Month: June 2022

Overdose Deaths Behind Bars Rise as Drug Crisis Swells

Drug-related mortality rates have increased in prisons and jails even as the number of people incarcerated for drug offenses has dropped. The pandemic lockdowns on visitors didn’t eliminate the problem, showcasing that guards have been a source of the contraband.

Annissa Holland should be excited her son is coming home from prison after four long years of incarceration. Instead, she’s researching rehab centers to send him to as soon as he walks out the gate.

She doesn’t know the person who’s coming home — the person who she said has been doing every drug he can get his hands on inside the Alabama prison system. She can hear it in the 34-year-old’s voice when he calls her on the prison phone.

Her son is one of almost 20,000 inmates in the Alabama prison system living in conditions the U.S. Department of Justice has called inhumane. In two investigations, it found that the rampant use of drugs causes sexual abuse and “severe” violence in the state’s prisons. The department has sued Alabama, alleging conditions in its prisons violate inmates’ civil rights. According to the Alabama Department of Corrections’ own report, almost 60 pounds of illicit drugs were confiscated from its prisons in the first three months of this year.

Even if Alabama’s prisons and jails are especially overrun by drugs, death, and violence, their problems are not unique in the U.S. Within three weeks this spring, incarcerated people died of overdoses in Illinois, Oklahoma, New York, and the District of Columbia.

The alcohol and drug overdose death rate increased fivefold in prisons from 2009 through 2019, according to a recent study from the Pew Research Center — a surge that outpaced the national drug overdose rate, which tripled in the same period.

As the opioid crisis ravages America, overdose deaths are sweeping through every corner of the nation, including jails and prisons. Criminal justice experts suggest that decades of using the legal system instead of community-based addiction treatment to address drug use have not led to a drop in drug use or overdoses. Instead, the rate of drug deaths behind bars in supposedly secure facilities has increased.

This rise comes amid the decriminalization of cannabis in many parts of the country and a drop in the overall number of people incarcerated for drug crimes, according to the Pew report.

“It certainly points to the need for alternative solutions that rely less on the criminal justice system to help people who are struggling with substance use disorders,” said Tracy Velázquez, senior manager for safety and justice programs at the Pew Charitable Trusts.

For decades, drug use in America has mainly been addressed through the penal system — 1 in 5 people behind bars are there for a drug offense. Drug crimes were behind 30% of new admissions to Alabama prisons in March. Nationally, they were the leading cause of arrest, and almost 90% of arrests were for possession of drugs, not sale or manufacturing, according to the Pew study. The researchers also found that fewer than 8% of arrested people with a drug dependency received treatment while incarcerated.

Velázquez said a lot of drug use is spurred by people with mental health issues attempting to self-medicate. Almost 40% of people in prisons and 44% in jails have a history of mental illness, according to the Bureau of Justice Statistics.

Holland said her son was diagnosed with schizophrenia and PTSD six years ago after struggling with drug use since his teens. The son, who asked that his name not be published for fear his comments could jeopardize his release from prison or subsequent parole, said a schizophrenic episode in 2017 led him to break into a house during a hurricane. He said he didn’t realize people were in the house until after he ate a sandwich, got a Coke from the fridge, and looked for dry clothes. They called the police. He was sent to prison on a charge of burglary.

“They don’t put the mental health patients where they should be; they put them in prison,” Holland said.

She’s not only frustrated by the lack of medical care and treatment her son has received, but also horrified at the access to drugs and the abuse she said her son has suffered in the overcrowded, understaffed Alabama prison system.

He told KHN he’s been raped and beaten because of drug debts and put on suicide watch more than a dozen times. He said he turned back to using heroin, meth, and the synthetic drug flakka while incarcerated.

“We need to really focus on not assuming that putting someone in jail or prison is going to make them abstinent from drug use,” Velázquez said. “We really need to provide treatment that not only addresses the chemical, substance use disorder, but also addresses some of the underlying issues.”

Beth Shelburne, who works with the American Civil Liberties Union, logged 19 drug-related deaths in Alabama prisons in 2021, the most she has seen since she started tracking them in 2018.

She said those numbers are just a snapshot of what is going on inside Alabama’s prisons. The Justice Department found the state corrections department failed to accurately report deaths in its facilities.

