cheaply made in a lab.
“So they are fake pills that look like something you know and trust, but are actually something else,” Lewis explained.
Walden said he’s already working on that aspect of the problem.
“China is very engaged in the production of fentanyl," Walden said. "I’ve talked to the Chinese ambassador about it earlier in the year. They’re helping, I think, in trying to shut down some of these facilities, but it’s still a big, big problem.”
Despite those efforts, not everyone is happy with the president's efforts.
Oregon’s top Democrat, Sen. Ron Wyden, said if the administration is serious about opioids, it shouldn’t be considering cuts to Medicaid.
Addiction counselor Steve Harris agreed. He said the main way addicts get help is via health insurance, and he remembers what it was like 10 years ago.
“We used to take phone calls constantly and just say, 'We can’t help you.' Which is just sickening," Harris said. "At least people now usually can get help."
Walden said opioid addiction strikes all economic levels and Affordable Care Act insurance only covers a small percentage of the population.
He said that while the new declaration doesn’t provide any new funds, it does give agencies flexibility to use existing money.
Walden also pointed out that last year legislation added about $1 billion to the opioid fight. Oregon recently received a $6.5 million slice.