Oregon’s mental wellbeing crisis are not able to be blamed on reduced Medicaid payments for vendors, a new study by scientists at Oregon Wellbeing & Science University instructed.
Oregon consistently ranks among the worst states for obtain to psychological wellbeing providers. But other states have worse Medicaid payment premiums for psychological wellness companies than Oregon, the analyze identified, displaying that merely elevating charges would not get the state out of the mental wellbeing disaster. The review was revealed Thursday in Health and fitness Affairs, a peer-reviewed wellbeing policy publication.
Condition lawmakers in 2022 elevated payment charges starting this yr for mental health expert services presented as a result of the Medicaid-funded Oregon Health and fitness Prepare. The Oregon Wellbeing System is liable for masking the healthcare care of about 1.5 million lower-revenue Oregonians, which include any behavioral wellbeing wants they could have.
“We know there are substantial obstacles in accessing mental wellness treatment,” said Dr. Jane Zhu, the study’s guide creator and assistant professor of medication, typical inner drugs and geriatrics at OHSU. “States that are chronically underfunding or underpaying their psychiatrists must take take note of where they stand. For these states, elevating the reimbursement level may well be one particular software to increase recruitment and retention of psychological overall health professionals.”
The examine looked at billed psychiatric providers throughout the country and in contrast the Medicaid payments throughout various states. It also compared Medicaid payments to all those for the very same companies compensated by Medicare, which serves individuals 65 and older and generally pays far more. Oregon is 1 of just 8 states with a Medicaid reimbursement fee that is on par or better than Medicare for psychological wellness providers, the examine located.
“Oregon’s not 1 of the least expensive-position states,” Zhu claimed in an job interview. “The costs are on a par with that of Medicare, and but we’re still dealing with in this state outstanding workforce shortages and greater needs and gaps in access, which indicates that there needs to be a great deal additional in conditions of proof, in conditions of how a lot does a reimbursement rate will need to improve in buy to induce providers to participate in Medicaid and to see a large amount of Medicaid clients.”
On average, Medicaid pays about 80{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of what Medicare does for the similar products and services, the research uncovered. States that paid out the minimum ended up Pennsylvania, Rhode Island and Maine, and individuals compensated the very best were Nebraska, Alaska and Arkansas.
Zhu explained variables besides reimbursement prices hinder obtain to care. Those include things like the administrative burdens vendors face, the high desire for mental well being expert services and workforce shortages.
“Reimbursement costs are critical, but in Oregon, I assume commensurate attention requirements to be paid out to some of these other components,” Zhu mentioned.
An OHSU report ready for the Oregon Health Authority in 2022 uncovered Oregon has the fourth-greatest amount nationwide of people unable to entry mental wellness therapy. The condition also has one of the highest fees of persons with psychological wellbeing problems, teams like Psychological Health America have continuously shown in rankings.
The research discovered that though small wages contribute to the workforce lack in the sector, other concerns like burnout, big caseloads and major administrative workloads also harm recruitment and retention into the field.
“Reimbursement charges are just a single piece of that puzzle,” Zhu explained. “We never know irrespective of whether increasing reimbursement fees will be productive in bettering access to mental health cure. Increasing reimbursement rates is in all probability likely to be needed but not enough.”
Condition lawmakers have launched a range of proposals this session to tackle the state’s psychological wellness crisis, which include funding for residential psychological health amenities. Gov. Tina Kotek’s prepare for behavioral wellness incorporates a lot more funding to recruit suppliers, plans to enable people as they are discharged from the Oregon Condition Hospital and local community psychological well being plans to aid men and women stay clear of jail. The governor also has requested Oregon behavioral wellbeing director Ebony Clarke to complete an assessment on the state’s behavioral health and fitness process, which will be the foundation of a 5-calendar year strategy.
Other than Zhu, other co-authors of the research are Stephanie Renfro, associate director of the OHSU Centre for Health Programs Efficiency Kelsey Watson, biostatistician in the Middle for Wellness Units Performance Ashmira Deshmukh, a recent graduate of the OHSU-Portland Point out College School of Community Overall health and John McConnell, director of the Middle for Health Systems Effectiveness and professor of crisis drugs in the OHSU University of Drugs.
— Ben Botkin, Oregon Cash Chronicle
The Oregon Funds Chronicle, launched in 2021, is a nonprofit news business that focuses on Oregon state authorities, politics and plan.
