By Patrick Evans
The Oregon health care system is failing to address the state’s drug and alcohol addiction crisis at every level, from providing prevention and recovery services to coordinating the response between health care providers and state agencies, speakers at a forum said Wednesday.
Speaking at a breakfast session at the Multnomah Athletic Club, four panelists and a moderator said fixes were long overdue. Oregon has the fourth highest addiction rate in the nation with the lowest ranking in access to treatment, resulting in over 2,100 deaths each year related to substance use disorders, said Mike Marshall, director of Oregon Recovers and moderator of the forum.
The panel, sponsored by the Oregon Health Forum, which is affiliated with The Lund Report, included Dr. Honora Englander, director of the improving addiction care team at Oregon Health & Science University; Karen Kern, senior director of substance use disorder services for Central City Concern; Tony Vezina, executive director of the 4th Dimension Recovery Center; and Dr. Reginald Richardson, executive director of the Oregon Alcohol and Drug Policy Commission. Nearly 170 people attended the breakfast forum.
The panelists identified major barriers to improving the state’s response to the addiction crisis, including a lack of effective public policy, insufficient funding for providers and intervention services, and a cultural approach to addiction that stigmatizes people suffering from substance use disorders.
In his opening statement, Marshal said Oregon’s inadequate response to its addiction crisis has had a big human toll, with high rates of children in foster care, high hospitalization rates and large numbers of people on the streets. It’s also racked up a big financial toll, he said, that cost the state $9.5 billion in 2009 alone.
Marshall compared the addiction crisis to the AIDS/HIV epidemic of the 1980s and ’90s and said that the health care system needs to change the conversation around addiction from one of moral failing to chronic illness.
“I do not believe we think about addiction in the same way, at the same level of concern with the very notion that it is, in fact, a crisis here in Oregon the way we think about HIV/AIDS. That really needs to change” Marshall said.
Kern said she has identified several problems with Oregon’s approach to the crisis, primarily the insufficient funding for treatment and recovery programs and reimbursement for counseling services. The reimbursement rate for individual substance use counseling is only about two-thirds of the reimbursement for individual mental health counseling services, she said.
“That’s about $45 for a 15- to 37-minute session for a certified alcohol and drug counselor, and $71 for a qualified mental health practitioner, providing pretty much the same service,” Kern said.
The lack of wage parity makes it difficult for addiction counselors to keep their doors open, fund adequate staffing and provide training, Kern said. Barriers to treatment compound the difficulty that clients face accessing service, such as transportation to clinics and long wait times for admission to recovery programs.
Kern said that the problem of access has been complicated by a lack of inter-agency communication and bureaucratic confusion at the state level. The Oregon Health Authority does not currently have a behavioral health director, and responsibility for substance use disorder treatment has been repeatedly shuffled between health authority departments, she said.
The failure to provide a coordinated statewide response puts an unsustainable burden on treatment and recovery centers. A former heroin user, Vezina turned his life around and is now helping others recover. He said the 4th Dimension Recovery Center he runs serves 600 people a month but only receives $250,000 in state funding each year. Vezina said the center depends on charity and fundraising to maintain operations.
“While we generally accept that addiction is a chronic disease, that doesn’t translate into how we fund addiction support and recovery services,” Vezina said.
Vezina even provides addiction intervention services for free, traveling to emergency rooms across the Multnomah County to respond to calls from people asking for services. He said he opens the center in the middle of the night for clients with nowhere else to sleep.
Low-income clients, in particular, suffer from the lack of investment in intervention and recovery programs, Vezina said, as those who cannot afford to pay for services must wait days or even weeks for admittance into recovery programs. Long wait times make it more likely that people will fall through the cracks and become ill or die from overdoses.
“When the desire to change dissipates, people are getting that much closer to dying,” Vezina said.
Vezina called for robust investment in peer-led intervention services, where mentors in recovery from addiction reach out to people at hospitals and clinics to engage them in a way that others without that experience cannot.
“People in recovery need to lead the charge,” Vezina said.
Speaking from his own experiences with addiction and homelessness, Vezina described significant barriers to recovery for those in poverty. He said people suffering from illnesses related to addiction such as skin infections or hepatitis C are denied care in emergency rooms and kicked onto the streets.
Those who do obtain recovery services like residential treatment are further put at risk by zero-tolerance policies that deny service if patients test positive for drugs or do not allow patients to continue use of drug treatment medications, the panelists said.
Drawing on her experience as a physician and addiction specialist, Englander said that providers tend to treat patients suffering from substance use disorder differently than patients with other chronic diseases.
“In addiction, we shame people and we blame them, we don’t say ‘someone’s returned to use or your drug screen shows they’re using multiples substances, what supports can we put around them?’ Instead people get kicked out of treatment,” Englander said.
Hospitals see the most vulnerable patients who suffer from substance use disorders, but staff and doctors don’t have the education to treat them, she said.
“What I call the structural stigma of addiction is really killing people,” Englander said.
The effort to tackle the addiction crisis at the state level is being led by the Oregon Alcohol and Drug Policy Commission. The agency has been tasked by House Bill 4137 to create a comprehensive plan for addiction prevention, treatment and recovery for review by the Oregon Legislature by Sept. 15 each year.
As director of the agency, Richardson said he was surprised on his first day to find that not only did the agency not have a budget or office, but also that he was the only staff member. Richardson has moved quickly since taking over, he said. The agency contracted with management company JBS International and started work this month to create a strategic plan for the state.
“We don’t have time or space to mess around, we need to get started,” Richardson said.
The agency will work with JBS International to identify budget priorities, make funding recommendations and contact constituencies and stakeholders across the state. The agency will need to determine the state’s capacity for providing care and create effective processes between governmental agencies and health care providers, Richardson said.
Finally, Richardson said, the state will have to find the political will to move forward to implement policy recommendations and create a shared vision among agencies.
“We’ve got to have a vision, there is no grand vision,” Richardson said.
“There isn’t a collection among state agencies where we’re all moving forward towards a given end,” Richardson added, “and I think whenever that is in absence you’re not going to have good public policy that moves things forwards.”