Thank you. We need credible voices raised and yours is essential, not only for the addicts themselves, but for the salvation of Portland. Tough love. This problem will not fix itself
Thank you and finally we are starting to see a shift in Portland's approach to these severe illnesses, usually products of both choice and disease. In 1740's England, the gin craze as it is called, has applicability to what we are seeing here in Portland. Over 100,000 people relied primarily upon gin for sustenance and there were many deaths including children. People were given simple jail time for public intoxication. Not only is this a humanitarian crisis for those who are severely ill, it is a crisis for other city dwellers whose neighborhoods are degraded causing deteriorating commercial real estate values, deteriorating property values particularly in neighborhoods experiencing this out their windows, and causing businesses to flee. What Portland is experiencing is a public emergency and it should be treated as such.
Two to six weeks in a psychiatric ward in a local general hospital can accomplish detox and also pick up the occasional circumstance of additional psychiatric illness or medical illness, that contributes to addiction. The general medical community and psychiatrists as well are reluctant to get involved in helping these unfortunate individuals, in part because of stigma related to mental disorders in general, but also because they are very complicated and difficult. Much more so than your average, mentally reasonably competent individual. After a few weeks of sobriety though, a different healthy person will emerge. It takes time both for the physical withdrawal to subside, and for the psychological issues to be dealt with.
Portland is wasting time by avoiding your plan and instead promoting a version of warehousing for those with severe illnesses that are left untreated. Gradually the city is coming around to the practical, humane, and reasonable approach that you are introducing. The overwhelming focus for decades on the right to refuse care, when one's health is obviously severely degraded by self-destructive behaviors, will be looked upon harshly by historians. Portland is finally realizing that their passive approach to mental health care has created this public emergency.
I thank Dick Perkins for his vivid description of the real experience of fentanyl addiction. In the old days, It was against the law to be under the influence of illegal drugs . Police officers could quickly and efficiently take these distressed people off the streets. Jails need not be ugly, onerous vicious places. Good medical staff and well trained personnel could work to humanely treat addicts. Criminal convictions could be pardoned or expunged after sobriety is achieved. Mr. Perkins recommendation for a Civil Commitment process would be time consuming and procedurally complex. Additionally , individuals may not have the benefit of the court appointed attorney required in all criminal matters. And after the adjudication that an individual should undergo a civil commitment, who will remove that person to a locked facility?
I agree that jails have medical staff, and can increase staffing, that can handle people with addictions and other medical illnesses. The law established by California v. Robinson, did away with making it a crime to be an addict. That legal decision has hampered the ability of law enforcement to combat drug epidemics. I think people have underestimated the severity of addiction. Community epidemics, much like infectious diseases, have taken the lives of many. Whether jail, civil commitment or both, we can both agree that people with severe addiction require containment, some place where they can't get their hands on drugs and need close medical monitoring during detox. Many on the streets need significant medical attention that would best be managed in a hospital at least for the initial period. Of course, it is always best if people choose to get treatment, but the consequences of their not choosing to deal with their impairments from drugs or psychiatric illness, has societal consequences which require more of our communities than we are currently providing.
So well written! Thank you for so clearly articulating exactly what the problem is and how we are NOT even beginning to address this issue in Portlandia.
Excellent analysis and plan. I would add one concept: reconnect the pleasure to the inevitable pain of actual withdrawal. Stop medicalizing a personal, moral failure. Mandatory detox, no meds, just medical on standby to assure no real harm...( I am a doc) If Popeye Doyle can do it...
Thank you, Paul for bringing this up. I am also a recovering heroin addict and detox myself cold turkey in the shelter floor of CityTeam Portland, no meds, just pure support around me 24 hours a day. The pain of that detox without comfort meds is one of the key drivers and we never going back to my drug of choice. I fear that the overuse of comfort meds, such as methadone, Suboxone, etc., deter a person from staying on the recovery path. Now many will say this is inhumane and that these drugs work very well, I have always been skeptical due to my own experience. I think there is a place in the continuum of care for MAT – medical assisted treatment – but the cold turkey method is extremely effective!
