The Opioid Crisis in Cowlitz County Washington State
The Opioid Crisis in Cowlitz County, Washington
Fentanyl, Overdose Deaths, and What the Data Shows in Longview, Kelso, Castle Rock, Woodland, Kalama, and Toutle
If you live in Longview WA, Kelso WA, Castle Rock WA, Woodland WA, Kalama WA, Toutle WA, or anywhere in Cowlitz County Washington, you have likely seen headlines about the opioid crisis. Editorials often frame the issue as a story about pharmaceutical companies destroying communities.
That narrative may have applied twenty years ago. It does not fully explain what is happening in Cowlitz County today.
As a resident of Southwest Washington, you deserve facts grounded in local data, not ideology. This analysis examines county and state level evidence to clarify what is actually driving overdose deaths in Cowlitz County and what solutions are proven to save lives here.
The Reality of Overdose Deaths in Cowlitz County
The numbers coming out of Cowlitz County are sobering.
The Cowlitz County Coroner recorded 52 overdose deaths in 2024 and 49 in 2023. Between January 1 and February 4, 2025 alone, 10 overdose deaths were recorded. Five occurred within roughly a day and a half. One victim was a 15 year old Longview resident.
In just over one month, Cowlitz County experienced nearly twenty percent of the previous year’s total overdose deaths. This is not a distant or abstract problem. It is happening in Longview neighborhoods, Kelso streets, and rural communities across the county.
How Cowlitz County Got Here
Cowlitz County has experienced elevated opioid mortality for decades.
From 2013 to 2015, the county opioid induced death rate was 12 per 100,000 residents compared to 8 per 100,000 statewide. Between 2012 and 2016, Cowlitz County ranked third highest in Washington State for opioid related overdose deaths.
Even earlier, the trend was clear. From 1998 to 2006, opioid related deaths in Cowlitz County tripled, outpacing the statewide increase. An average of 13 people per year died from opioids in the county during the mid 2010s.
The risk has been persistent. What has changed is the drug supply.
The Fentanyl Shift in Longview and Kelso - Cowlitz County WA.
The current crisis in Cowlitz County is no longer driven primarily by prescription opioids.
Over the past five years, overdose deaths in the county have doubled while fentanyl involvement increased from 12 percent to 55 percent of all deaths. In 2018, fentanyl was involved in only two of seventeen overdose deaths. By 2022, fentanyl was involved in twenty one of thirty eight deaths. In 2023, seventeen of nineteen overdoses involved fentanyl.
According to the 2023 Cowlitz County Coroner report, most overdose deaths involved multiple substances. Forty two included fentanyl. Thirty four included methamphetamine. Seven included cocaine. One included heroin.
Fentanyl is the dominant driver of fatal overdoses in Cowlitz County today.
Why Fentanyl Is Different
Fentanyl is up to fifty times stronger than heroin and one hundred times stronger than morphine. A dose small enough to fit on the tip of a pencil can be fatal.
Originally developed for medical use, fentanyl is now illicitly manufactured and commonly found in counterfeit pills, methamphetamine, and other street drugs circulating in Longview, Kelso, Castle Rock, Woodland, Kalama, and rural Cowlitz County.
Many people who overdose never intended to use opioids at all. This contamination of the drug supply has fundamentally changed overdose risk.
Are Prescription Opioids the Main Cause
Prescription practices contributed to the early phases of the opioid epidemic. Current data does not support the idea that they are the primary cause of today’s deaths.
Across Washington State, more than eighty percent of opioid poisonings involve opioids, and nearly eighty percent now involve synthetic opioids such as fentanyl. While some overdose victims had a prescription history, that does not mean they died from taking medication as prescribed.
People may mix substances, take non prescribed pills, or unknowingly consume fentanyl through illicit drugs. Focusing primarily on prescriptions misses the main threat facing Cowlitz County residents today.
What First Responders Are Seeing in Cowlitz County
The Longview Fire Department reported a significant increase in overdose related calls in recent years. By mid 2023, responders had already handled approximately 330 overdose calls.