Shemia Fagan’s office has released an audit of Oregon’s implementation of Measure 110, which decriminalized user amounts of street drugs.
SALEM, Ore. — A measure approved by Oregon voters in 2020 with the mission of completely overhauling how the state approaches drug crimes and addiction treatment has not yet been given the chance to produce tangible results, according to the results of an audit released Thursday by the Oregon Secretary of State’s office.
There were two main aspects of Measure 110 when it was adopted just over two years ago: the decriminalization of user amounts of narcotics and a major allocation of funding toward addiction treatment programs from Oregon’s legal cannabis taxes.
Drug decriminalization went into effect almost immediately. By early 2021, minor drug possession crimes were no longer subject to the typical jail and court systems. Instead, law enforcement agencies were directed to greet these violations with a fine that could be dropped if the user seeks treatment. Positive results have not been quick to emerge.
But the other big part of Measure 110, the part that was supposed to fund addiction treatment programs so that they’d be readily available, took much longer to tackle. It wasn’t until September of 2022 that the Oregon Health Authority announced funds had gone out to each county in the state.
And this — the reason for this delay, that is — became the primary focus for the audit by Secretary of State Shemia Fagan’s office. After all, the Measure 110 framework has yet to produce much else for auditors to assess.
In a statement that accompanied the auditor’s report, Fagan openly expressed her feelings on Measure 110 — that she wants, and Oregon needs, to see it succeed.
“It is plain as day that Oregon’s drug treatment system is failing,” Fagan said. “This is incredibly frustrating for me, and many Oregonians, because treatment is a matter of life and death for people we know. I have a brother in recovery right now. I want to see Measure 110 work.”
RELATED: Peer mentors key to Measure 110 success are working in a broken addiction care system
‘Too early to tell’
Measure 110 passed in November 2020 with more than 58{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} voter support. Like most ballot measures, the provisions didn’t really go into effect until a few months later, early 2021 — which means that it’s really been around for about two years, as of this audit’s release.
Regardless, the headline of the Secretary of State’s office audit is pretty straight and to the point: it’s too soon to know whether it’s actually working.
“We got off to a rough start,” said Audits Director Kip Memmott during a Thursday press briefing. “Some of this government-by-ballot-initiative causes some problems, and it takes time to structure government properly which can be frustrating. But auditors, you know, we talk a little bit wonky about controls and governance and outcome measures, but you really have to have those in place to assess performance.”
What Measure 110 didn’t require as a provision are tools for entities like the Secretary of State’s office to gather data on how it’s progressing. Much of the program is still a black box, so auditors couldn’t get an accurate assessment of how many people are being helped or if the money is going where it’s needed.
As of this phase of the rollout, $302 million in Oregon’s marijuana tax money has been diverted to Measure 110.
Of that total funding, $32 million in “access care grants” were awarded by the Oregon Health Authority early in the process in provide some funding while the more permanent programs were still being developed. However, little to no data was collected by the OHA, and auditors were unable to determine if the grants were effective or how they were spent. There was no data on whether the grants actually improved access to addiction care.
Many of the service providers were small and unfamiliar with state-run programs, the OHA told auditors, so health officials determined that forcing them to report more data would be “unduly burdensome.”
The misfortunes of being a trail blazer
In embarking on the implementation of Measure 110, the state had to do something that was not only new to Oregon, but something new to the U.S. As a result, it seems to have suffered from the novelty of it all.
The measure required that Oregon create an Oversight and Accountability Council, one that the audit said has “ultimate decision-making authority” in implementing programs and handing out grants. OAC councilors were all appointed at the same time and have the same term length, serving on a volunteer basis. Council members, many of whom had full-time jobs outside of the OAC, reported spending 40-hour weeks on their Measure 110 tasks.
At the same time, the council struggled to find its footing alongside the Oregon Health Authority, resulting in “delays, confusion, and strained relations between OHA and the OAC.” The audit describes an ill-defined relationship between the council and the OHA, resulting in many dropped balls and occasional head-butting.
Often lacking the expertise that the work required, things like grant-making, council members had to lean on OHA staff. But, the audit found, OHA’s facilitation was often ad hoc and its obligations not clearly defined by the measure itself.
“Staffing resources dedicated to M110 have ranged from a handful of people to dozens of staff,” the report said. “For example, in February 2022, eight OHA staff were assigned to M110 work. Although OHA has since increased staffing resources toward M110 implementation, key roles continue to experience staff turnover.”