Thank you. We need credible voices raised and yours is essential, not only for the addicts themselves, but for the salvation of Portland. Tough love. This problem will not fix itself
Thank you and finally we are starting to see a shift in Portland's approach to these severe illnesses, usually products of both choice and disease. In 1740's England, the gin craze as it is called, has applicability to what we are seeing here in Portland. Over 100,000 people relied primarily upon gin for sustenance and there were many deaths including children. People were given simple jail time for public intoxication. Not only is this a humanitarian crisis for those who are severely ill, it is a crisis for other city dwellers whose neighborhoods are degraded causing deteriorating commercial real estate values, deteriorating property values particularly in neighborhoods experiencing this out their windows, and causing businesses to flee. What Portland is experiencing is a public emergency and it should be treated as such.
Two to six weeks in a psychiatric ward in a local general hospital can accomplish detox and also pick up the occasional circumstance of additional psychiatric illness or medical illness, that contributes to addiction. The general medical community and psychiatrists as well are reluctant to get involved in helping these unfortunate individuals, in part because of stigma related to mental disorders in general, but also because they are very complicated and difficult. Much more so than your average, mentally reasonably competent individual. After a few weeks of sobriety though, a different healthy person will emerge. It takes time both for the physical withdrawal to subside, and for the psychological issues to be dealt with.
Portland is wasting time by avoiding your plan and instead promoting a version of warehousing for those with severe illnesses that are left untreated. Gradually the city is coming around to the practical, humane, and reasonable approach that you are introducing. The overwhelming focus for decades on the right to refuse care, when one's health is obviously severely degraded by self-destructive behaviors, will be looked upon harshly by historians. Portland is finally realizing that their passive approach to mental health care has created this public emergency.
I thank Dick Perkins for his vivid description of the real experience of fentanyl addiction. In the old days, It was against the law to be under the influence of illegal drugs . Police officers could quickly and efficiently take these distressed people off the streets. Jails need not be ugly, onerous vicious places. Good medical staff and well trained personnel could work to humanely treat addicts. Criminal convictions could be pardoned or expunged after sobriety is achieved. Mr. Perkins recommendation for a Civil Commitment process would be time consuming and procedurally complex. Additionally , individuals may not have the benefit of the court appointed attorney required in all criminal matters. And after the adjudication that an individual should undergo a civil commitment, who will remove that person to a locked facility?
I agree that jails have medical staff, and can increase staffing, that can handle people with addictions and other medical illnesses. The law established by California v. Robinson, did away with making it a crime to be an addict. That legal decision has hampered the ability of law enforcement to combat drug epidemics. I think people have underestimated the severity of addiction. Community epidemics, much like infectious diseases, have taken the lives of many. Whether jail, civil commitment or both, we can both agree that people with severe addiction require containment, some place where they can't get their hands on drugs and need close medical monitoring during detox. Many on the streets need significant medical attention that would best be managed in a hospital at least for the initial period. Of course, it is always best if people choose to get treatment, but the consequences of their not choosing to deal with their impairments from drugs or psychiatric illness, has societal consequences which require more of our communities than we are currently providing.
So well written! Thank you for so clearly articulating exactly what the problem is and how we are NOT even beginning to address this issue in Portlandia.
Excellent analysis and plan. I would add one concept: reconnect the pleasure to the inevitable pain of actual withdrawal. Stop medicalizing a personal, moral failure. Mandatory detox, no meds, just medical on standby to assure no real harm...( I am a doc) If Popeye Doyle can do it...
Thank you, Paul for bringing this up. I am also a recovering heroin addict and detox myself cold turkey in the shelter floor of CityTeam Portland, no meds, just pure support around me 24 hours a day. The pain of that detox without comfort meds is one of the key drivers and we never going back to my drug of choice. I fear that the overuse of comfort meds, such as methadone, Suboxone, etc., deter a person from staying on the recovery path. Now many will say this is inhumane and that these drugs work very well, I have always been skeptical due to my own experience. I think there is a place in the continuum of care for MAT – medical assisted treatment – but the cold turkey method is extremely effective!