Mental Health Association of Portland

From The Oregonian, May 15, 2012

Heeding an arbitrator’s ruling to reinstate fired Portland officer Ronald Frashour, who shot and killed Aaron Campbell in 2010, would violate the U.S. Constitution, Oregon’s Constitution and Portland’s City Charter, attorneys for the city say.

The lawyers deployed their full arsenal of legal arguments for the first time in briefs filed this week. They’re defending Mayor Sam Adams‘ unusual decision — under challenge from the police union — to buck the arbitrator’s reinstatement ruling in March.

Frashour shot Campbell in the back with an AR-15 rifle on Jan. 29, 2010, after Campbell had been struck with multiple beanbag-shotgun rounds and turned to run toward his girlfriend’s apartment building. Campbell was unarmed, but Frashour said he thought Campbell was reaching for a gun.

The mayor and Police Chef Mike Reese fired Frashour. But on March 30, Arbitrator Jane Wilkinson ordered the city to reinstate Frashour with lost wages, saying a reasonable officer could have concluded that Campbell “made motions that appeared to look like he was reaching for a gun.”

Adams decided not to follow the arbitrator’s ruling — a first involving an officer terminated for use of force. The Portland Police Association filed an Unfair Labor Practices complaint on Frashour’s behalf.

Overturning arbitrator rulings is an uphill battle.

The state Employment Relations Board focuses on whether the arbitrator’s decision forces a public employer to violate public policy set out in statutes or judicial decisions, not whether the employee’s conduct violates public policy.

The board uses a three-part test: Did the arbitrator find the employee guilty of misconduct? If so, did the arbitrator relieve the person of responsibility for the misconduct? And lastly, is there a clearly defined public policy that makes the award unenforceable?

Police union attorneys argue that the city will lose outright on the first question because the arbitrator found Frashour acted within bureau policy.

Portland attorneys Howard Rubin and Jennifer Nelson, hired by the city to defend Frashour’s firing, argue that the board’s focus is too narrow and Frashour’s use of deadly force was unreasonable and disproportionate to the circumstances he faced.

Frashour’s reinstatement, they said, would:

• Violate public policy, as defined in the U.S. Supreme Court case Graham v. Connor. That ruling said an officer’s use of force must be objectively reasonable based upon the totality of the circumstances at the time of the incident.
• Violate public policy as defined in the U.S. Constitution’s Fourth Amendment and Sec. 9 of the Oregon Constitution, which says no one should be subject to unreasonable arrest or seizure.
• Violate federal code that makes it unlawful for a government employee to engage in a pattern or practice that deprives persons of rights, privileges or protections under the U.S. Constitution.
• Conflict with Portland’s City Charter. The charter, the attorneys wrote, “allows the City to enforce through discipline the highest standard of efficiency and safety where use of deadly force is concerned, which is more stringent than the legal standard for criminal or civil liability.”

Here’s the May 2012 edition of Eyes & Ears, a mental health consumer run newsletter for consumers, their friends & family and mental health professionals.

Download and read the May 2012 issue at:

Online Reading Version of Eyes & Ears – with links
Full article version of Eyes & Ears – for printing
Contact the editor at eyes.ears_newsletter@yahoo.com

Included in this issue:

* FolkTime Looks to Expand Peer Support Services for Veterans
* Central City Concern has head start on new law
* Shelley Dixon Shares Her Story
* Developing Policies and Practices for Medication Optimization by Robert Nikkel, MSW
* DOJ investigating 17 police, sheriff departments – including Portland, Oregon
* Consumer Advocates Create Watchdog Group to Monitor CCO Developement; and other CCO news
* BoltBus, launching May 17th, offers rides to Seattle for $7
* Extra on the online version with links: National Survey on Abuse of People with Disabilities; Part 1: The Development of WRAP; Impossible Choices: Thinking about mental health issues from a Buddhist Perspective; DSM-5 news; The Art of Seeing Depression; Is the FDA violating its own mandate to approve safe drugs?; Group wants ‘fair shake’ from state psychiatric security board; and more
* Coming Events: NAMI Walk; Downtown Compassion health clinic; Centerstone Grand Opening; Alternatives Conference coming to Portland and more

Besides other news there are a variety of listings of meetings, services, support groups, job opportunities and more.

 

We include this news story in our archive because of our continuing interest in persons routinely harmed by the police in the Portland area and concern that most of these persons are impaired by mental illness or addiction. There is no indication from the public record that Adalberto Flores-Haro was impaired in any way.

From The Oregonian, May 12, 2012

A Multnomah County grand jury Friday found no criminal wrongdoing by members of Washington County’s Tactical Negotiation Team in their March 13 shooting of Adalberto Flores-Haro at New Columbia in Portland.

But the Portland Police Bureau is continuing an investigation into whether Flores-Haro should face any criminal charges, according to the Multnomah County District Attorney’s office.

Flores-Haro, 31, was shot three times – once in the forearm, and twice in the torso, when he came out the front door of his home holding a handgun to scare away what he thought were prowlers outside his home, his family said.

Flores-Haro’s attorney Michael Rose said he was “disappointed, but not surprised,” by the grand jury ruling, considering how rare it is for an officer to face criminal charges for use of force. But he said he’s disturbed that police would consider bringing criminal charges against his client.

“To see him being the target or subject of further investigation is sort of outrageous,” Rose said.

Yet police and attorneys for two of the officers involved suggested Friday that Flores-Haro pointed the gun at them and fired. No police reports or grand jury transcripts were released, because of the pending inquiry.

“Investigators have evidence suggesting Flores-Haro fired at officers and are continuing the investigation,” Portland police spokesman Sgt. Pete Simpson said.

Brian McLeod, a 12-year member of the Washington County Sheriff’s Office and Hillsboro Officer Steven Slade, an 11-year member of his department, fired their handguns. Washington County sheriff’s deputy John Egg, a 14-year member of the sheriff’s office, fired a less-lethal 40 mm grenade launcher, at Flores-Haro. They were huddled together beside another home, across from Flores-Haro’s front door, about 30 feet away, their lawyers said.

“It’s pretty clear he not only raised a gun at them but fired,” said Portland attorney Jim McIntyre, who represents McLeod.

“They responded to a lethal threat,” said Portland attorney Mark Makler, who represents Egg. Egg tried to use the less-lethal 40mm weapon in a lethal way, by aiming at Haro’s head, Makler said. He missed.

Flores-Haro’s stepson, Daniel Ibarra, 17 told The Oregonian that Flores-Haro did not know that the men surrounding his home in the 9500 block of N. Woolsey Avenue were authorities approaching to raid a home two doors away from his home.

Flores-Haro’s lawyer said his client was shot by officers “dressed in black, skulking around the neighborhood” who didn’t identify themselves, and then left him suffering from wounds outside his residence for about 10 minutes before getting him help. Rose also said he thought Flores-Haro’s gun was unloaded.

Flores-Haro did not testify before the grand jury because of the pending investigation into his actions. His wife, Alma Granados Millan and her son did testify, Rose said.

Flores-Haro may suffer permanent damage to his arm, Rose said.

Yet the officers’ attorneys said their clients identified themselves as law enforcement. Makler said the largest of the three officers, Slade, was screaming that they were the police or from the sheriff’s office. The three officers have returned to regular duty.

The District Attorney’s office said no transcripts of the grand jury proceeding would be released because a death didn’t occur and pending charges are possible.

READ – Hillsboro officer and two WCSO deputies identified who were involved in March 13 shooting in Portland, March 23, 2012
READ – Man shot by Washington County tactical officers was armed, thought intruder was on his property, family said, March 14, 2012
READ – Police investigating North Portland shooting during ‘active tactical incident’, March 13, 2012

From the Portland Tribune, May 9, 2012 – by Peter Korn. Second of Two Parts

Painkiller cuts send some patients to street drugs

A year ago, Dr. Gary Oxman, Multnomah County’s public health officer, saw evidence that demanded what he calls a moral decision.

He had watched as each year the number of Multnomah County residents dying from prescription painkiller overdoses had grown.

Physicians with whom Oxman consulted, who had moved to Portland after practicing elsewhere, told him that doctors here tend to prescribe more pain medication than doctors in other cities.

Last May, Oxman’s county health department dramatically changed its policies. Nine pages of guidelines were developed requiring that physicians, before prescribing painkillers, comprehensively assess the patient not only physically and mentally, but also from an addiction standpoint.

The result? Some patients at county clinics have been told they can’t get prescriptions anymore. Others have had their doses reduced.

Compared to a year ago, about half as many of the county’s primary care patients are on prescription painkillers.

But another disturbing trend has captured the attention of public health officials. The number of deaths in Multnomah County due to heroin overdoses has increased dramatically in the past year (see “Welcome to Heroin City,” May 3). And a number of people in the local health care community have told the Tribune that part of that rise may be an unintended consequence of the new guidelines.

Pain sufferers and addicts, they say, cut off from their prescriptions, have begun looking for alternative sources of relief and have found it in the cheap heroin flooding Portland’s streets.

None of the physicians or addiction treatment specialists the Tribune interviewed disagreed with the county’s new policy. Someone had to draw a line somewhere and begin halting the cycle that creates new addicts in Oregon, they say.

The county’s new policy — followed by most other local clinics that provide health care to the poor and uninsured — is an important first step.

Sarah Goforth, who oversees mental health and addiction services for nonprofit Central City Concern, says the county made a hard choice, but the right one.

“We have people getting cut off from their pain pills and turning to illicit drug use,” Goforth says. “It’s tricky. (The county) is letting us all know this is going to stop. We own that this is out of control and we don’t want to be a part of it anymore.”

Not like other addicts

Northwest Portland resident Pam Boyd can visualize a future as a heroin addict, and it frightens her.

Boyd, 56, was a substance abuser for years. She used Vicodin to excess, she drank and smoked pot. Depression and a variety of ailments allowed her to rationalize her habits. But she had her limit.

“As long as I didn’t do heroin I figured I was OK,” Boyd says. “I figured I wasn’t as bad as all the other addicts.”

In 2000, she was hit by a car, suffered a series of severe injuries, and, she says, couldn’t find a doctor willing to prescribe enough of the pain medication she so desperately wanted. One night, she was at a party when she heard people making noise behind a bathroom door.

“I stuck my arm in and said, ‘I don’t know what you’re doing in there, but give me some of it,’ ” she recalls.

Somebody stuck a needle into her arm. That was her first heroin injection. Eventually, she developed a major heroin habit.

