A patient shows a drawing she made at Bridge to Pathways detox center in St. Helens.

Doctors and nurses at Columbia Memorial Hospital can treat acute conditions and symptoms of chronic drug or alcohol abuse, but patients who need to go through the painful withdrawal of detoxification get a card with a list of local rehabilitation facilities.

The closest medical detox center on the list is in St. Helens, 66 miles away in Columbia County.

The lack of local detox options can be an obstacle to recovery, a gap in the health care network that can keep people — especially those on public insurance and the uninsured — trapped in addiction.

At a Clatsop County Board of Commissioners meeting in December, Commissioner Lianne Thompson asked Amy Baker, the executive director of Clatsop Behavioral Healthcare, to describe an unmet need. Baker’s thought was detox.

“Outpatient services for substance abuse can be really effective, but if somebody’s got dependency, they’ve got to get clean and sober first in order for those services to really work,” she said in an interview.

Baker suspects a fair number of people end up doing detox in jail or at hospitals, but that is not the same as medically supervised withdrawal with specialists who understand the process. “It is pretty much St. Helens, programs in Portland, or people end up doing it on their own,” she said.

A community health assessment released in 2014 ranked obesity, mental health and substance abuse as Clatsop County’s health priorities.

Data from the Robert Wood Johnson Foundation show that 21 percent in Clatsop County report binge or heavy drinking, compared to 19 percent across Oregon. The Oregon Health Authority put hospitalizations for drug overdoses in the county at 39.6 per 100,000 between 2010 and 2014, about the same as Columbia County but lower than Tillamook County and urban Multnomah County.

Baker, who moved to the North Coast last June to take over Clatsop Behavioral Healthcare, the county’s mental health contractor, said her outsider’s perspective is that substance abuse and addiction are significant concerns. Opioid abuse, in particular, is prevalent, part of a national spike in heroin and prescription painkiller use.

One of Baker’s crisis managers noted, anecdotally, that about 75 percent of the patients she assesses for mental health in hospital emergency rooms have “some sort of substance on board.”

Trece Gurrad, the vice president of patient care services at Columbia Memorial Hospital, said the issue is hard to quantify beyond her own gut feeling, since the hospital does not track whether patients who ask about or need detox eventually find help.

It was the emergency room nurses, she said, who thought it was important to have the cards with contact information for rehab and detox at their fingertips.

“It was one of their projects,” Gurrad said. “They put all that together and made a little card that we distribute for folks.”

Allison Whisenhunt, who leads care management at Providence Seaside Hospital, said the lack of access to detox is definitely a problem. She said hospitals are not set up to handle detox, even though patients who are dependent on drugs or alcohol, if they stay long enough for other medical treatment, can often go through withdrawal.

Ideally, Whisenhunt said, the county would have a facility to manage detox and would accept any payment source. “It’s really difficult,” she said. “Even when I see somebody in the emergency room who says, ‘I’m ready. I want to do this.’ We still have to call their insurance and figure out which places are accepted. And, again, they’re not usually local.

“So I think a place that was nearby, that also had open access, would be a huge first step.”

Lt. Matt Phillips, the jail commander for the Clatsop County Sheriff’s Office, said questions about detox are just a small part of a much larger issue around substance abuse.

At the County Jail, Phillips said, deputies do intake screenings and ask about substance abuse and whether an inmate believes they will experience withdrawal. “Our medical staff will monitor inmates and provide appropriate medical care during their time in custody,” he said in an email.

Like patients at hospitals, Phillips said some inmates stay long enough at the jail to fully detox. He said having a local detox option — or even a place to hold suspects until they are sober — would at times be helpful for law enforcement.

A facility “would be nice for the times when the arrest of an individual for a minor charge isn’t in the best interest of the person, the justice system or the community. An example is an extremely intoxicated person walking in the road and yelling. This behavior is dangerous to the individual, but primarily causes public annoyance or inconvenience.

“Often when the person is unwilling to change behavior, he or she is arrested on a disorderly conduct charge, and brought to the jail. The District Attorney’s Office may choose not to file charges, which really results in the misuse of the jail.”

Experts in substance abuse and addiction say people have to want to get sober for treatment to be effective. Detox can be an initial step toward recovery, but withdrawal should be followed by therapy.

The North Coast has several residential treatment centers and outpatient treatment options for substance abuse, from Astoria Pointe and Rosebriar to Klean and the North Coast Medical Clinic. Clatsop Behavioral Healthcare also provides substance abuse counseling.

Local residential treatment centers typically only take private health insurance and require pricey out-of-pocket expenses. A detox-only option is rare.

The community health assessment found that about a third of Clatsop County residents have public insurance, such as the Oregon Health Plan, the state’s version of Medicaid. People who need detox and are uninsured are urged to sign up for the Oregon Health Plan.

“There are not enough treatment facilities on the planet to treat everybody that needs it,” said Scott Ward, a regional director in California for Sunspire Health, which operates Astoria Pointe and Rosebriar.

Ward, who used to be the executive director at Astoria Pointe, said Sunspire Health refers people who are unable to get into their residential treatment programs to other providers.

For people on the Oregon Health Plan, the closest option is Bridge to Pathways, the medical detox center in St. Helens. The facility is backed by the Columbia Pacific Coordinated Care Organization, which serves Columbia, Clatsop and Tillamook counties.

Since opening in 2015, Bridge to Pathways has treated 417 patients, including 60 from Clatsop County. The detox center has around-the-clock nursing and support staff and partners with Oregon Health & Science University for medical expertise.

“The difficulty with addiction and substance abuse is that people have windows of readiness to be willing to seek treatment,” Baker said. “And if it’s really hard to get them into the services that they need, then you often lose that window of opportunity.”

Getting people from Clatsop County into a detox or residential treatment program, Baker said, can be a real challenge.

“We’re grateful that we have that,” Baker said of Bridge to Pathways. “It’s just always harder when the resource is not in your own community.”

While St. Helens is just an 80-minute drive from Astoria, she said it “feels like a much further distance than what it necessarily is.”

Clatsop County, like many other rural, geographically isolated places in Oregon, has significant gaps in medical and mental health care. Compounding the limited financial resources, the community health assessment found there is often difficulty coordinating care between hospitals, behavioral health agencies and social-service providers.

Astoria and other communities have stepped forward to help fill some of those gaps. Columbia Memorial Hospital, for example, has partnered with Oregon Health & Science University on the Knight Cancer Collaborative, which will enable patients to receive radiation therapy locally and spare them long drives to Longview, Washington, and to Portland. A crisis respite center in Warrenton — a collaboration between the county, Columbia Memorial, Providence Seaside and the regional mental health authority — can be an alternative to hospitals and jail for people with a mental health emergency.

A local detox option would likely require similar partnerships. Thompson, the county commissioner, said a community conversation on unmet mental health and substance abuse needs would be valuable.

“That’s a great place to start,” Thompson said. “Because if you have detox, you’re giving them a chance right then when they’re at a crisis point, and maybe that’ll be their bottoming out point and they’re ready to go forward and recover or gain help.”