By Tanner Aliff. For The Register-Guard, March 6, 2021
It took a while for me to get used to the screaming of handcuffed patients spastically yelling murderous threats at their police escorts as they wheeled them through the emergency room. It didn’t faze the veteran nurses — probably didn’t even crack their top 50 memorable moments on the job. But as an intern mental observer at the time, seeing the same Medicaid-covered patients time after time failing to get treated for substance abuse made a deep impression on me.
It’s the reason I doubt that Oregon’s recently passed Measure 110, which lessens the penalty for possession of illegal drugs, will do much good for anyone struggling with addiction.
In this era of astronomical health care costs, a reliable safety net to catch those less fortunate is crucial to protect human dignity. But all health providers, cities and states need to recognize how easily negligence can make those safety nets fund cyclic suffering. When that happens, the results aren’t pretty.
Take it from a guy who once cared for the mentally ill.
The hospital I worked at did not have an in-patient psychiatric care facility for people like this. And since it could not be definitively determined that such accidents presented a future risk for self-harm, nor could the patients be declared a threat to others, they would usually just get sobered up and referred to an out-of-town outpatient program.
This created two problems. One, the outpatient programs require the willing participation of a person struggling with addiction with no incentive to face the hardship of overcoming withdrawal. Two, many patients struggling with substance abuse were often low-income and didn’t have access to transportation to commute to an out-of-town facility.
As a result, I would see the same patients in the emergency department multiple times a month.
The icing on the cake: These patients were usually enrolled in the Oregon Health Plan. That means taxpayers were repeatedly, according to a 2018 Oregon Health Authority report, paying a median cost of $13,000 per hospitalization just for people struggling with addiction to miss out on direly needed psychiatric care, and once again be in a position to spin the revolving door of recrudescence.
My internship was just a glimpse into Oregon’s horrific history of struggling to combat addiction, recidivism and public health inefficiency. Considering that in 2017, Oregon’s spending on substance-related services quadrupled to $6.7 billion (16.84% of the state budget), with only 1% being spent on preventive measures, it is no wonder the Oregon Legislature took a radical approach to create a solution, this according to the 2020-2025 Oregon Statewide Strategic Plan for the Alcohol and Drug Policy Commission.
When a state reaches a ratio where 1 in 10 citizens are diagnosed with Substance Use Disorder (based on a 2017 Oregon Substance Use Disorder Research Committee report) and an average of five citizens die weekly from an opioid overdose, according to the Oregon Health Authority, it’s time for a change.
On the surface, Measure 110 seems innovative. Using the revenue generated from marijuana taxes to create free rehabilitation centers that address underlying psychological factors of addiction is a step in the right direction. But it’s foolish to expect people struggling with addiction to choose rehabilitation over paying a meager $100 Class E violation.
Sure, homeless populations, which tend to have issues with substance abuse, may be incentivized to opt for rehab over a $100 fine, but for many middle-class families and working-class adults, $100 is hardly a dent in their wallets — a cheap escape from having to deal with ongoing or developing addiction.
Instead of creating a critical intervention moment where people have to choose between life-altering criminal charges or rehab, they can now pay a fine and go back into the world without having taken any action to fight or prevent addiction.
If proponents still want to refuse pressing criminal charges for possession, they should at least raise the fine to $2,000 or more.
When I first heard of Measure 110, I was hopeful that it would staunch the flow of screaming patients in the emergency department and that taxpayers would be able to breathe a sigh of relief knowing their contributions mattered.
Unfortunately, unless Measure 110 is changed, I think this bold new approach will be of little effect. Not much will change for ER nurses, as overdosing patients will remain a common sight on the job.
In order for Measure 110 to elicit decreases in addiction and substance-use spending, the rehab option needs to be the go-to choice over the fine.
Tanner Aliff is a Portland-based Young Voices associate contributor.