“A lot of the people that are dying, I would argue, don’t belong in prison,” Shelburne said. “What’s so disgusting about all this is we are sentencing people who are drug-addicted to time in these ‘correctional facilities,’ when we’re really just throwing them into drug dens.”

The corrections department’s reports reveal at least seven overdose deaths in 2021, three of which officials classified as natural deaths. It reported 97 deaths in the first three months of this year that have yet to be fully classified.

Though Republican Gov. Kay Ivey recently announced a grant of more than $500,000 for a program to help incarcerated people address drug use disorders, the number of graduates of drug treatment programs in the state’s prison system has plummeted in the past decade to record lows. About 3% of prisoners completed a treatment program in 2021, down from 14% in 2009.

In contrast, California reported a 60% reduction in overdose deaths in its prisons in 2020, which state officials attributed to the start of a substance use treatment program and the widespread availability of medication-assisted therapy.

Alabama’s system is developing a medication-assisted treatment plan with its health contractor, said Alabama Department of Corrections spokesperson Kelly Betts. Before 2019, medications that curb drug cravings or mute highs were given only to those who could be separated from the general prison population, according to Deborah Crook, the department’s health services deputy commissioner.

“The science has changed considerably and there are more medication options that are safer to prescribe — even in general population,” she wrote in a statement.

Though prison officials have long blamed visitors for bringing in drugs, the ban on visitation during the pandemic did not lead to a drop in drug use inside. Multiple officers were arrested in Alabama last year and accused of bringing drugs into jails and prisons, and the Department of Justice’s 2019 report found dozens of officers arrested in the previous two years on charges related to drug trafficking and other misconduct.

Illegal drugs are “a challenge faced by correctional systems across the country,” Betts wrote in an email. “The ADOC is committed to enforcing our zero-tolerance policy on contraband and works very hard to eradicate it from our facilities.”

Betts did not specify how these policies are enforced. The department also refused to respond to a detailed list of questions about drug use and overdoses in its prisons, citing the litigation with the Justice Department.

Holland doesn’t know what will happen when her son gets out. He said he hopes he can restart his business as an electrician and provide for his family. But the four years of his so-called rehabilitation have been a nightmare for both of them.

“They’re released messed-up, hurt, and deeply dysfunctional. What do you do with someone that’s been through all that?” Holland said. “That’s not rehabilitation. It’s not.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

Readers and Tweeters Weigh In on America’s Medical Debt, Obesity Epidemic, and Opioid Battles

KHN gives readers a chance to comment on a recent batch of stories.

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

So, you're American, you have a lousy health insurance plan, you get cancer. You survive cancer. But can you survive your massive medical $$$ debt?https://t.co/e6Jzw9W4SR

— Laurie Garrett (@Laurie_Garrett) June 17, 2022

— Laurie Garrett, New York City

Medical Debt as the Ultimate Medical Mystery

I read your investigation about health care and debt on NPR’s site (“Diagnosis: Debt: 100 Million People in America Are Saddled With Health Care Debt,” June 16). However, it seems the story’s focus is wrong. It shouldn’t be about how we pay for these astronomical medical bills but why are they so high to begin with? How do hospitals get away with their fees? For example, my daughter, who is 7, has been to the hospital/emergency room five times in her life. Each bill has been completely different with no rhyme or reason. The latest one was $7,000 for about a three-hour ER visit and for two IVs! It’s the highest bill we have ever seen, and that includes a two-night stay at a hospital. In addition to this bill, collections called us — and it hadn’t even been 60 days since our visit and had been only a few weeks since the hospital visit. So now our credit score could be affected, and we haven’t even had a chance to review or figure out how to pay this bill. Would love all this explained.

— Ilyssa Block, Kansas City, Missouri

A Hard-Learned History Lesson

Although I liked the article by Noam N. Levey and Aneri Pattani on people burdened by medical debt (“Diagnosis: Debt: Upended: How Medical Debt Changed Their Lives,” June 16), it uses the term “grandfathered in.” This term was used as a rule to prevent Black people from voting after the Civil War. Please make an effort to refrain from using this offensive term.

