Methamphetamine, Oregon, Portland discussed on Here & Now
Now, the opioid epidemic has gotten a lot of the headlines, but overdose deaths involving methamphetamines have more than quadrupled over a six-year period. That's according to the National Institute on drug abuse in Oregon Health authorities report that meth is now the leading cause of drug related deaths in the state, Dr Andy mendenhall is the chief medical officer for central city concern, that's a nonprofit agency providing housing and healthcare services to homeless and the medically underserved population in Portland, Oregon. He joins us now. Welcome to here. Now. Thank you. Jeremy a pleasure to be here. And when you look at the numbers here between twenty fifteen and twenty seventeen Oregon saw four hundred twelve deaths from meth and psychostimulants. What are you seeing when it comes to the meth crisis? There in Oregon will the meth crisis has had a long history in Oregon. But in the last couple of years in particular, we've seen methamphetamine related deaths out. Pace opioid related deaths for the last three years running and why primarily due to an uptick in the use of methamphetamines across the population of patients in particular that were serving people with very severe poly, substance use disorder and also in combination with the fact that there's a deeper supply chain for methamphetamines that are more, pure and more potent. So therefore patients are are using more substance and suffering fatal consequences, and when you talk about the deeper supply chain, whereas the meth coming from the information that I have that comes from a local and regional law enforcement gives us a window of understanding that this is foreign sourced methamphetamines, primarily from different Latin American countries and on the west coast of the United States much of this comes up, the I five quarter I five which means it's coming all the way up. Through California to get to where you are. That's correct. It's coming up from California to Oregon and Washington and who are the users. Is there a profile of the typical person who is getting addicted to meth the typical person who's using methamphetamines is a little bit difficult to characterize? We do see trends associated with poverty. We know that methamphetamines affect many people of lower socioeconomic class and disenfranchised communities with high unemployment in the Portland metropolitan area and the population. We're serving we're seeing methamphetamine use concurrent with opioid use in many of our homeless patients that have Polly substance use disorder. We see it ranging from young adults all the way to people in their fifties and sixties who are really treating the pain of their of their existence the pain of their their life experience. Depressed disenfranchise. Chai's with with very poor opportunities, or at least a belief that the opportunity to change is is a large reach for them, which gets to my next question. Which is why do people end up using it in the first place because we know that becomes very addictive, and it's hard for people to stop. But why did they use it in the first place? Well, let's take a step back. Just a great question. I think that it's a really important question to understand why do people seek relief for or seek reward through the use of any substance. I think that if we look at human history and look at how we've evolved as a species human beings have taken substances to change their consciousness for millennia. And I think that methamphetamines in a way or no different. I think that there is a great body of science that says that many human beings will seek reward to pathological levels. If we think about the National Institute. Drug abuse and their director doctrine revolt. Cow who talked about the disease state of addiction as a chronic relapsing brain disease that's characterized by compulsive use. Despite harm. We have to knowledge that many of us use substances, we use substances without significant harm in that represents the vast majority of people that do use substances, and that's really a ubiquitous part of the human condition. Whether we're talking about the social use of alcohol, the recreational use of cannabis the use of nicotine are all examples where people may or may not suffer any negative consequences when we're talking about substances like opioids heroin methamphetamines in particular to your question. We see that most patients have started with the use of alcohol or nicotine or cannabis. And there's good evidence. Not to say that those are gateway substances that. Lead directly to the use of more potent substances. But rather that individuals that have a propensity or proclivity to experiment with substances to use substances also are frequently at risk of using other substances. So when we consider the social demographics of who uses if you will methamphetamines, this is a community based disease state where people are exposed individuals using substances. They are exposed to people using stronger and stronger substances, and at some point people will will pick up methamphetamines, and at some point some of them decide that it's not what they want and they find their way to you. How patients find their way to you and to try to get some help. So we are proud to serve the homeless population. And population of patients who are impoverished within the Portland metro. Alton region. We have many ways in which seek care one of the primary. Portals of entry is our substance use disorders continuum. So we have people that present right off the streets seeking treatment for their substance use disorder seeking recovery. Many of our patients are concurrently seeking housing services. We have a large medical detoxification facility that people will start their journey with us as well presently. We're serving about six thousand patients in our substance use disorders continue on an annual basis and what did the treatments what's affective in treating people who use meth? So the primary treatment for stimulant use disorder in particular methamphetamine, use disorder is really an evidence based practice of outpatient longitudinal group-based treatment along with one on one psychotherapy. There are no FDA indicated medications for the treatment of methamphetamine use at this time. And there's a behavioral intervention called contingency management whereby people are essentially rewarded for having negative urine drug screens or provided with little little incentives. If you will for compliance with treatment, this is really the basis of best practice for the treatment of stimulant use disorder. Nothing Fateh means in particular and concurrent with that. It's important to note that the recovery community of mutual help groups the recovery community of people in sober living housing in. Supportive recovery. Housing type facilities. Creates an environment of recovery for people where they can have and develop new relationships with people that are on the same pathway, that's a literature based and also very important part of the work that we're doing it central city concern to help patients, you're using nothing vitamins. Okay. So let's go back to where we started with this, which is that there's been so much attention put on the opioid crisis in this country is that attention on opioids taking away funding that could be used to help with this growing meth crisis. Most definitely not I think that if we look at the history of addiction treatment in the United States. There's been a slow but successful volition towards the medicalisation of the treatment of addictive disease and over time with the passage of the two thousand eight mental health and addiction parodies act, which really went into full implementation in two thousand. Thousand twelve there has been an acknowledgement that addiction is in fact, a disease that patients and communities and populations who suffer from this disease deserve access to high quality treatment. I think the challenge right now is that in the face of the epidemic both with respect to opioids and with respect to methamphetamines. There's still a gal. Meaning there's a gap in access we need more funding for these services in order to provide access and capacity to the population. That's currently suffering right now. I wonder Dr mendenhall if you could just leave us with the personal story of one of your patients somebody who's come in to try to recover from this addiction and has had success. I think it's important to remember that recovery is possible. I work with patients every day who never expected if you will that they would would grow up or have an experience of developing severe substance use disorder. Millions of people are living in the United States today in long term successful recovery from stimulants. I remember a patient that that I saw about five or six months ago who had been living on the streets for seven or eight months twenty four year old gentleman. He was using almost exclusively methamphetamine, he was suffering really significant psychiatric consequences from from that substance and had gotten involved in the criminal Justice system was living in our recovery housing. And starting to benefit from our employment services and has been working and achieved one hundred twenty days of abstinence, which for him was the first time since he started using them Fateh means at the age of fifteen that he had a chief that that time line of abstinence good for him. That is.