Boyd has been clean of illicit drugs for four years. But injuries from her first accident and a second one, when she was hit by a car on Southeast 82nd Avenue, have left her in constant pain. When she gets up in the morning, the first thing she does — has to do, she insists — is take OxyContin and lie still for 20 minutes before the pain subsides enough to allow her to get out of bed and begin the day.

She takes painkillers throughout the day.

Boyd’s physician, Dr. Rachel Solotaroff, says Boyd’s prescriptions exceed the recommended ceiling of 120 milligrams total morphine per day. Her plan is to taper the doses so Boyd gets under that ceiling, but she won’t do it in a vacuum.

The Old Town Clinic, where Boyd receives care, has developed a program called RENEW for patients who need alternative therapies. Boyd has taken relaxation and meditation classes there. She’s tried acupuncture at the clinic as well as nutrition classes, and next week she is scheduled for physical therapy and an aromatherapy class.

One-on-one, Solotaroff, with patients such as Boyd, is re-enacting the hard choice that Oxman has dealt with on a countywide level. But it’s not easy.

Boyd says all the alternative therapies provide only temporary pain relief. If she were to be cut off from her prescriptions — Solotaroff says that won’t happen — returning to heroin would loom as a real possibility.

A floating life

Solotaroff, Central City Concern’s medical director, isn’t a big fan of prescription painkillers, even for patients suffering chronic pain. The drugs, she says, dull the sensation but don’t generally help patients learn to deal with their pain.

“Opiates don’t help you set goals to improve your activity or occupation or socializing,” she says.

Boyd exemplifies that half of the equation, according to Solotaroff.

“If we were just doing pain medication with her, she might just sit at home all day,” Solotaroff says. “It’s an isolated and not fulfilling life, kind of floating. What Pam is doing, which is remarkable, is trying to work with us to get opiate doses lower and understand it’s only going to take away 10 or 20 percent of the pain.”

Boyd says most of the people she knows will “go back to the street” if denied their pain prescriptions. That means heroin for their pain, as well as shoplifting and prostitution to make enough money to buy the heroin.

When Multnomah County issued its new clinic guidelines, Solotaroff says, it essentially changed the way all clinics in the county operated.

“Everybody was heading in that direction, but when the county made its changes it forced the other community clinics to do the same thing or all the county’s patients were going to migrate to your clinic. You’d be the candy man,” she says.

Solotaroff says at the Old Town Clinic most of her patients, when assessed using new guidelines, are considered at high risk for addiction. She says an unintended consequence of the new rules has an increasing number of patients going from one doctor to another or switching clinics or even visiting hospital emergency departments in an attempt to gain access to new prescriptions.

Some of her patients have told her that since their prescriptions have been reduced they have begun buying drugs on the street.

Solotaroff says the county was right to lead the way with its new guidelines, but she’d like to see other changes that could help head off some of the consequences.

A moral imperative

The Old Town Clinic runs a program from its new building in Old Town, which has space to offer a variety of alternative therapies. The goal, Solotaroff says, should be that every time a physician tells a patient his or her pain medications are going to be cut off or reduced, the patient has immediate access to resources such as a physical therapist and an addiction specialist.

The latter can advise a patient on the dangers of going to the black market for pain meds or heroin, and possibly check in with the patient once a week. The former can offer pain relief alternatives.

That won’t be easy, Solotaroff says, and money is only one of the reasons. Most primary care physicians are not trained in addiction, and are unprepared for dealing with patients who might be gaming the system in search of extra painkillers they can use or black market.

“The primary care and medical community is very separate from the behavioral health and addictions community,” she says. “I don’t think they talk to each other very much. They don’t sit as the same table.”

Oxman says Multnomah County primary care clinics have social workers who can work with patients being weaned off painkillers. But, he says, a comprehensive pain package with a host of alternative pain therapies — what Solotaroff is able to offer — isn’t something the county can provide now. He wishes it could, and he recognizes the potential short-term cost of cutting down on painkiller prescriptions without the alternatives.

“Should we have waited until we had all that stuff in place to change our prescribing practices?” Oxman asks. “I felt there was this moral imperative. We were in a position of knowing our own patients were dying and it would be years before we had adequate capacity.”

Others are searching for alternatives. Volunteers of America’s clinics treat a large number of county residents on probation and parole. Greg Stone, director of the VOA’s inpatient men’s residential drug treatment center in Northeast Portland, says the new 18- to 25-year-old heroin addicts are harder to keep in treatment.

“They can’t tolerate the physical and emotional distress, and they’re not sufficiently motivated to be able to hang in there,” he says.

As a result, Multnomah County has provided money for a pilot project that will allow some of those new heroin addicts to be treated with methadone, an option that almost all recovered heroin addicts abhor, Stone says.

Typically, Stone says, recovered addicts see methadone as substituting one addiction for another, but rarely a path to sobriety.

“We have a crisis right now, so maybe it’s worth giving it a shot,” Stone says.

An ‘evil thing’ takes over life

Chris Pin smoked heroin for three days and knew he was addicted.

Pin grew up in a middle-class home in the Johnson Creek area, partying with alcohol and pot and occasionally cocaine and all the while able to hold down a job as a cable installer.

Pin first tried heroin on a Sunday afternoon. His older brother and some friends called it “a Sunday smack down.”

Pin smoked heroin, got sick, puked and settled into the relaxed state the dope provided. A couple months later, he paid $100 for the phone number of a heroin supplier. He smoked for three days and was hooked.

“I remember vividly a sickening feeling, and my mind was turning me toward heroin,” Pin says, adding that his mind was telling him he could no longer make it through a day without heroin.

Oddly, the first time Pin gave himself an injection of heroin was the day before his mother drove him to Hooper Detox so he could attempt to get clean. Now clean and sober, he recognized the contradiction in his thought process:

“I’m going to be getting clean tomorrow, I might as well try it one time, today,” Pin says.

Pin spent six years as a heroin addict. His favorite place to score was among the day laborers near East Burnside Street and Grand Avenue. He’d wade in asking for “chiva,” and eventually find a supplier.

Pin recalls talking to a Mexican dealer while in jail, and hearing the man say he was going to get deported but he’d just use the opportunity to get more drugs in Mexico and come straight back.

Pin traveled all over the West and tried to buy heroin in cities ranging from Las Vegas to San Francisco and Phoenix, but never found it as easy as in Portland. He knew people who lived in Seattle and would come to Portland for their dope.

Pin, who now has a job as a machinist, says he is still dealing with the time he spent as a heroin addict, because once or twice a year he hears about an old friend dying of an overdose.

“It’s just the most evil thing to me. I don’t know how I ever thought it was fun,” Pin says.

Needle points to new level

Jimmy (not his real name) swore he’d never put a needle in his arm. A steady user of black market prescription painkillers — OxyContin was his favorite — Jimmy was accustomed to paying close to a dollar a milligram for his fix.

He was a University of Oregon student using recreationally until the night he had only $30 on him, not enough for the Oxy high to which he’d become accustomed. A friend offered him a free smoke of heroin and explained the drug’s advantage — its cost.

“I didn’t know how cheap heroin was,” Jimmy says, adding that he set a limit.

“I vowed at that time that I would never shoot. Once you bring a needle into it, that’s a whole new level.”

But it’s a level most young users find themselves reaching eventually, say addiction specialists.

Now the only way Jimmy can get the rush he desires is from injecting heroin, which he does every morning and sometimes before bedtime.

Jimmy has left school. Until a year and half ago, he was able to work as a Web designer. Now he spends his days as a low-level drug dealer, a lifestyle interrupted by two and a half weeks in jail after one bust.

Drug’s heavy (and low) price

Mike Longatino wasn’t an addict when he arrived in Portland in 1995 at the Greyhound bus station. But, he says, the drug found him quickly enough.

“I got off at the bus station and hadn’t walked more than three or four blocks and I was asked if I wanted to purchase cocaine and heroin two or three times,” he says.

He hadn’t even liked heroin the couple of times he’d tried it at parties. But Longatino, 38, says he learned that a small bag of heroin and cocaine — what addicts call a speedball — could be bought for anywhere from $7 to $30. And price, he says, did matter, especially after he reached the point where he would try to shoot up as much as he could in a day.

Longatino began stealing from stores to support his habit. He then turned to burglary and panhandling. Some days, he’d earn $20 begging on the street, and occasionally as much as $200.

It all went for dope.

Longatino says he kicked heroin in jail, thanks to “a cocktail” of drugs offered there that helped him withdraw.

His last jail sentence included a visit to the Volunteers of America inpatient treatment center in Northeast Portland, and after his nine-month stay, with VOA’s help, he moved into the nonprofit Oxford House in Northeast Portland, a facility for recovering addicts.

Longatino knows how lucky he is. Heroin, he says, is almost impossible to permanently leave behind.

“All the people I’ve been through treatment with at the VOA, I can count on one hand the ones who have stayed clean,” Longatino says. “And it’s a really good program.”

The Mental Health Association of Portland is seeking a contributing editor for this web site.

This a volunteer position suitable for a university internship for a communications, journalism or mass media student. There is no honorarium or stipend. The position is open until filled.

Expect five to ten hours of work per week. Work includes reading Oregon online newspapers, reviewing psychiatric, institutional and political academic publishing, and reviewing aggregate databases for national and world news of interest. Work also includes amending prior posts, writing editorials, interviews and reviews.

A good prospect will submit a cover letter and resume in PDF with URLs of published writing. They will be consistent in their behavior, able to follow editorial guidelines and instruction, make a commitment of at least three months, and have experience with WordPress, Twitter and Facebook.

Submit your resume via email to info@mentalhealthportland.org.

To Portland City Council Members,

Comments in relation to consent item #492 from the Portland City Council agenda of May 9, 2012.

READ – Portland City Ordinance 492, from May 2012
READ – The Mental Health Association of Portland’s comments to City Council from May, 9 2012
WATCH – Council video from May 9, 2012

Portlanders share a problem – those of us who suffer from mental illness routinely contemplate and commit suicide. It is not a problem limited to our city, but its effects can be mitigated here.

The Mental Health Association of Portland offers thanks to David Hidalgo and the staff of the Multnomah County Crisis Center, to Lisa Turley and the staff of the Bureau of Emergency Communications, and to the Portland City Council and their staff – especially Commissioner Amanda Fritz, for thinking through a difficult problem and attempting the beginning of a solution.

Mental illness and suicide affect Portland’s entire community – friends, families, neighbors – people we care about.

