Other than the planned safety inspection from officials at the Washington State Department of Health (DOH), January 25 was a routine morning at the Trent Shelter.
Bob Lutz, the former health officer of the Spokane Regional Health District (SRHD), and representatives from the DOH’s Program for Transient Accommodations, had invited Spokane City Council representatives from District 1 — where the Trent shelter is located — to shadow them as they checked the shelter’s hygiene and safety conditions in the wake of the Shigella outbreak that had been ravaging shelter occupants for months.
Council Member Jonathan Bingle and Nicolette Ocheltree, the council’s housing and homelessness policy advisor who went on Council Member Michael Cathcart’s behalf, followed Lutz and the DOH officials around the shelter as they noted potential health concerns.
Lutz took the group outside to look at the bathrooms — outdoor portable toilets with no running water that have been the frequent target of public outcry and media attention. Bingle said the group members looked at about half of the portables to check their condition, but a few were locked.
He thought nothing of it. People lock bathrooms when they’re using them.
Ocheltree recalled other details Lutz had pointed out during the inspection. A woman was brushing her teeth with non-potable water from the hand washing stations because there was no other option accessible to residents. None of the hand sanitizer dispensers were working. Pipes had frozen recently, and the showers — none of which are ADA accessible — had no hot water for residents to use (a recurring problem). The room that was supposed to be used to keep sick residents in isolation had been converted to storage.
The conditions were jarring to Ocheltree. Bingle noted conditions “weren’t great,” but said “I honestly don’t know what to expect when you’ve got 350+ in a single space, especially if some of them have serious issues.”
For Lutz, who visits the shelter frequently to provide clinical services, “There was nothing unusual about it,” he said. “It was just like every other day.”
Until it wasn’t.
As Bingle and Ocheltree began to walk back to where they’d parked, they were met with the wail and flashing lights of fire engines and an ambulance pulling up to the shelter.
Employees of American On-Site Services, the company that owns and maintains the portables, had arrived to clean, but one of those locked doors just wasn’t opening.
When the cleaners finally pried it open, a man tumbled out.
Lutz and a nurse were still on site, having just begun delivering medications to shelter residents. They were called back to the portable bathrooms. Lutz described the man’s condition like a doctor: “He was unresponsive and he was cyanotic and not breathing. His pupils were fixed and dilated so I knew that he had passed on.”
The man had overdosed.
Because the portable toilets are only cleaned once a day, in the mornings — and shelter staff does not regularly check them for people doing drugs inside — no one could tell how long the man had been dead. “[SFD] put monitors on him,” to check for vital signs, Lutz said, “but given his status, it was pretty evident he had been dead for a while.”
He had certainly been deceased when the council representatives toured at 7:30 am and noticed the locked portable.
Bingle and Ocheltree found out about the death later that day, as they visited the annual Spokane Homeless Connect event. A service provider who had been out at the Trent Shelter that morning told them.
“It was pretty disturbing, especially considering all the conditions that we saw leading up to that. And then the questions flood your brain like ‘Did he die while we were outside? How long was he dead?’” Ocheltree said. “But it also wasn’t that surprising, unfortunately, and I think that desensitization was also disturbing.”
Bingle says, based on the number of calls he’s gotten from service providers in the last month, it’s clear to him this wasn’t a one-off tragedy, but part of a much larger problem.
“A couple weeks ago, Julie [Garcia] called me and was like ‘We’ve had 40 overdoses this weekend,’ and I was like ‘there’s no way, there’s absolutely no way. That’s a ridiculous number,” Bingle said. “But sure enough, man. It was like 15 on one day, 10 on another, eight on another.”
RANGE has consistently heard similar reports since at least December — from city leadership, civil servants and service providers like Garcia, who is the director of Jewels Helping Hands — some of them on background because the people either weren’t authorized to comment or were just passing on bits of information they had heard from other people.
Like the man who died, that informal network of information sharing also appears to be the symptom of a larger problem: spotty, unreliable and just non-existent data surrounding overdose deaths locally.
By February 5, during the city council’s Open Forum, the whispers became a shout.
