Mental Health Association of Portland

Oregon's independent and impartial mental health advocate

Strategies for Discontinuing Hypnotic Use

Posted by admin2 on 23rd March 2013

The OHSU Department of Psychiatry would like to invite (you – the public) to Grand Rounds taking place this Tuesday,  March 26, 2013 from Noon – 1 PM in conference room 8B60 (8th floor) of the main hospital.

Strategies for Discontinuing Hypnotic Use [medications]

Rocky Garrison, Ph.D., CBSM, Affiliate Assistant Professor, Department of Psychiatry/OHSU Clinical Psychologist

At the end of this presentation, participants should be able to:

  • Describe three strategies for discontinuing hypnotic use
  • Compare outcome results of the three strategies to routine care
  • Describe four factors which affect withdrawal planning

Like this presentation? Presentations are typically archived within 24 hrs of the event. You can access these presentations by visiting us on-line at the following location.

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Washington County sheriff’s sergeant, deputy justified in shooting death, says DA

Posted by admin2 on 29th December 2012

By Rebecca Woolington, The Oregonian, Dec. 29, 2012

Jeffery David Anderson

Jeffery David Anderson

A Washington County sheriff’s deputy and sergeant were justified in their fatal shooting of an Aloha man who pointed a loaded rifle at them in July, the Washington County District Attorney’s Office determined this month.

Shortly before 8:15 p.m. on July 7, sheriff’s deputies responded to reports of a man armed with a rifle walking along Southwest 195th Avenue near Farmington Road in Aloha. Multiple people told 9-1-1 operators that the man was pointing the weapon at neighbors and passing vehicles.

Sheriff’s Sgt. Chad Lotman and Deputy Brian Wood were some of the first authorities to arrive at the incident, wrote Chief Deputy District Attorney Roger Hanlon in a letter upholding the shooting to Sheriff Pat Garrett. They found the man, whom they identified as 56-year-old Jeffery David Anderson, standing in 195th Avenue with the firearm. Read the rest of this entry »

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Editorial: OHSU should get drug companies out of research, education

Posted by admin2 on 26th November 2012

By The Oregonian Editorial Board, November 24, 2012

Under legal pressure in recent years, several of America’s big pharmaceutical companies started publicly reporting the cash payments they make to medical researchers who deliver presentations to other doctors — a good thing. Better yet are federal mandates that will require all drugmakers do that and more starting next year.

But the half steps toward transparency require nothing more than a neutral declaration by a drugmaker that it pays thousands of dollars annually to a Portland or Bend doctor who may use the company’s visual aids and findings in “educating” medical providers.

It shouldn’t work that way. As ethicist and physician Susan Tolle of Oregon Health & Science University puts it: “I think it’s marketing, not education.” So, too, did the more than 100 OHSU students who earlier this year signed a petition saying the school should prohibit faculty from joining the speakers’ bureaus of pharmaceutical companies.

Now OHSU weighs a rule that would do just that, ending even the appearance of conflicts of interest. The proposed rule has cleared the dean of OHSU’s School of Medicine, The Oregonian’s Nick Budnick reports. But it still needs sign-off by the schools of dentistry, nursing and pharmacy before adoption as a university-wide standard.

OHSU and its president, Joe Robertson, should make this standard a reality soon. And OHSU, as the state’s premiere medical research and treatment center, should seize this opportunity to lead by example. A wide embrace of such transparency, particularly in Oregon, would build trust as our health care providers and treatment centers struggle to find thriftier approaches to managing chronic disease and emphasizing prevention.

A medical conflict of interest, real or suspected, runs across several levels. Any Oregonian undergoing medical treatment must have the confidence his or her doctor is possessed of independent judgment and free from a drugmaker’s influence.

But doctors are also entitled to know they’re not being sold a bill of goods by an otherwise well-regarded colleague who “teaches” by using slides and data furnished by a sponsoring drugmaker. And medical students must have every assurance their training and careers will go untainted by bias or any influence that could warp an honest search for truth and treatment efficacy.