— MB Piccirilli, Portland, Oregon

Upended: How Medical Debt Changed Their Lives https://t.co/IbJwJoOt3N @khnews This has to stop! NFP healthcare systems destroying the lives of the people they are designed to serve?!? Unethical. STOP! #healthcare #UniversalHealthCare #MedicareForAll #bankruptcy

— Andrew Gallan PhD ⛳️🇺🇦 (@agallan) June 20, 2022

— Andrew Gallan, Boca Raton, Florida

Steering Clear of Predatory Billing

Every month I see and hear these “Bill of the Month” stories on NPR’s webpage or broadcast on the NPR affiliate station in my area (“Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?” May 31). Every month I pat myself on the back for having decided that there is no way I am ever going to put myself through so-called screenings, which are just one more avenue for the U.S. health delivery system to screw people over as that health delivery system is well aware that there is no oversight for this type of predatory billing. I can tell you at my age and with only Social Security retirement as sole income, I couldn’t ever hope to hire legal help to dispute a bill like those featured in “Bill of the Month” — a bill like that would either cause me to have an immediate heart attack or file bankruptcy or both. Nope. No screenings. I actually have decided that, if I have any choice in the matter, I will simply forgo any so-called medical care. Obviously, if I keel over and pass out and someone hauls my sorry self into the emergency room, I won’t have the choice (except to walk out once “revived”). Given the state of health care and the predatory behaviors of the bottom-lining money-hungry hospitals, clinics, and even just doctors, my choice is simply to opt out. KHN needs to use its voice to tell the U.S. medical community that people are so tired of the garbage that they simply refuse care.

— Jan Baldwin, Coburg, Oregon

First colonoscopy: $0Second colonoscopy: $2kAnother example of how the fine print can put patients on the hook for bills that should be covered, especially in this case of a preventative screening. Patients deserve better.https://t.co/v55XVdGAeB

— Terry Wilcox (@Terrilox) June 2, 2022

— Terry Wilcox, Vienna, Virginia

In Michelle Andrews’ story about unexpected costs after a polyp removal during a colonoscopy, she states the anesthesiologist “merely administers a sedative.” This is an understatement. Anesthesiologists perform a review of the patient’s chart, see the patient pre-procedure, monitor their vitals during the procedure, and assess them post-procedurally. Furthermore, anesthesiologists are prepared to manage unexpected emergencies, including unexpected aspiration, allergic reactions, cardiac arrest, etc. This is more than “merely administering a sedative.”

We keep folks from dying or having complications and train a long time to do so. The flippant manner in which our actions are framed in the article is unfortunate.

— Dr. Elizabeth Leweling, Chicago

Preventive care, like screening colonoscopies, are free of charge to patients under the Affordable Care Act. @DrLindaMD @AlexMMTri @EvanKirstel @FriedbergEric @nkagetsu @rstraxMDhttps://t.co/qLP9l5SSPl

— Ian Weissman, DO (@DrIanWeissman) June 1, 2022

— Dr. Ian Weissman, Milwaukee

As president of the American Society for Gastrointestinal Endoscopy, I listened with interest to a recent segment on “All Things Considered” regarding patient cost sharing for a screening colonoscopy. The segment featured patient Elizabeth Melville, who received a bill for her screening colonoscopy that involved a removal of a polyp.

I was dismayed by the segment, which included several factually incorrect and misleading statements by Dr. Elisabeth Rosenthal, and which were incredibly damaging to efforts to eliminate impediments and misinformation about screening colonoscopy. ASGE has been at the forefront of policy efforts to eliminate patient out-of-pocket costs for screening colonoscopy, including those screenings that involve the removal of a polyp or other tissue. As the segment correctly noted, the Affordable Care Act provides for coverage without patient cost sharing of preventive services that have an “A” or “B” rating from the U.S. Preventive Services Task Force, which includes colorectal cancer screening. Recognizing that colonoscopy is the only cancer screening modality that also allows for actual removal of precancerous lesions in real time (and thus preventing the cancer), it is particularly important that patients and consumers understand the facts.