Meanwhile, tasked with coming up with grant applications from scratch, the OAC designed a 240-point application, sometimes requiring long responses, that was “burdensome to complete and challenging to navigate” for service providers. Confused applicants who reached out for help then often received conflicting guidance from OHA staff.
“It had too many elements that needed to be evaluated, too many reviews that needed to take place before they could make those funding decisions, and they didn’t have the staff support from OHA to get to those reviews and make recommendations,” said Audit Manager Ian Green, “so that’s what led to months-long delays.”
Too many cooks
Measure 110’s fledgling programs have also suffered from issues already replete in Oregon’s addiction recovery and mental health systems: redundancy and a lack of integration with other, similar services.
For an example, the audit looked at a Recovery Center Hotline that Measure 110 required OHA to establish. The agency did get the hotline set up, but had only received 119 calls related to the drug treatment program as of June 2022, at an estimated cost to the program of more than $7,000 per call.
Of those calls, only 27 people were interested in drug treatment resources.
There are multiple hotlines in Oregon that already cover similar issues, including the statewide Alcohol & Drug Helpline and the Oregon Behavioral Health Support Line, both of which were better established and received substantially more calls. And some of the providers responsible for actually providing the services funded by Measure 110 have their own hotlines, the report pointed out.
“These services may be duplicative since current law requires such support also be provided through a statewide hotline,” the report said. “At the time of this report’s release, OHA still had plans to continue the statewide hotline in addition to any redundant hotline services provided by (service providers). OHA told auditors reducing potential hotline redundancy is not its legal responsibility, and it does not plan to work to prevent the risk of such redundancy as a result.”
The audit also underlined that Measure 110 did not direct the OAC to collaborate with other, potentially major partners, like the Oregon Department of Corrections and Oregon Housing Community Services; both of which often intersect with substance use through the criminal justice system and housing programs.
More than 63{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of inmates experience substance use disorders, the report noted, but less than 5{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} have access to intensive treatment while in custody.
“The lack of access to treatment in and out of custody has been a missed opportunity for the state,” the report said.
There’s also the issue of law enforcement, which is still supposed to have a role in the process despite Measure 110’s drug decriminalization. Through the measure, officers are empowered to issue class E citations when they come into contact with someone in possession of user amounts of narcotics.
In spite of this, auditors were told by different jurisdictions they questioned that “they handled this process with some degree of variability.” Some issued many citations, while others “showed reluctance to engage.”
And even when law enforcement officers do issue citations, they may or may not provide the Measure 110 hotline number to the drug user and encourage them to call it, the report said.
“Law enforcement agencies sharing limited information with providers may help increase outreach to individuals who may need help taking the first step to recovery,” the report continued. “Steps to unify statewide process for issuing class E citations and promoting the hotline should also be taken.”
According to OHA data from the first year of decriminalization, 16,000 people accessed services, but only 0.85{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} entered treatment. A total of 60{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} received “harm reduction” like syringe exchanges and overdose medications. An additional 15{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} got help with housing needs, and 12{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} obtained peer support.
A problem or a solution?
Depending on who you ask, Measure 110 is either the cause of, or solution to, Oregon’s rampant substance abuse and addiction over the last several years. Thus far, there’s not enough data to support either argument.
In 2022, KGW’s The Story spoke to an officer with the Multnomah County Sheriff’s Office, who said that Measure 110 had “everything to do with” the explosion in fentanyl use on the streets of the Portland metro area.
“By decriminalizing that, it’s basically legitimized criminal organizations,” he said. “Drug possession, use and sale is just rampant, with very little consequences, and it’s taken away our tools as police officers to sort of interdict that.”
A member of the OAC, herself a recovering addict, pushed back on that characterization at the time— noting that the surge in fentanyl has been a nationwide phenomenon, not specific to Oregon.
An interesting fact identified by the Secretary of State’s office audit is that, even prior to Measure 110, Oregon had no adults in custody serving prison time solely for drug possession charges.
“The Oregon Department of Corrections noted that existing sentencing guidelines would have prevented someone from serving time for drug possession alone,” the report said. “Department officials reported other crimes, such as property or people crimes, would need to be committed to end up in their custody.”
In that sense, very little has changed. People committing crimes related to substance abuse and addiction are being arrested and prosecuted for the other crimes, not for drug possession — if they’re being arrested and prosecuted at all.