To contemplate suicide is not unusual, nor does it indicate the need for police action. It is not, in itself, a threat to anyone. It is not illegal. It is a normal symptom of a set of common illnesses.

We routinely tell those in our community who are contemplating suicide, especially children and teenagers, to talk about those thoughts with someone they trust. The flaw in this approach is that the suicidal are reluctant to trust others. People with mental illness call 9-1-1 because they are desperate, but operators do not have the time to listen until the caller’s suicidal feeling passes. They are there to dispatch police, fire, and medical personnel as needed.

A calm and patient approach is, however, integral to the Multnomah County Crisis Hotline. It makes sense to simply transfer calls by the suicidal from the BOEC to the crisis hotline.

There must be discretion about transferring these calls. The confidentiality of the caller is vital to maintaining trust, and 9-1-1 and crisis workers must be able to determine who is at risk and who poses a risk to others.

The Mental Health Association of Portland would like to re-emphasize that suicide is not illegal. Attempting suicide is not illegal. Talking about suicide is not illegal. Mental illness and addiction are not illegal. When 9-1-1 operators relay calls to the police from persons who are having a mental health emergency, we have effectively criminalized mental illness.

With today’s vote, Portland’s City Council shows awareness of this inadvertent criminalization of mental illness and an intention to change it. We must ask, however, that you routinely review the capacity of the county crisis hotline to respond knowledgeably and resourcefully to Portland’s mental health emergency calls. The county’s provision of mental health services is, at best, spotty, and the inconsistent ability to recruit and retain competent mental health services staff is well documented.

Thank you again for your attention to this complicated problem.

Written and presented by James Mazzocco – Advisory Council member
Mental Health Association of Portland

From the Salem Statesman Journal, May 9, 2012

Salem Hospital takes steps to reduce excessive prescriptions as overdose deaths rise

READ – Reducing prescription painkillers in the Salem Health emergency

For Matt Harp, it all started with a baseball injury.

He was a sophomore in college when he separated his shoulder. After surgery, his doctor prescribed him oxycodone, a narcotic painkiller.

He took them as prescribed: three 40 milligram doses per day. Looking back, he said, he was hooked by the eighth day of using the medication.

Harp was able to refill his prescription twice. By his 90th day of using oxycodone, the formerly strong athlete was too weak to roll over in his bed and reach for the pills on his nightstand.

Harp told his story Tuesday at a Salem Hospital news conference, where emergency department doctors announced new policies they’re using to reduce excessive prescription of narcotic painkillers.

Although Harp’s story has a happy ending — he is completing his education to become a certified drug and alcohol counselor and is married with an 8-year-old son — many others throughout Oregon and the U.S. haven’t been as fortunate.

As the number of prescriptions for narcotic painkillers has risen in the past decade, so too, have deaths resulting from overdoses of those drugs.

Deaths involving prescription painkiller overdoses more than tripled from 1999, reaching almost 15,000 in 2008, according to Centers for Disease Control and Prevention.

In Oregon, 193 people died from prescription drug overdoses in 2011, according to the Oregon State Medical Examiner. That’s more than the deaths caused by heroin and cocaine overdose combined.

The quantity of prescription painkillers sold to pharmacies, hospitals and doctors’ offices was four times larger in 2010 than in 1999, according to CDC.

Local officials in law enforcement, the justice system and addiction treatment communities say addiction commonly begins the way Harp’s did.

“So many young kids are being prescribed OxyContin (an oxycodone brand name) for minor pains, and what that does to them is that gets them addicted to OxyContin and the withdrawals from OxyContin causes severe muscle aches and pain, and it makes them go back to the doctor,” a Marion County sheriff’s drug detective said.

By the time providers catch on that their patient is addicted, it’s often too late, the detective said. People then start looking for other ways to get their fix, including the streets.

“The (nonmedical) prescription drug use right now in Marion County is rampant,” he said.

The Statesman Journal has agreed not to name the detective because he works undercover.

Salem Hospital’s emergency department has implemented protocols to reverse the trend of overprescription of painkillers, officials said.

Starting in September, the department reduced its distribution of narcotic painkillers by 70 percent in an effort to clear the streets of excess pills that could be diverted or misused.

A big part of the strategy is the Oregon Prescription Drug Monitoring Program, which was signed into law in 2009 and began operating in June 2011.

Pharmacies populate the database when they dispense controlled substances. The database tracks schedule II, III and IV controlled substances, which have varying potential for abuse.

If doctors don’t find objective reasons behind complaints of pain or if a patient specifically asks for narcotic medications, they can look up the patients in the database to see who their providers are, what other prescriptions they have filled and when.

The database can raise the red flags that nonmedical users of the drugs try to hide, said Dr. Rumm Morag, an emergency medicine physician at Salem Hospital.

Oregon Health Authority spokeswoman Christine Stone said that although Oregon pharmacies are required to participate in the program, not all have an updated computer system that enables them to participate.

About 96 percent of the state’s pharmacies are uploading data into the system.

As of October, 37 states have operational prescription drug monitoring programs.

Another focus in Salem Hospital’s efforts is to refer patients back to their primary care or pain management doctors to help prevent doctor shopping.

It also is no longer prescribing long-acting opiates, such as OxyContin, for noncancer patients. Use of non-narcotic medications will be prioritized and Schedule III narcotics may be prescribed for up to three days.

On May 1, a woman who obtained oxycodone by committing identity theft at the Salem Hospital emergency department was sentenced to more than three years in prison.

Sarah Flom, 25, was arrested June 13, 2011, while she was admitted in the hospital under a false name. It was the second of two consecutive days she used the false name and was taken to the emergency room by ambulance, according to Salem police reports.

In November 2010, Flom went to the hospital on three occasions using her sister’s identity, the investigation found.

On Nov. 15, 2010, Flom was admitted to the hospital for five days under her sister’s name, and her family, including the sister, actively covered for her, according to police reports.

When Flom was arrested in June, she eventually told police that she was addicted to narcotic pain medications and heroin.

Police estimated a monetary loss of more than $37,000 in Salem Hospital and Marion County Fire Department services.

Morag said the hospital’s new safeguards might not prevent such cases.

“Addiction is a powerful thing,” he said.

The hospital’s goal is to reduce the amount of narcotics that are out in the community, he said, but people still will fall through the cracks.

A major concern for people in the law enforcement, justice system and addiction treatment communities is that prescription drug addiction often leads people to heroin.

Salem police Lt. Dave Okada said that almost all suspects that detectives interview in heroin-related charges have a history of prescription drug abuse. Often, when users start seeking narcotic painkillers on the street, they find that heroin, which also is an opiate, is cheaper and easier to obtain, he said.

In 2011, Salem police had 201 heroin-related arrests, more than double the number from 2007, Okada said. Statewide, 143 people died because of heroin in 2011, a 59 percent increase from the year before.

The Marion County sheriff’s detective told a similar tale as Salem police.

“It’s a gateway to heroin abuse,” he said.

From the Portland Tribune, May 3, 2012  Words and pictures by Christopher Onstott – Part 1 of 2

On my first attempt at buying heroin in Portland I was told to come back in an hour.

I’m a reasonably clean cut, 34-year-old white man with one wrist tattoo, no drug contacts; a photographer, not an addict.

Within five minutes at O’Bryant Square downtown, I had sidled up to a gaunt middle-aged man, and asked if he knew where I could find some “black” — a street name for black tar heroin.

“The natives might be back in an hour,” he said.

I’d come back in an hour.

Ten minutes later, I approached a youngman on the sidewalk across the street from Pioneer Courthouse Square who told me he had just been ripped off to the tune of $15. I asked him for black. He said I should follow him around the corner. But then his girlfriend came up behind me, asking to see my track marks, accusing me of being a cop.

I had the impression that if she hadn’t come by I would have had my black tar heroin, or at least a number.

That’s the goal. Little pieces of paper with suppliers’ phone numbers are treated like currency on the street. A dedicated addict will pay up to $100 to secure one, and always keeps two or three on hand.

Back to O’Bryant Square, where casually standing around with a group of street kids brought in offers of meth, crack cocaine and pot, but no heroin. Odd, since heroin use in Portland has skyrocketed in the last year.

There were 84 heroin overdose deaths in Multnomah County last year, up from 57 in 2009. A growing body of federal data show that in the span of a few years, Portland has become one of the nation’s top cities for heroin use.

Portland is awash in heroin, and it’s killing us. That’s what the numbers say.

Criminal justice officials and addiction treatment providers say that the numbers only tell half the story. Heroin, they say, has moved from a drug used mainly by the poor to one increasingly used by the middle class.

More specifically, it is being used by young men and women younger than 35 who are looking to move beyond the highs they’ve experienced from prescription painkillers, such as OxyContin.

All this is made possible, experts say, because heroin is incredibly cheap and easy to obtain here.

Still, I’d been out on the street for close to two hours and I hadn’t scored.

Weary of role-playing with street kids, I headed home, stopping first for a drink at the Plaid Pantry on Southeast Burnside Street. Sipping my Gatorade in the parking lot, I hardly noticed the young white man who walked up and asked, “How’s it going?”

“Not bad,” I answered with a shrug.

He countered with, “Wanna buy some bud, bro?”

“No thanks,” I answered. Then I asked, “Got any black?”

That’s how easy it was to buy heroin on a Wednesday afternoon in Portland. My new friend told me he lived downtown, but his dealer on 82nd Avenue “gets the best (stuff).”

I explained to him that I was on my way to a tattoo appointment, which was true, and couldn’t come with him now. I offered $20 for his dealer’s number. The number would lead to a call, a meeting place — often a MAX station — and the buy.

Cell phone numbers were exchanged, with the promise of an extra $5 for the contact number. After my tattoo appointment, an exchange of text messages, then a series of very fast phone calls setting up a meeting at a quick market on Southeast Foster Road, where I met my new friend and a scruffy companion, maybe in his late 30s, who I took to be his supplier.

My friend tried to hand me a small bag of black tar heroin. I say I need to use the cash machine inside. Somehow, I’ve got to tell this guy I’m not a heroin user.

He follows me, basically breathing down my neck, no personal space. The machine spits out $20 and I hand him the money. He starts to hand me the bag, but I deflect him.

He gives me a look somewhere between confused and surprised. But thankfully, he doesn’t give me a look that says I’m a cop who has tricked him.

He heads back outside to talk to his companion. I explain that I’m a journalist, not a user. Would he talk to me?

He looks at me and says, “Oh my God, that’s so f….ing cool.”

