After months of delays, momentum is now building to create a stabilization center to treat people experiencing a mental health crisis due to methamphetamines, according to new reporting by The Lund Report. Multnomah County and the City of Portland signed a memorandum of understanding in May to partner on the center, which would be the first of its kind in Oregon. Unlike other sobering facilities, the stabilization center would allow several days for people to detox from meth before trying to link them to recovery services. Emily Green, managing editor for The Lund Report, joins us to talk about this effort amid a surge in meth-related visits to emergency rooms, which for the first time, have now surpassed visits due to alcohol in Multnomah County.
Note: The following transcript was created by a computer and edited by a volunteer.
Geoff Norcross: This is Think Out Loud on OPB. I’m Geoff Norcross. It’s taking longer than anybody wanted, but Portland is on the cusp of having a methamphetamine stabilization center. This is a facility for people who are experiencing a crisis related to meth use. There currently isn’t one in the state of Oregon. Previously, people in crisis have been taken to emergency rooms or even jail. Advocates say the new center will be a necessary resource for people suffering from meth addiction. Emily Green wrote about this recently. She’s the managing editor for the Lund Report, which covers Oregon health news, and she joins us now. Emily, welcome to TOL.
Emily Green: Hi, thanks for having me.
Norcross: Can you first describe how big of a problem meth is in Portland and Multnomah County?
Green: Meth has been a longstanding issue in Oregon. We’ve been among the most impacted states for decades, but in recent years we’re seeing an increase in emergency room visits related to meth. In Multnomah County, there were 7500 meth-related visits last year, and they actually outnumbered alcohol-related visits, which usually tops the list. Additionally, I spoke with Judge Nan Waller, who oversees Multnomah County’s Mental Health Court, and she says every day she sees people in her courtroom, many of whom are meth users who are there simply because they were dangerously intoxicated. And police needed to get them off the street, with jail being the only place to take them, but to hold somebody in jail, they have to be charged with a crime and that just sets the whole criminal justice system into motion. So we’re seeing great need for stabilization for people who are experiencing meth induced psychosis, and jail and hospitals are just not the best equipped to handle all of their complex needs.
Norcross: And we’ll get into why that is a little bit later on. But how do those statistics that you told me for Portland and multnomah County, how do they compare to the rest of the state?
Green: We’re seeing an increase in these issues statewide. I don’t know exactly the number of ER visits in other areas, but I know anecdotally that these are issues that stakeholders in every corner of the state are dealing with.
Norcross: Has the potency or availability of meth changed over the past few years?
Green: When Oregon banned the sale of ephedrine, the main ingredient in Sudafed over the counter, Mexican cartel-made methamphetamine took over. And it has a different chemical formula, and anecdotally, folks are seeing a lot more severe mental health crises associated with the use of that drug. It’s also a lot cheaper and more widely available than meth ever was before.
Norcross: So if someone is experiencing a meth-induced psychotic episode and ends up in the emergency room, what usually happens to them?
Green: If they’re exhibiting violent behavior or acting erratically, often they can be sedated with something like thorazine and then held until they’re stabilized and come out of that psychosis, which can in some cases be dangerous. Because often paranoia and the belief that others are out to get them can lead them to be aggressive towards people who are actually trying to help them, like nurses and doctors.
Norcross: And how would this meth stabilization center that is going to open sometime in the next year, how is it going to be different?
Green: Well, like so much surrounding this project, many of the details at this point are vague. But they imagine a place that will hold people for up to five days of observation, and that’s a lot longer than a sobering center which typically holds people for about 24 hours. And I spoke to Robin Henderson, who is the Chief Executive of Behavioral Health at Providence which saw about 2000 meth related ER visits last year, and she said typically in a hospital folks stay for a couple of days, and during that short time they’re just often unable to get to a place mentally where it makes sense to approach them with treatment resources. For that, she said they need at least five days. So the stabilization center, the hope is that it will give people the amount of time they really need to withdraw from the drug and get to a place where if they want treatment, it’s something that they consider. It will also offer medication- assisted treatment, which there are a few emerging drugs that are showing to help with methamphetamine cravings.
Norcross: You mentioned a sobering center as an option for these people in crisis. Not a good option, but an option just the same. And now that doesn’t even exist. Portland’s only sobering center closed in 2019. Why did it close?