In posting to its website a legible and useful state-by-state accounting of doctors who are paid by drugmakers, the newsgathering organization ProPublica found that pharmaceutical companies employed widely different metrics in reporting their payments. That complicates things, at least in the short term.

But an ethics rule is uncomplicated. It simply bars researchers from accepting a drugmaker’s money to lecture, lead a discussion or demonstrate a procedure to our medical professionals. Those activities are within the realm of education, not marketing, and must be safeguarded.

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OHSU Grand Rounds, author and educator Stephanie Coontz

Posted by admin2 on 4th September 2012

Stephanie Coontz

Stephanie Coontz

The OHSU Department of Psychiatry would like to invite you to Psychiatry Grand Rounds.

We have a great line-up of presentations that we are looking forward to sharing with you!

Our first presentation will be held next Tuesday, September 11th from noon – 1pm in conference room 8B60/8th floor of the OHSU Hospital.

“For Better AND Worse: The Ongoing Revolution in Family Life”

Stephanie Coontz, M.A. – Professor of History and Family Studies, Evergreen State College, Olympia, WA, Director or Research and Public Education, Council on Contemporary Families

Coontz is the author of A Strange Stirring: The Feminine Mystique and American Women at the Dawn of the 1960s (Basic Books, 2011) and the award-winning Marriage, A History: How Love Conquered Marriage (Viking Press, 2005).

She also wrote The Way We Never Were: American Families and the Nostalgia Trap (1992 and 2000, Basic Books), The Way We Really Are: Coming to Terms with America’s Changing Families (Basic Books, 1997), and The Social Origins of Private Life: A History of American Families.

She edited American Families: A Multicultural Reader (Routledge, 2008). Her writings have been translated into French, Arabic, Spanish, Russian, Czech, German, Norwegian, Turkish, Greek, Chinese, Ukrainian, and Japanese.

Learning Objectives:

  • Identify the main changes in family relationships and structures over the past 30 years
  • Analyze emerging patterns of sociological and psychological dynamics in couple relationships and parent-child relationships
  • Distinguish between causes and correlations in evaluating the outcomes of these changes
  • Gain understanding of the new challenges facing individuals and families

Target Audience – Psychiatrists, psychologists, psychiatry residents and fellows, medical students, social workers, masters in administration, physician assistants, nurse practitioners, nurses and pharmacists.

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Oregon Study: Medical Journals Paint a Too-Rosy Picture of New Antipsychotic Drugs

Posted by admin2 on 24th March 2012

By Joe Rojas-Burke, The Oregonian, Friday, March 23, 2012

Counting Pills

(Jamie Francis / The Oregonian)

Published reports on the new drug Fanapt gave it high marks.

One medical journal emphasized its “comparable efficacy” to other drugs used to treat schizophrenia, and prominently noted a lower risk of certain side effects.

There was no mention that competing drugs outperformed it in three of the first clinical trials, or that in one trial a placebo worked just as well. The Journal of Clinical Psychopharmacology‘s summary also made no mention of Fanapt’s tendency to disturb the heart’s electrical activity and increase risk of cardiac arrest.

The one-sided reporting, uncovered by researchers in Oregon, adds to growing evidence that medical journals paint an overly rosy picture of new drugs. The analysis, published this week in PLoS Medicine, found that many unfavorable results on psychiatric drugs never appeared in the articles doctors rely on to learn about trial results.

“It’s unsettling,” says lead author Dr. Erick Turner, a former drug reviewer for the federal Food and Drug Administration and now at the Portland Veteran Affairs Medical Center and Oregon Health & Science University.

The findings do not imply the drugs don’t work. But rather, doctors and consumers don’t get a full, nuanced picture about drugs and can’t make the best decisions without all the facts about safety and effectiveness.

The bias toward publishing positive results is a widespread problem for drug treatments of all kinds.

