Roads to Recovery: Help is available for Tribal members

By Danielle Harrison

Smoke Signals staff writer 

(Editor’s note: This is the sixth and final in a series of Smoke Signals stories in 2021 that examines addiction and recovery.)

Tribal members seeking drug and alcohol recovery services have a multitude of options.

In Grand Ronde, they can make an appointment with Behavioral Health for an intake and assessment. Once that is finished, the Tribal member is either referred to specialized services or begins outpatient alcohol and drug treatment or mental health counseling.  Tribal cultural practices are integrated throughout.

There also is a medication-only treatment option after assessment by a counselor and dual-diagnosis treatment for concurrent alcohol/drug and mental health disorders.

The newest treatment option is the Great Circle Recovery Center in Salem, an outpatient clinic for those battling opioid-use disorder and the first Tribally operated facility of its kind in Oregon.

The Tribe began looking into offering medication-assisted treatment in the wake of the opioid crisis that swept through the United States beginning in the early 2000s. The crisis led to millions of people with addiction problems, some of whom were not helped by traditional abstinence-based, 12-step programs.

Some dismiss medication-assisted treatment as “swapping one drug for another,” which Great Circle Recovery Center Operations Director Jennifer Worth says is a common misconception.

“Many are confused by the concept of medication-assisted treatment,” Worth says. “It doesn’t mean replacing one drug for another. It’s a form of treatment that minimizes risk and meets all people where they are at. It cuts down on and eventually helps to end their use. Many people are overdosing and dying, or hiding in their addictions to pain medications or use of illicit opioids, like heroin, in secret due to shame. We do not judge. We work to take away stigma and meet people with a warm, caring mindset. You can’t heal until you find safety. … Great Circle is about welcoming Tribal members and the larger community into a small holistic healing environment.”   

In addition to the medication piece, the clinic also provides a wound care center for treatment of sores and abscesses that are often a component of drug use, as well as child care, medical transport, peer support specialists, group therapy, smudging and art therapy with cultural components.

“I have amazing folks working here with lived experience,” Worth says. “They understand addiction in a way others can’t by just looking at a textbook.”    

Medication-assisted treatment is not new. Methadone, the most commonly used form, has been utilized to treat opioid dependence since the 1950s. Buprenorphine was developed in the 1960s, but not offered to patients battling drug addictions until 1995. Suboxone has been prescribed since the early 2000s. All reduce withdrawal symptoms and help control drug cravings.

Great Circle Recovery Dr. Danica Clark says the overall goal of medication-assisted treatment is to decrease illicit drug use and death rates, along with rates of syphilis and hepatitis C, which are common among intravenous drug users.

“How long a patient continues with medication-assisted treatment is very individual,” Clark says. “Some people eventually taper off and others do not.”

As far as clinic clientele goes, Worth says they have people who are addicted to opioids ranging from prescription medication to heroin.

“We see all walks of life here,” she says. “There are working class, homeless, business workers, parents and other professionals. Opioid-use disorder touches all facets of life and the cycle is vicious.”

Dispensing of the medications is highly regulated. There are 22 cameras located throughout the closely monitored facility. There are also regular inventory checks and no one is allowed to be alone in the medication room. The medicine itself is locked in a secure safe. Registered nurses dispense it under the watchful eye of a supervisor. Clients who have earned take-home doses are given their medication in lock boxes. To help prevent inappropriate use or sale, clients are subject to random callbacks where they must bring their medication box in to be inspected to ensure they are using it as intended.

“The biggest thing for us is controlling diversion,” Worth says. “That is where people are using medication in an inappropriate way such as taking half or using an illicit substance instead of medication and selling it.”

Opioid crisis hit Native communities hard

According to the National Institutes of Health, Native communities have been deeply affected by the opioid crisis, and many have been overwhelmed by opioid overdoses, deaths and a strained health care system. This has led to some communities offering a two-tiered treatment approach, which includes a culturally centered aspect combined with medication.

With that in mind, the Health & Wellness Center launched medication-assisted treatment in Grand Ronde in 2019, but also wanted to expand its health services to the two largest metropolitan areas in Oregon: Portland and Salem.

Although COVID-19 required a major pivot, medication-assisted treatment for Tribal members in the metropolitan area remained a goal of the Tribe’s Health & Wellness Center in 2020, especially as overdose numbers skyrocketed nationwide during the pandemic. A combination of pandemic-related isolation, stress, financial problems and loneliness also led to many relapses during this time.

Preliminary data from the Centers for Disease Control and Prevention project an increase of almost 30 percent in drug overdoses across the United States, from approximately 70,000 in 2019 to 100,000 in 2020, the highest number of overdose deaths ever recorded.

When someone visits Great Circle Recovery seeking help, the goal is to get them in immediately and decrease the possibility of an overdose instead of requiring them to wait days or weeks for treatment.

“We do everything possible to get them in as quickly as possible,” Worth says. “We are a rapid access clinic so that the first day you come in, you meet with a doctor within an hour of arrival.”

The Salem clinic officially opened to the public in March 2021 and the Portland clinic is expected to open in February 2022. So far, it’s been well received in the community, with 100 intake evaluations and 70 clients.

Since one of the biggest barriers to treatment is reliable transportation, Worth is hoping to eventually have a service that can pick up clients in Grand Ronde, Willamina, Sheridan and other rural areas that lack robust public transportation.

Currently, the Tribe offers a medical transport service that members can call to arrange if drivers are available, but Worth envisions an ease-of-access transport that is similar to regular bus service.

“We want to be able to pick people up and not have another barrier in the way of treatment,” she says.

Stigma remains the biggest barrier

The biggest barrier to medication-assisted treatment continues to be fear of judgment from family, friends or others in the recovery community.

“Stigma is the biggest piece,” Worth says. “People judge what it means to be an addict, but there is no one profile to see what addiction and recovery look like. We know that people approach recovery in many ways. We don’t condone using illicit opioids or other substances, but we understand using any substance as a symptom. Many are trying to manage pain of all kinds from physical to emotional. For us reducing use is an important part of the recovery process and we know that everyone is different in how they achieve this path.

“Most importantly the medications are lifesaving, just like insulin or any other medication for a chronic condition. We operate just like a primary care doctor’s office with more services on site. It’s tailored to the needs of each person.”

Tribal member Chris Martin works as a peer support specialist at the Salem clinic. He notes that clients who are lacking a sense of identity and searching for more positive activities enjoy the cultural components, such as smudging.

“They ask questions about our culture and try to adopt that for themselves to heal,” he says. “People aren’t stigmatized. They are people here, not just a number. We have several clients who have said they feel accepted and safe. … We treat everyone the same regardless of gender, race, demographics or socioeconomic status. People want to feel cared for. They need connection and they are starting to feel that here.”

Lead Chemical Dependency Counselor Joe Martineau has 31 years of sobriety from drugs and alcohol. He says that he used to be a believer that the worse your withdrawal was, the more likely you’d think about that when tempted to use. Over the years, he says he has changed his opinion. He visited the Salem clinic after it opened to assist staff with the cultural components of treatment so that they would feel comfortable participating in those activities with clients.

When he sees clients at Behavioral Health who tell him they want to try medication-assisted treatment but are scared of being judged, Martineau tells them to think of it as a part of their overall recovery.

“I tell people this is what you need for now and if you need something Native American to approach it with, do a ceremony with it,” Martineau says. “Treat it as medicine and pray. There is a balance with scientific benefits and spiritual. The withdrawal from drugs today is not what it used to be 30 years ago. It can kill you. I’m trying to help with education and spirituality.”