Ten minutes later, we’re in my car, as Jimmy (not his real name) explains how he went from being a University of Oregon athlete so afraid of needles that he had to turn away from movie screens whenever a scene showed a needle going into someone’s arm, to a daily heroin user who gets by dealing and occasionally panhandling.

I agree to drop Jimmy at his home in Northwest Portland. But first, a stop at a pub on Northwest 21st Avenue where he uses the bathroom to inject $10 worth of heroin into his arm.

Along the I-5 corridor

People who deal with the local drug scene –from law enforcement officers to drug counselors — continually use the phrase “perfect storm” to explain Portland’s skyrocketing rates of heroin use and overdose.

According to reports from the U.S. Department of Justice National Drug Intelligence Center and U.S. Drug Enforcement Administration officials interviewed by the Tribune, meth became harder to produce in Mexico, so the cartels and their gangs turned to producing heroin. Needing a distribution route into the western U.S., the Mexican gangs chose the Interstate 5 corridor.

Meanwhile, according to local addiction treatment providers, a different set of circumstances has been creating a growing demand for heroin in Portland. Oregon has always been an easy place to legally obtain prescriptions for painkillers such as OxyContin and Vicodin, many of which ended up on the black market.

In recent years, studies ranked Oregon somewhere in the top half dozen or so states for abuse of prescription drugs. One 2007 federal study by the U.S. Department of Health and Human Services reported that Oregon had more youth painkiller abusers than any other state.

In the past year, state and county health officials, hoping to reduce the number of people becoming addicted to prescription painkillers, changed their guidelines, making it harder for physicians to prescribe painkillers. In addition, drug companies in 2010 changed the composition of OxyContin, making it almost impossible for addicts to crush and inhale it for their preferred jolt.

With prescription painkillers harder to get through local doctors and a favorite painkiller almost worthless to hard-core addicts, the supply of black market prescription painkillers became scarcer, and the price headed up.

Pain sufferers who had been dependent on legal drugs to get through the day, as well as recreational users, needed a new supply. And there was heroin, cheaper than the prescription drugs, plentiful and potent.

As outlined in documents from the U.S. Department of Justice National Drug Intelligence Center, the Mexican cartels were producing an excess supply of heroin and could sell it cheap, so cheap that local distributors didn’t need to cut it in order to make a profit. Instead, they could afford to sell it more pure, and potent, potentially hooking more addicts. But some users, not knowing they might have to scale down how much they injected, died of overdoses.

Dr. Gary Oxman, Multnomah County’s public health officer, says he’s been expecting the current surge in heroin overdoses. In his view, heroin and prescription painkiller use in Portland are inextricably intertwined

“I think we probably have these two epidemics fueling each other,” Oxman says.

The new wave

Portland has been “a heroin city” for decades, according to Oxman, but until recently the cost of the drug has been high. The new set of circumstances — cheap Mexican heroin available at the same time county physicians have begun cutting patients off from prescription painkillers — has changed the fundamental dynamic of heroin in Portland, he believes.

“The heroin got cheaper,” Oxman says. “I assume that’s not an accidental move on the part of the cartels. I think basically they went from a low-volume, high-price distribution model, to a high-volume, low-price distribution model.”

Typically, $10 or $15 will buy enough heroin for an injection that will last all day, according to heroin users interviewed by the Tribune. Prescription pills that will get an addict through the day run about $1 a milligram on the street, so a serious user might have to spend $50 or more to stay high all day, the users say.

Oxman’s staff has been studying the overdose problem, even interviewing heroin addicts to get a better handle on what is happening on the street. In an annual survey of people using the county’s needle exchange service, 43 percent of heroin users said they became hooked on prescription drugs first. And most of those people were younger, rather than middle-aged or older addicts.

Multnomah County Deputy District Attorney Ryan Lufkin says many in the “new wave” of heroin addicts started out stealing painkillers from family medicine cabinets or trading for them in schoolyards, made possible because physicians and dentists for years have been prescribing more than individuals needed.

“There’s this huge class of people who probably wouldn’t have used heroin in their entire lives if they had not become addicted to prescription pills,” says Lufkin, who adds that virtually every heroin addict he’s interviewed — a number in the hundreds — started on pills.

The county overdose statistics back up what nationwide studies have indicated — heroin has exploded in Portland during the past two years, while its use has remained stable or risen slightly in most large cities outside Oregon.

But physicians across the country have been over-prescribing pain pills, Oxman and Lufkin acknowledge. And while West Coast heroin arrives almost exclusively from Mexico along the Interstate 5 corridor, Portland is not the only city on I-5. Yet there are more heroin deaths each year in Multnomah County than in Seattle’s much more populous King County.

One of the most eye-opening studies in recent years comes out of the federal Office of National Drug Control Policy, which tallied drug use data for inmates entering county jails in 10 cities across the country, including Portland. More than one in five people entering the Multnomah County jail in 2010 tested positive for opiates — far and away greater than any of the other nine cities, which included New York, Chicago and Atlanta.

In Portland, 18 percent of county jail inmates reported having used heroin within the prior 30 days. Chicago was second, with 12 percent reported use.

But what is most alarming about the Arrestee Drug Abuse Monitoring Program data is how different cities appear to be trending. In all the other cities surveyed, heroin use remained fairly consistent in recent years or grew slightly. In Portland, it has jumped.

As recently as 2009, Chicago’s reported per capita heroin user rate almost doubled that of Portland. Four years ago, Portland trailed both Chicago and Washington, D.C. Now, at least as far as testing of people entering the jail, Portland is No. 1 and trending higher.

Low risk, high reward

The National Drug Intelligence Center 2011 Drug Threat Assessment Report says that heroin production in Mexico has risen from nine metric tons a year to more than 50 metric tons. Eric Martin, policy and legislative liaison for the Addiction Counselor Certification Board of Oregon, is convinced that Oregon is getting more than its share.

Martin points to a 2007 map produced by the Intelligence Center which shows Portland/Salem as having the Pacific Northwest’s largest Mexican cartel presence.

“Portland/Salem is basically the distribution hub for the entire Northwest region,” Martin says.

Deputy DA Lufkin says he’s not aware of Portland serving as a hub for the cartels, but logic dictates we might be.

“Everything in this world is connected,” he says.

As Lufkin sees it, “Certain things are never going to change about Portland that makes it an attractive city for heroin addicts.”

That starts with Oregon’s drugs laws, which Lufkin says would make Oregon a logical place to set up a drug distribution network.

Most users or dealers caught selling less than five grams of heroin, according to Lufkin, receive a sentence of probation until their fifth conviction, which can net up to 12 months in jail, but rarely does.

That means prosecutors have little leverage to force most small-time dealers to provide names of people further up the distribution system.

“The cartels have found the place that affords them the least risk in drug seizures and the highest reward in distributing to local users,” Lufkin say.

In addition, Lufkin says, Oregon law provides prosecutors little leeway in going after black market dealers of prescription painkillers.

“Even if you were trafficking in thousands of pills of OxyContin, it would still be a probationary sentence,” he says.

Heroin addicts regularly tell Lufkin that they moved to Portland because of the availability of cheap heroin.

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Prosecutor: Treat, don’t jail heroin users

As far as Multnomah County Deputy District Attorney Ryan Lufkin is concerned, an addict who has been arrested multiple times for heroin possession is sick.

During February’s legislative session, Lufkin unsuccessfully supported a bill that would have allowed prosecutors to treat repeat heroin offenders as they would people who attempt suicide, and civilly commit them to treatment, even against their will.

Lufkin says he’s going to return for a second attempt next year.

The 2012 session’s House Bill 4022 would have classified people arrested at least three times for heroin possession as mentally ill, and set it up so they could be committed for up to seven days of addiction treatment.

The county prosecutes about 1,100 heroin users a year, according to Lufkin, and about half have prior convictions for possessing the drug. Between court and jail, prosecuting a heroin addict runs between $3,200 and $28,000, Lufkin says. And the jail time, when they get it, rarely does addicts much good.

“We can spend all the money that’s necessary to bring someone to a jury trial on a heroin charge with no results, or we can adopt a system that actually is the right tool to hit this problem,” Lufkin says. “This person has a disease. They’re an addict. It’s a recognized mental health disease, and we can get them access to treatment and the thing saves money.”

But that would be targeting the wrong people, says Alex Bassos, training director at Metropolitan Public Defender.

The problem, Bassos says, isn’t the users getting arrested for possessing heroin. The problem is those who are overdosing. And those two categories, he says, aren’t nearly as overlapping as people might think.

Bassos says the DA needs to make it a policy to use current civil commitment laws for heroin offenders who have repeatedly overdosed. Those laws, he says, which allow prosecutors to civilly commit people who attempt suicide, should work.

“That is exactly what civil commitment is for,” Bassos says. “They have a (medically defined) mental disorder, and that’s compelling them to do something which is dangerous to themselves and others.”

Bassos, who says the D.A.’s plan “should terrify civil libertarians,” thinks it also isn’t practical because there are already long waiting lists for the best treatment for addicts — inpatient beds in treatment facilities.

Lufkin says heroin offenders already require addiction treatment as part of their probation, and that with civil commitment it would happen more immediately and with a huge cost savings.

“The savings in time will help addicts stay alive and get faster access to treatment,” Lufkin says. “The savings in money can go back into treatment resources to pay for essential treatment services, such as cutting down the waiting time for inpatient beds.”

From The Oregonian, April 30, 2012

The heavily redacted mental evaluation report on Daniel Butts, the accused killer of Rainier Police Chief Ralph Painter, contains very little information not revealed in court during his aid and assist hearing earlier this year.

READ – the not-redacted Aid & Assist judgement from Columbia County Judge Ted Grove, February 2, 2012

But the report—released today by Columbia County Judge Ted Grove after The Oregonian filed motions a year ago that the reports be made public—does shed new light on the 22-year-old man’s behavior in the Columbia County Jail. [This document was not made available to the public beyond The Oregonian - and not posted by The Oregonian.]

Butts was arrested on Jan. 5, 2011 after police say he wrested Painter’s gun away and then shot the chief in the head at a Rainier stereo shop.

A Columbia County grand jury indicted Butts on nine counts of aggravated murder, which could carry the death penalty, and other charges including attempted aggravated murder, robbery, burglary, theft and unauthorized use of a vehicle.

Last December and again in January, Judge Grove heard expert testimony from mental health professionals, as well as police officers, on Butts’ behavior before and after the shooting.

