Sunday May 3rd, 9:00 AM – 1:00 PM

Cover The Uninsured – free health screening and information!

Blood pressure screening, body mass index screening, vision tests / eye exams, foot exams, talking with a doctor, FREE hair cuts!

All are available while supplies last.

EVERYONE IS WELCOME

O’ Bryant Square – SW 9th and SW Washington in downtown Portland, within TriMet’s Fareless Square

More information at Cover The Uninsured. This service is provided by the Robert Wood Johnson Foundation.

Brian Lindstrom’s acclaimed documentary Finding Normal is now available for sale on DVD.

See – www.findingnormal.org

Finding Normal is a feature-length cinema-verite documentary film about long-time heroin and crack addicts trying to rebuild lives devastated by addiction and incarceration.

The film follows two men and one woman leaving a detoxification treatment center in Portland Oregon, and entering Central City Concern’s Recovery Mentor program, which provides clean and sober housing, drug treatment, and – perhaps most importantly – a recovery mentor who knows first-hand what it takes to stay clean, stay out of prison, and build a “normal” life.

The film witnesses the day-to-day challenges of recovery, the heart-break of relapse, and the simple victories of a “normal” life: singing in a church choir, going fishing, watching a daughter graduate from high school.

Opinion published in the Salem Statesman Journal on April 27 2009 by Gina Nikkel, Ph.D., who the executive director of the Association of Oregon Community Mental Health Programs. These agencies are immediately and directly affected by the Governor’s proposed budget cuts to mental health services.

The Community Mental Health Programs (CMHPs) are the primary safety net for the most seriously mentally ill and addicted in Oregon.

These programs have been consistently underfunded for many years and, in spite of criticism, they are there day after day, providing services to very high risk people.

It has been the CMHPs that have absorbed the costs of the cuts of 1,000 front line mental health workers and 1,000 addiction front line workers in the budget cuts of 2002-03. Oregon’s mental health and addictions system faces staggering cuts again in 2009; elimination of mental health crisis response, elimination of acute psychiatric care, elimination of non-Medicaid outpatient mental health care, elimination of addiction treatment, etc.

If these cuts are taken, we will face a cycle of spending even more tax dollars inappropriately in emergency rooms, jails and prisons for our most vulnerable neighbors, only this time our law enforcement, courts and corrections systems are facing similar budget cuts.

At a time when dangerous criminals wait months for a trial, cycling in and out of jails too full to hold them, when the sick and injured sit for hours in the emergency room waiting to be seen, the last thing we ought to do is burden jails and hospitals with people whose severe mental health and addictions needs they were not designed or funded to serve.

People with the disease of serious mental illness and addiction should be cared for at the most appropriate, most cost effective levels of care in the community rather than defaulting to the most expensive institutional (or worse) settings.

Oregon has implemented world class innovations such as the Children’s System Change Initiative which is serving more children in less expensive ways than ever before; the Early Psychosis Intervention programs that diagnose and help young people manage serious mental illness before its allowed to disable them; Addictions Treatment for Moms and Dads, helping parents overcome their addictions and reclaim their children from the foster care system; the Strengthening Families prevention curriculum which helps high-risk teens and their parents learn to communicate and set boundaries; and other system-wide Evidence Based Practices.

Let’s not lose heart and go backwards.

Editorial by Stephen Kliewer, from the Wallowa County Chieftain, April 23 2009

The state of Oregon has stated that it is going to cut 30 percent of the funding for addictions and mental health this coming year. An ugly number considering such services are already underfunded and there is a rising demand for services.

But the real story is even worse. That 30 percent cut includes the total elimination of non-Medicaid community mental health services to adults and seniors. It includes a 100 percent cut of substance abuse treatment services to adults and seniors. It includes a 100 percent cut to crisis services, meaning that there would be no mental health hotline for suicidal people, or people with a severe mental health crisis. Those people would have to call law enforcement, or the emergency room. But there would be no funded mental health support for the ER staff. It includes a 100 percent cut to addictions prevention. A small amount of funding remains for high needs children, but that is all that is left.

Some in Salem argue that these lost services will be made up in the expansion of OHP standard membership. There are dangerous flaws in this reasoning. It may be over a year before people can actually get enrolled. During the six to 18 months before any of the people who lose care will be enrolled and able to access Medicaid services, uninsured people with severe mental illness and addictions will have no recourse besides emergency rooms, jails, and the streets.

Many of the people who currently rely on non-Medicaid services, the “sliding fee scale,” will never be eligible for OHP. These include military veterans who live too far from a VA facility to access care but too close to be exempted to see non-VA providers, Medicare beneficiaries whose needs for rehabilitative services are not covered, and the remaining uninsured and underinsured.

The funding that is being cut provides for adult and seniors mental health, crisis services and alcohol and drug services.

