Social Change Discussions

Having an awareness of one's needs when recovering from substance use disorder is essential to a successful recovery. That consciousness of self has proven to have played a vital role in advocating for the decriminalization of drugs in Oregon, but change does not happen alone.

Several stakeholders from various addiction and behavioral health services organizations, state officials, and housing and youth agencies came together with a common purpose and shared vision to collaborate on this historical social change effort.

Two years after the enactment of Oregon’s Measure 110 (M110) to decriminalize the possession of small amounts of drugs, removing punitive approaches and offering more social support, such as substance use disorder treatment, harm reduction, and healthcare for people who use drugs, the measures “success” or “failure” is already being called into question.

Because measures like M110 have the potential to influence policy-making in other states and even other countries, it is essential to have evaluations that accurately reflect the conditions and engage with the people who are directly impacted. A team of researchers and providers came together to interview people who use drugs in Oregon to get input on what principles and essential outcomes should be measured.

While the researchers understood that the true impact of the measure could not be meaningfully evaluated less than a year after being implemented, stating “this kind of rush to judgment is premature, rests on faulty assumptions about what kinds of measures matter, and reinforces the outdated and non-evidence-based belief that police involvement and coercion are what will make M110 successful,” (Netherland, et al., 2022) the media began reporting on issues and calling into question the measure's success.

Because public health research often does not include consults done with people directly impacted by policy, leaving too narrow of an area of focus or lacking significant information, the researchers interviewed people using drugs in Oregon to gain insight into what principles and metrics should be considered when evaluating M110.

First, participants suggested that people who use drugs, their families, and their communities are directly impacted and are the most vital resource and need to be consulted throughout every step of the process. Their second suggestion was to have researchers who understood the issue, used trauma-informed language, and were up to date on the local and national drug policies. Along with many other suggestions, the participants strongly urged the need for assessing the outcomes of how the policies are implemented in” real life.”

This podcast highlights the efforts in Portland, Oregon, to address the opioid crisis, touching on what’s working and what’s not. The passage of Measure 110 removed the punitive measures and increased access to social services, including addiction treatment, but the unsuccessful rollout of funding delayed its application. The podcast speaks on studies showing conflicting results regarding the impact of M110 and whether decriminalization led to an increase in unintentional overdoses. One study found an increase of 182 unintentional overdoses in Oregon. In contrast, the other study found that when compared to other large cities in neighboring states, overdoses were up everywhere, not just in Oregon. Regardless, the public seems bound to blame M110, and efforts are in the works of “fixing” the measure and re-criminalizing hard drugs.

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This article combines multiple opinions from stakeholders who are directly impacted by the substance use and overdose crisis we see in Portland and across the state of Oregon. These opinions shed light on the issues and how supportive the funding from Measure 110 has been or has not been for the organizations offering low-barrier services. From outreach workers going out into the streets trying to connect people to services; to a lack of withdrawal management programs and residential beds for follow-up substance use treatment, to not having the necessary staff to care for more patients – the deficit of access to care is being felt across the behavioral health field for potential patients and care providers alike. The answers to the problems vary depending on who you ask. Still, Oregon ranks among the poorest of all states in its access to services while having some of the highest substance abuse and mental health problems in the country.

There is a broad array of agencies, organizations, institutions, and individuals who hold a stake in the addiction services crisis we have seen in Portland within the last few years. These stakeholders range from treatment providers to policymakers to family members who are directly affected by their loved one's disease. Still, delays in the distribution of Measure 110 funding intended to support the creation and expansion of programs left their hands tied in addressing the crisis.

Stakeholders say the state, not the community council, was to blame for the delay occurring after the Oregon Health Authority took over the grant application evaluation process. However, the state claimed the hold-up was because the evaluations required careful review.

“People are dying every day, and we just can’t wait any longer to get this money out,” said Tera Hurst, executive director of Health Justice Recovery Alliance (Hurst, 2022).

Other organizations feel the state needs better infrastructure and policy changes and are waiting for the Alcohol and Drug Policy Commission to live up to its intention.

“On paper, (it) has been a powerful agency,” says Mike Marshall, the executive director of Oregon Recovers. “It can tell different agencies what it’s supposed to be doing with authority.”

However, according to Marshall, it seldom uses that power, especially in the past five years.

Findings from research done by OHSU-PSU show that Oregon has almost half of the addiction treatment services it needs to meet the demand sufficiently.

“The problem was that we’ve been under capacity, and there hasn’t been a political priority for this specific issue,” said Tony Vezina, the chair of the commission (Marshall & Vezina, 2023).

Recently, when asked about the topic, a spokesperson for Gov. Tina Kotek’s office said that the governor “is committed to addressing the state’s addiction crisis and is working to bring greater focus to the issue across state governments (Green, 2023).”

In an attempt to combat the opioid epidemic we see today in Portland, many local organizations and state agencies are working tirelessly to address the needs of individuals struggling with addiction. The introduction of Fentanyl, a synthetic opioid that is 50 to 100 times stronger than morphine and often added to other drugs, making it more addictive and dangerous, according to the Centers for Disease Control and Prevention (CDC) (Prevention, 2023), combined with Oregon’s deficit regarding sufficient access to substance use disorder treatment, providers are overwhelmed with need and unable to meet the demand adequately.

