‘Nobody chooses to be an addict’

Portland Tribune – April 15, 2018

Officials from Clackamas, Washington and Multnomah counties gathered at Marylhurst University Friday afternoon for a Tri-County summit aimed at sharing strategies and coordinating inter-agency efforts to combat the opioid crisis.

A panel of county officials and an audience of roughly 150 people listened to a series of talks from police, county and jail system staff. The most common refrain: addiction is a chronic condition, and it must be consistently treated as such in order to achieve recovery.

The discussion was moderated by Dwight Holton, CEO of the organization Lines for Life, which sponsored the conference. The goal, he told the audience at the beginning of the event, would be to start a discussion about the areas and services that the counties have in their control, and how they can be utilized more effectively.

The panelists included a majority of the commissioners from all three counties, as well as U.S. Attorney Billy J. Williams. Lake Oswego City Councilors Jackie Manz, John LaMotte and Jeff Gudman and Assistant City Manager Megan Phelan were among the audience members.

Former Vancouver Police Chief Brian Martinek gave an opening speech, recounting the extremely personal story of his own son Taylor’s struggle with addiction and the ways in which it impacted his life and his family.

The addiction began in the same way that many addictions have begun during the current epidemic, Martinek said. Taylor played football in college and suffered injuries to his shoulder and elbow, which required three surgeries.

“You can guess what medications he was given,” Martinek said.

Taylor’s use of opioid pain medication increased, and Martinek said he spent several years in and out of various jobs, emergency rooms and jail. Taylor’s family tried to help him, Martinek said, but there were gaps in the system that left Taylor vulnerable, such as insurance coverage that didn’t allow for enough time in rehab.

Nevertheless, Martinek said, Taylor did eventually recover and was clean for a period of several months, during which time he also found steady employment and housing. Unfortunately, he relapsed last year. Not long after he had resumed taking oxycodone, Martinek said, Taylor purchased pills that turned out to be laced with fentanyl, and as a result he overdosed and was unable to be revived.

Martinek implored the audience to treat people suffering from addiction with compassion, respect and understanding, and to work to eliminate biases and the stigma that addicts face in the current system.

“Nobody chooses to be an addict,” he said. “If we would apply the same principles we do with other diseases to addiction, we would change the results.”

Washington County Health and Human Services Director Marni Kuyl and Multnomah County Health Officer Paul Lewis delivered a second opening talk, focusing on the origins and consequences of the opioid crisis.

Opioid use has existed throughout recorded human history, Lewis said, but the current crisis stems from a few key factors. The first is that opioids are abundant and cheap, providing a large return on investment for producers and a cheap fix for buyers. The second is that the body begins to adjust to opioids, requiring progressively larger doses to achieve the same effect. Opioids are also being heavily over-prescribed, he said, creating a starting point for addiction.

“If we don’t get to the prevention stuff, we’ll be having this same conference in 10 years,” he said.

The rest of the conference was divided into three “policy sessions,” each with a series of guest speakers from a particular group of agencies. The first session focused on the role that public safety officials can play.

Multnomah County District Attorney Rod Underhill discussed several new approaches his office has begun to employ in the past two years as part of what he called the “Treatment First” program, which evaluates individuals based on the extent of their needs and their risk level of relapse.

He also discussed the Law Enforcement Assisted Diversion (LEAD) program, which allows officers to redirect low-level drug offenders to services and resources specific to their needs, rather than sending them directly to jail. The program is still in the pilot stage, he said, and currently has 95 participants.

NaphCare Health Services Administrator Melanie Menear discussed the topic of opioid detox management in jails, and said Washington County jail officials have been trying to address the fact that 70 percent of the jail’s average daily population struggles with opioid use and access to treatment medications is limited.

“What we did differently was change the culture within the jail itself about how we treat detox,” she said.

Detox has to be understood as a medical intervention rather than a punitive exercise, she said. That means jail staff have begun to emphasize more frequent monitoring and increased availability of medications, and worked to combat dehydration. Officials added the drug buprenorphine to the detox program in 2017, she said, which can be used as a way to taper off drug use and substantially reduce the symptoms of withdrawal.

Clackamas County Sheriff Craig Roberts discussed the concept of a continuum of care for offenders in the legal system. If an addict is sent to jail, he said, it creates an opportunity where they’ll be sober and can be connected with resources to help put them on the road to recovery — but only if the jail system seizes the opportunity.

Recovery assistance programs can sometimes fail because they don’t take a long-term approach to treatment, he said, whereas “we believe it takes 12-18 months that these folks are in our program.”

As a recent pilot project, he said, the county has made the drug vivitrol available as part of the program, rather than simply demanding that users quit cold turkey. Vivitrol binds to opiate receptor sites in the brain, which reduces the urge to use more opioid drugs. The results have been encouraging, he said, although the high cost of vivitrol has been an ongoing challenge.

Multnomah County Sheriff Michael Reese elaborated on the continuum of care idea, discussing how the culture of law enforcement needs to incorporate more proactive treatment.

“I hear corrections officers saying, ‘I didn’t sign up for social work,'” he said. “Yes, you did.”

The second session focused on connections to treatment involving agencies other than law enforcement. Officials from Clackamas Fire District #1 discussed community paramedic responses to overdoses, and Lines for Life’s crisis line director, Greg Borders, discussed strategies to connect people to recovery resources.

Central City Concern employees Gary Cobb, Sean Hubert and Rachel Solotaroff led the final session, entitled “Aligning Resources with Results: An Integrated Approach.” That workshop was followed by a closing discussion among the panelists.