People seeking help for drug addiction in Clatsop County lack access to residential drug treatment options.

 

Rebecca Sarpola’s journey to recovery began on a Greyhound bus headed 250 miles away from home.

Sarpola, who has lived in Clatsop County her entire life, had never sought professional help for drug addiction before. Nearing the end of a suspended sentence, she’d been given terms for probation: get treatment, or return to jail. She remembers the day well.

That morning, she walked through the doors of the Clatsop County Jail at 7 a.m., and within a few hours, found herself waiting for a bus in Portland. Standing alone in a cold, bare corner of the station, she felt a twist of anxiety rush over her.

It would be easy to run. After all, she didn’t have anyone to tell her what to do or where to go. She knew plenty of people she could get drugs from in Portland if she wanted to.

As the bus approached, she had to make a decision.

“In that moment, I had the choice to either go get on the bus or not get on the bus,” she said.

Sarpola climbed on board.

Hours later, the bus stopped again in Grants Pass. In the waning daylight, she got off and lugged her suitcase down the road to the closest gas station, where she eventually managed to get a ride from a stranger to the treatment center.

Like many Oregonians seeking drug treatment, Sarpola wasn’t hoping to travel hundreds of miles from home. Ideally, she would have stayed in Clatsop County and gone to a local facility that took her public insurance. The only problem is, that facility didn’t exist.

Over the past several years, The Astorian has documented how the lack of options for drug treatment on the North Coast have created obstacles to recovery and contributed to a range of problems, from crime and crisis response to mental health and homelessness.

In 2017, The Astorian reported that there were no local medical detox options for people going through withdrawal from chronic drug or alcohol abuse. In 2021, the newspaper detailed how Clatsop County had only two residential facilities for treatment of substance use disorder, neither of which accepted the Oregon Health Plan.

Today, little has changed, despite a rising need for services.

Following the state Legislature’s reversal of Oregon’s landmark drug decriminalization law, lawmakers have emphasized a desire to focus on treatment over jail time, but doubts remain about whether communities will have the resources necessary to do so or whether the same patterns will repeat.

‘Overdose is just part of use now’

In Oregon, fatal drug overdoses have skyrocketed.

According to a report released in January by the Oregon Health Authority, the state recorded 280 unintentional opioid deaths in 2019. By 2022, that number had more than tripled — and although the agency is still compiling data for 2023, the numbers appear to be following a similar upward trend.

Official fatal overdose counts have been slightly more stable in Clatsop County — hovering around 30 a year over the last five years — but because the data is based largely on hospital emergency room visits, it doesn’t necessarily give a full picture. Unreported overdoses likely put the numbers higher.

“What we’re hearing and seeing is really, the unhoused community are wanting to be prepared because they’re really saving each other,” said Trista Boudon, recovery services program assistant manager at Clatsop Behavioral Healthcare, the county’s mental health and substance abuse treatment provider. “And these are going to be the overdoses that are not reported, where they’re saving each other, bringing each other back, and they don’t want to call emergency services because it was reversed — the person lived, all is well. But it’s expected.”

Boudon attributes many of the region’s mounting overdoses to the introduction of fentanyl.

Just a couple of years ago, heroin was a much more likely cause of overdose on the North Coast, but now, they’re seeing practically none of it at all. The shift started with para-fluorofentanyl, which is 30 times stronger than morphine. Then came fentanyl, which is 100 times stronger than morphine. Boudon said they’re even starting to see some carfentanil creep onto the scene.

Carfentanil is 10,000 times stronger than morphine.

Higher potency means higher risk of overdose. It also means higher resistance to naloxone. A regular kit of naloxone contains two 2-milligram doses, but Boudon said in some cases that’s no longer cutting it. Now, the team consistently brings at least 15 kits — each containing two 8-milligram doses — out into the community with them each week.

With fentanyl, overdose becomes a question not of if, but when. Rick Martinez, recovery services program manager at Clatsop Behavioral Healthcare, said all of the people their team has met with who have used fentanyl have reported at least one overdose.

“We’re mainly learning that overdose is just part of use now,” he said.

‘Everybody is somebody’s son or daughter’

For April Mckay, the overdose epidemic is personal. Her son, who had struggled with methamphetamine use in Clatsop County for years, recently was found dead in Seaside.

“Everybody is somebody’s son or daughter,” she said. “I mean, he was a beautiful person that made some bad choices in life, but we’ve got to help these people more when they do want to make the right choice.”