Angel Tomeo Sam, a service provider with Yoyot Sp’q’n’ii and a member of Experience Matters, a coalition of local organizations and individuals working to address homelessness, spoke during Open Forum at the city council meeting on February 5, asking the council to step up and do something about what she called “the current fentanyl crisis in Spokane.”
“On Saturday, there were 21 overdoses in Spokane, on Friday there were 13 and on Thursday, I spent a couple of hours administering Narcan on a couple of folks that I know,” Tomeo Sam said. “In the week from last Thursday to the previous Friday, there were 10 people that I served in this community who died of a fentanyl overdose.”
Tomeo Sam was at the meeting with a letter co-written by her colleagues at Experience Matters, requesting the city declare a state of emergency because the “devastating impact of fentanyl-related incidents, including overdoses and fatalities, has reached a critical level, necessitating urgent and comprehensive intervention.”
Multiple citizens used their time at the microphone to ask city council members to pay attention to the swell of overdoses on the streets.
William Hulings, a regular fixture at council meetings, used his two minutes to read a short story he’d written that day after walking the streets.
“In the heart of Spokane, a city grappling with shadows that seem to grow darker by the day, the devastating impact of fentanyl casts a long mournful shadow over the lives of its residents,” Hulings wrote. His time ran out before he could finish reading the story in its entirety, but he finished by asking the city council to “do something about the fentanyl problem.”
In order to respond to a crisis, though, it’s important to know the scale, so you can begin to calculate the response. What’s the historical trend? Was this a sudden spike, or did it build gradually? Are these overdoses geographically concentrated? Is that concentration new, or does it follow established patterns from previous data? If these are the number dead from overdose, how many more people are overdosing, but survive? How much Naloxone, also known as Narcan, is it taking to bring people back from the brink?
Questions like this could give city officials, service providers and private funders — or in a world where the Regional Homeless Authority ever becomes a functioning entity, the RHA itself — the tools to devise a plan for how to scale the response, and how to target the most at-risk populations. But that’s assuming the city, the county, or some other entity has the data to answer those kinds of questions.
Lacking official data, we decided to compile our own.
Between February 13 to February 21 — and, incidentally more than two months after we had reported Spokane County was canceling its Opioid Task Force — RANGE contacted 14 people across 8 agencies and organizations to try to understand if comprehensive data exists, and if so, how one could get up-to-date, accurate data on the actual number of overdoses, fatal or otherwise, that have happened in 2024, along with historic data to understand the relative gravity of the current crisis.
It turns out, we weren’t the only ones looking.
“We don’t feel well-informed.”
Prior to the February 5 meeting, council members had also been hearing murmurs of a crisis, and before the evening council meeting that had brought so much more testimony about the crisis raised the issue during the Public Safety & Health Committee meeting. Both Paul Dillon — freshman council member and the new chair of the committee — and Cathcart asked Lori Markham, Executive Director of Spokane Regional Emergency Communications (SREC), to provide any available data on overdoses, including hospital transports, Naloxone usage and any data points related to fentanyl in the region.
Markham said that the SREC data collection system was accessible by the Spokane Fire Department (SFD), and that she’d be happy to assist SFD in pulling data from the system to give to the council.
It wasn’t immediately clear why Markham didn’t volunteer to pull the data herself. And though Julie O’Berg, the interim chief of SFD had presented before Markham and answered questions about the city’s Naloxone stock, she hadn’t made any specific promises to pull overdose data.
Weeks later, as council members continued to receive emails calling for the city to declare a state of emergency, they still had not received the data they’d asked for, according to both Dillon and Cathcart. Dillon went digging on his own and found some information from the state Department of Health, but that data ended in 2022, over a full calendar year before the crisis in question.
Dillon’s new colleagues welcomed him to the club.
“We don’t feel well-informed,” Bingle told RANGE. “Whenever it comes to anything homelessness-related, we’re never well-informed, because for whatever reason, the data is missing, the data isn’t communicated, and this is no different.”
Bingle added that Cathcart has been leading the charge on asking for transparency and data access.
“This is something that Michael’s been harping on for a long time. We just need to see the data. Good, bad, indifferent — we just need to see the data,” Bingle said, describing it as an issue of access and follow-up.