Regardless, as Fagan underlined in her preamble to the audit report, the need for what Measure 110 was supposed to provide is clear. As of 2020, Oregon had the second-highest substance use disorder rate in the nation, and ranked last for access to treatment. At least two people die each day from unintentional opioid overdoses in Oregon, and another five die of alcohol-related causes.
Looking at the entire U.S., a report by the National Institute on Drug Abuse found over $700 billion in associated costs relating to crime, poor health, and lost work productivity due to substance use disorder.
“With Measure 110, voters, myself included, sent a clear message to state leaders that we need a new, more effective plan for drug treatment in Oregon,” Secretary Fagan said. “OHA and the State Legislature must continue working to make the new program work for our families and our communities.”
In a statement released Thursday, brand new OHA Director James Schroeder largely agreed with the audit’s assessment and pledged to take action on the report’s four main recommendations for improvement:
“The Secretary of State is right: It is too soon to measure the success of Measure 110. However, OHA recognizes that Measure 110 can only achieve the voters’ intent and reduce the harms from untreated substance use if OHA provides timely, robust support to its implementation and effective, reliable assistance to the Measure 110 Oversight and Accountability Council. OHA will deliver on that commitment.
“Measure 110 represents a new approach to reducing the terrible toll illicit substance use takes on people and families in communities statewide. Measure 110’s first-in-the-nation approach provides more resources for harm reduction, treatment, peer counseling, housing and other services that will give people with substance use disorders the services and support they need to recover, prevent relapse and live heathier lives.
“Under Measure 110, these services are provided through locally coordinated Behavioral Health Resource Networks (BHRNs). Last fall, BHRNs in every Oregon county received funding from OHA to begin delivering more comprehensive and integrated services at the local level.
“The launch of these networks represents the real start of Measure 110 in Oregon.
“OHA agrees with all the Secretary of State’s recommendations directed toward our role in implementing Measure 110. We will pursue each recommendation with urgency and focus.
“Governor Kotek has made it a top priority to make the behavioral health system and Measure 110 work better for communities statewide. I recognize that Measure 110’s success depends on Oregon’s ability to solve many larger challenges in the behavioral health system, such as the need to expand treatment capacity and better support counselors and other workers. I’m committed to getting better outcomes for people with substance use disorders and other behavioral health needs. I look forward to reporting on our progress.”
On a sunny September evening in 2021, Nathaniel Sean Stringer joined family and colleagues for a recovery celebration at a park in the eastern Oregon town of Ontario. To enthusiastic applause, he received an award for his service to those struggling with addiction.
Just weeks later, Stringer overdosed on fentanyl and died inside a grocery store. He was 35.
His death shows how fragile recovery from addiction can be — and his story highlights a major pressure point in Oregon’s expanding addiction care system at a pivotal time.
Before he died, Stringer exemplified a growing statewide trend. He worked for the Malheur County Health Department as a peer mentor. “Peers” are people in recovery from addiction who engage with people who use drugs, offering mentorship and resources while demonstrating by example that recovery is possible. There are nearly 1,900 peers who specialize in addiction in Oregon, typically earning about $18 to $24 an hour.
Now, using money generated through Oregon’s 2020 drug decriminalization law, Measure 110, a state-appointed council is pouring money into hiring many more peers as part of a shift toward treating addiction as a health care issue. Increasingly, peers across Oregon are connecting with people in need through street outreach and working in addiction care, mental health or homeless services, hospitals and jails.
Origins Faith Community is a nonprofit day shelter for people experiencing homelessness in Ontario, Ore. On Oct. 13, 2022, Anthony Caliendo walks through the dining room before the day’s lunch is served.
Kyle Green for The Lund Report
But without adequate funding for detox facilities for withdrawal management, residential treatment and recovery housing, people inside the system say the state’s burgeoning peer workforce amounts to a pipeline that often leads nowhere.
A recent analysis from Oregon Health & Science University showed that Oregon’s addiction care system is half the size it should be to meet demand.
Stringer was hired before Measure 110 was implemented and those close to him believe factors outside his job drove his relapse. What’s clear, however, is that while people in the peer mentor role are tasked with motivating people to seek treatment, they — like Stringer did — frequently grasp for resources that don’t exist when their clients are ready to quit using. The situation puts tremendous stress on the very people on which the system’s current expansion relies.