Mckay said she wishes there were more resources available for those navigating homelessness and substance use disorder — but in the face of rising overdoses, that’s an uphill battle.

“Everything we do, we’re doing to try to prevent future deaths and suffering. And no matter what we do, it almost never feels like enough,” said Amy Baker, Clatsop Behavioral Healthcare’s executive director.

Access to residential treatment is by far the North Coast’s biggest challenge, Baker said.

In January, the Oregon Health Authority released a draft report on residential behavioral health facilities. According to estimates in the report, the state would need roughly 3,000 more inpatient treatment beds to meet projected needs, including at least 1,156 beds specifically for substance use disorder. Adding those substance use disorder treatment beds would cost upward of $320 million.

Clatsop County has two residential facilities that provide substance use disorder treatment and accept private health insurance: Virtue at the Pointe Recovery Center, a 38-bed facility in Astoria that focuses mostly on veterans, and Awakenings by the Sea, an 18-bed facility in Seaside that offers services for women. While that’s more than some counties have to offer, it still leaves gaps for people on public insurance like the Oregon Health Plan, or who have no insurance at all.

“It is a glaring hole in our community,” Baker said. “It’s a glaring hole across the state, honestly.”

Baker said detox facilities, where patients typically spend five or six nights to initially get sober, can be a helpful first step for recovery, but they often aren’t what people need for long-term abstinence. In fact, a person’s risk of overdose actually increases if they go from not using to using again after detox. The key is to have somewhere to transition to.

On the North Coast, that’s no easy task.

For those serving a prison sentence, terms of parole often require that a person remain in the county that they’re from, which can effectively take treatment off the table if the area doesn’t have a local facility. But even when a referral outside of the county is possible, treatment isn’t always guaranteed.

Martinez said waitlists for facilities outside the county are long, and the list of options becomes even shorter for people with co-occurring physical or mental health concerns.

Often, facilities don’t even have an estimate for how long it will take to get someone into treatment.

“When there’s like no light at the end of the tunnel, that’s pretty discouraging,” he said. “I can’t even instill hope in the clients because I can’t say, ‘Hey, give me two weeks and we can get you in somewhere.’ I mean, I’m literally saying, you know, it could be three months, or I can’t even guess when you might be able to get in anywhere.”

Sarpola’s experience is one example of the lengths a person might go to access treatment. Even for detox, she said, she had to travel two hours away to find a clinic that would take her. Choosing to get help wasn’t easy, and the added complication of waiting on a bed and arranging transportation only made it more difficult.

“It’s really hard when you’re stuck in addiction, because you get stuck, literally — like you want to change, but you’re a slave to the drug,” Sarpola said. “For somebody who’s trying to get sober, but doing drugs and trying to get into a detox, it’s really hard between that time that you’re thinking about it to get there, because you have to call the detox sometimes like three or four days in a row.”

Generally, the first 24 to 48 hours after a person decides to get treatment are a critical window for connecting with resources. Boudon said when clients at Clatsop Behavioral Healthcare want to start treatment, staff quickly get to making phone calls — but too often, the answer they hear is “no.”

Sometimes it’s a hard “no.” Other times, it’s a milelong waitlist with instructions to call every day, or every other day, or only from 8 to 10 a.m.

A person can only hear “no” so many times before the momentum starts to wear away.

“Probably the most devastating point is when you have someone that says, ‘I think I’m ready.’ In that exact moment, what they’re expressing is complete and utter hopelessness of continuing to stay the same,” Boudon said. “What they’re … admitting to is that that fear and that pain of staying the same is bigger than their fear and that pain of change. They’re ready for change, because they know if they keep doing what they’re doing, they’re going to die.”

‘A pretty big hurdle for rural counties’

In March, the Legislature passed House Bill 4002, recriminalizing possession of small amounts of illicit drugs after a three-year experiment with decriminalization.

A core focus of both decriminalization and recriminalization has been treatment. In coordination with HB 4002, the Legislature allocated roughly $211 million in funding for addiction-related services, treatment and programs and gave counties the option to develop grant-funded deflection programs to help steer people into treatment. Whether counties’ behavioral health infrastructure will be able to support those programs, however, is unclear.

Clatsop County is just beginning to develop its deflection program. At this point, County Manager Don Bohn said the county still wouldn’t have any local facilities to send participants on public insurance if the program were to involve inpatient treatment.

He sees that gap as part of a larger issue with the way rural counties are funded.