“Nobody ever says, ‘No, you can’t see the data,’” Bingle continued, “but whether or not they actually make it a priority to get us the data, there’s one thing or another, and we’ve never had the ability to just log in and see it for ourselves.”
For Bingle, service providers with front line experience — people like Garcia (of Jewels Helping Hands), Tomeo Sam and Hallie Burchinal (of Compassionate Addiction Treatment) — have been the most accurate and responsive place to get data from.
“They’re going to be the best source of information for all that. I learned more from them than from our city staff,” Bingle said. “I don’t want to take shots at our city staff, it just is what it is.”
Show me the numbers
Members of the Spokane City Council didn’t have access to the data they needed to make informed policy decisions. We were curious — if everyone is saying there’s a crisis, exactly how hard could it be to find out just how many overdoses there have been in the new year?
RANGE started by emailing both SFD and the Spokane Police Department (SPD) on Tuesday, February 13. We asked how many overdose calls were received in 2024, how many of those calls were fatal, how many of those overdoses were due to fentanyl and how those numbers compared to data from the same time period in 2023.
Our first responder (spoiler alert) ended up having the best real-time data, (they also circled back with us to keep providing better data as they found it throughout the week) — and the imperfection and shortcomings of that data is illustrative of the systemwide issue.
Justin de Ruyter, SFD’s Public Information Officer, responded the same day and set up an interview for Wednesday. At the Wednesday interview, we learned from de Ruyter that, according to SFD’s call dispatch system — a source collected by SFD, and theoretically available to SREC, overdose calls had gone up 30% since last year. De Ruyter said that amounted to 249 overdose calls from January 1 to February 7 — an average of 6.4 overdose calls per day, compared to 4.4 in 2023, and 3.3 in 2022.
De Ruyter said that Spokane’s data collection system was clunky compared to the programs he had access to in his previous job at the Portland Fire Department.
“Going into the reports and trying to pull the data can be challenging,” de Ruyter said. “The data that we have, our programs, it’s time consuming to get through.”
In Portland, de Ruyter said, “we could run all sorts of reports and look at data in different ways.” It isn’t that way in Spokane. “When you guys start asking these questions, my hands get tied pretty quickly,” he said, “It can sometimes take hours and three or four people to get some basic kind of stuff forward.”
And even with a better system, the data collection process itself for emergency response is inherently messy. Sometimes, responders go to an emergency call for a heart attack — which would appear in the call logs as a cardiac arrest — and realize the person is actually overdosing. In those cases, the call log doesn’t necessarily get updated automatically, so even with a better data system, there will need to be work put in to actually making sure the individual data points are accurate. With the way that data is currently collected, de Ruyter told RANGE, he has to follow up with dispatch or with Emergency Medical Services (EMS) on calls initially logged as cardiac arrests to see if those ended up being overdoses.
Additionally, there were a few pieces of information that de Ruyter just couldn’t access. SFD was able to tell RANGE that their numbers show 63 individuals had been given Naloxone — best known under the brand name “Narcan,” one drug that responders use to revive people during an overdose — and that 30% of those individuals had been given multiple doses. Because EMS is under SFD, those numbers included treatments administered by paramedics.
The data does not, however, track any doses of Naloxone administered by the police, service providers or bystanders. It wasn’t clear if tracking these other sources of Naloxone treatment would be feasible at the SFD level, raising questions — still unanswered — about which agency is best-equipped to spearhead rapid data collection efforts and house and administer that data.
Another difficulty in the SFD data is geographic. The way the current system collates data, de Ruyter couldn’t easily provide concrete location data about where overdoses were most frequently happening.
“Anecdotally, I can tell you where they’re at: [near] all the shelters,” de Ruyter said. “But I don’t have any way, with our programs, to make a heat map and show what times they’re coming in and where they’re coming in.” A few days later, with approximately three hours of work, Dillon Russell, a lieutenant with SFD was able to crunch those numbers.
Lastly, de Ruyter said SFD can be relatively confident about patient outcomes that happen while in SFD or EMS’ care, but doesn’t have any sense of what happens after that. Because people who die of an overdose don’t always die in SFD or EMS care. They may die at the hospital, or somewhere else, and SFD’s data would have no way of capturing that information.