Following passage of the ACA, legislative and regulatory corrective actions have been necessary to ensure that patients who undergo a screening colonoscopy that includes a polyp removal are not stuck with a surprise bill. As noted, screening colonoscopy is a unique preventive service in that it not only detects cancer, but it can prevent it through removal of suspicious or potentially precancerous polyps or lesions. In 2020, Congress passed legislation that would phase out by 2030 cost sharing for Medicare beneficiaries when a screening colonoscopy turns diagnostic during the screening encounter. That means, if a Medicare beneficiary has a screening colonoscopy today and a polyp is removed, that patient is likely to have an out-of-pocket payment obligation.

The difference in cost-sharing rules for commercially insured patients and Medicare beneficiaries has created confusion for patients, and the changes in regulation have created complex billing scenarios. Dr. Rosenthal referred to billing for colonoscopy as a “gray area.” This is not a gray area to ASGE, as coding rules are clear. But there are scenarios that could impact whether a patient has an out-of-pocket obligation for a colonoscopy. For example, often insurers will not cover a screening colonoscopy without cost sharing if the screening occurs less than 10 years after the patient’s previous colonoscopy. These shorter screening intervals typically occur when a patient is considered high-risk, or if there was a finding during the previous colonoscopy, such as a polyp, as used in your illustration. Many insurers regard these colonoscopies as “surveillance” or “high-risk” colonoscopies and will not cover them as a preventive screening without cost sharing. This is not the decision of the physician or hospital; this is a decision made by the insurance company.

I was particularly struck by Dr. Rosenthal’s comment that “it is not OK to change the game in the middle of the test,” which leads to a patient getting a bill. I want to be very clear that when a patient is scheduled for a screening colonoscopy, the physician performing the colonoscopy has no idea whether a polyp or tissue will be found and will need to be removed. This is not a “gotcha” game that physicians are playing with patients, as insinuated by Dr. Rosenthal’s remarks; there are coding and billing rules that must be followed when facilities and physicians are submitting claims to insurance companies. ASGE continually works to ensure that we educate and promulgate coding rules and updated guidance for our 15,000 members worldwide.

The cost-sharing policy for colorectal cancer screening, and screening colonoscopy specifically, is complex and confusing. We are disappointed that NPR did not use the segment as an opportunity to work through the complexity to provide consumers with a better guide of questions to ask their insurance company before scheduling a colonoscopy, including whether a screening colonoscopy performed at an interval of less than 10 years will be covered under their health plan without cost sharing.

— Dr. Bret T. Petersen, ASGE president, Rochester, Minnesota

Great Bill of the Month reporting today by @mandrews110 for @KHNews. Nobody likes getting a colonoscopy. Patients shouldn't be penalized for doing the right thing and getting recommended cancer screenings: https://t.co/cNlEj85IZ4

— Ryan Holeywell (@RyanHoleywell) May 31, 2022

— Ryan Holeywell, Washington, D.C.

Taking the Doctor’s Advice

Dr. Taison Bell was wonderful to listen to (“Watch: UVA Doctor Talks About the State of the Pandemic and Health Equity,” May 26). I really appreciated his presentation and the valuable things he had to say. Thanks for including it in your KHN mailing!

— Jan McDermott, San Francisco

I spoke with ⁦@hnorms⁩ from ⁦@KHNews⁩ about the state of the pandemic and health equity. There is still a lot to be done to movement smart policies that help high risk communities of color. https://t.co/LAf2WCIN0X

— Dr. Taison Bell (@TaisonBell) May 26, 2022

— Dr. Taison Bell, Charlottesville, Virginia

Mad Over ‘New MADD’ Coverage

This article is grossly inaccurate and insulting (“The New MADD Movement: Parents Rise Up Against Drug Deaths,” May 23). Most fentanyl users are not all-star athletes or honor students. Their parents are not more educated than the parents of addicts. And the parents of addicts have been mobilized for years, with many feeling that the fentanyl movement has distracted attention away from needed health care. The article says that the drugs are being introduced by Mexican cartels that seek vengeance against low-level dealers, many of whom are just friends getting things for one another. The article distinguishes between drug users and fentanyl “victims,” creating and reinforcing the stigma these groups claim to be trying to eliminate. It does a great disservice to those of us who lost children to addiction and overdose, and is insulting to our children and to us as parents. Thank you.