In Oregon, service providers are largely funded by the state. Bohn said in any county, whether it has 40,000 people or close to a million, it costs the same amount of money to get the first treatment bed — and as it turns out, that amount is pretty high. According to the Oregon Health Authority’s January draft report, the average development cost for a residential substance use disorder or withdrawal management facility is more than $6.5 million, and the average cost per bed is around $285,000.

“Certainly the reimbursement rates from the state have to be sufficient for the providers to actually provide the service, but a barrier to creating the infrastructure is the fact that the state funding right now for rural counties just is not sufficient to create the first bed,” Bohn said. “And there’ll be creative discussions with local partners and with the state about how we might be able to get over that hurdle, but it’s a pretty big hurdle for rural counties.”

While the county isn’t responsible for providing direct services, it does act as a facilitator by distributing state funds to local providers. To establish local residential treatment beds, Bohn said the state would have to make it a priority. That type of investment can’t happen overnight, though.

“It’s gonna take millions of dollars to build this capacity over time,” said Dr. Sejal Hathi, the new director of the Oregon Health Authority. “I think that what I would encourage counties to think more about is how can we prevent folks from needing that level of care in the first place? How can we invest in education and awareness-building in schools and among parents and families to prevent individuals from developing substance use disorders and to mitigate substance misuse as soon as it’s noticed?

“Because the reality is that some of these inpatient beds are just going to take a while to get up and running.”

Bohn sees prevention and education as important parts of the county’s role. The county’s health promotions team, for example, focuses on community health through a range of projects, including networking with local school districts. But prevention and education aren’t a substitute for timely, accessible treatment services.

“I don’t think it’s just direct service,” Bohn said. “But if you’re in crisis, it is about direct services. And if you’re a family that has a family member in crisis, it’s about direct services — it’s how do you access the services that your loved one needs?”

‘You have to want to change’

In some ways, Sarpola said she sees Clatsop County as a dead end.

“People will go in and out of jail, in and out of jail, and not want to change,” Sarpola said. “So you have to want to change, and it’s hard when we don’t have resources for recovery out here, really.”

Among other things, she wishes she saw greater access to treatment, transportation to treatment and sober living. Gradually, the state is taking steps to help make some of those changes.

Over the last few years, Hathi said the state has funneled nearly $1.5 billion toward behavioral health resources. It’s also identified $87 million for shovel-ready projects, and recently finished a 90-day sprint of listening sessions revolving around responding to overdoses and expanding access to naloxone.

On a local level, funds appropriated through Measure 110 — the drug decriminalization law — have also given service providers in Clatsop County a boost.

Measure 110 set aside grant funding for local Behavioral Health Resource Networks, including nearly $6.2 million for Clatsop County’s network. The network includes Clatsop Behavioral Healthcare, Clatsop Community Action, the Clatsop County Public Health Department, Helping Hands Reentry Outreach Centers, Iron Tribe Network, Morrison Child and Family Services and Providence Seaside Hospital Foundation. Funds have supported a range of projects, including housing, harm reduction and a new medication-assisted treatment program at the Clatsop County Jail, where adults in custody can access counseling through Clatsop Behavioral Healthcare.

Funding is only part of the solution, though. Baker said she also sees a systemic flaw in the way treatment is set up to begin with, which often divorces substance use disorder from other behavioral health issues and makes it difficult for people to get the full scope of care they need.

“If this state were serious about solving this problem, we would re-look at what the treatment model needs to look like, and then design it and then figure out how to pay for it rather than continuing to use kind of our outdated models and expectations and hoping that somehow or another, it’s going to fit this fentanyl homelessness crisis that we’re in right now,” she said.

Hathi feels similarly.

“I think one of the challenges historically has been that we fragment both our narratives around and our financing systems for treating and facilitating treatment for substance use disorders versus mental health disorders,” she said. “So I want to kind of view it as one and the same and make sure that we’re not neglecting people with co-occurring disorders, which, too often, I think those policies, narratives and ideologies therefore do.”

Hathi sees the path forward as an all-of-society effort. That means investing in infrastructure like staff and treatment beds, but also bridging gaps in the full continuum of care and equitably promoting mental health and well-being. It means making sure people have food, shelter and social services — all the things that give them the best chance possible of staying sober.

Mckay, who watched her son experience both drug addiction and homelessness, is ready to see a change, too.

“If there was a place when they did want that help to go and start the ball rolling, it might not change everybody, but … even if it was 1 out of 100, it would be worth it,” she said.