Trials with favorable outcomes were nearly five times more likely to be published than those without, researchers at the University of California San Francisco found in 2008 when they examined all the new drugs approved by the U.S. Food and Drug Administration in a two-year period. Medical journals frequently reported conclusions more favorable than those in reviews by the FDA.

“And that’s only focusing on half the picture,” says Lisa Bero, the UC professor who led the study. “The other half of that equation is safety. How much information about harm remains unpublished?”

Turner and co-authors obtained 24 clinical trials submitted to the FDA by drug companies seeking approval for eight second-generation anti-psychotic drugs: Abilify, Fanapt, Zyprexa, Invega, Seroquel, Risperdal, Consta, Geodon. The Oregon researchers compared the FDA data – some obtained only after a request under the Freedom of Information Act – with medical journal articles.

Four studies submitted to the FDA were never published. All yielded negative results. In three, the newer anti-psychotic drug worked no better than an inactive placebo. In one, the new drug proved no more effective than an older, cheaper competing drug.

Some journal articles selectively left out unflattering results. Studies showing Fanapt statistically inferior to three competing drugs were not brought up.

The lead author of the Fanapt paper, Dr. Steven Potkin of the University of California at Irvine, was traveling this week, an assistant said, and “unable to respond.”

Study authors who conduct clinical trials with funding from drug companies don’t necessarily have access to all of the data collected or the freedom to independently analyze findings, experts say. Bero, in her 2008 study, did not find any cases in which drug companies prohibited doctors from publishing trial results, but some researchers complained about foot-dragging. “It is clearly important that this should be published,” one clinical trial researcher said. “I have been and continue to be in contact with [the drug company] to see how this can be published.”

Novartis, the maker of Fanapt, in a written statement said it “is committed to transparently disclosing the results of all clinical trials, whatever their outcome, so that healthcare providers can make fully informed treatment decisions for their patients.” The company said safety and efficacy outcomes from all Novartis-sponsored Fanapt trials have been published in peer-reviewed journals or are on the FDA’s website. Novartis said studies finding Fanapt inferior to competing drugs “were not designed as head to head comparisons.”

The extent of bias in anti-psychotic studies was not as severe as Turner and colleagues found for antidepressants in a study they did in 2008. Nearly a third of the clinical trials of antidepressants by drug companies produced questionable or negative results that never appeared publicly in print.

Part of the problem rests with journal editors, who have a long history of favoring studies with positive results and rejecting those showing a treatment doesn’t work. Journals in recent years have tried to correct the bias.

To allow a more complete view of drug trial results, Congress in 2007 mandated a clinical trial database run by the National Institutes of Health. FDA spokeswoman Sandy Walsh said the agency “has initiated a number of transparency programs over the past few years to help inform the public of the agency’s activities while also preserving confidential information.”

Turner, Bero and others who have studied publication bias insist the FDA urgently needs to disclose more information — and make it easier for doctors and consumers to interpret.

“We need access to data that shows all of the outcomes,” Bero says. “Right now, the best place to get that is through regulatory agencies.”


Also see:

The Skanner: Study: Medical Journals Don’t Give Doctors Full Picture on Psychiatric Drugs


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OHSU-led Consortium Wins $21 Million Grant to Study Alcoholism, Stress

Posted by admin2 on 18th March 2012

By Oregon Health & Science University, for The Lund Report, March 8, 2012

Consortium will continue studying mechanisms that link stress, anxiety, alcohol intake

OHSU Logo

The National Institute on Alcohol Abuse and Alcoholism has funded a five-year, $21 million Integrative Neuroscience Initiative on Alcoholism grant to support a multi-site consortium led by an Oregon Health & Science University researcher.

OHSU will receive approximately $6.3 million over five years, funding projects in the laboratories of Kathleen A. Grant, Ph.D., head of neuroscience at the Oregon National Primate Research Center (ONPRC) and professor of behavioral neuroscience in the OHSU School of Medicine; and Betsy Ferguson, Ph.D., associate scientist in neuroscience at the ONPRC.