This money helps support psychiatric services, therapy, case management, nursing care, and a variety other services that provide stability for people with mental illness. If we do not have a system that provides these services we will pay for it in a cost shift to emergency rooms, law enforcement, courts, jails, prisons and the state hospital.

What do these cuts mean for Wallowa County? Let’s start by looking purely at dollars. Not counting the prevention dollars, which go to Wallowa Valley Together Project, Wallowa Valley Center for Wellness currently receives around $212,000 a year into the county to provide non-Medicaid services. The current budget being put forth at this time cuts $183,400, or 86.5%, of that amount. The OHP increase, when it begins to be felt 6-18 months after services are eliminated on July 1st, would at best replace only around $46,000 of those funds, a cut that still is around 65%. This represents at least 2 full-time clinicians from a system that is already stretched thin by need. Thus it is not merely the loss of services to those without insurance that is at stake, it is the ability of community-based health programs across the state to maintain the level of staffing needed to meet the needs of all people with mental health and addictions issues, including those with insurance. These cuts would effectively decimate the community-based mental health system for everyone.

What is tragic is that for the past ten years the state has been developing a system of care based on a healthy community-based mental health system. They have moved people into the community from residential programs. They have encouraged the development of drop-in centers such as Wallowa’s Riverside Center. They have moved people from hospitals to homes such as Wallowa River House, putting more and more of the responsibility on the local programs. And now they propose to cut the funding that allows stable programs to exist. Even the state admits that it will have to suspend the Oregon Administrative Rules (OARs) if they do this because the providers who survive the cuts will not be able to do what the state has mandated they accomplish. Even if funding returns several years down the road, the provider system in many communities will have disappeared. Key personnel will have been lost and the system may never recover.

Meanwhile, back in Salem, the bureaucracy that has been developed to oversee these endangered programs, cuts are also being made. But let us look at those cuts. They are taking a 4% cut in the personnel salary line, and a 2% cut in supplies. To me this is astonishing, perhaps even immoral. While the local programs, which actually provide the services to people in the local community, are being cut between 65% and 86.5%, the people sitting in cubicles who supposedly oversee these programs get cut 4%.

This does not make sense to me. I doubt it if will make sense to the person who cannot get out of bed and to work because of severe depression. Or to the wife whose husband is suffering from alcoholism, but does not have a local treatment program available. I doubt if it will make sense to the person who is suicidal, and in desperation calls the crisis phone, but finds that there is no one on the other end of the line to help them stay alive. Something is wrong with this equation.

I believe that these cuts, if implemented as proposed, will do two things. It will mean that the cubicles in Salem stay filled with bodies, while around half of the clinical offices in Wallowa County will stand empty.

It will mean that someone will continue to commute to work and push papers related to programs that no longer exist (who has to oversee OARs that are suspended?), while somewhere in Oregon, perhaps somewhere in Wallowa County, a suicidal person will die; a family will be torn apart by alcoholism; a youth will start drinking early and heavily, a severely mentally ill person without support will end up first on the street, and then in jail.

If you think the way these cuts are currently structured makes sense, then do nothing. If you think they don’t make sense, then contact Senator Nelson (503-986-1729, sen.davidnelson@state.or.us) or Representative Smith (503-986-1457 or rep.gregsmith@state.or.us) Demand that the necessary cuts be spread equally across the whole system, not taken out of direct services for the sake of administrative overburden. You may also testify to the Ways and Means Hearings. The closest hearing is Saturday, April 25 at the Pendleton Oregon National Guard Armory, 2100 N.W. 56th Drive 10 a.m. to noon. Representative Smith will hold a Townhall in Enterprise on May 2nd at 10am at Community Connections.

Tuesday, April 28 Governor’s Council on Alcohol and Drug Abuse Programs

9:30 am – 3:30 PM, 500 Summer St. NE, Room 137, Salem

+++++++++++++++++++++++++++++++++++++++++

Wednesday, April 29, 7:00 – 8:00 PM

Judge Richard Baldwin & Heidi Grant, PsyD. talk about the Mental Health Court of Multnomah County, what it does and how it operates.

Providence Hospital, 4805 NE Glisan, Social Room

The meeting is free and open to the public.

The Mental Health Court provides support and resources for people who are on probation and suffer from a diagnosed mental illness and/or substance abuse.

From the Longview Daily News, April 19 2009

Heroin addiction is shooting upward in Southwest Washington – and so are heroin overdoses. Emergency Department personnel at St. John Medical Center have seen “a definite steady and noticeable increase” in heroin cases, said spokesman Randy Querin.

Police reports show officers frequently coming in contact with heroin users in the past several months, including a prostitute who said she turned tricks to support her habit, a woman who said she used heroin to take the edge off her cravings for meth and a man twice found turning blue from heroin overdoses on different bathroom floors four days apart.