The hearings weren’t held to determine Butts’ mental state at the time of the shooting, but whether he is able to assist his defense attorneys during a trial. In the past year, Butts was evaluated several times both at the Columbia County Jail and at the state hospital in Salem, where he stayed for 20 days last July.

Grove ruled that Butts could assist his attorneys in his defense, saying he believed Butts was “gaming the system.”

But earlier this month Grove ruled that Butts be returned to the Oregon State Hospital in Salem for additional mental health evaluation. Grove made the decision during a hearing on a writ of habeas corpus filed by Butts’ attorneys, said Columbia County District Attorney Steve Atchison.

The writ stemmed from the treatment of a self-inflicted wound Butts suffered when he stabbed himself in the forehead with a pencil in January. The wound became infected, but Butts refused treatment, officials said.

While by all accounts Butts was a difficult inmate, almost a year to the day after he was arrested for Painter’s murder, jailers observed Butts standing near the toilet in his cell “striking himself in the head, neck and face.”

The officers ordered him to stop, but when they approached Butts he ran and slid under his bunk. When he refused to come out, officers shocked him with a Taser. During the scuffle, officers fell on the “slicked up floor” as Butt kicked at them. He was stunned again, handcuffed and stunned a third time.

Despite their efforts, Butts continued to resist. He was then placed in a restraint chair, and again “he remained uncompliant,’’ according to a letter from Dr. Jerry Larsen contained in the report to Butts attorneys, Patrick Sweeney and Dianna Gentry. Officers placed a “spit hood” over Butts head to keep him from spitting at the officers.

Corrections deputies noted three pencils stained with blood. The following day, paramedics examined the wounds and told officers they were superficial.

According to another jailer, during an interaction with Butts he stuck his penis in the pass through of the cell door, and “almost threw it towards me.”

Several days after he was shocked with a stun gun, Butts (who by then had been moved to special holding cell) asked to be returned to his regular cell.

An officer asked him if wanted to hurt himself and he told them no. When the officer told Butts he was concerned that he might have to use his Taser on Butts, Butts said “That will not be necessary. I’ll be good.”

Oregon State Bar members share their stories of dependency and addiction — and recovery
By Melody Finnemore – for the Oregon State Bar Bulletin

“Elaine” was born into a family of alcoholics and watched her father, also an attorney, battle the disease for many years while growing up in the Midwest. “My father had a lot of great intentions that never seemed to happen until he got sober when I was 14,” says the Portland attorney.

“I was desperately afraid I would have problems with alcohol, so it wasn’t until I was 18, the legal age in my state, and a freshman in college that I started drinking,” she adds. “I took to it like a duck to water. I was a daily drinker almost immediately.”

A self-described perfectionist, she maintained strong grades throughout college though she drank on a regular basis. Her drinking grew steadily worse as she completed her first year of law school, while working at a law firm during the day and taking law courses at night.

“For the first time in my life, I wasn’t the smartest one in the room, and that scared me,” she says. “I was a functional alcoholic. I kept up and got good marks, but inside I was falling apart. I felt like alcohol was the glue that held my life together at that point, and I was afraid I couldn’t stop drinking or, if I did, that my life would fall apart.”

She turned to her father who, by that time, had been sober for nine years. He advised her to join Alcoholics Anonymous. She initially entered a 30-day, outpatient treatment program and joined a state lawyer recovery group modeled after the Oregon Attorney Assistance Program (OAAP) of lawyers concerned for lawyers. She attended a meeting each week and stayed sober for a couple of years. She began drinking again after her life got better and she convinced herself it hadn’t really been that bad.

Elaine graduated from law school in 1982 and married her first husband the following year. She moved to join her husband in New Orleans, which she called a “drinker’s paradise.” There her drinking worsened.

“I held it together for about six months, but the loneliness of leaving my family to move to a new city where there was a completely different culture was too much,” she says.

A move to Portland proved no easier. She was in another new city with no friends. Her drinking was causing problems in her marriage. And she was hit with another emotional blow when her mother was diagnosed with cancer and died in early 1985.

“She was concerned about me, but I kept the truth from her because I didn’t want her to worry,” she says. “The six weeks after she died were the most difficult time of my life. She was my closest friend.”

The decision to sober up for good came during an evening soon after that. She remembers drinking wine out of a box at the kitchen table and arguing with her former husband. When she went into the bathroom to clean their cat’s litter box, she found her father’s A.A. sobriety medallion, which he always carried in his pocket, behind the litter box. She can only surmise that the medallion accidentally fell off the bathroom counter during her father’s visit shortly after her mother’s death.

After reading the serenity prayer on the back of the coin, she says, “I just looked up and said to Mom in heaven, ‘I give up. I’ll get sober again.’” She sought help through OAAP 21 years ago and has remained sober ever since.

“Since then, I’ve put my life back together. I divorced in 1988 and remarried in 1994. I have a thriving law practice and the respect of my colleagues. My life is full, and I can weather the ups and downs of life with grace,” she says.

In her professional life, clients often seek her help for legal difficulties that may go hand in hand with drug and alcohol problems of their own. When appropriate, she shares her battle against alcoholism with clients. “I will share with a client that I know what it’s like to hit rock bottom and that life can get better when you face your problems,” she says.

In addition, she serves as an A.A. sponsor for others struggling with alcohol addiction. “It makes it all worth it. A.A. allows you to take your worst experiences and share them with others to show you’ve been there and to offer hope,” she says.

She says the key to maintaining her sobriety is to deal in a constructive way with the emotions that led to drinking, such as a compulsive need for achievement and perfection, into healthier channels such as running, golf, work and volunteer work, as long as she doesn’t overdo those, too.

She believes that she is genetically different than non-alcoholic drinkers and therefore can never safely use alcohol again regardless of how long she is sober or how well she functions.

“I continue to go to A.A. meetings because I’ve seen too many times what can happen to people who don’t go. I don’t ever want to drink again. Besides, I like meetings — it’s a place to stay honest with myself about my alcoholism and have a chance to help others. I’ll do whatever it takes so I never drink again.”

COMMITTING TO SOBRIETY

Susan Gerber also began drinking in high school, although alcohol was not part of her conservative, Jewish upbringing.

“My brother and I say everyday that we have the best two parents on the planet – it was like the Brady Bunch. There was never a drop of alcohol in the house,” she says. “I always felt different, though, so I had my first Miller Genuine Draft and felt funny and more comfortable. I started drinking to get drunk every time.”

Gerber continued to drink through college, law school and private practice as a trial lawyer. The problem grew worse when she accepted a job as an assistant district attorney in Chicago.

“It’s so stressful and disgusting, because you see so many victims who have had horrible things done to them,” she says. “It was the biggest relief to drive home and have a beer to take the edge off.”

Gerber says her decision to quit drinking wasn’t instigated by any external crisis. Like so many alcoholics, however, she suffered a shattering crash at rock bottom.

“Nothing horrible went wrong. I didn’t have any DUIs or anything like that. It just eventually got to the point where I felt what they call utter and complete demoralization,” she says. “You look in the mirror and hate yourself, and you just want to die. I’d gotten to that point where I thought I’d rather kill myself than live the way I was one more day. I didn’t like who I was or how I was treating my family or my co-workers.”

Gerber joined A.A., where the newfound clarity that came with being sober gave her some perspective on her life. She realized she wasn’t happy with her work as a private practice attorney. After three years of sobriety, she decided to quit her job, sell her house and volunteer for the American Bar Association’s Central and Eastern European Law Initiative (CEELI). The program promotes a worldwide exchange of ideas and programs that include training for foreign lawyers and other professionals.

As part of the program, Gerber moved to Albania for a year to teach law students there how to serve as lawyers and judges, preserve civil rights and recognize the downfalls of corruption.

“It was a really depressing experience, but an amazing experience,” she says, adding she lived without a phone and only occasional access to the Internet. “It was very spiritual not having contact with a lot of other people.”

Upon returning to the United States, Gerber obtained her license to practice in Oregon in 1999 and began working for the state’s Department of Justice in 2001. Now an assistant attorney general for DOJ’s trial division and sober for eight years, Gerber attends three or four A.A. meetings each week and sponsors two other members. Her commitment to the recovery program is essential to her sobriety, she says.

“The longer you remain sober, life becomes more routine, and when it’s routine it’s easy to become complacent. Your memory goes and you begin to think, ‘Okay, maybe I can drink like other people,’” Gerber says. “Helping other people helps me out of myself. It’s literally the one thing that keeps me sober.”

WHAT MONEY CAN’T BUY: SELF-ESTEEM

Like many boomers, “Mark” grew up in an atmosphere where drugs and alcohol were readily available. Drinking was perceived as a positive pastime in his family even though several generations of his male relatives had battled alcoholism.

“My father took care of our family, and I think he was a pretty typical businessman for the 1950s. He drank socially, and when I was nine or ten he would give me an occasional beer,” he says. “I started drinking more in high school as well as smoking pot and doing other drugs that were prevalent during the late ’60s and early ’70s.”

While attending law school at Willamette University, Mark drank and smoked pot daily. He quit smoking pot gradually, finding it interfered with his legal practice. He continued to drink, however, and was involved in an alcohol-related accident in the early ’80s.

“I was fortunate that one of the paramedics convinced me to take a ride in the ambulance to have my broken arm looked at because it stalled off the police,” he says. “I would have had a DUII because I’d had five martinis.”

Despite the near miss with the police and potentially more tragic consequences, he continued to drink through the termination of his legal partnership and the birth of two children in the late ’80s and early ’90s.

“Through all of that the drinking just steadily progressed, and there are parts of that time that I’m not at all proud of because I did some pretty shameful things,” he says. “Why it took so long to reach out and get help, I don’t know. It’s the nature of the disease, I guess. My wife asked me time and time again, ‘Don’t you think you should get some help?’”

He found excuses not to get help or face the problem head on. Instead, he focused on managing his practice, and says working as a sole practitioner actually enabled his drinking because he didn’t have to answer to other partners. In addition, chronic anxiety added to the problem.

“I’m a nail biter to this day, and alcohol always took the anxiety off. When the drinking gets out of hand, alcohol not only eliminates the anxiety but, over time, exacerbates it,” he says. “Over time it goes from drinking to feel good to drinking so you don’t feel so bad.”

He sought help through OAAP in 1992, intending to get his drinking under control but not necessarily stop.

“With time I realized I needed to stop altogether, because my mental and physical health were deteriorating quickly,” he says. “Drinking took more than my health, and recovery has given me more than just not drinking. My drinking took something that no amount of money could buy — my self-esteem. Recovery has restored this and more.”