— Susan Elamri, Detroit

Interesting read detailing the lack of accountability for drug dealers selling fentanyl laced counterfeit pills resulting in death/overdoses. Consequences and rehabilitation should not be mutually exclusive solutions, we can do both. https://t.co/KlvBH3O1kq

— Chief Paco Balderrama (@BalderramaPaco) May 23, 2022

— Paco Balderrama, chief of police, Fresno, California

When ‘Overweight’ Is ‘Normal’

Quoting from the article “‘Almost Like Malpractice’: To Shed Bias, Doctors Get Schooled to Look Beyond Obesity” (May 24): “Research has long shown that doctors are less likely to respect patients who are overweight or obese, even as nearly three-quarters of adults in the U.S. now fall into one of those categories.”

Perhaps the answer is to change the scale of weight. Why do 25% of adults get to be called “normal” and 75% of adults are “overweight”? Let’s base the decision on reality-based observation!

— Leslie Rigg, Lake Worth Beach, Florida

1) Anti-fat bias is real and certainly an issue. For physicians and others who treat people with #obesity, the question becomes where to draw the line. 'Almost Like Malpractice': To Shed Bias, Doctors Get Schooled to Look Beyond Obesity https://t.co/ap127widIs via @khnews

— Stewart Lonky, MD (@LonkyMD) May 24, 2022

— Dr. Stewart Lonky, Los Angeles

Innocent Until Proven Otherwise

I wanted to raise a concern about the story “‘Desperate Situation’: States Are Housing High-Needs Foster Kids in Offices and Hotels” (June 1) — and it’s certainly not unique to your story. It says:

“These children already face tremendous challenges, having been given up by their parents voluntarily or removed from their homes due to abuse, neglect, or abandonment.”

Sometimes, of course, that’s true. But no reporter would write that every person in jail is a criminal. Many are awaiting trial and can’t make bail. Similarly, children can be in foster care for weeks, even months before any court ever determines if they have been “abused” or “neglected.” Until then, they are in foster care because their parents have been *accused* of abuse or neglect.

(Also, by the way, neglect laws are so broad and vague that often what the parent really is guilty of is poverty — but that’s another issue.)

— Richard Wexler, executive director of the National Coalition for Child Protection Reform, Alexandria, Virginia

[Editor’s note: Thanks so much for your insight. The article has been updated to reflect that the parents are absent “due to accusations of abuse, neglect, or abandonment.”]

.@sclaudwhithead looks at "hoteling," Georgia's practice that makes high-need foster kids sometimes sleep in hotels or offices. The pandemic made the problem worse, but state lawmakers spent more to try to pay extra for foster parents to take kids. #gapol https://t.co/xRXbKCSVEM

— Jeff Amy (@jeffamy) June 1, 2022

— Jeff Amy, Atlanta

Key to Harm Reduction: Buy-In From People With Addiction

With overdose deaths skyrocketing to never-before-seen levels, the United States needs harm reduction strategies to protect the health and wellness of Americans. In 2020, 41 million Americans needed substance use treatment within the previous year; however, of those who needed such treatment but did not receive it at a specialty facility, a staggering 97.5% did not feel they needed it. Although America has a troubling treatment gap exacerbated by systemic legal and regulatory barriers to evidence-based addiction care, most people who need substance use treatment don’t want this treatment as it is currently being offered.

To support our friends and family members living with addiction, our system must also embrace harm reduction approaches that engage people who use drugs (PWUD) before they are ready for abstinence-based treatment (“As Biden Fights Overdoses, Harm Reduction Groups Face Local Opposition,” June 14).

Harm reduction saves lives. Drug checking services and naloxone distribution prevent overdose deaths, while syringe and related service programs help stop the spread of infectious diseases such as HIV/AIDS and hepatitis. These are all worthy ends in themselves, but harm reduction has the further benefit of building a meaningful alliance between health care professionals and PWUD. With this therapeutic relationship, PWUD have facilitated access to high-quality, evidence-based treatment and services when they become ready for this help. It’s an obvious point, but too many people overlook the fact that a person can’t receive treatment or enter recovery if they’re dead.