INIAStress Logo

The consortium, Integrative Neuroscience Initiative on Alcoholism: Stress, Anxiety and Alcoholism, or INIAStress, extends a cross species approach in exploring neural mechanisms that link stress, anxiety and excessive alcohol intake.

Alcoholism affects millions of Americans, devastates families, compromises national preparedness, depresses economic vitality, and burdens the country’s health care systems. Untreated addiction costs America $400 billion annually and recent research indicates that alcoholism and alcohol abuse alone cost the nation’s economy approximately $185 billion each year, according to NIAAA-funded research.

Alcohol abuse and alcoholism result from a complex interplay of genetic and environmental factors, according to Grant and her colleagues in the consortium. Many aspects of an individual’s response to the environment activate the hypothalamic-pituitary-adrenal axis and are therefore labeled as “stress.” Much of the stress in modern society is a subjective state of anxiety, where competing goals generate conflict and activate brain mechanisms involved in arousal and attention. These stressful states are often seemingly relived by drinking alcohol and may be a primary factor in establishing excessive alcohol consumption.

“While there is a great deal of evidence supporting stress-alcohol interactions, less is known about how these interactions alter the brain at the molecular, cellular and systems levels to maintain excessive drinking and alcoholism — and why this addiction is so difficult to treat,” Grant said. “This consortium is tackling the larger picture of brain mechanisms that control alcohol consumption, the response to stress in these brain areas, and the reciprocal relationship between excessive drinking, the physiological state of stress and the subjective state of anxiety.”

The consortium’s main approach will be to characterize the genetic basis of key neural mechanisms in stress and anxiety in order to clearly assess individual risk for the development of alcoholism or to develop tailored therapeutic approaches to treating the anxious alcoholic.”

The grant represents the second competitive renewal for the INIA consortium, which is made up of 15 lead investigators from 10 institutions in the United States and Europe. The group received its initial round of funding in 2001. The other institutions involved are: Johns Hopkins University; University of North Carolina at Chapel Hill; University of Tennessee Health Sciences Center; Medical University of South Carolina; Wake Forest University; Virginia Commonwealth University; Vanderbilt University; University of Sussex, England; and Institute of Neuroscience, Italy.

To date, the consortium has made significant scientific progress. Accomplishments include the publication of more than 300 articles on the topic of genetic and environmental components of alcohol-stress interactions; the production of unique, genetically altered, mice for addressing the role of key genes in stress, anxiety and alcoholism; a growing database of translational research linking findings from mice, non human primates and human beings; and supporting the inclusion of new investigators into the realm of alcohol research.

The NIAAA is one of the 18 institutes that comprise the National Institutes of Health. It supports and conducts biomedical and behavioral research on the causes, consequences, treatment and prevention of alcoholism and alcohol-related problems.


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Shot on the Street
What the Shooting of Two Homeless Men Ought to Mean for Portland’s Camping Ban

Posted by admin2 on 5th March 2012

By Denis C. Theriault, Portland Mercury, March 01, 2012

It was about 9pm on a blustery, rain-soaked Tuesday night — and, yet, thanks to a horde of Mardi Gras revelers, Old Town was unusually festive.

Precisely what happened next isn’t exactly clear, but the basic inflections of the story, told by a handful of different people, all agree on one point: A group of homeless men had been turned away from their usual overnight spot at Right 2 Dream Too (R2D2) — the camp-like refuge on NW 4th and Burnside — because the small lot, dotted by a few dozen tents, had already been filled by others with nowhere to go.

Shelter space, like it is every winter night, was also tight, and so the men had to make do. They could have crashed on the sidewalk across from R2D2, waiting amid drunken noise and dampness, until a tent maybe opened up in the wee hours. Instead, they split up. One man went in one direction, and the other two went another: east, across the Willamette River and down into the grim-but-dry industrial underbelly of the Morrison Bridge.

Sometime before 5am on Wednesday, February 22, they were sleeping, covered, when a dark-colored station wagon pulled down SE Belmont. Someone inside leaned out with a gun and opened fire, and then the car vanished as quickly as it arrived. Carter Hickman, 57, took a bullet to the chest, while Albert Dean, 43, was merely grazed — and soon both men were on the way to OHSU.