He now serves as a sponsor for others in recovery and works with impaired attorneys through other bar programs. He continues to attend several support meetings each week. “I did most of my daily drinking at lunch, so I find lunch meetings work well for me,” he says.

Though it took time to rebuild his economic stability, he found that many other aspects of his life improved dramatically soon after he made the commitment to stay sober.

“There’s been a lot of family growth and changes in that time. There have been some really wonderful gifts that have come out of being sober,” he says. “Besides having my health restored, I have grown emotionally. I have found joy in living and a sense of who I am. My life has purpose, and I find satisfaction in what I do. I am convinced that today I am a better father, a better lawyer and a better member of my community.”

He advises others who feel they have dependency problems to reach out for help so they, too, can regain what they may have lost along the way.

“I do not doubt for one minute that anyone who has lost control of their drinking can have everything I have received and more, if they are willing to ask for help,” he says. “If you think you have a drinking problem and need help, please pick up the phone. It is a call that will save your life.”

SHATTERING THE DENIAL

Ted Grove has faced addiction nearly every day for the last 11 years in his role as a Columbia County Circuit Court judge. Raised in the Midwest, Grove started drinking as a teen. He began drinking heavily with his older teammates when he joined the Des Moines Rugby Club while still in high school.

“I was a daily drinker and sometimes a binge drinker. By the time I was 21 I would say there weren’t many days I didn’t drink, and once or twice a week I drank a lot,” he says.

Grove attended law school at Lewis & Clark College, where his drinking continued. He graduated in 1978, but worked in the woods as a tree planter and logger for a couple of years after graduating while some legal issues were resolved.

“I would get drunk and get belligerent. I would upset people and law enforcement would cuff me and take me away,” he says.

He had marital and physical problems by the time he was 30. Still, he refused to admit that alcohol was controlling his life.

“Basically, you function in life for the continued right to drink. You tell yourself that as long as you’re able to make it work, you don’t really have a problem,” he says. “After one substantial drunk, my wife warned that she wouldn’t be around much longer. It was pretty clear that alcohol was kicking my butt.”

Grove contacted Don Muccigrosso at the Oregon Attorney Assistance Program in 1982, but admits the initial effort was half-hearted. “I called Muccigrosso to show my wife I was serious about quitting drinking. I immediately regretted it and, as the day progressed, I was planning my first after-work drink,” he says. “Just before 5 p.m., Don called and asked me to meet him.”

Grove started attending OAAP and other recovery meetings outside of the small Columbia County town where he lived and practiced law.

“Like most alcoholics, we have this myth or perception that other people don’t realize how much we drink or how big of a problem it is,” he says. “It wasn’t long before I recognized that I needed to get involved in meetings in my community.”

Grove says he quickly gave up on the notion of anonymity in a small, rural community. As a circuit judge, he has openly shared his story from the bench.

“Over the years you touch an amazing number of families, whether for good or not,” he says, noting 85 percent of the people in his court system battle chemical dependency problems. “I am still active in the recovery community, attending open meetings and have held hands during the closing prayer with people I’ve sent to prison, mothers who have had their parental rights terminated and parents whose children I’ve sent to prison. I’m always surprised that I feel no anger from them.”

At 53 years old, Grove has been sober for 23 years and now serves as a mentor for others in recovery. The experience benefits him as much as those he sponsors, he says.

“It causes you to reconnect with the program at a more basic level because you try to assist someone who is new to the recovery process. It reminds you of the problems, experiences and insecurities you felt during the early stages of recovery,” he says.

His job also brings the issue front and center on a near daily basis. “I have these people who come before me who are suffering from the same disease of addiction, so it’s a bit of a 12-step call on a daily basis for me.”

His message to other recovering alcoholics is simple: Everything you lose when you’re drinking is restored to you in your sobriety.

“It’s an amazing transition when you think of it. One day you’re drinking yourself to death and the next you’re not taking a drink at all and are taking the first steps as a recovering alcoholic,” he says. “It’s all about letting people know there is life after recovery and it’s a damned good life.”

THE DANGER OF CROSS-ADDICTION

Heroin was the drug of choice for “James,” an Oregon attorney who has practiced law for nearly 20 years at some of the most well-known law firms along the West Coast.

James’ drug abuse began in the early 1970s when he was a seventh grader and started smoking pot. “It was so prevalent and easy to obtain, and it was accepted. In the crowd I ran around in, it was pretty much the social norm,” he says. “I’ve probably used about every drug that’s been available at some point in my life until I got into recovery.”

While he experimented with LSD, cocaine and other drugs, James didn’t begin drinking until college. Then, he would binge on beer during the weekends. He continued to drink, smoke pot and use other drugs throughout law school and during the start of his legal career. A job with a high-profile firm on the West Coast exacerbated his drinking problem.

“It was common to go out after work and share war stories and drink,” he says. “It came from the top, and I think partners need to realize they have a tremendous influence over the younger associates who want to succeed in the firm.”

James says his addictive personality eventually led him to try heroin, which at first was inexpensive, pure and easy to obtain.

“It was a very solitary practice for me. I never used that drug with anybody else,” he says. “The reason it was a good fit for me, if you could call it that, was because it was an instant stress reliever. And unless you knew what to look for, you wouldn’t know I was high because it was odorless and it didn’t make me doze off or look stoned.

“However, the whole process of getting, using and functioning made me one of the busiest, hurried persons I knew,” James adds.

Initially he smoked it during the evenings to relax after a long day at work. It wasn’t long before he did heroin in the mornings before work and during his lunch breaks.

“It escalated quite rapidly. Inevitably – and it is inevitable that this will happen with this drug – I used more and more and took greater risks to obtain it,” he says.

James eventually was arrested for possession of heroin and placed in a diversion program. He relapsed and, thanks to the skills of his defense lawyer, was allowed back into the diversion program.

“I had no life, and I was chained to buying and using that drug. I had to feed my habit,” he says. “It eventually resulted in the loss of my marriage and, while I never received a complaint from a client, I actually took myself out of practice for a couple of years.”

James stopped smoking heroin six years ago when his connections dried up and he could no longer obtain it. He replaced heroin with alcohol and found the impact on his life was just as negative.

“That’s the danger of cross-addiction. For an addict, and I consider alcoholics to be addicts, any drug can start the cycle again,” he says. “I gave myself permission to use alcohol and cigarettes, and the result was just as disastrous.”

James sought help after realizing that he eventually was going to do great harm to somebody else or himself. He entered a recovery program and has been clean and sober for several years. James moved to Portland, remarried and now has a young child. His legal career is thriving, yet there are no more 15-hour work days, and he is able to enjoy time with his family. James continues to be active in the recovery community and has sponsored other recovering addicts.

“I attend several meetings every week and I probably will for the rest of my life, and it’s not a burden. In fact, any time I start to think it’s a burden I know it’s time to get to a meeting,” he says.

RECLAIMING HER DIGNITY

“Joan” has battled a series of addictions ranging from gambling to smoking crack. She began experimenting with alcohol and pot in high school. Her use in college escalated to drinking binges that lasted entire weekends.

Several years later she began her insidious battle with cocaine. “I’d been out drinking when someone passed me a crack pipe, and without hesitation, I took a hit. I was hooked instantly. I found what I had been searching for my entire life – complete escape — in seconds.” She would chase that first euphoric feeling for many years.

Joan was living a double life — law student by day, junkie by night. She ventured into the worst areas of town to feed her addiction, noting, finding that she actually starting feeling comfortable in crack houses.

“Although I wasn’t a daily user, it affected me on a daily basis. Trying to keep up the façade to hide my addiction was exhausting. I entered into a self-induced schizophrenic state when I used; nothing mattered more to me than getting that next hit,” she says.

It didn’t take long for Joan’s increased drug use to cause problems. Her class attendance dropped. She was so stressed about a final exam that she had to get stoned to take the test.

She also fell behind in her rent and faced phone and electricity disconnections.

After graduation Joan prepared to take the Oregon bar exam. Although she didn’t jump right back into using cocaine, she reports that drinking and smoking pot took priority over attending bar review classes. She failed the exam and was soon smoking crack again. Within weeks her addiction was in full force

“The first time it occurred to me that I might have a problem was when I saw a T.V. program with a toothless heroin addict who was sharing how her addiction led to homelessness and prostitution. I thought, ‘Oh my God, that could be me,’” Joan says. (But, that epiphany evaporated as soon as the next craving hit.)

She finally asked for help after being threatened at knife-point by a dealer. “My sister pleaded with me to tell her what was wrong. Fortunately, she caught me in a moment of sheer panic and desperation, and I confessed,” Joan recalls. “I called a recovering alcoholic attorney I knew, and he took me to my first 12-step meeting at the OAAP.”

Over the next five and a half years Joan dutifully attended meetings, but she couldn’t accumulate more than several months of continuous sobriety. “I’d go 30 or 60 days, start feeling better, and the next thing I knew I had a beer in my hand — and from there it was a short road to the crack house,” she says. “I understood that smoking crack was a problem, but just couldn’t grasp the idea that I couldn’t drink alcohol. I couldn’t use any mind-altering substance without suffering severe consequences.”

Next, Joan attended inpatient treatment, but that still wasn’t enough. She used several more times before she would hit bottom. The end of her use came when she was living with some friends and smoking crack in their basement. She was car-less and unemployed. “It was 3 a.m., I was out of dope and down to my last $50. Panicked, I thought that if I could just take one more good hit, I’d be able to figure everything out,” she says. “All I could do was pace back and forth and watch the clock. At 5 a.m., I headed out to catch the first bus of the day to purchase more drugs.”

Joan says that as she headed back to the basement with her new stash, she was extremely paranoid. “I was sure I was being watched and followed. But then I thought, what’s the worst that could happen? I’d get arrested and go to jail. That calmed me down. Crack cocaine had become more important to me than my freedom. I had hit bottom.”

She checked herself into an intensive, outpatient treatment program and has slowly pieced her life back together. She attends recovery meetings almost daily and works with other alcoholics and addicts in recovery. She worked various low paying jobs for a couple of years before joining a law firm as a paralegal for the past year.

Although Joan passed the Oregon bar exam several years ago, she withdrew her previous application to work on strengthening her recovery. She re-took the exam in the summer of 2006. “I just didn’t want to rush into re-applying for admission; my sobriety had finally become more important to me than having to re-take the bar exam,” she says. In October, Joan will have been clean and sober for three years.

