Emergence of polysubstances in Oregon presents challenges for treating addiction


Shane Ersland


The recent emergence of polysubstances in Oregon communities is presenting unpredictable and dangerous circumstances for drug users and those attempting to care for them.

Behavioral health advocates discussed efforts to address the state’s drug problems at the 2023 Oregon State of Reform Health Policy Conference. Samantha Byers, adult behavioral health director at the Oregon Health Authority (OHA), said the state’s drug supply is becoming increasingly unpredictable.

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“We absolutely need to address fentanyl, and the specifics on how that plays out,” Byers said. “It’s lethal. But the reality is that community members that are using are blending their substances. So what you’re seeing is a rapid increase of fatalities where methamphetamine looks like the [causal] substance, but it’s because it’s blended with fentanyl. Or it’s a concoction that came together. So addressing the fentanyl crisis is one thing, but what keeps me up at night is, what is the polysubstance use strategy?”

Blanchet House Executive Director Scott Kerman said staff at the organization—which has provided food, clothing, shelter, and residential programs for those in need for 71 years—have been attempting to help people on P2P methamphetamine (a polysubstance) for over a year.

“The super-meth is causing such extreme psychosis in individuals that it’s hard to see where the light is at the end of the tunnel for them,” Kerman said.

The thing that keeps Kerman up at night is the fact that he is serving people who he knows—not with certainty but with extreme confidence—are going to die on the street, he said. 

“And they die on the street because there’s nowhere for them to go, and there’s no help available to them. Despite heroic attempts by our staff, there are so many brick walls, whether it’s to do with civil commitment standards that have an extreme view of what it means to be in imminent danger to oneself, or the fact that even if we were to modify and reform these standards, there’s no place for them to go.”

— Kerman

It is now taking four doses of narcan, on average, to revive individuals who are suffering from an overdose, Kerman said. 

“It often takes six or seven,” he said. “I think about the trauma that inflicts on my staff, who came to be part of a meal service program, and are now first responders.”

Oregon Alcohol and Drug Policy Commission Director Annaliese Dolph said siloes are creating major obstacles to providing care as well.

“And not just siloes between people, organizations, and state agencies,” Dolph said. “We have amazing researchers at (Oregon Health and Science University) that are doing great research. They just came out with research about (medication assisted treatment) in jail. 

How are we connecting what those researchers are doing with what (Byers’) team is doing? To what (Kerman’s) team is doing on the ground? To what our county public health [department] is doing? We have so many siloes at all levels here. We have to start talking to each other. So many people touch all these systems. And it never comes together.”

Byers sees promise in the attention that behavioral health issues are receiving from officials in the state, however.

“There’s a concerted focus and energy around trying to understand and attend to individuals with a substance use disorder. I’ve been in social services for 20 years, and it’s the one time where it’s like—even with stigma and lack of understanding—there is an energy in our state around no matter what our thinking, there’s a solution we need to figure out. And I feel optimistic about that.”

— Byers

Dolph was appointed to her position by Gov. Tina Kotek in July, and believes Kotek’s appointment to the position in 2023 gives behavioral health professionals a tremendous opportunity. 

“Kotek’s three priorities are homelessness/housing, behavioral health, and early literacy and education,” Dolph said. “And we’re going to need all three of those things. These things are all intertwined.”

Blanchet House provides opportunities for those suffering from addiction that they might not find elsewhere. The organization is located in Portland’s Old Town District, which is often referred to as the “Skid Row” of the city. It offers free meals to anyone who needs them, and operates two transitional housing programs. 

“These are the kinds of programs that fit in the continuum of care for people in recovery, trauma recovery, (and) addiction recovery—that six to nine months of supportive housing/supportive employment space that helps prepare people for supportive housing,” Kerman said. “We can hold up to 45 men in our program in Old Town.”

The secret jewel of the organization is its farm in Yamhill County, Kerman said.

“We have a 60-acre working farm that is specifically designed for men with addiction,” he said. “It’s an eight to nine month program, and part of that recovery is not only being in a beautiful natural location, but getting to care for our farm animals. We have pigs, chickens, goats, ducks, and geese. We have a beekeeping program. We have a woodshop where they can tinker with wood. The animals are there for therapeutic reasons. All of our programs are free.”

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