As a physician, I swore an oath to do no harm — not to do nothing. Failing to embrace and expand harm reduction efforts, by definition, leaves too many of our friends, family members, and loved ones at an unacceptable risk of dying. The dichotomy between offering more addiction treatment and providing PWUD with the tools they need to live healthier lives is a false choice. The United States must simultaneously invest in treatment expansion and increase the availability of low-threshold harm reduction services; otherwise, I fear the country’s addiction and drug overdose crisis will continue to get worse.

— Dr. Brian Hurley, president-elect of the American Society of Addiction Medicine’s Board of Directors, Los Angeles

. @POTUS wants to expand #harmreduction programs as part of strategy to reduce #drug #overdose deaths, but idea faces complicated reality on the ground as programs operate on fringes of legality, w/ scant budgets, & fierce opposition. @renurayasam @khnews https://t.co/qbSBtMkn38 pic.twitter.com/pYV8mB1nEc

— Deni Carise (@DeniCarise) June 21, 2022

— Deni Carise, Philadelphia

How to Beat the Opioid Epidemic

Do you want to control the scourge of fentanyl in America (“The Blackfeet Nation’s Plight Underscores the Fentanyl Crisis on Reservations,” May 25)? There are two options:

1. Distribute the drug solely by the government, ensuring its purity, proper dosage, and safe setting for the user, providing real-time overdose care and optional consulting for anyone who wants to quit, all for free.

2. Make some nonaddictive antidepressants (generally SSRIs, or selective serotonin reuptake inhibitors) less restrictive. You know, how health care in your country is expensive, visiting a psychiatrist or psychologist, refilling, blah-blah. I know, the nation who can’t agree on banning AR-15s from being sold to 18-year-olds won’t agree on this.

What if you let people have some SSRIs over the counter? These are not recreational, are generally safe (way safer than opioids), and do help with anxiety. Hey, what drives people to opioids? Aren’t anxiety levels at their highest all across the globe?

Also, the drugmaker mafia will support it.

Just as we have embraced over-the-counter drugs for widespread diseases like colds, we might adopt the same concept in mental health care as well. Anxiety is becoming more widespread compared with colds (my gut says).

— Alireza Mohamadi, Tehran, Iran

Fentanyl spreads west, including to the Blackfeet Nation.https://t.co/ZrykuZQ06c

— Keith Humphreys (@KeithNHumphreys) May 25, 2022

— Keith Humphreys, Stanford, California

Dust-Up Over Pollution Coverage

This article appears written from a lopsided viewpoint (“Some People in This Montana Mining Town Worry About the Dust Next Door,” June 8).

Very few cities pass the World Health Organization’s unrealistic threshold of 5 micrograms per cubic meter, and why would you get a mechanical engineer to provide input on environmental issues? Why, because the real environmental specialist said this was not an issue? As for dust on a picnic table, that is a horrible example. We get dust on our picnic table anytime the wind blows, and we don’t live by a mine. Maybe WHO should recommend that the wind stop blowing because it causes dust.

From the WHO’s website: “In 2019, 99% of the world population was living in places where the WHO air quality guidelines levels were not met.” This is not a reasonable standard and was selected by bureaucrats that are out of touch with life and the real world. All of the real information and statistics say there is not a problem, but your article makes a problem where one does not exist and people who are not willing to fact-check you will think there is a problem. All these people with health issues are unfortunate and that’s very sad, but people everywhere have sad health issues. Stick to the scientific facts and real monitoring numbers, and don’t drag “The Sky Is Falling” people into news articles. Facts matter!

— John Utaz, Salt Lake City

Cultivating an interest in ‘dusts’ at the moment and this article includes extractive industries/ mining. https://t.co/JsXCA7rxkD

— Cat Rushmore (@CatRushmore) June 9, 2022

— Cat Rushmore, Glasgow, Scotland

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

Sobering Lessons in Untying the Knot of a Homeless Crisis

The homeless tragedy in Portland, Oregon, now spills well beyond the downtown core, creating a crisis of conscience for a fiercely liberal city that has generously invested in homeless support services.

PORTLAND, Ore. — Michelle Farris never expected to become homeless, but here she was, sifting through garbage and towering piles of debris accumulated along a roadway on the outskirts of Northeast Portland. Farris, 51, has spent much of her adult life in Oregon, and has vivid memories of this area alongside the lumbering Columbia River when it was pristine, a place for quiet walks.