As crimes go, this was particularly horrifying. And the questions, and the fears, remain fresh: Did the men do something to bring this upon themselves? Or was this one of those rare, random, senseless incidents?

But none of that really matters. Because this was something else: a wakeup call. On the streets, violence and vulnerability are inextricably linked — it’s just that we never really hear much about it. According to Multnomah County’s 2011 one-day homeless street count, nearly half of unsheltered people reported enduring some kind of violence that might otherwise have been avoided behind walls or if they were just somewhere safe.

And that wakeup call comes at a portentous time for Portland. Twin protests over the city’s ban on tent camping — one of them around the clock — remain outside city hall, confronting staffers and politicians with the issue daily. On February 29, after at least one false start, the city is scheduled to present a tepid plan to settle a years-long federal lawsuit over that same camping ban. And March 1 will mark the second month of steep fines for R2D2′s landlord — continuing a code enforcement crackdown on the well-managed safe haven for the homeless that, its backers say, the city really ought to be embracing instead.

Like Chasing Ghosts

Until the night they were shot, Hickman and Dean — better known by some as “Joe” and “Allen,” respectively — had been staying off and on at R2D2 for about five weeks. They had a regular tent near the rest area’s entrance, specially chosen because of their work schedule.

“We’d always put them in the same spot” in C7, said Joe Green, R2D2′s top security man, a couple of days after the shooting. “They always had to get up early to go to work.”

That’s the point of Right 2 Dream Too. It’s built so people who need a night’s sleep, or several, or a place to dry out, can sack out in peace and store their belongings — and then maybe get their bearings enough to find and keep a job and begin the slog back up to self-sufficiency.

Most nights, if its residents can’t make it back early enough, there’s a long line of people hoping to check in by 7 pm. The site holds up to 80 people, and on any given day, two or three dozen of them are new faces.

Joe and Allen and their friend became quiet fixtures at the site, Green and others say. When they weren’t working, they would help keep things tidy and even helped reengineer some tents. They would take meals at Sisters of the Road or at nearby churches.

“There were always the three of them,” Green says. “We would call them our workers.”

Later, an Occupy Portland member wrote that he remembered seeing the men in camp last fall.

But learning more about Joe and Allen was, in some ways, like chasing ghosts. On Friday, February 24, police said, both were still in OHSU, with Hickman expected to live. But an OHSU switchboard operator said there was no record Hickman had ever been at the hospital and said Dean, despite what police said, had been released from the emergency room after the shooting.

Neither man has a serious criminal record in Multnomah County. Court records, in fact, show just a single TriMet exclusion for each, issued on separate days in August 2011. The files list the same cell phone number (it’s not working) and a common address, the Portland Rescue Mission, at 111 W Burnside.

It was only after I made my way to the end of the dozens-strong line of Rescue Mission visitors that someone’s ears perked up. “I know them,” said a stricken-looking younger man, who gave his name as John. “They came from Seattle.”

On his way inside the mission, John offered a heartbreaking detail: He said the men weren’t just friends, but partners who were living “as husband and husband.”

“They’re my best friends,” he finished, before disappearing inside.

“Am I Scared? I Don’t Know”

It’s still unclear, publicly at least, why Joe and Allen were shot. Police, despite offering a $1,000 reward for tips (503-823-4357), are sharing precious little about what detectives have uncovered, including during their interviews with the two men.

Rhetoric at city hall and among social services providers immediately homed in on the possibility that the attack was random — a sociopathic strike against two people who did nothing more than bunk up on a sidewalk under a bridge. That fear was felt on the streets.

Less than 24 hours later, a block east of the shooting, a man named Tim was propped up in a lawn chair keeping watch on three blanket-swaddled companions, one of them a pregnant woman. It was a gritty vigil, with trains lurching past a few blocks away, cars rumbling overhead, and rats skittering for food scraps.