Green: According to Central City concern which operated it, it closed due to safety concerns. It just wasn’t equipped to handle the influx of people who were being brought in on meth or similar drugs who could behave erratically and sometimes violently. It was really designed to help people sober up who are intoxicated by alcohol
Norcross: Emily, what is the current treatment protocol for somebody who is in a meth-related crisis?
Green: Unfortunately, there is no medically assisted treatment options for meth that come anywhere close to being as effective as methadone or buprenorphine for opioid use disorder. But recently, actually in Portland, both Coda and Cascadia have rolled out some medically assisted treatment programs for meth, using drugs that are shown to reduce cravings by about 11% more than the placebo. But by far the most effective treatment for meth use, that we know of right now, that is evidence-based, is contingency management, which is a method of rewarding patients for successfully engaging in drug treatment or for giving drug-free urine samples. Rewards are often gift cards and small amounts that increase over time. And in Oregon Measure 110 has for the first time provided a sustainable funding stream for implementing these types of programs. So we’re actually about to see a lot more of them across the state.
Norcross: If you’re just tuning in, we’re talking about the new methamphetamine stabilization center that is in the works for Portland. Emily Green wrote about this. She’s the managing editor for the Lund Report. Emily, this effort to open this center launched in November of 2020, and it has been plagued by delays. We don’t have a hard date for when it would open. We’re hearing sometime next year. Can you lay out some of the reasons for the slow progress in getting it open?
Green: Really it started when people knew they needed to replace the sobering center, and they wanted to have something that was better, and equipped to handle meth use. And it started with just a handful of providers and other interested parties. But as time progressed now, about 80 organizations and over 160 individuals are involved in this process and nearly two million [dollars] has been spent. But first the pandemic, like so many other things, caused delays. And then there was the politics of figuring out between the City of Portland and Multnomah County who was going to be doing what, caused another delay of several months. But now the ball is really rolling. The city and county have come to an agreement that really puts the county in the driver’s seat in terms of project management, but with the understanding that they will be in close consultation with the city at each step and and they are going to be finalizing a charter that outlines the executive committee structure for that, next week.
Norcross: Okay, so when this does get built, can you describe how the process will work if somebody is having a meth related crisis and they’re brought to this facility? What will the treatment look like and what will the experience be?
Green: That is something I have asked a lot of people that are involved in this project, and much of that is still being figured out. The hope is that first responders will be able to drop people off with ease, making it a little-barrier process for police and ambulances. So it’s a more attractive alternative to dropping somebody off at jail, for example. But exactly what will happen and how, are details that are still very much being determined. They are sending out a request for information to providers next week, that kind of lays out a preliminary plan, and the hope is to work with providers to see who’s capable of doing what. And whichever organization ends up undertaking this, will help determine exactly what the processes look like.
Norcross: Okay, but you can basically say patients will be there for longer than 24 hours, like they would be in the ER, and they will get services unlike they would get in jail.
Green: Yes, the idea is that it will be very much trauma-informed, peers, people with lived experience of meth use and addiction, will be there at every step. Really in many ways trying to meet people where they are at, and offering a doorway to different services, whether it be treatment or harm reduction is really the greater vision for this place. And I should say, along the way, for much of this planning process, people were dreaming pretty big. They really saw this as being something that would serve anyone experiencing acute intoxication, whether it be alcohol or opioid or whatever. But they realized they had to start somewhere, and it really got narrowed down to methamphetamine, just because of the great need in the community
Norcross: Who are the stakeholders in this project, aside from the City of Portland and Multnomah County?
Green: Oh, so many different health providers. The Unity Center, Providence, different behavioral health services, individuals. And they’re also consulting with folks who have experience with meth use, to get their input on what they hope a center like this will provide.
Norcross: Where does the offer currently stand?
Green: Well, right now? The council did apply for Measure 110 funding to keep the process moving . . .
Norcross: Decriminalization measure that passed last November, or in 2020 I believe?
Green: Yes, that’s right. So there’s grant dollars attached to different recovery and treatment resources. They applied for about four million. However, the council distributing the funds denied their applications, so they’re still figuring out where the funding is going to come from. It’s probably going to come from a variety of sources. The cost is still being determined. However, all those involved say it is moving forward and they do hope to see something open sometime next year.
Norcross: Any idea where it might be?
Green: That is also still being determined. But sources I spoke to believe it will be somewhere near the city center.
Norcross: Emily Green, thank you so much.
Green: Thank you.
Norcross: Emily Green is the managing editor for the Lund Report.
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