“I absolutely believe in peers, I believe that they are the best people to engage people who are using drugs into treatment,” said Sarah Poe, director of the Malheur County Health Department, where Stringer worked. But peers don’t themselves provide treatment and without more services to connect people to, she said, “It’s really hard work for peers to show up and keep trying to push this boulder up a hill — when the hill keeps getting more steep.”
‘He was those people’s hope’
Stringer grew up in Nyssa, a small rural community where both his parents were educators and his grandfather raised sheep. Nyssa sits west of the Idaho border, south of Ontario. In an area known for its crops and cattle, the dusty landscape is dotted with small, well-weathered homes. Malheur County has Oregon’s lowest median income.
Starting with oxycodone as a teenager and then heroin as a college student, Stringer wrestled with addiction for 15 years, going in and out of treatment. His mother, Sherry Stringer, said that one time he vomited before getting into her car after graduating early from an inpatient program. He told her it was because he was afraid of what might come next.
And yet counselors at every treatment center her son went to told her that he was so good at helping others in the program.
“I remember thinking so many times,” she said, “why can’t he help himself?”
Eventually, he did. In 2019, Stringer was a proud father and three years into his recovery as he neared completion of an intensive drug court diversion program. He single-handedly opened a nonprofit syringe exchange to help prevent the spread of disease through intravenous drug use, a need he knew was great. That’s when he connected with health staff at Malheur County for advice on the medical aspects of running an exchange.
County staff were so impressed with Stringer, they later asked if he’d like to work in their new peer support program. He jumped at the opportunity.
In many ways, the job was a perfect fit. His family and friends described him as charismatic, known for his levity. He was empathetic, non-judgmental and defended the underdog. His uncle remembers him in his youth sticking up for a soccer teammate bullied for not being able to afford a uniform.
Stringer was skilled at connecting with clients. Having once contracted Hepatitis C from injecting drugs, he followed up with county clinic patients who had just tested positive, knowing they likely got it the same way. He let them know he had stopped using and could help them do the same.
A video of him accepting the award at the recovery event shows Stringer telling the crowd he loved “every single day” of his job at the county. “The outreach we do is just so important. I get to feel like we are making a difference on the ground, which is what it’s all about.”
But the traits that made him good at his job also added to his stress. His family said it weighed heavily on him when he couldn’t connect his clients to the treatment they needed.
“He was frustrated that there weren’t enough resources,” his uncle, Matt Stringer, said. In the absence of treatment beds, he remembers his nephew considered letting clients stay at his home so they could stop using.
Nathaniel Stringer’s uncle, Matt Stringer, sits on his back porch in Ontario, Ore., on Oct. 13, 2022. A retired music marketing executive, Stringer returned to Malheur County from New York to care for his mother when she was ill.
Emily Green/The Lund Report
The results of a 2020 statewide survey of Oregon peers indicate the pressure felt by Stringer is mirrored across the state. Participants listed the lack of services for clients as a major challenge, “specifically treatment and housing.”
“When you have two or three or four clients that are needing support right now and you’re driving them around to each detox center, making phone calls, calling your personal contacts and then nothing is happening — it’s defeating,” Amanda Esquivel, who has worked as a peer recovery mentor in Portland for the past two years, told The Lund Report in September. “I did that this morning … right now, that individual is waiting at home to get into detox.”
In the weeks leading up to Stringer’s death, his uncle noticed subtle signs that his nephew might not be OK. Pandemic stress and feelings of helplessness around situations with friends and family that were out of his control were climaxing. But he insisted he was fine, colleagues said.
Peers interviewed for this story said it can be hard for people whose jobs are intertwined with their recovery to ask for help when they need it. And peers may fear losing their jobs if they relapse.
Morgan Godvin, a person in recovery who sits on the council implementing Oregon’s drug decriminalization law, is open about this dilemma. If she relapsed, she would “probably hide it,” she said on Twitter. “It would be so profoundly disappointing to everyone who has invested their time and resources in me. I fought really hard to stop being a bitter disappointment. I can’t go back there.”
On Oct. 17, 2021, Stringer went to an Albertson’s grocery store not far from Ontario, over the Idaho state line. He walked into the bathroom and consumed a substance containing a fatal amount of fentanyl, his family said.
His family and friends believe it was a momentary lapse.
A picture of Nathaniel Sean Stringer hangs on a wall inside the Malheur County Health Department outside the room where his office used to be on Oct. 13, 2022.
Emily Green/The Lund Report
Stringer left behind a wife of one year, a 3-year-old son and a 12-year-old stepson. His death sent waves of shock and grief through eastern Oregon’s recovery community, which included many people he had helped and who looked up to him.