“Sobriety allows me to reclaim my dignity on a daily basis. The constant feeling of impending doom has been replaced by hope. I finally really believe I will get to practice law someday,” Joan says exuberantly.

She feels that she owes an enormous debt of gratitude to the OAAP staff as well as the other OAAP support group members, noting: “Without their love and support I would not have made it.”

ABOUT THE AUTHOR
Melody Finnemore is a Portland-based freelance writer. She is a frequent contributor to the Oregon State Bar Bulletin.

From the South County (Scappoose) Spotlight, April 25, 2012

State struggles with rising number of heroin overdoses, availability of illicit narcotics

It was meant to strike a hefty blow to the region’s heroin supply.

A two-month Columbia County Narcotics Team investigation led to a large-scale bust Feb. 24 at the Gresham house of suspected drug dealers Maribel Sebastian-Evangelista, 31, and Amadeo Lupercio-Quezada, 32.

Along with an assortment of narcotics and paraphernalia in the couple’s home, police reported finding candles burning at a shrine to Mexican folk hero Jesus Malverde, the unofficial patron saint of drug traffickers.

And while police say the arrest cut off a large amount of drugs flowing through the region, the effect may be temporary.

Officers are well aware of a sobering reality – where there is demand, there is always supply. Heroin will find a way.

“There is always somebody higher up the chain,” said St. Helens Police Detective Sgt. Phillip Edwards.

Though it seemed 10 years ago that the Northwest’s thirst for heroin had been washed away by a tide of cheap, home-brewed methamphetamine, these days police say it’s becoming more common to find black tar heroin on the streets.

Just like in Columbia County, officers in Washington County have been dealing with the low-cost, readily available narcotic.

“Heroin’s pretty cheap right now, and they can get a three-day high for $20,” said Forest Grove Police Officer Jennifer Smith. “I would say, other than marijuana, it’s the second-most popular drug that I’m seizing off people. When it comes to hard drugs, heroin is definitely number one.”

Rise in overdoses

It’s not just police who are seeing an uptick in the use of the illicit opiate.

According to the Oregon State Medical Examiner, the drug was involved in 143 of the 240 deaths in Oregon last year that involved heroin, cocaine and meth. Methamphetamine was involved in 107 deaths, while cocaine was involved in 33 deaths.

There were two reported drug-related deaths in Columbia County in 2011, one from heroin and one from meth.

Overdoses from heroin have been on the rise in Oregon for years. Between 2010 and 2011, the medical examiner’s office reports a 59 percent jump in heroin fatalities.

While police say heroin use appears to be up in Columbia County, based on drug-related arrests, meth remains king. In 2011, the Columbia County Sheriff’s Office arrested 41 people for methamphetamine possession and seven for heroin. Two people were arrested for possessing cocaine.

Why now?

What’s spurring some drug users’ switch to heroin isn’t entirely clear.

Users can be introduced to the drug through a friend network or by a boost in availability.

Sgt. Edwards said most of this region’s drug supply flows from Portland.

“That’s usually the stopping point for all the drugs,” he said.

Portland’s drug activity impacts other communities as well.

“In the past, whenever Portland has seen a spike, we’ve seen a spike in overdoses,” said Lt. Michael Rouches, spokesman for the Hillsboro Police. He said two of three overdoses reported to Hillsboro police in the past 15 months happened in the last two days of March.

Police also speak of the influence a single dealer can have in small areas like rural Columbia County. Once someone’s selling the drug, users get hooked and start searching it out.

On top of that, users can quickly gobble up a flood of cheap drugs.

Some say a rise in the use of pharmaceuticals like OxyContin and Methadone – both opiates – might be introducing people to a high similar to that of heroin.

The Oregon Medical Examiner’s office is also seeing more deaths related to pharmaceutical opiates. In 2011, 100 people died from Methadone overdoses, 56 died from OxyContin overdoses and 37 died from overdoses of hydrocodone, a drug commonly known by the brand name Vicodin.

All three drugs are used to medicate persistent and temporary pain stemming from injuries. But they also wind up on the street, being peddled by dealers for about $30 a dose. At street prices, a fix of heroin costs around $10.

Pharmaceutical opiates are prepared in doses, but black tar heroin – the most common on the street – is not.

Batches of heroin can range in potency and intravenous users who are used to a certain amount of one batch of the drug can accidentally overdose when they hit a more potent supply.

“When there happens to be a strong batch out there,” Rouches said. “that’s when we see problems.”

April 29, 2012, from AP.com

Telecare caused quite a stir in 2010 when it opened two residential homes in northeast Bend. Neighbors feared their property values would drop and worried that some residents of the mental health facilities might be dangerous. They later complained about residents’ tendency to smoke on neighborhood sidewalks.

The debate put a magnifying glass on the treatment of mental illness, which is delivered much differently in Central Oregon today than it was even a decade ago.

Before the 2005 opening of the Sage View Psychiatric Center near St. Charles Bend, anyone who experienced a psychiatric problem requiring help faced a long trek. Adequate care was available in the Willamette Valley and Pendleton, but not here.

Sage View administrator Molly Wells remembers very well what services looked like back then. “Before, we had two hold rooms on the fourth floor (of St. Charles Bend) and we had to send all of the clients to Pendleton or (Salem) or Portland.”

Mental health care has changed dramatically thanks largely to a 1999 U.S. Supreme Court decision, which coincided with local officials’ desire to create more options for the mentally ill and with the state’s push for deinstitutionalization.

As a result, Central Oregon today provides a greater spectrum of care for people struggling to cope with schizophrenia and other mental illnesses.

The 1999 Supreme Court case, commonly called the Olmstead decision, determined that it is discriminatory to keep the mentally ill in institutions if they can reasonably be placed in community settings instead.

According to a February 2011 memo from the Oregon Department of Human Services/Oregon Health Authority, “To achieve the intent of the Olmstead decision Oregon intends to move healthy people to independent housing that promotes recovery, resiliency, independence and wellness in a system that is consumer driven and assists people in obtaining ‘a key to their own door.’ ”

That means cutting the length of time people stay in the Oregon State Hospital in Salem and expanding “independent living environments” around the state.

A study completed in 2010 by Accumental Health, a nonprofit contracted by the state, found that about 60 percent of people in some form of mental health facility could be placed in less restrictive facilities or could conceivably live independently.

However, a 2010 state memo discussing the Oregon Health Authority’s plan to honor the Olmstead decision noted that Oregon’s system was “under stress because the state had relied on creating a facility-based approach to service delivery” reliant upon large hospitals. As a result, “the mental health system at present is meeting less than 50 percent of the need for public services for adults and children.”

The problem was evident in Central Oregon. Because the area lacked the necessary homes and community-based facilities, the mentally ill either remained in the state hospital much longer than necessary or were released to other areas of the state.

“We didn’t have nearly enough resources,” said Deschutes County Mental Health Director Scott Johnson. “I’d hear from a mom, ‘I’ve got a daughter (receiving care) in Medford and I want to bring her home,’ and we realized we needed to do more to keep people in our community.”

Bob Joondeph, president of the advocacy group Disability Rights Oregon, says it’s better to place the mentally ill in smaller facilities for several reasons.

“In a big state hospital there’s huge bureaucracy,” he said. “If you just look at our state hospital, there are all kinds of problems. . It is clinical, and supervision becomes more difficult with more and more wards and doctors. The tradition at the state hospital in Salem is that wards are these independent little fiefdoms, so there are difficulties (for patients) in transferring to different levels because of the politics within these institutions.”

Smaller facilities, he said, avoid many of those problems.

“They tend to be more relaxed environments,” he said. “The staff (relationship) to the patients is steadier and more direct, more long-term, and that’s good for folks.”

Joondeph said Oregon’s treatment model has long involved the transition of the mentally ill to smaller facilities as they recover. The model hasn’t worked perfectly, he said, but he believes the state is trying to revive it.

“For many years the system that was originally designed to be a step down became sclerotic,” Joondeph said. “It became clogged. And our mental health system is designed for people to move, and so once any part of the steps in movement become clogged, it backs up, and you end up with folks staying (too long).”

The state hospital, meanwhile, has had its share of problems. The hospital is famous for its role in the 1963 Ken Kesey novel and 1975 film “One Flew Over the Cuckoo’s Nest.” In 2008, the U.S. Department of Justice’s Civil Rights Division issued a critical report on problems at the hospital that violated patients’ rights. Among them, the report found the hospital wasn’t protecting its patients from harm, wasn’t providing proper assessments and mental health care, overused seclusion and restraints, and didn’t properly manage medication. The federal investigation into the hospital continues.

In 2010, Oregon began to implement the Adult Mental Health Initiative, which seeks to better use facilities already in place and to improve the coordination of care. The initiative aims to address a problem identified in a 2010 Oregon Health Authority memo: “Currently, too many Oregonians living with mental illness spend too much time in the wrong level of care and cannot access services that could help them become more independent.”

To combat the problem, the state decided to transfer responsibility for managing the residential services to local mental health organizations. The state’s large residential facilities “are less flexible and more costly than a community-based supportive housing system,” the memo states.

The Adult Mental Health Initiative provides funds directly to counties and other mental health organizations, allowing local government officials to determine — and pay for — the services their communities need. Deschutes County’s mental health department has used these funds for about a year to run its Assertive Community Treatment, or ACT, team. Each team member makes regular visits to a small number of people living independently or in supported housing, said Travis Sammon, the team’s supervisor. By making health checks, bringing medicine and ensuring the provision of needed services, team members help those dealing with mental illness live largely on their own.

“We can take people who have been in residential care for years, and what we’re able to do with the ACT team is put them in their own apartments,” Sammon said. “Some of them are 50 years old, and it’s the first time they’re on their own.”

ACT team members look for indications that their clients are struggling to manage their apartments and keep themselves clean and well-fed. They track police calls and visits by their clients to the emergency room.

Using local residential treatment homes, meanwhile, can prevent hospitalization for people in a downward spiral, said Sammon, though “sometimes it takes a while — a week or a month or three months.”

To Sammon, who worked in a state hospital before coming to Deschutes County, keeping the mentally ill in their home communities is vital.

“Being in a state hospital — it’s not very helpful to a lot of people to be in that situation,” he said. “It’s a very unappealing environment to help those who are not the illest of the ill. The units have people who are very psychotic, violent, aggressive. And that’s the last place you want to be if you’re trying to get help and recover.”