Historically, Portland has had an issue with substance-dependent individuals. In 1979, Central City Concern (CCC) was charged with providing services to the inebriants of Old Town. In the 1980’s CCC took over the operation of Hooper Detoxification Stabilization Center, where individuals receive medically observed withdrawal management services and are connected to substance use disorder treatment after being medically cleared from detoxification. Central City Concern is one of the largest non-profit organizations in Portland that offers substance use disorder treatment, supportive and permanent housing, primary and mental health care, and employment services (Concern, n.d.). With the implementation and funding from Measure 110, CCC has constructed multiple low-income, supporting housing buildings that offer access to peer support and treatment services, as well as the openings of culturally specific programs (Concern, 2021).

In 2020, Oregonians voted to approve Ballot Measure 110, which eliminated punitive measures of possessing small amounts of any drug, including cocaine, heroin, and methamphetamine, called decriminalization (Oregon, 2020). The ballot measure was approved to address the recognized issues that:

• Drug addiction and overdoses are a serious problem in Oregon. • Oregon needs to expand access to drug treatment. • A health-based approach to addiction and overdose is more effective, humane, and cost-effective than criminal punishment. • Making people criminals because they suffer from addiction is expensive, ruins lives, and can make access to treatment and recovery more difficult.

Between 2021-2023, 244 organizations received approximately $265 million in Measure 110 grant funds from the taxation of cannabis. These funds were to address the issues above by offering trauma-informed, culturally specific, and linguistically responsive services. Services include but are not limited to (Oregon, 2020):

• Screening for health and social service needs • Screening and referral for substance use disorder and appropriate outside services • Individualized intervention planning • Low-barrier substance use disorder treatment • Harm reduction services • Peer support services • Housing services

Since the ballot measure was passed, Oregon has struggled to implement these policies and provide treatment services to everyone in need, which has gained increasing criticism from residents. Recently, a group of business owners and political leaders filed voter initiatives with the Oregon Secretary of State office in hopes of “fixing” the original Measure 110, prohibiting the use of hard drugs in certain spaces and making the use and possession of small amounts of methamphetamine, fentanyl, and heroin illegal again (Dake, Sept. 18, 2023).

What comes next for Oregon and the Portland area is unknown, but lives are at stake.

With the soaring rates of unintentional opioid overdoses since 2019, the crucial demand for access to substance use disorder (SUDs) treatment for people struggling with addiction in Portland is higher than ever. Still, a report from 2022 shows that these social services in Oregon are almost half the size they should be to meet this demand.

In collaboration, OHSU-PSU School of Public Health researchers and the Oregon Health Authority conducted a study analyzing the care gaps in services for substance use disorder prevention, harm reduction, and treatment and recovery. According to the report, data shows the state would need to double its services to sufficiently meet the current needs of Oregonians struggling with addiction and highlight significant care gaps, including access to services.

The report highlights three significant needs for continuum SUDs care:

• There is a 49% gap in substance use disorder services needed, including prevention, harm reduction, treatment, and recovery services.

• Most substance use disorder providers lack the capacity to meet demand for services.

• Statewide gaps in equity and access include insufficient provisions of culturally relevant services to protected classes, language interpretation and translation services, and a workforce that does not represent the demographics of the state field (Lenahan, Rainer, Baker, Goren, & Needham Waddell, 2022).

Multnomah County Mental Health and Addiction Services Division identified in its directory 19 addiction treatment organizations serving uninsured, underinsured, and undocumented individuals or offering services to youth, families, and adults, including culturally specific programs for BIPOC and LGBTQ+ populations (County). According to the report conducted by OHSU-PSU, this number should be closer to 38.

With the introduction of Fentanyl onto the streets, those using drugs are at a much higher risk of overdose, as it is increasingly being found in a wide range of recreational drugs, increasing its danger.

According to the Oregon Health Authority's most recent report on Opioid Overdose Public Health Surveillance Update, the Summary of Findings:

• Mortality data for 2023 still need to be completed, as the recent months' results may change. Totals by year are as follows: o 2019 unintentional opioid overdose deaths total 280. o 2020 unintentional opioid overdose deaths total 472. o 2021 unintentional opioid overdose deaths total 737. o 2022 unintentional opioid overdose deaths total 955. o 2023 unintentional opioid overdose deaths total 304.

(ESSENCE, 2023)

The need for adequate access to substance use treatment is evident in the active and open drug use we witness on the streets of Portland, the individuals seeking services who cannot gain access due to long wait lists, and the mortality rates we continue to see in the several hundred every year. Even with ample funding from the state, the report shows there are not enough qualified providers to meet the demand. This means people are waiting, and it is clear that substance use disorder is a condition where if people wait, people die. There can be no more waiting. Our mothers, fathers, sisters, brothers, children, and loved ones are dying.