“That’s what broke my heart,” his uncle told The Lund Report. “He was those people’s hope — and then that happens to him?”
Where has all the Measure 110 funding gone?
Today, a picture of Stringer hangs on a wall in the Malheur County Health Department, outside the door to where his office used to be.
With just 29 staff, the agency is a small operation, located inside a modest one-story office building on the southwest side of Ontario. A rainbow-colored mural spreads across the wall where guests check in at a reception window.
Sarah Poe leads the department. A person in recovery herself, you can hear her passion for her peer support team and their clients as she talks about the high hopes she had for the improvements Measure 110 money could bring to her county — and how those hopes quickly faded.
Measure 110 was sold to voters on the promise of expanding access to drug treatment in a state that ranks highest for its rate of illicit drug use and dead last for its access to treatment, according to federal data.
Following the measure’s passage, however, its proponents have said Measure 110 spending should not focus on residential treatment, arguing that it can be paid for by the Medicaid-funded Oregon Health Plan.
This change has come as a blow to providers who thought much of the measure’s $300 million would go to expanding treatment infrastructure, then watched as the council that oversees Measure 110 spending rejected applications for stabilization centers, residential treatment and detox facilities.
Even with recent increases in reimbursements, Medicaid doesn’t come close to covering the full cost of treatment. That’s why Heather Jefferis, executive director of the Oregon Council For Behavioral Health, calls addiction care in Oregon “the most extreme example of how historic underfunding creates tragic outcomes.”
Providers also need money to purchase or erect the buildings that will house needed services, to begin with. The Legislature’s recent investments in behavioral health care have largely gone to mental health, not addiction treatment. And, there’s no plan for investing in the level of detox beds, residential treatment or housing for people in outpatient treatment that would be required to meet demand.
The frustration is evident statewide and especially in Malheur County.
“We got all this money that came into our community and you know what it gave us? More peers, more syringe exchanges, more Narcan,” Poe said, referring to an opioid overdose-reversing drug. These services are critical, she said but on their own, “they’re not a full solution. And we really, really, really needed a detox facility.”
Origins Faith Community is the only place in Ontario, Ore., where people living in poverty can get a free meal. On Oct. 13, 2022, homemade meatloaf and stuffing were on the menu.
Emily Green/The Lund Report
Poe wondered aloud why the state isn’t taking steps to ensure each region has the basic building blocks of a functioning treatment system in place: a detox center for withdrawal management, an overdose prevention coordinator, sufficient residential treatment, recovery housing and other baseline necessities.
In Malheur County, Poe said she’s watching as health department peers hand out more and more Narcan so that people using heroin and opioids can reverse potentially-fatal overdoses.
“Narcan is just there to keep someone alive to then get them into the treatment that they need,” Poe said. “But then we need to have the treatment piece there.”
Lack of support, resources for peer mentors
Janie Gullickson fought through methamphetamine addiction before becoming the director of the state’s most prominent peer-run organization, the Mental Health & Addiction Association of Oregon. Her enthusiasm is infectious when she speaks about the strength and resiliency of the peers she represents. As one of Measure 110′s chief petitioners, she believes in the law and its role in “expanding addiction recovery services across the continuum.”
Working out of her nonprofit’s headquarters in Northeast Portland, Gullickson oversees training, supervision and support for peers around Oregon — including in state-supported programs like Stringer’s in Malheur County.
Gullickson told The Lund Report that the recovery community in Oregon has seen an increase in relapses and overdoses during the pandemic, including among peers like Stringer.
In the wake of Stringer’s death, the health authority began requiring more structure to supervisory support for peers in state-funded peer programs, though a state spokesperson denied any connection between the two.
And for county-based peer programs that wanted outside help, the state also provided supervision and support by contracting with Gullickson’s organization.
“Some had great, experienced peer supervisors and were already doing peer programs. But it was those ones that felt very isolated and didn’t have that infrastructure that we focused on,” Gullickson said. They also worked with Malheur County, where the peer supervisor had been Stringer and his replacement was a member of his team, she said.
According to a statewide assessment, Gullickson’s nonprofit helped conduct in 2020, fewer than half of peers reported receiving supervision once a week or more. Some participants attributed high turnover to a lack of support, trauma and burnout.
But Gullickson said it’s important not to “other” peers by suggesting they need more supervision than other workers and suggested stigma may play a larger role than supervision in relapse.