Sammon said the ACT team is cheaper, too. According to Oregon State Hospital spokeswoman Rebeka Gipson-King, the average cost for a patient to stay in the state hospital is $21,875 a month, or $262,500 each year.

“I can house a person for $6,000 for a full year,” Sammon said.

Much of this money is used to subsidize rent and provide housing vouchers for people who often receive less than $700 per month in Social Security Disability Insurance.

In 2010, nine people from Deschutes County were admitted for state hospitalization. In 2011, four were.

“I believe this is a direct result of having increased residential beds, which allowed us to divert a number of individuals instead of sending them to the state hospital,” Sammon wrote in an email.

The average length of hospitalization dropped as well over the same period. In 2010, locals committed to the state hospital typically spent 94 days there. In 2011, those stays lasted only 65 days.

Although the area has seen an uptick in the number and variety of placements available for people who are struggling with mental illness, many say there is a need for even more.

“We want lots of options. The state as a whole, they’ve made past development of structured residences more of a priority to meet the need,” said Kevin McChesney, who oversees Telecare’s Oregon operations. “Because of the budget we’re only serving 40 to 45 percent of people, so there’s a huge unmet need. We need those RTFs (residential treatment facilities) and RTHs (residential treatment homes), because people are backing up in the secure facilities. It’s a real need.”

In 1999, HousingWorks Director Cyndy Cook took her first step into supported housing for the mentally ill.

A pair of Deschutes County case managers showed up at her door that year and told her they couldn’t treat clients who didn’t have places to live.

“They were in crappy old motels,” she said. “Some were living in camps.”

Spurred by their pitch, Cook toured the Willamette Valley, talked to developers and mental health departments and checked out housing.

“I said, ‘We should be doing this, and we can do this better.’ ”

In 2000, HousingWorks opened Emma’s Place, an apartment community in which people with severe and persistent mental illness can live for as long as necessary. HousingWorks is also responsible for Horizon House, a two-year transitional housing facility in Bend, which opened in 2005; Prairie House, an apartment complex for people with mental illness in Prineville, which opened in 2006; and Barbara’s Place, an apartment complex in southwest Redmond for chronically homeless people with severe mental illness, which opened in 2010.

In 2010, Telecare Corp., in conjunction with the state, opened two five-bed residential treatment homes in northeast Bend. Those homes allow residents to come and go as they please, but provide structured times for eating meals and taking medicines and receiving various types of therapy.

“If you’re in a larger facility like the state hospital, you get three meals a day and housekeeping and all these things that make it so you’re at camp,” Joondeph said. “You go and all these things are taken care of. It’s not like living in the community.”

Months later, the Alameda, Calif., company opened a secure residential treatment facility on Poe Sholes Road in Bend. The locked facility has 16 beds and two staff members for every five residents. It also features a variety of oversight levels. Some residents earn the right to go out into the community on hours long passes. Others remain locked up, including some who are always in a staff member’s line of sight.

The goal at the secure facility, which opened in January 2011, is to help residents develop skills. Some, for instance, can earn a food handler’s card and work in the facility’s dining area and, eventually, a restaurant. Others work on hygiene and other coping skills like housekeeping.

“We try to get them to identify their hopes and dreams, then try to give them activities to move toward that,” said Emilie Dauch, the facility’s director. “If you’ve been institutionalized a long time, your hope has died to some extent. . Even the idea of an open kitchen can be a new thing.”

The region also has several adult foster homes to serve people with mental health issues.

Given the availability of many treatment options, a mentally ill person could conceivably suffer a psychotic episode and receive treatment without ever leaving Bend: starting at the emergency room or Sage View, moving through local facilities, and eventually returning to an apartment or family home. Those who present a danger to themselves or others can still go to a state hospital for help, as can those with significant needs. They return to the area when they feel better.

“We want people to move to lower levels of care, with more responsibility,” Johnson said. “If they deteriorate, they can move back up to a higher level. That continuum of care should go both ways.”

Ultimately, the local expansion of mental health treatment reduces the likelihood that Central Oregonians will end up in the state hospital. In addition to reducing treatment costs, this can prevent disruptions for patients, who would have to head to Portland, Salem or Pendleton for treatment, Sammon said. Such upheavals can force the mentally ill into a frustrating cycle: rebuilding lives that are already fragile.

Here are a bundle of documents and historical photographs of the Oregon State Hospital. These come from a variety of sources, including the State Archives and the State Library (which are fairly unsearchable through Google or Bing or other search engines). Some of the items come from our personal collection.

Female inmates receive nurse’s aid training at the Oregon State Hospital in the mid-1960s. (Board of Control Records, Photographs, box 4, separated from State Institution Research Reports, box 76, folder 23)

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Nurses display handicrafts created by patients at the Columbia Park Hospital and Training Center in a 1968 biennial report. (Board of Control Records, Photographs, box 4, separated from State Institution Research Reports, box 76, folder 23)

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This color lithograph depicts the Circuit Rider statue in front of the Oregon State Capitol in 1924. The lithograph was included in theprogram commemorating the dedication of the statue. The Capitol was destroyed by fire in 1935 and the statue was moved to the east side of the current Capitol. (Board of Control Records, Circuit Rider Statue Dedication Program, box 82)

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This architectural drawing depicts a proposed Oregon State Building in Portland. The drawing was created in circa 1938. The Board of Control oversaw the construction and maintenance of numerous state buildings. (Board of Control Records, Photographs, box 1, separated from State Building Construction Records, box 17, folder 9)

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Roller skating at the Oregon State Hospital in the late-1960s. (Board of Control Records, Photographs, box 4, separated from State Institution Research Reports, box 76, folder 23)

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A boy surveys some of the damage on the grounds of the Oregon State Hospital in the wake of the Columbus Day Storm of 1962. The storm caused extensive damage on the hospital campus and throughout much of Oregon. (Board of Control Records, Photographs, box 1, separated from State Institutions Correspondence, box 46, folder 11)

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Civilian defense officials wanted to use various state institutions for housing in the event of an emergency during the war. Shown above is the exercise yard at the Oregon State Insane Asylum in about 1905. (Photo no. OSH0023, Oregon State Hospital Records, OSA)

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• Minutes from a September 1968 Oregon Criminal Law Revision Commission discussion about partial responsibility for crime by persons impaired by mental condition
• Minutes from an October 1968 Oregon Criminal Law Revision Commission – same subject
  (This is perhaps one of the formative conversations about creation of the Psychiatric Security Review Board.)
• Oregon State Hospital Superintendent’s Overview 1968, 1968. By Dean Brooks, MD.
• Oregon State Hospital Administrator’s Overview, 1968. By Ken Gaver, MD
• Oregon State Hospital Administrator’s Overview, 2009. Unknown author. This text has a lengthy history of the hospital and timeline, a bibliography and organizational chart.
• An alphabetical list of the cremated remains (called ‘cremains’ by the funeral industry) of over 3000 patients of the Oregon State Hospital. These patients either had no family willing or able to collect their remains when they died, mostly in the late 19th and early 20th century. Families who identify relatives on this list should contact Medical Records Services at 503-945-2976. You can also reach Medical Records Services by e-mail at oshcremains@state.or.us or postal mail: OSH Medical Record Services, 2600 Center St. NE, Salem, OR, 97301. See also Oregon State Hospital unites families with cremated remains of deceased patients.
• The History of the Oregon State Hospital from 1883-2012, an unsigned Western Oregon University student 2-page essay. Includes a table of causes of insanity reproduced from the Seventh Biennial Report of the Oregon State Insane Asylum, December 1894 and November 1896.
• Effects of Publicity on a Forensic Hospital, by Scott M. Reichlin, M.D., and Joseph D. Bloom, M.D.Bull Am Acad Psychiatry Law, Vol. 21, No. 4, 1993
• The 2011 union contract for nurses at the Oregon State Hospital.
• The Right to Refuse Treatment in Oregon’s State Hospitals. PowerPoint presentation. Presented at OHSU Grand Rounds by Joseph D. Bloom, M.D., Martin Epson, M.D., M.T.S. and Liban Rodol, J.D., M.D. in 2012.
• Post-Hinckley Insanity Reform in Oregon, by Scott M. Reichlin, MD; Joseph D. Bloom, MD; and Mary H. Williams MS. Bull Am Acad Psychiatry Law, Vol. 18, No. 4, 1990
• Using a Specialized Foster Care Community Treatment Model for Children and Adolescents Leaving the State Mental Hospital, by Patricia Chamberlain and John B Reid, from the Journal of Community Psychology July 1991.
• Oregon State Hospital, 1883–2008, from the American Journal of Psychiatry – February 2009

From the Salem Statesman Journal, April 24, 2012

A theft of patient information from the car of the Oregon State Hospital’s chief of psychiatry has created a confidentiality breach affecting approximately 550 current and former patients, the hospital reported today.

Patients at Oregon State Hospital received a hand-delivered letter today explaining the details of the April 13 break-in of Dr. Michael Duran’s car outside the 24 Hour Fitness health club at 4546 SE McLoughlin Blvd. in Portland, hospital spokeswoman Rebeka Gipson-King said.

A backpack containing hospital notes and records is among the items taken by the thief, Gipson-King said. The records include:

• A case load list containing the names of approximately 550 patients in the care of the hospital during the first week in March. The list also includes the patients’ hospital identification number, and the doctor and treatment program assigned to each patient.
• Approximately 20 progress notes of individual patients, randomly drawn by Duran as part of an audit he was conducting of his doctors’ work. These notes include dates of birth and could include health information like the patient’s diagnosis.
• A notebook containing Duran’s day-to-day work notes.

The Social Security numbers of the patients were not compromised, and no electronic patient information was involved, Gipson-King said.

Letters detailing the breach will go out to all 618 patients treated by Oregon State Hospital during the entire month of March, to make sure everyone who could be affected is notified, Gipson-King said.

About 290 of those patients will be further notified that they could be one of the 20 people whose progress notes were taken during the theft, Gipson-King said. Because Duran’s audit was random, that is as far as hospital officials can narrow down the list.

“We have no reason to believe the information has been misused, but we want to make sure our patients are aware and have the support they need,” OSH Superintendent Greg Roberts said in a prepared statement. “The state hospital takes patient privacy very seriously. We will take any and all steps necessary to ensure no similar incident happens in the future.”

The break-in occurred around 10:15 p.m., after Duran had put in a late night at the hospital’s Salem campus. On his way to his home in Portland, he stopped off at the gym to work out, Gipson-King said.

Gipson-King said Duran took steps to hide the backpack, but the thief rooted it out and took off with it.