“Am I scared?” he said. “I don’t know. I don’t know if I can get any sleep. Being out here like this, I don’t want someone to roll up and go pow-pow-pow-pow.”

Since then, reactions have grown more measured. But the emphasis on vulnerability remains.

“In terms of this specific incident, we don’t have a good idea yet of what was happening there. But we do know that people sleeping on the streets take a variety of different risks,” says Marc Jolin of JOIN, an agency that works to link homeless Portlanders with services and housing. “Violence, theft, assault. That is not uncommon. We get reports from folks of the violence they experience at the hands of partners on the street, and verbal and physical assaults… from strangers.”

The 2011 street count found more than 1,700 people sleeping outside, and a few thousand more in emergency shelters. The Portland Police Bureau does not directly track how many reports each year involve someone who’s considered homeless. Nor does the bureau track cases in which violence seems to be motivated solely because a victim is homeless. Multnomah County, alongside Street Roots, is currently trying to put a number on how many homeless Portlanders die on the streets — of natural causes and otherwise.

The National Coalition for the Homeless, however, has tracked a modest increase in hate-crime-like attacks against Oregon’s homeless in recent years. Overall, from 1999 to 2009, it counted 37 attacks, 10 of them fatal.

But some attacks never lead to a report. Not that they don’t hurt. The same night Joe and Allen were turned away from R2D2 — Fat Tuesday — drunks walking by couldn’t resist pounding on the site’s walls or shouting insults, says one of the men keeping watch that night, Dale Ardway.

Inside the Machine

The plight of Right 2 Dream Too — founded in October 2011 by the same organizers behind Dignity Village out by the airport — has added new electricity to the fight against Portland’s camping ban.

And because it sits on private land, hosted by a landlord who’s partially trying to jab a finger in the city’s eye, R2D2 has had time to show off its success. Cops in the area appreciate the eyes on the street. Neighbors, looking past the fact that the site sits under the Chinatown Gate, appreciate the quiet respect R2D2′s residents have for the area.

The place runs like a machine, with security patrols around downtown, governing meetings, ample storehouses of tools, blankets, and food, and strict rules against intoxication and violence. It’s given hope and offered a model for how to cheaply, if still imperfectly, help people in need at a time when government coffers are starving just as much. R2D2 takes couples and pets and undocumented immigrants, and asks few questions — something the shelters in town don’t always do.

And yet the city has declared the place an unpermitted recreational campground — and is bombarding its landlord with massive fines that could drive it out of existence. Getting a permit, and adding facilities like a sewer line to get legal, are too expensive for volunteers who rely on donations to pay for steady bills like laundry, electricity, and porta-potty service.

“We provide walls. We provide security, and they want to charge us money for something they should be doing,” says Ibrahim Mubarak, an R2D2 spokesman and founder.

Mubarak says close to 600 people passed through the site from February 1-15, and that security has to kindly refuse, on some nights, up to 20 people. Nearly a dozen inhabitants have found more permanent housing, he says, and dozens more have used the respite to find work.

They’re raising money, dreaming of a bigger lot downtown, close to social services—and pleading with city hall.

“If they close us down, where are these people going to go?” asks Mubarak. “What sidewalk can they sleep on?”

A Chill From City Hall

Reaction from Portland City Hall has so far been frigid. Commissioner Dan Saltzman, who runs the city bureau in charge of code enforcement, has steadfastly refused to waive any fines. In fact, his office says, they’re considering whether to ask a city hearings officer for permission to dramatically increase the $641 monthly fine in coming months.

At one point there was hope among organizers that Commissioner Amanda Fritz might broker a compromise — she showed up at a march in support of the site — but that talk has since fizzled.

Portland’s housing commissioner, Nick Fish, also has been quiet about the site. In the aftermath of the shooting, he issued a statement lashing out at the attack, but it was criticized by some advocates for not being more vocally supportive of R2D2.