(Left to right) Tyler Woods, Tiffanie Stabler and Steven Wolf talk in the alley behind Origins Faith Community. They work for Malheur County and hand out naloxone, hygiene kits and other supplies during the day shelter’s free meals.
Kyle Green for The Lund Report
“What we’ve seen sometimes is people won’t say, ‘Hey, I need help right now’ in the way that we would think people in recovery would be able to do. But when they get in this profession, often then it’s like, ‘Oh, I’ve got to prove myself.’”
Before 2020, the state required that peers have at least two years of recovery behind them before taking the 40- or 80-hour certification courses. To meet the demand for peers and behavioral health counselors, authorities lowered the requirement to one year.
Adding to the stress of their job, many peers also say that the residential programs currently used in Oregon need to offer longer stays and different approaches to increase their effectiveness.
Kevin Fitts, a peer and director of the Oregon Mental Health Consumers Association, told a crowd during the recent opening of Multnomah County’s Behavioral Health Resource Center that while the focus now is addressing the extreme shortages in behavioral health, the question that’s being neglected is whether the current model for treatment is succeeding.
“Are we having beneficial outcomes for the consumer of the services? Got me!” Fitts said. “We have a system in crisis. … What is important is getting the services that these people need out on the street. Well, are these services meeting the needs? Are people moving forward?”
Measure 110 delivers fraction of hoped for funds
On a Thursday morning in September, the smell of homemade meatloaf filled the air inside a mid-century brick church on the northwest side of Ontario.
Steven Wolf greeted patrons as they walked up to the back door. Wolf is a peer mentor, a job that Stringer recruited him into. The two graduated from drug court together before becoming peers.
Like most mornings, Anthony Caliendo, 52, was the first to show up. He’s experienced homelessness since July. He told The Lund Report he’s not interested in drug treatment. But Wolf said he helped Caliendo rely more on cannabis and less on meth — a harm reduction method employed by some peers.
Caliendo said Wolf is easy to talk to because he comes from a similar background. “He’s been hungry and spent his money on dope instead of food,” he said.
Anthony Caliend, 52, is experiencing homelessness in Ontario, Ore. He’s seen here sitting in the chapel at Origins Faith Community, where he receives free meals and peer services, on Oct. 13, 2022.
Kyle Green for The Lund Report
With no local year-round homeless shelter in the area, the church is the only place in Ontario where people can get a free meal. No longer operating as a house of worship, the building serves as a drop-in center run by a small nonprofit called Origins Faith Community, which is not religiously affiliated.
Staff at Origins saw Measure 110 as the opportunity they had been waiting for. They launched a peer program with Measure 110 funds and hired Wolf as its first peer.
But as the state program unfolded, it became clear that the robust local system Origins and other local providers had planned was not going to be possible.
Origins originally asked the Measure 110 council for $3.1 million. But the state wouldn’t fund the requested transportation services, the new drop-in center and the purchase of a 20-unit apartment building adjacent to the church.
Altruistic Recovery, an outpatient behavioral health clinic across town, requested $13 million to create a detox and residential treatment facility but was also denied.
Of the $265 million in funds distributed through Measure 110 this year, $1.8 million went to Malheur County.
That money, locals lament, will fund only seven beds — slated for an apartment complex that a local nonprofit plans to purchase as housing for people living with co-occurring HIV and substance use disorder.
Origins, meanwhile, got $616,000 — less than 20{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of what it hoped for.
Counselor Dana Rush, who left Origins following cuts made in November, said she thought that Measure 110 was going to be different.
“That’s why we were so excited about it — that finally, we could really meet people where they were,” she said, her voice breaking as tears filled her eyes. “And then to watch all of the stuff unfold and go, ‘Oh my gosh, we’re not going to be able to do that. OK, give us just what you can so we can just get started. And maybe we can build what we can. And we’ll do what we can. And we’ll keep doing what we can until — dang it — we’re just gonna keep doing what we can do.’”
The Lund Report produced this story with support from the Association of Health Care Journalists and The Commonwealth Fund. Emily Green can be reached at emily@thelundreport.org.
Many men and women see Evaluate 110 as a contributor to the state’s drug habit difficulty, and some argue it must be repealed.
SALEM, Ore. — It is really been almost two yrs given that Oregon voters passed Measure 110, decriminalizing possession of small quantities of tricky prescription drugs. The system was to use funds from the state’s marijuana tax to build additional habit services — placing emphasis on remedy around punishment.