Wednesday, the Cowlitz-Wahkiakum Narcotics Task Force arrested 11 suspected heroin dealers in connection with an investigation that began in November. Agents seized nearly a kilo – about two pounds – of heroin during the investigation, said Sgt. Kevin Tate of the Task Force.

Drug culture changing

“There’s a fundamental difference in the illegal drug culture of Cowlitz County than two years ago,” Tate said. “Addicts are increasingly relying on opiates as their drug of choice, and frequently their drug of choice is heroin.”

Shawn Strock, 23, a former Cowlitz County resident living in Portland, is in recovery for heroin addiction and makes daily visits to a Vancouver methadone clinic.

He said he began using heroin when he was 20 (the average age for a first-time user, according to the U.S. Centers for Disease Control). His addiction to narcotic painkillers began at age 15 and included OxyContin, Roxicodone, Fentanyl and morphine.

He and other addicts told The Daily News they switched to heroin because of the high cost of pills.

“Pills are so expensive,” Strock said. “Oxy 80 (an 80mg OxyContin pill) is going for 70 bucks now, but you can get a balloon (about .3 gram) of heroin for $20. Oxy 80 lasts 4 hours, but a balloon of heroin, when you first start out, will last you all day.”

Economic downturn not related to drug choice

But don’t jump to the conclusion that the current economic downturn has anything to do with an addict’s drug choice, Tate said.

“This shift is what we have been preaching about for years now – it is not surprising, shocking or due to the economy,” he said.

In 2006, local and federal narcotics agents made a dramatic roundup of 26 people illegally selling prescription painkillers, which brought the public’s attention to pill abuse by children and teens.

Tate said the investigation also educated narcotics agents about introductory addictive behavior, and the task force’s latest heroin investigation is a natural continuation of the pill investigation.

“Many of the baby addicts are adolescent addicts now addicted not to pills, but to a general class of opiates,” Tate said. “What we’re seeing is that the ‘gateway process’ is accelerated. The window from never using to heroin addiction used to take quite a while, with many opportunities to get out. Now it’s concentrated, going from no drug problem to addicted in a short time span.”

Kids as young as 13 using heroin

Strock said he’s seen kids as young as 13 using heroin – and addicts as old as 75 or 80.

Querin said St. John Emergency Department staff have noticed an increase in heroin use from teens to middle age.

Tate said it distresses him personally to see some young people he knew as babies have become heroin addicts.

“We’re seeing 14, 15, 16-year-old kids addicted to opiates. When we see that 17-year-old high school junior or senior that suddenly OD’d, that’s impactful.”

Heroin withdrawal is like a severe case of the flu, Tate said. The stronger the addiction, the more severe the reaction.

Symptoms include cramping, diarrhea, chills and nausea, and can last as long as a week.

Addiction pushes users to crime

“When you know you’re going to get the worst flu ever, your fear level goes up, and you’ll do anything to avoid having that feeling,” Tate said. This includes stealing from loved ones to get money for more heroin, he said.

“There’s an increased focus on self,” he said. “Lying and deception become easier.”

Addiction makes it easy for heroin users to justify committing burglaries, thefts, robberies, prostitution and other things they’d never have considered before taking dope, he said.

Some heroin addicts point to tighter restrictions on prescription drugs after the 2006 raid as the reason they switched from pills.

“I’ve had a couple flat-out say, ‘I was pushed to heroin because I couldn’t get pills,’ ” Tate said. “I think that’s a bunch of crap. They’re using because they chose to use. Addiction or not, it’s still a choice.”

Former Task Force agent Paul Carlson, who worked on the pill investigation, said many of the major pill dealers were already using heroin before the arrests.

“I don’t think (the raid) made the problem worse,” Carlson said. “If you’re addicted to Oxy, for full-fledged addicts it’s not much different than heroin.”

He said the raid had a positive effect on the community because it scared customers on the fringe of the drug world, many of whom were teens, into quitting.

“I think there was a huge impact on the pill population, the ones that weren’t dealing,” he said. “They saw the wide roundup and that freaked them out.”

Steady climb in heroin overdoses

At St. John Medical Center, Emergency Department workers code overdose patients either “poisoning/heroin” or “unspecified opioid type dependence,” but the opioid is most likely heroin, said PeaceHealth spokesman Randy Querin. He said there’s been a steady climb in opioid/heroin cases at St. John since 2007, from 128 in the first half of 2007 to 259 in the last half of 2008 (see table).

Overdoses are “more common than you realize, but most people don’t die,” said Carlson, who said he responded to a lot of overdose calls when he was a Longview patrol officer. “If it wasn’t for Narcan we’d have a ton of deaths.”