Cowlitz County fire and emergency medical teams are administering more naloxone because fentanyl requires higher or repeated doses. Responders are also encountering more cases where bystanders administer naloxone before EMS arrives.
This reflects both increased danger and increased community awareness.
Short video about Kelso Washington in Cowlitz County
Who Is Dying in Cowlitz County
Local age data challenges common assumptions.
Between 2009 and 2015, the highest opioid death rates in Cowlitz County occurred among people ages 25 to 34 and 45 to 54. Historically, less than one percent of opioid deaths involved people under 18.
However, fentanyl has changed this pattern. In April 2024, four overdose deaths occurred within three days, all involving people ages 22 to 33. In early 2025, one overdose death involved a 15 year old Longview resident.
No age group is immune.
Homelessness and Substance Use in Cowlitz County
Substance use and homelessness are closely connected in Cowlitz County.
People with the most severe behavioral health needs often sleep unsheltered in downtown Longview, along the West Side Highway, near the Cowlitz River, and in wooded areas throughout the county. Many cannot access traditional shelters due to mental health conditions, substance use disorders, or safety restrictions.
These realities require housing solutions that account for addiction and behavioral health, not exclusionary policies that push people further into risk.
Treatment Access in Cowlitz County
Despite the severity of the crisis, effective tools are available locally.
Medication assisted treatment using methadone or buprenorphine reduces illicit opioid use by up to ninety percent. These treatments are available in Kelso and Longview.
Naloxone is widely distributed throughout Cowlitz County and covered by Medicaid. It is available at local health providers and pharmacies and through mail order programs for Washington residents.
Fentanyl test strips are also being distributed locally to reduce accidental exposure. These interventions are evidence based and save lives.
Local Government Response
Cowlitz County adopted a two tenths of a cent behavioral health tax generating approximately 1.2 million dollars annually. These funds support mental health court, drug court, early intervention programs, behavioral health treatment, supportive housing, and substance use services.
While Washington State saw a modest decline in opioid deaths in 2024, early 2025 data shows Cowlitz County continues to face elevated risk.
Where Cowlitz County Residents Can Get Help
Crisis support is available 24 hours a day.
Cowlitz County Crisis Line 360 425 6064
Washington Recovery Help Line 1 866 789 1511
988 Suicide and Crisis Lifeline
*Medication assisted treatment, outpatient and residential substance use programs, and free naloxone are available throughout Longview, Kelso, and Castle Rock.
What the Data Shows for Cowlitz County
True statements supported by local data
Cowlitz County overdose rates exceed the Washington State average
Fentanyl is the primary driver of overdose deaths
Young adults and working age residents are heavily impacted
Substance use and housing instability are closely linked
Misleading narratives
Focusing primarily on prescription opioids
Dismissing medication assisted treatment
Ignoring fentanyl contamination in non opioid drugs
Missing from public discussion
The effectiveness of naloxone
The need for housing that accepts people with substance use disorders
Local recovery success stories
What Cowlitz County Needs Moving Forward
Expanded medication assisted treatment access in Longview, Kelso, and rural areas
Countywide naloxone saturation
Housing options that do not exclude substance use disorders
Continued behavioral health tax funding
Public education focused specifically on fentanyl risk
My Conclusion
The opioid crisis in Cowlitz County Washington is real, ongoing, and driven primarily by illicit fentanyl. Solutions rooted in evidence already exist and are saving lives locally.
Our community response must be grounded in data, compassion, and proven strategies. The people we lost in early 2025 deserve nothing less.
This article is for informational purposes only and does not constitute medical advice. If you or someone you know needs help, contact a qualified provider or call the Washington Recovery Help Line at 1 866 789 1511.
Charles D. Hendrickson is the Executive Director of Love Overwhelming and has worked for decades in housing, behavioral health, recovery services, and community based systems in Cowlitz County and Southwest Washington.
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