With some effort, Russell was later able to tell RANGE that 10 people had died of overdose in SFD or EMS care, or were already dead upon their arrival so far in 2024.
And so, even with the most accurate data we were able to find in Spokane, the best answer we got was still anecdotal. “Anecdotally, yes. Fentanyl has changed the game, right?” de Ruyter said. “And there will be hot batches of fentanyl that come through … Anecdotally, we’re seeing more dead people.”
What de Ruyter provided was helpful, but still not as specific as we were hoping to find. Luckily, he had ideas as to where we should go next. For fatalities, Spokane County Medical Examiner. For everything else, the Spokane Regional Health District (SRHD), as de Ruyter believed they were the ones keeping the best data.
Ok, but really, does anyone have the data?
The same afternoon RANGE interviewed de Ruyter, we emailed the medical examiner and SRHD, asking the same questions about overdoses and fatalities. We also reached out to an SPD email listed for general media inquiries, and asked Dawn Kinder, the director of Neighborhoods, Housing and Human Services (NHHS), if the city had access to some kind of dashboard where this kind of data would be collected. (Kinder never responded.)
SRHD, the place that de Ruyter thought kept “the best data,” answered first.
Whether or not SRHD has the best and most comprehensive data, though, ended up being a little bit beside the point. Their most recent data was over a year old, and couldn’t tell us anything about the current crisis. “We rely on the healthcare systems’ reporting to the state,” wrote Kelli Hawkins, SRHD’s Public Information Officer. “Once that data is collected, verified and cleaned, then it’s made available to us.”
Hawkins said that SRHD didn’t have data for 2023 yet because it hasn’t been finalized by the state Department of Health (DOH), but that “Spokane has seen a higher than the state overall drug overdose rate, mainly in 2021 and 2022, which possibly continues into 2023.”
The data SRHD does have may end up being a good source of historic data to compare new trends against, and that data turns out to be very easy to access by anybody with a web browser. “The most up-to-date data on overdose deaths, through 2022, is available on our Opioid Dashboard,” Hawkins wrote.
As for where we could go to get that more up-to-date data, Hawkins pointed us back to some familiar sources. “I recommend reaching out to the hospital systems and to EMS to get anecdotal information on what they are seeing in 2024 compared to previous years,” she wrote.
The next day — Friday, February 16 — we caught a break.
First, we called the number listed on EMS website, and reached Russell, de Ruyter’s colleague at SFD (EMS/Medical Services Office falls under SFD’s umbrella) who said he’d be able to get back to us with some more concrete data later that afternoon.
Then, Erin Hut, Mayor Lisa Brown’s communications director, responded to an email we’d sent that morning, and said that any data the mayor’s office had would come from everywhere we’d already contacted: SRHD, SFD and SPD. Hut also recommended reaching out to the state DOH.
While waiting for a call back from Russell, we found a report published from the state DOH with data from January 2024. That data, which was based on reporting from regional EMS to the Washington Emergency Medical Services Information System, surmised that there were 174 “suspected overdoses” in our region in just the first 31 days of the year.
This was helpful, but not necessarily specific to just the City of Spokane, and didn’t yet include anything from the first week of February, which — anecdotally — had been deadly.
Around 3 pm, RANGE received a call back from Russell. His Friday had been anything but typical; he was the only person in the office, and had received three different calls asking for the same set of data.
Shortly after our email went out to Hut, Russell had received a call from the mayor’s office, asking to have access to the exact set of data RANGE had been trying to find.
“I’ve been in this position since July of last year, and in the entire time I’ve had inquiries, the specific data that you’re asking about I’ve only ever had the county ask for,” Russell said. “Today was the first time I’ve had someone from City Hall ask for it.”
After the call from the mayor’s office, he said he received another call from someone in a similar office asking for the same information.
They all wanted data immediately, sending Russell into a three-hour fire drill to pull the raw numbers into a digestible format with relevant information like frequent times and locations for overdoses. He called us to walk us through some key points, and said there may be additional infographics and data visualizations available later, pending approval from city legal.
On the evening of Thursday, February 22, nine days after emailing Julie Humphreys, the communications Manager for Spokane Police Department, we received a call back from Lieutenant Terry Preuninger, one of at least three information officers employed by SPD. Preuninger echoed what others had told RANGE: “anecdotally, there are way more overdoses.”
