Editor’s note: Throughout 2023, OPB is taking a deep look at the biggest social and economic challenges facing Oregon today – their origins, their impacts and possible solutions. This week we are looking at the gaping holes in the state’s mental health system, including the rising challenge of addiction and the lack of services for people struggling with drugs and alcohol.
PROBLEM: Roughly one in five Oregonians has a substance use disorder.
Headlines in 2022 declared Oregon to be the “worst in the nation” for addiction. But many local experts in behavioral health say state rankings should be taken with a grain of salt. The most often quoted rankings, created by the advocacy group Mental Health America, rely heavily on the responses to an annual survey conducted by the federal Substance Abuse and Mental Health Services Administration. But since the survey collects information about people’s self-reported drug use, it is likely capturing a combination of different things - regional differences in rates of use, yes, but also regional differences in openness to talking about it.
Still, addiction to substances, a sharp increase in overdose deaths and a lack of public resources dedicated to detox and treatment programs are real problems in Oregon.
Oregon’s substance use disorder treatment system is about half the size it should be, according to a recent study and survey of providers done by the OHSU-PSU School of Public Health.
Detox programs provide medical support while people go through the painful — and potentially life threatening — symptoms of drug withdrawal. In Oregon, such programs are notoriously difficult to get into.
“I laid on my son for three days while he shook uncontrollably — detoxing at home because he just was ready to be done and couldn’t get into any facilities,” said Pam Connelly, who said she wasn’t able to find a detox program to help her 37-year-old son when he was ready to quit using substances. Connelly is a member of the group Oregon Moms for Addiction Recovery who traveled to Salem in February to ask legislators for more funding for addiction recovery.
Illicit drug use has – understandably – captured the most public attention and generated alarming headlines. Fentanyl can take people’s lives the first time they try it and is responsible for a rapidly increasing share of overdose deaths. Meth too, is a deadly habit that claims far too many Oregonian’s lives each year and, because it can trigger psychosis, causes a particular strain on the state’s mental health system.
The death rate from drug overdoses has doubled in just four years. In 2017, 13 people per 100,000 in Oregon died of a drug overdose. In 2021, there were 23 overdose deaths for every 100,000.
But it’s a legal drug that arguably hurts - and kills - the most people.
“Alcohol is the great dirty little secret of the pandemic,” said Dr. Robin Henderson, the chief executive for behavioral health for the Providence health system in Oregon.
She said alcohol is a significant cause of visits to Providence emergency departments. “We put a lot of effort into the opioid crisis and I don’t mean to diminish that at all, but we’re not having those same conversations about alcohol,” Henderson said.
On average, six people die each day in Oregon from alcohol related causes, according to the Oregon Health Authority. Drunk driving crashes and acute alcohol poisoning make up a relatively small fraction of those deaths; the majority are due to the long term effects of alcohol, including alcoholic liver disease, heart disease and cancer, according to state epidemiologists.
In 2021, alcohol was responsible for far more emergency department visits than any other substance nationally, according to the federal Substance Abuse and Mental Health Services Administration. In a survey of medical records from a sample of hospitals nationwide, it was involved in 42% of all drug-related visits, compared to 15% for opioids, 11% for methamphetamine, 11% for marijuana, and 5% for cocaine.
Even before the pandemic, alcohol was the third leading cause of preventable death in Oregon, behind tobacco and obesity but ahead of overdose deaths. Most people know alcohol use can cause liver disease, but it also significantly increases a person’s risk of many cancers, including head and neck, esophageal, liver, breast and colorectal cancer, among others.
Illicit drug use likely rose during the pandemic as well, and overdose deaths are climbing quickly. On average, three Oregonians die each day from unintentional drug overdose. But while Oregon’s drug overdose death rate is below the national average, its alcohol induced death rate is above it.
PROMISING STRATEGY: Tax alcohol and use the revenue to fund detox and treatment programs that the state hasn’t been able to stand up with Measure 110 funding.
Last year, OHA launched “Rethink the Drink,” a public health campaign aiming to increase awareness of the risks of excessive drinking — the kind of drinking a lot of people do that may not meet the definition of alcohol use disorder, but still raises your risk of cancer and other health problems. According to the site, four to five drinks on a single occasion or more than one to two drinks a night, every night, count as excessive drinking.
The group Oregon Recovers is pushing state legislators to do more to curb excessive drinking. They point to Oregon’s beer and wine taxes, which haven’t changed in 45 years and are among the lowest in the nation.
Raising the tax rate on alcohol would likely lower the amount people consume. In 2007, a scientific workgroup that assesses public health prevention strategies for the federal government evaluated the research on alcohol taxes. The group found strong evidence taxes work to curb drinking. For example, it estimated that beer consumption can be expected to decrease 5% for every 10% increase in price.
Advocates also point to Maryland, where researchers found alcohol sales - a proxy measure for drinking - dropped after the state increased its alcohol tax in 2011.
Advocates say teens and binge drinkers are particularly price-sensitive, so the tax is a good way to reduce some of the most harmful alcohol consumption taking place.
Oregon’s beer and wine industry successfully defeated an attempt to pass a tax increase in 2021, but Rep. Tawna Sanchez, D-Portland, who is in long-term recovery herself, is reportedly planning to re-introduce a new version of the measure.
Sanchez declined an interview request, and so far only a placeholder version of the bill, HB 3312, is available on the state legislature’s website.
Oregon Recovers and the Oregon Alcohol Policy Alliance say revenue from the proposed alcohol tax would go to fund treatment programs, including detox spots, and prevention and education campaigns, among other things.
Any funding generated by an alcohol tax would be more flexible than the state’s marijuana tax dollars, which can’t be used to pay for services (including detox) that are also paid for with federal Medicaid funding.
If you or someone you know is struggling with addiction, you can call the free and confidential treatment referral line (1-800-662-HELP) or visit findtreatment.gov to find providers in your area who can help people overcome substance abuse.
Up next: Thursday, we’ll examine another missing link in Oregon’s mental health system: Oregonians who struggle the most with mental illness experience revolving doors — in and out of jails, housing and medical institutions.