OPINION: Demystifying stigma surrounding addiction in era of misinformation and crisis in Oregon

Regardless of your proximity to the issue, Oregonians can agree that the state is facing a crisis in terms of substance use and its far-reaching effects.

Fentanyl, a medication nearly 100 times more potent than morphine and 50 times more potent than heroin, has rapidly increased in prevalence and emerged as the most common cause for death by overdose in the state.

In fact, according to the C9DC, Oregon experienced almost a 44% increase in fentanyl-related deaths from 2022 to 2023, the steepest surge in the country. Admittedly, as a doctor in Portland, my proximity to the issue is closer than most, but I have been humbled in recognizing fentanyl’s overwhelming presence in our community.

In 2020, Oregonians overwhelmingly supported and voted for Measure 110 that decriminalized personal possession of drugs, using marijuana taxes as leverage to expand addiction treatment services. While easy to pin the worsening drug crisis on Measure 110, this is an oversimplification of the issue.

Overdose statistics are far more likely related to the influx of such a fatal drug as fentanyl as opposed to the measure created to lessen the burden of those facing a treatable medical illness. Furthermore, two separate longitudinal studies using a variety of drug data found no association between overdose data and Measure 110’s implementation.

In an attempt to further solidify this point, I offer two stories: one of a patient I have personally treated and one of an individual of whom I will never meet because she suffered the effects of addiction and could never escape the cycle of consequences amidst drug addiction.

“Steve” was a patient I met with debilitating chronic pain that he was initially prescribed opioid therapy that exacerbated his post traumatic stress disorder (PTSD) and mental health. I opted to place Steve on a buprenorphine patch, an effective method of pain control that would be much safer for him.

In fact this medication is used for both chronic pain management as well as opioid use disorder, and is known to significantly reduce risk of opioid-involved overdose death. Unfortunately, when mistakenly told by another provider this medication is an “opioid blocker,” Steve was so resistant to engage in conversation about therapy due to fear of the medication being conflated with a stigmatizing illness, altering others’ view of him.

Leigh also suffered the effects of an institution established to penalize those with substance-use disorder.

Leigh began drinking alcohol at age 12 and fell into the throes of addiction in the way of cannabis and later heroin use. In 2007, she rear-ended a state trooper and was faced with a decision: two years of treatment or seven years of prison. She chose treatment. She exited treatment with an awakened sense of hope, which she carried into medical school where she achieved high honors.

Leigh’s story seemed to represent a “perfect” outcome of Measure 110. However, following graduation, she was unable to find a job due to two felony records of which she had already been pardoned. Leigh tried for three years to match into a residency program without success. She wrote her suicide note in stages, adding lines each time she had faced injustice for her past and finally closing her letter with a chilling plea, “This has to change. Please. Make my life, and my death, mean something. Something for someone else. This is my hope.”

For Steve and Leigh, something has to change. Measure 110 has the propensity to disseminate an escape for those suffering from addiction by allowing them access to treatment and peer support as opposed to inundating our justice system with consequences those with substance use may never be able to shake.

Truly, there is no perfect solution, but allocating funding and resources to help Oregon citizens suffering from addiction is essential. Sadly, of the funding allocated to the passing of Measure 110 in 2020, only one third of the active grant funding through December 2023 was utilized, demonstrating the critical need of workforce expansion to help those in need of substance use treatment in Oregon.

Policy makers, law enforcement, and physicians have worked judiciously to help those struggling while attempting to uphold the original intention of Measure 110 by signing House Bill 4002, which balances treatment with accountability of substance use.

In the end, increasing access to evidence-based treatment resources and ultimately second chances for our actions is an imperative step in addressing the epidemic of addiction, for the benefit of Steve, Leigh and the many others in our community affected.