Great Circle Recovery expands with new Portland mobile clinic

By Nicole Montesano

Smoke Signals staff writer

Great Circle Recovery, the medication assisted treatment program run by the Confederated Tribes of Grand Ronde, continued to break new ground this summer, adding a second mobile clinic to its offerings.

The new unit operates out of the Portland clinic.

Because many of the agency’s clients are unhoused, the mobile unit parks at PDX Saints Love, 247 S.E. 82^nd Ave., on weekdays from 7 a.m. to 12:45 p.m., adding its treatment options to the services offered by the day center.

The day center offers showers, hot meals, hygiene wound care and other services in addition to medication assisted treatment.

 New Great Circle clients are required to complete their intake first at the fixed Great Circle clinic, located at 3580 S.E. 82^nd Ave. Once assigned to the mobile clinic, they can use it for meeting with counselors and for taking their prescribed medication, under observation from a nurse.

“It offers all the same services as our fixed clinic,” Operations Director Jennifer Worth said.

A mobile unit was a big ask, on top of everything the clinic is already doing, but is important nonetheless, according to Worth.

“It just allows us to reach more people,” she said.

A custom-built Tesco medical unit featuring a logo of Willamette Falls and a traditional canoe, the mobile unit is distinctive and that’s deliberate. The main clinic lobby in Portland features a mural of Willamette Falls, along with Indigenous artworks on the walls. Worth said she wants Tribal members to see those reminders of the Tribe and feel connected.

 Worth said in an email that the agency had both mobile units built specifically and designed with input for opioid care.

“We had to build out the medication area and the body of the unit in order to have the same things we have in the clinic area,” she said.

Great Circle Recovery is the first Tribally-owned opioid treatment program in Oregon. Its treatment clinics are the option of last resort for people suffering from opiate addiction. Doctor Jim Laidler, who works in the Portland clinic, said that last resort provides a stable landing place from which people who have struggled with addiction for years can finally begin to rebuild their lives.

Just a few months after opening, the van already has 30 clients established. The Portland clinic has 300 patients, Worth said.

The Portland mobile unit is the second one operated by Great Circle. In 2022, it added a mobile unit to its Salem clinic that also travels to Grand Ronde and McMinnville. In February of 2023, Great Circle opened a clinic in Portland and in August of this year, it added the Portland mobile clinic.

Although treatment is open to anyone, Great Circle prioritizes Tribal members.

The need for treatment is acute, Worth said. Methamphetamine, long a scourge in the Pacific Northwest, is now being combined with fentanyl, a potentially deadly combination that wrecks lives.

“We are seeing cocaine going up in the younger demographic,” she said. “The majority are taking fentanyl and stimulants.”  

While a variety of treatment types are used to help stabilize people and, in many cases, get them off opioids, medication is sometimes needed to help in the process and that’s where Great Circle comes in.

New clients meet first with an addiction-certified doctor, who will discuss different medication options and then with a counselor, who reviews their needs. Clients undergo screening for syphilis, tuberculosis, Hepatitis C and HIV. During their treatment, they continue to receive both individual counseling, in which they address factors that help trigger drug use, social pressures, stress and other issues, along with group counseling and peer support services from specialists who have themselves been through the recovery process.

The clinic is equipped with an onsite lab for processing blood draws and can make same-day medical referrals in many cases, an important component.

“The medical complexity is unlike anything I have seen in my career,” Worth said. “A lot of them haven’t gotten any medical care. They come in and they’re so sick – and with the opioid dependency on top of it.”

Great Circle Recovery offers what is known as wrap-around care, which seeks to address clients’ total needs to give them a better chance of breaking their addiction, restoring their health and rebuilding their lives. They may also be referred to other agencies for some of their needs.

“Recovery doesn’t happen alone,” Worth said. “It happens in community.”

It’s a long road to treating an addiction with methadone. Often, buprenorphine and naltrexone are used first, in part because buprenorphine can be prescribed by health care workers, while methadone is only available from federally licensed clinics like Great Circle. Although methadone may be more effective at controlling cravings than the other two medications, it is also addictive in itself and causes physical dependency.

Generally, Laidler said, the clinic wants people suffering from addiction to start with other efforts: Counseling, 12-step programs, buprenorphine and naltrexone, before trying methadone.

But for those who need methadone, he said, it’s a vital option.

“Most of the people who come to us, they’ve tried so much and had so many failures,” Laidler said. “They’ve just been beaten down and it takes them awhile to get back on their feet.”

Laidler said people sometimes criticize methadone treatment, saying they clients are just “substituting one drug for another.”

And that’s true, he said. “We’re substituting one that’s regulated, controlled and known,” that allows people to function, and begin to stabilize their lives.

“We know what the dose is,” Laidler said. “We can taper it down. The people you’re getting it from aren’t likely to rob you. At the very least, it’s harm reduction.”

In many cases, Laidler said, clients’ use of methadone is temporary.

“There’s a lot of paths people take,” he said.

A common one goes something as follows: A client remains on the drug for six months to a year, while working on other aspects of recovery during which time their lives become more stable.

“They can move toward tapering the dosing down and getting off it after a while,” Laidler said.

But it doesn’t work for everyone. Some clients, who have found themselves simply unable to remain stable without medication assisted treatment, may remain on it for years.

“It’s not ideal to have people dependent on the medication,” Laidler said. “But let’s be honest, people are dependent on medications for a lot of things – diabetes, heart disease. If it’s working for them, don’t mess with success.”