But lots of persons see the evaluate as a contributor to the state’s drug addiction problem, and some argue it really should be repealed.
Keith Humphreys is an pro in the prevention and remedy of dependancy. He advised Oregon lawmakers recently that the state’s drug plan encourages drug use and has no deterrents.
“Addicted people today commonly do not search for procedure and restoration without exterior pressure from family, buddies, employers, well being care suppliers or the legislation. Why does this subject? It matters mainly because Oregon has eliminated all authorized tension to prevent drug use and seek procedure. For the reason that numerous addicted persons are not working or in contact with their loved ones, people pressures to end using drugs and alcohol are absent from their lives,” Humphreys said.
He did not say voters really should overturn Evaluate 110, but he did say the condition could make changes to the measure that would enable gradual development in the number of addicts in Oregon.
Associated: Regardless of dismal start off, hopes remain for Oregon’s drug decriminalization and remedy program
Humphreys launched and co-directs the Stanford Network on Addiction Coverage. He also served as a member of the White Property Commission on Drug-Free Communities less than President George W. Bush and was a senior advisor at the White Household Place of work of Countrywide Drug Manage Plan under President Barack Obama.
He laid out Oregon’s problem in stark conditions.
“For the reason that the West Coastline has an individualistic lifestyle with a tolerance for substance abuse, social pressures to look for treatment method are generally nominal. So on the one particular hand, we have really worthwhile medicines which are extensively out there. On the other hand, very little or no strain to quit employing them. Beneath individuals disorders we ought to hope to see particularly what Oregon is enduring. Considerable drug use, extensive habit and not a great deal procedure searching for.”
Evaluate 110 does make it possible for law enforcement to create tickets for $100 if an individual is found to be in possession of smaller quantities of medications for private use, and a individual can have the ticket wiped away by contacting the Lines for Lifetime helpline.
Most who are issued tickets disregard them, in accordance to Dr. Todd Korthuis, head of addiction drugs at Oregon Wellbeing & Science College.
“The authentic approach to ticket people today who use medicines and have them simply call a treatment method hotline has not worked. Of in excess of 3,000 tickets issued as of the end of this summertime, the hotline obtained 137 phone calls for treatment, most of whom weren’t on the lookout for procedure. They ended up seeking for screening for legal reasons,” explained Korthuis.
He additional, “Only 1{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of people issued a ticket for drug possession asked for data about therapy resources. In my discussions with treatment method leaders about the state, not 1 has had any affected individual enroll in therapy due to these tickets.”
Similar: Oregon’s Evaluate 110 has hence much mainly unsuccessful to fund dependancy therapy services
Humphreys spoke to lawmakers about Portugal, which decriminalized person amounts of medicine very long right before Oregon.
“Now its truly worth noting that Portugal, which is generally cited as the inspiration for Oregon’s drug coverage, areas large social and lawful stress on addicted men and women to request treatment method. The open use and flagrant drug dealing that we see in West Coast metropolitan areas in this nation are just about absent in Portugal, which shuts them down and utilizes court docket strain to get them in to remedy. I have spent a whole lot of time in Portugal and I know the men and women who built their coverage, so be sure to just take it from me: Oregon is not adhering to Portugal’s case in point and will not get its effects.”
He also talked about harm reduction — not halting drug use, but producing it safer. He mentioned it is a terrific solution as prolonged as it is not the only tactic.
“Proof-centered harm reduction can preserve lives, but it won’t be able to do it by itself. Generating the opioid overdose rescue drug Naloxone far more available, for illustration, translates into a more compact part of overdoses ensuing in demise. But hurt reduction is not hurt elimination. Persons who use medicine will nonetheless go through. So be sure to blend in your head that reality with a different essential fact: reducing the harm of drug use will in no way lower the sizing of the addicted populace. That is the function of dependancy cure and restoration in the brief phrase and avoidance in the long term,” explained Humphreys.
He said if Oregon proceeds on its path of not complementing successful harm reduction with sturdy prevention and remedy initiatives, it should anticipate a rise in drug use and addiction.
Meanwhile, more than $300 million in marijuana tax bucks was sent to Evaluate 110 programs aimed at treating folks who are addicted to medicines. The income, which took almost two years to be despatched out , is now in place to get started funding courses which includes outreach and peer mentorship, needle exchanges and restoration housing.
