Think Out Loud

Behavioral health systems in Oregon face challenges dealing with increasing use of meth

By Lucy Suppah (Think Out Loud) and Allison Frost (OPB)
Aug. 8, 2022 7:26 p.m. Updated: Aug. 8, 2022 10 p.m.

Broadcast: Monday, Aug. 8

Oregon has seen an increase in methamphetamine use over the past decade. This has caused an increase in patients experiencing mental health illness induced by meth use within Oregon’s behavioral health system. Many issues have contributed to this problem, including a new formula of meth. Emily Green, the managing editor for The Lund Report, tells us more.


The following transcript was created by a computer and edited by a volunteer:

Dave Miller: This is Think Out Loud on OPB, I’m Dave Miller. We end today with Oregon’s ongoing methamphetamine crisis. For years now, meth has been responsible for more unintentional overdose deaths than any other single drug. Meth is also seen as a major contributing factor to many other societal crises in Oregon right now, including homelessness and untreated mental illness. Yet according to new reporting by Emily Green, who is a managing editor at The Lund Report, the state lacks a coordinated effort to respond. Emily Green joins us now with more details. Welcome back.

Emily Green: Hi, thanks for having me.

Miller: Thanks for joining us once again. I want to start with things that the writer Sam Quinones has argued. We talked to him last fall, he wrote a book first about the opioid epidemic, and then followed up with a new one that had a focus on meth, and his contention which he shared with us that really made the rounds is that meth has changed in its chemical formulation, and it’s leading to more psychosis. You talked to many experts in Oregon and people with on the ground experience. Do they agree with his basic point?

Green: You know, it was his article in the Atlantic based on the book that really got me looking at this in the first place. I thought if what he’s saying is true, then surely the mental health system in Oregon that for years has been struggling to meet demands must be having some impacts. What we found is that not only is meth having a big impact on the mental health system, but also on hospitals, jails, and the homeless communities. It’s exacerbating several ongoing state crises, including the hospital and staffing issues your last two guests spoke about.

Behavioral health workers in many ways do agree with his premise, that meth has changed, and we are seeing longer lasting and more severe psychosis among meth users, although it is a bit more nuanced than that. Also a factor is homelessness. A lot of the population where we’re seeing the most severe psychosis are also struggling with homelessness, and it comes with its own additional factors that can trigger mental illness, including trauma. Living outside often means living in a constant state of hypervigilance. It can be hard to take care of yourself, to rest, to sleep, to eat well. So when you combine homelessness with meth use, and this is especially true for anyone who has a genetic predisposition for mental illness, it can be a recipe for a severe and lasting psychosis.

But I do want to highlight that there are many people who use meth who never become psychotic. Many people experiencing homelessness don’t use meth. And many people who are homeless and use meth also don’t become psychotic. It really seems to be that trifecta of factors that is having a big impact. But that is a population that is growing steadily in Oregon.

Miller: In other words, the population of people who have underlying mental health issues, are homeless, and use meth, that intersecting trifecta is increasing.

Green: It is. And in some cases, practitioners believe the meth might be triggering mental illness that they could have a genetic predisposition for, but maybe they wouldn’t have become symptomatic if it wasn’t for meth use. So it is in some ways driving an increase in mental illness as well.

Miller: Let’s dig into some of the things you mentioned in passing earlier. What impact has methamphetamine had at the Oregon State Hospital?

Green: So the state psychiatric hospital in Salem has been in the headlines for years for its inability to meet demand, overcrowding issues, and it’s well reported that this is largely due to boarding a growing population of patients who are being treated because they were arrested, charged with a crime, but then found mentally unfit to proceed in court.

What hasn’t really been given much attention is just how intertwined with meth use much of these patients’ mental illness is. In fact, about 70% of these patients have a history of meth use. And again, hospital staff pointed out that most of these same patients are also experiencing homelessness. But when you have such a high population of these folks occupying beds at the state hospital, then the state hospital can no longer take other patients that need long term acute care that the state hospital provides. Instead, other hospitals around the state are warehousing those patients. They’re not set up to give that kind of long term care.


In fact, I spoke with Robin Henderson, Providence Oregon’s chief of behavioral health, and she said Providence has a lot of these patients, they’re not set up to provide the kind of long term therapies they need. In some cases, there’s nowhere for these patients to even go to be outside. And she told me about one man, who luckily they have found a placement for since then, but he was with the hospital for nearly 700 days. And she said for 700 days, his feet literally didn’t touch grass. So the impact to other patients is tremendous.