Narcan (naloxone) is an antidote that neutralizes the effects of opiates in a minute or less, depending on how much heroin the person has taken.

Mike Turner, a paramedic/firefighter with Cowlitz 2 Fire & Rescue since 1986, said paramedics don’t keep track of overdose numbers, but he injected Narcan in about 15 overdose patients in the last year.

“I wish there was a way we could videotape these people before we intervene,” he said. “They’re essentially dead. They’re not breathing. There’s barely a heart rate. Then they wake up, and they’re mad and deny using drugs. Sometimes there’s a needle still in their arm, but they’re always in denial. They think we’re stupid. We’re not the cops. We don’t need to be lied to. We just saved their lives, for crying out loud.”

As for fatal overdoses, Coroner Tim Davidson said his office documented 21 drug deaths in 2008. One was definitely heroin and the rest were fatal mixtures of drugs, he said.

He’s awaiting toxicology results on suspected drug overdose deaths from this year.

Sgt. Tate of the Task Force offered these theories for the increase in heroin overdoses, fatal and nonfatal:

The user is new to the drug and doesn’t know how much to take.

The user is changing the method of taking the drug from smoking to injecting, but is not changing the amount taken.

The source of the user’s drug supply fluctuates, and therefore so does the purity level, but the user can’t tell the purity by looking. Higher purity means the drug has not been diluted as much with other substances and is therefore more potent.

The user mixes heroin with other drugs without realizing how they interact chemically. The user also might inadvertently double-dose by taking a time-release opiate such as OxyContin and later taking heroin, not realizing the other opiate is still in the system.

How to tell if someone is a heroin addict

Heroin addicts don’t stand out like meth addicts do, but here are a few clues suggested by police and heroin users:

Immediately after taking heroin, a user goes “on the nod” – lethargic, incredibly sleepy, unable to function.

For the majority of the high, the user is very upbeat and seems normal.

Because the high wears off in four to six hours, look for recurring “flu” (withdrawal) that seems to disappear quickly (because the user takes another fix). The average heroin user is in withdrawal about half the time.

* Abrupt mood swings.
* Pinpoint-sized pupils.
* Stealing and other crimes.

Several heroin addicts in recovery told The Daily News they’d like to see a methadone clinic in Cowlitz County similar to the two clinics in Vancouver. All said those clinics serve a large number of Cowlitz County patients.

Methadone is a synthetic narcotic designed to help wean addicts off heroin. Taken orally once a day, methadone suppresses narcotic withdrawal. It’s only available in clinics. Its critics point out that methadone is also addictive.

A newer drug, Suboxone, also treats opiate dependence and is considered to have a lower potential for abuse than methadone, according to the U.S. Food and Drug Administration. One of its ingredients is naloxone, also used in Narcan. Suboxone requires a doctor’s prescription.

Tate said enforcement, education/prevention and treatment all are equally important. He’d like to see longer sentences given to dealers. Ninety-seven percent of people arrested by the task force are found guilty or plead guilty, he said.

“I think treatment is fantastic, but if we put them back in our community they’re going to stay in our community and they’re going to do what they know how to do: Deal drugs.”

He said law enforcement and community leaders have talked for years about the necessity for a balanced approach to drug treatment and interdiction.

“Show me a program that works,” he said. “We (law enforcement) saw people dying. We have tools to stop people from dying – and make an opening for treatment programs to do their part. I would love to see every one of those heroin addicts in treatment and clean.”

EXTRA – The straight dope on heroin, Longview Daily News

From Willamette Week, April 22 2009

Local mental health and addiction services and state prisons aren’t the only potential budget cuts that could make life more brutish in Portland.

The potential loss of several key programs at the state Department of Human Services is truly sobering.

Following is a list of six programs that would be lost from DHS’ addictions and mental health division in a worst-case, 30-percent-cut scenario:

• Eliminating acute inpatient psychiatric care for nearly 6,000 adults.

• Eliminating 24-hour psychiatric community crisis services. About 15,200 use these services each year.

• Eliminating adult outpatient mental health services for 2,925 adults per year who are not eligible for Medicaid.

• Eliminating alcohol and drug prevention programs for more than
1,500 families per biennium.

• Eliminating problem gambling prevention and treatment that 3,700 clients access every year.

Multnomah County Forum to Save Our Human Services

Tuesday, April 28th, 4:30-7 PM

501 SE Hawthorne, Multnomah County Building, first floor boardroom

This location is accessible for people with disabilities.

Overview of the crisis we face

• Impartial informational presentation on the proposed cuts in Chair Wheeler’s Executive Budget.

Advocacy strategies to save our services

• Actions we can take to minimize these cuts and protect our most vulnerable citizens.

Accessible by Tri-Met bus lines #4, 6, 10, 14, 33
Street parking available. Parking garage across street locked up at 6 PM