Op-ed: Oregon’s addiction crisis is dire, but not hopeless
Oregon’s addiction crisis exceeds that of almost every other state. Two out of three Oregonians suffer from addiction or know someone who does. The problem is all around us.
Despite its pervasiveness, too few Oregonians receive treatment. Recovery remains out of reach. This is a failure of our community to help people who suffer from a medical condition.
Substance use disorder (SUD), the preferred medical term for addiction, has multiple sources, many of which are at work long before someone takes the first drink or first pill. A traumatic childhood renders adolescents at risk for acquiring an SUD by depriving them of the self-esteem, social skills, education and health care that would otherwise allow them to resist addiction when they face adult challenges. A family history of SUD and a peer community rampant with SUD compound the risk.
The result is that 1-in-15 Oregon adolescents depend on alcohol or illicit drugs, and the rate increases to 1-in-10 among adults. Those rates exceed national averages. Oregon spends billions of dollars every year on direct health care expenses, social services, and lost earnings and taxes associated with SUDs.
Meanwhile, the personal and family impacts are tremendous. Drug-related diseases, self-injury and overdose kill more Oregonians than firearms, motor vehicle accidents or any other source of trauma. More than 1,500 Oregonians die each year from the direct effects of SUD. Many times more die from medical causes exacerbated by their SUD.
Most medical providers recognize that SUDs are a chronic medical problem, but popular social attitudes are not so generous. Stigma follows SUD sufferers throughout their lives. They must hide their problem to avoid ostracism from friends, from family, from employment, from health insurance companies, from social services and from law enforcement. The all-too-common attitude that SUD is a moral failure discourages patients seeking help. Misplaced moral condemnation also discourages families and communities from offering help.
As a result, only about 10 percent of people who suffer from an SUD enter treatment. And for them, more barriers await.
Private and public insurance policies consider SUD treatment a low priority, both in benefits offered and payment for services. Treatment centers too often are isolated from primary care facilities. Many areas in rural Oregon have no SUD treatment centers at all. Patients in treatment also might lose access to future health care benefits if they suffer a relapse.
SUDs do not occur in isolation from the communities in which we live. Culturally appropriate treatment alternatives are vital and must accommodate patients from diverse races, communities and geographic locations for any chance of success. Success also depends critically on returning the patient to a better life than the one that perhaps provoked the disease in the first place.
As crucial as reforming and improving access to diverse treatment options are to help the hundreds of thousands of Oregonians who suffer from SUDs, prevention is key to changing things long term.
The most successful prevention opportunities occur in childhood with social services that provide relief to families that struggle to provide a safe upbringing for their children. Children who grow up healthy, educated and able to deal with adult stress are less likely to acquire an SUD.
The Oregon Substance Use Disorder Research Committee spent almost a year interviewing experts and reviewing the medical and social literature to understand these issues. Our report “Substance Use Disorders in Oregon – Prevention, Treatment & Recovery” offers evidence-based, attainable recommendations for Oregon to improve how we address the SUD epidemic.
The recommendations include prevention efforts, especially targeting children, as well as changes to our social services, health care insurance, physician practice and criminal justice systems. These interventions require sustained attention from the governor, the Legislature and all Oregonians.
The cost of prevention, treatment and long-term recovery is far less than the cost of letting our friends, family and neighbors with SUDs continue to harm themselves and others. A successful response to our SUD epidemic means a long term investment in our future.
Brief bio: Samuel Metz, MD is a retired Portland physician. He is co-chair of the Oregon Substance Use Disorder Research Committee and corresponding author of its report, “Substance Use Disorder – Improving Prevention & Treatment in Oregon.” He can be reached at OrSUD@samuelmetz.com.