And hospitals are also dealing with meth more directly, in that meth-related emergency room visits have over the last three years increased by 20% in both rural and urban hospitals in Oregon. So it’s a statewide issue. And these visits can often involve a patient who is experiencing meth-induced psychosis. At its worst, this can be dangerous to both the patient and hospital staff. And again, hospitals aren’t the best place to be dealing with meth-induced psychosis and what that patient really needs to get better.

Miller: Given that meth figures so prominently in a lot of the issues afflicting Oregonians right now, you’d think, or maybe you’d hope, that there would be a concerted statewide focused effort to respond. But your reporting, especially the second in the series of two articles that you recently put out, found that that’s not really the case. You got a striking quote from Reginald Richardson, the director of the state’s Alcohol and Drug Policy Commission. He said that years ago, with funding available to target opioid treatment, “we did forget about meth.” How could that have happened?

Green: And I do want to point out, he was speaking, I think, about society as a whole. But in many ways I think there’s been kind of an apathy around meth. It is viewed by many, I think, to be very difficult, if not impossible to treat in some instances. But that belief leaves out that there are some promising interventions that are emerging, and I can get to those.

But I was struck that, while we have this growing high impact, high cost problem with meth use, and we find out that we have the highest rate of meth use in the nation in Oregon, given the widespread awareness of that and the growing awareness that meth has changed and that it is impacting our mental health systems, it was surprising that leadership at the Health Authority and in the Governor’s office, haven’t pivoted or attempted to come up with any sort of strategy to get at this problem.

Instead, what they’ve told me they’re doing is they’re trying to fix the behavioral health system in a holistic way, so that everybody suffering with any sort of substance use disorder or mental health issue is getting the treatment that they need. But that approach ignores the outsized role that meth is playing.

And the approach itself is disjointed. There is a lot of money, $300 million every two years through Measure 110, Oregon’s landmark drug decriminalization law, and more than a billion dollar investment from recent legislative sessions. But I think the failure to address meth really illustrates that with all this spending, no one has really mapped out a plan to ensure that this money will actually be used to address some of Oregon’s most pressing needs.

Miller: Oregon’s rate of methamphetamine use, you note it was rising before voters decriminalized illegal drugs, including meth, in 2020. Has there been an increase in meth usage since Measure 110 passed?

Green: Measure 110 is often blamed for rising drug use, but I think it’s important to note that the data showing that we are number one for meth use, that is actually data from the year 2020. It only recently became available, and that’s from a federal survey on drug use. So we had already jumped from ninth to first in the nation for meth use in 2020 when voters passed that law.

But when we look at every metric for measuring the meth problem, we’re seeing increases across the board. We know that methamphetamine contributed to more deaths in Oregon than fentanyl or heroin in 2019, 2020, and 2021. We’ve seen a 75% increase in the volume of methamphetamine confiscated on Oregon highways between 2016 and 2020. Sometimes this data takes a little time to come through, but there’s every indication that it is a problem that is growing, and showing no signs of slowing down.

Miller: What would it look like if, as a state, we did have a focused, concerted effort specifically on meth? Because that’s really at the heart of your reporting, that this is a huge problem, and it’s not being singled out, it’s not being given the attention it deserves by state officials. What would that attention actually look like?

Green: Well, Oregon has been here before. Back in 2004, then Governor Ted Kulongoski convened a task force on methamphetamine that was largely successful in wiping out local labs by putting Sudafed behind the counter. Although some folks I talked to said we don’t have time for a task force, we need something more urgent. One local lawmaker suggested a meth czar, somebody to take accountability and leadership, and to coordinate with agencies working on homelessness and the Justice Department, because really all of these issues are inextricably linked.

And there are solutions that potentially could be harnessed to get at this. There’s a highly effective treatment for meth use that, until recently, was difficult to fund. It involves rewarding drug free urine samples and successful engagement in treatment with small amounts of money. It’s much cheaper for taxpayers than leaving the addiction untreated. The state could offer providers education about the program, and ensure it’s available in every region.

There are some emerging medications that have been shown to curb meth cravings. Both Coda and Cascadia in Portland have new programs. But there are a surprising number of folks I spoke to, providers who provide addiction services around the state, that were completely unaware of these programs or medications. So a concerted effort could better educate providers on what treatments are available.

And another opportunity is working with Measure 110 to make sure that the hundreds of millions of dollars going out are going to fund some of the facilities that experts say are needed to really help intervene in addiction crises. And the state is also in the process of planning crisis stabilization centers as part of the new 988 suicide and crisis lifeline system. If the needs of meth users are taken into account in that planning, this is also something that could potentially be organized. If there were some sort of leadership on this issue, that could make a big difference too.

There are lots of opportunities that advocates and experts pointed to that really could be harnessed to make a difference in this issue. It’s just that nobody is doing that.

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