Because overdosing isn’t a crime, though, Preuninger said it’s complicated for SPD’s data system to maintain a log of data. The police also have similar data hygiene issues as SFD — if something is called in incorrectly, and then when SPD arrives on scene, it’s actually an overdose, or vice versa, there isn’t a procedure in place to correct those records.
One additional wrinkle: sometimes, officers from SPD just come across a person suffering overdose symptoms without a call coming in, and then step in and administer Naloxone. Preuninger said there is currently no reliable record for any of those interactions.
“We’re the law and order guys, that’s what drives our data collection,” Preuninger said.
The bottom line (maybe)
When all was said and done, RANGE learned that from January 1 to February 16, EMS and SFD had logged 113 overdoses. 52 of those overdoses had occurred downtown, in the 99201 zip code. Ten people had been pronounced dead on scene, and 156 doses of Naloxone had been given — almost 20% of Naloxone administrations given in the entirety of 2023 — with 12 doses being the highest number administered to one patient.
So, after a week on the hunt, we had some concrete, Spokane-specific numbers.
After de Ruyter and Russell both concluded they had no way of identifying the true fatality rate because their numbers didn’t include numbers from SPD or any deaths that occurred after patients had left their care, Russell recommended RANGE try the Medical Examiner.
Tuesday, February 20, a week after we’d originally started our quest, we got the last piece of the puzzle — Johnathan Waldrop, the Medical Examiner Operations Manager, said in a brief email that there had been “31 confirmed overdose deaths thus far in Spokane County.”
Remaining questions
After a long, circuitous process that started with nothing but anecdotes and found some hard data along the way, we still have far more questions than clarity, but RANGE did find something of an answer to the basic question:
Yes, Spokane is having an overdose crisis.
As for all those other questions, though, about geography and frequency and intensity of overdose incidents — the questions that might help us begin to better understand, and hopefully eventually solve the overdose crisis — we still don’t have good answers.
Why was it so hard to get data? Why did we have to contact multiple agencies? Why did multiple agencies point us to SRHD for the best data, only for SRHD to have the least up-to-date information? Why isn’t there some kind of real time database that’s easily accessible for local electeds, so they can make informed policy decisions?
As mentioned, de Ruyter and Russell from SFD were by the far most helpful, but it took them both a lot of labor and time. They pointed to data collection systems and programs that are outdated and require manpower to pull data and break it down in a way that is useful.
“A lot of our data comes out and it’s very blocked data … It doesn’t really cross section anything to make it interesting, or meaningful,” Russell said. “Don’t get me wrong, this isn’t new data, we just don’t track it in this way.”
De Ruyter doesn’t think that electeds and city staffers making important decisions about funding and legislation should have to rely on anecdotes. He wants to see more transparent resources and data sharing.
“There needs to be an emphasis on putting our resources together and sharing this data almost in real time,” de Ruyter said. “These are all data-driven decisions we need to be making: what’s effective, what’s not effective, and if we’ve tried this program, what are the results of that program. It’s all data.”
And that data is important, not just to electeds and RANGE readers, but to boots-on-the-ground service providers or emergency responders, who might need to know things like “how much Naloxone on average is needed per patient?” and “where are the most overdoses happening?” so they can make informed decisions about outreach and treatment.
“You do the best that you can with what you’ve got, right?” Council Member Bingle said. “But not having the data is tough.”
Russell wants to see more effective data collection and distribution too.
“My hope here in my office, in my job: I’m trying to help the providers in the field right now that are still on firetrucks do a better job. How do we give them as much information as we can so they can be high IQ out there, doing the best work,” Russell said, “I want to help them.”
So that’s the story. After a week and a half of digging, we found numbers that showed overdoses, fatalities and Naloxone usage are quantifiably, not just anecdotally, worse than 2023 and 2022.
As we were concluding reporting for this piece, RANGE followed up a final time with the city council members who had originally asked for this data, to find out if they’d received any numbers themselves.
Council Member Dillon responded quickly with a one word text: “Nope.”
This story has been edited to correct the name of the Neighborhoods, Housing and Human Services department.