“The city is making progress in its effort to end homelessness,” he wrote. “The opening of Bud Clark Commons is but one notable example. This shameful criminal act reminds us that everyone in our community deserves a safe and decent place to call home.”

The Commons, which wouldn’t be here without Fish, has been a godsend — for some. It has a day center that’s helped thousands since June 2011, but its shelter has room for only 90 men at a time, and its 130 apartments for the chronically homeless are already full (and they also allow substance abuse). Then there’s the cost: $47 million, making it hardly replicable.

If Fish is sympathetic to R2D2′s model, he’s keeping his cards very close. After protesters filled his office earlier this month, he agreed to sit down with Saltzman and talk about R2D2 — nothing more.

In his favor, last December Fish did push the council (over the clamor of the Portland Business Alliance) into backing a car-camping pilot program that could, one day, be stretched to include a site like R2D2. Under his plan, churches and nonprofits would be able to host as many as four cars, with a written agreement from Saltzman’s office directing code enforcers to turn a blind eye.

A dozen or so churches have expressed interest, and the Portland Housing Bureau is expected to release specific guidelines as soon as this week.

But when asked about R2D2 the day after Joe and Allen’s shooting — after the Mercury first reported the men had stayed there — Fish walked very carefully.

Instead, he said the shooting of Joe and Allen was a chance to rally against looming city budget cuts that might threaten millions in cash for things like short-term rent assistance, more social services, and more brick-and-mortar housing.

“I want to know what the options are at this site first,” he says. “You know there’s not support on this council for the wholesale relaxation of the camping ordinance, even though as practical matter we don’t always enforce it.”

The fluid nature of the city’s camping ban — a term of art some of its lawyers disagree with — is glaringly obvious down under the Morrison and Hawthorne Bridges, where some people prop up tarps and other structures that offer more cover than mere bedrolls.

It’s up to officers, right now, to decide when to enforce city rules against tents and sidewalk sleeping. One officer’s wishes on one night may not be the same as another cop’s on another night. Just like violence, that murkiness is another fact of life for Portlanders on the streets.

And whatever settlement emerges from court may not make that any clearer.

A previous attempt at an agreement would have allowed small tent clusters. The latest version, last time the city discussed it on the record, was expected to include only changes in training and enforcement, but not any exemptions.

“There’s no ban in town. It’s happening. It’s tolerated,” says David Woboril, a deputy city attorney who handles police issues and isn’t working on the settlement. “But the city has to manage it.”

Woboril and Fish both said the city worries that large camps won’t always be as well run as R2D2 — and will cost the city resources to keep the peace.

“Large camps have a victim problem,” Woboril says. “That’s always the question: Can you do it on a large scale?”

The folks at R2D2 say they, at least, have earned the right to keep trying. Mubarak says activists from California and cities across Oregon have come around to take notes. Cities don’t have to spend big, he says, or surrender the rule of law to let homeless residents help themselves.

Joe Green, R2D2′s main security volunteer, was thinking about all the other homeless Portlanders who could’ve wound up like Joe and Allen.

“Without us,” he said, “there’d be a whole lot more lives at stake.”

The Mercury’s Sarah Mirk contributed to this report.
Photos by Daniel Cronin


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Iowa Senator’s Letter to Oregon Hits Hot-Button Issue: Child Psychiatrist’s Prescribing Rate

Posted by admin2 on 2nd March 2012

By Nick Budnick, The Oregonian, Friday, March 02, 2012

Abilify header_logo

Psychiatrist Curt Sturos tends to troubled kids in southern Oregon and considers himself part of a growing awareness that mental health drugs may be overused.

So it was a surprise to find himself exhibit A in a recent letter from a powerful U.S. Senator, demanding to know what Oregon is doing to crack down on doctors who overprescribe.

State Medicaid records show Sturos authorized more of the mental health drug Abilify for the last three years than any other Oregon doctor. A letter to the Oregon Health Authority from Sen. Chuck Grassley, R-Iowa, who wants to curb Medicaid spending nationwide, called the rate “shocking.”

While Sturos calls the letter unfair, and an Oregon Health Authority review found nothing wrong, his situation shows how psychiatrists and other doctors face increasing scrutiny of their prescribing, particularly when it comes to children. Yet doctors in Oregon say the state lacks options beyond drugs to treat severely troubled children.

Ajit Jetmalani, M.D.

Ajit Jetmalani, M.D.

Young brains are considered more vulnerable and few drug safety studies exist due to ethical concerns about testing children, said Dr. Ajit Jetmalani, director of the Oregon Health & Science University’s Child Psychiatry Program. He also believes the mental health system needs more non-drug alternatives.

“If we’re all expecting medical providers to write prescriptions – and are not willing to invest in alternatives – then we’re going to get more prescriptions,” he said. “I think that is a duty of medical providers to push back.”

Pushing Begins

Earlier this week, the American Academy of Child and Adolescent Psychiatry issued cautious new prescribing guidelines for child welfare agencies. And a December federal report found that foster kids in five states, including Oregon, were more likely to be prescribed psychiatric medication — including at levels not considered safe.

Sturos cares for 250-300 People — about 200 are children or teens, he said. Many are foster kids and autistic with significant behavioral problems. He favors Abilify, a drug the Food and Drug Administration has approved for children 10 and above with bipolar disorder and other mental health conditions, because of fewer side effects than comparable drugs, including less weight gain.

In 2009, Sturos wrote 1,104 prescriptions costing Oregon’s Medicaid program $457,335, nearly twice the next highest prescriber, records show. In 2010 he wrote more than 1,000 compared to 666 for No. 2. In 2011, his total grew to 1,243 prescriptions, though Sturos says some of these were written to help a colleague in training.

“On a weekly basis I am working with our teams to try to provide the best access to non-medication treatments for kids with various conditions such as depression, schizophrenia, PTSD, bipolar disorder,” he said.

Prompted by Grassley’s letter – versions of which went to other states – the Oregon Health Authority in January reviewed Sturos’ numbers. “We do not feel this doctor’s prescribing practices are out of line,” wrote Tom Burns, director of pharmaceutical programs for the Oregon Health Authority, in a Feb. 9 reply.

Little Tested

Last year, Harvard researchers evaluating the scientific evidence for long-term use of Abilify for bipolar disorder essentially found only one clinical trial met scientific standards but a design flaw may have made the drug appear more effective.

“Frankly, I think it’s an embarrassment to the profession that (Abilify) has been accepted so uncritically for this indication,” one of the professors told CNN.

Terry Lee, an instructor at the University of Washington, treats kids in the state’s foster care and the juvenile justice systems. He often weans his less-troubled kids off Abilify and other medications, finding psychotherapy, anger management and social skills training is what’s needed. “They lose weight, they report feeling more alert, more awake and less sedated,” he said.

Similarly, psychologist Peter Sprengelmeyer says children often improve with scaled-back medications.

“I think sometimes what we’re doing is medicating for a chaotic environment,” says Sprengelmeyer, who heads OSLC Community Programs, a Eugene nonprofit that provides mental health care to kids in foster homes and the juvenile justice system.

Other states do more than Oregon to oversee prescribing to kids, experts say.

In Illinois, for instance, youths in foster care or state custody receive an independent medication review by a state psychiatrist, and the drugs’ effects are tracked over time, says Dr. Michael Naylor, who heads the program. He says medication should be only part of treatment — but qualified people to provide psychotherapy for kids are hard to find.

Jetmalani of OHSU says good things are happening in Oregon, including a new hotline to help primary care physicians make better prescribing decisions for children. And state health reform could result in a better, team-based approach to children’s mental health.

Meanwhile, though Sturos was supported by the state, his prescribing practices are now being reviewed by Jefferson Behavioral Health, which manages prescribing practices for Jackson County and several others. Sturos says it’s good to ask questions, and he has nothing to hide.

“If Senator Grassley or any state officials wish to come and look at the details of what we’re doing I’d be happy to show them,” he says.


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