Now for miles in both directions, the roadside was lined with worn RVs and rusted boats doubling as shelter. And spilling out from those RVs, the trash and castoffs from this makeshift neighborhood also stretched for miles, making for a chaos that unnerved her.

Broken chairs, busted-up car parts, empty booze bottles, soiled blankets, discarded clothes, crumpled tarps. Every so often, it was more than she could bear, and she attacked the clutter around her own RV, trying furiously to organize the detritus into piles.

“Look at all this garbage out here — it used to be beautiful nature, but now it’s all polluted,” she said, as a stench of urine and burned rubber hung in the damp air. “The deer and river otters and beavers have to live with all this garbage.”

She paused a moment, glancing in the distance at a snow-capped Mount St. Helens. A line of RVs dotted the horizon.

Portland’s homeless problem now extends well beyond the downtown core, creating a crisis of conscience for this fiercely liberal city that for years has been among America’s most generous in investing in homeless support services. Tents and tarps increasingly crowd the sidewalks and parks of Portland’s leafy suburban neighborhoods. And the sewage and trash from unsanctioned RV encampments pollute the watersheds of the Willamette and Columbia rivers.

The RV encampments have emerged as havens of heroin and fentanyl use, a community of addiction from which it is difficult to break free, according to interviews with dozens of camp inhabitants. Even while reflecting on their ills, many of the squatters remarked on the surprising level of services available for people living homeless in Portland, from charity food deliveries and roving nurses to used-clothing drop-offs and portable bathrooms — even occasional free pump-outs for their RV restrooms, courtesy of the city.

Giant disposal containers for used syringes are strategically located in areas with high concentrations of homeless people. Red port-a-potties pepper retail corridors, as well as some tony family-oriented neighborhoods. In parts of the city, activists have nailed small wooden cupboards to street posts offering up sundries like socks, tampons, shampoo, and cans of tuna.

“Portland makes it really easy to be homeless,” said Cindy Stockton, a homeowner in the wooded St. Johns neighborhood in north Portland who has grown alarmed by the fallout. “There’s always somebody giving away free tents, sleeping bags, clothes, water, sandwiches, three meals a day — it’s all here.”

Portland, like Los Angeles, Sacramento, and much of the San Francisco Bay Area, has experienced a conspicuous rise in the number of people living in sordid sprawls of tents and RVs, even as these communities have poured millions of tax dollars — billions, collectively — into supportive services.

Portland offers a textbook example of the intensifying investment. In 2017, the year Mayor Ted Wheeler, a Democrat, took office, Portland spent roughly $27 million on homeless services. Under his leadership, funding has skyrocketed, with Wheeler this year pushing through a record $85 million for homeless housing and services in the 2022-23 fiscal year.

Voters in the broader region of Multnomah, Washington, and Clackamas counties in 2020 approved a tax measure to bolster funding for homelessness. The measure, which increases taxes for higher-income businesses and households, is expected to raise $2.5 billion by 2030.

But as debate roils about how best to spend the growing revenue, Portland also offers a sobering lesson in the hard knot of solving homelessness, once it hits a crisis level.

What Portland has not managed to do is fix the housing piece of the homeless equation. The city has about 1,500 shelter beds, not nearly enough to meet the need. It lacks ready access to the kind of subsidized permanent housing, buoyed by case managers, medical care, job placement, and addiction treatment, that has proven successful in cities such as Houston in moving people off the streets.

Nor has Portland come close to replenishing the stocks of affordable housing lost as its neighborhoods have gentrified and redeveloped.

Wheeler rejects claims that Portland has attracted homeless people to the region with its array of day-to-day services. But he acknowledged that the city does not have enough housing, detox facilities, or mental health care options to meet the need: “We are not appropriately scaled to the size and scope of the problem.”

“And, you know, is that our fault?” he said, calling for more state and federal investment. He pointed to “a foster care system that delivers people to the streets when they age out,” and a prison system that releases people without job training or connections to community services.

Meanwhile, the mission has grown more daunting. The 2019 homeless count in the Portland region, a one-night tally, found more than 4,000 people living in shelters, vehicles, or on the streets. This year, that number stands at roughly 6,000, according to the mayor’s office, a 50% surge that is, nonetheless, widely considered an undercount.

Making it more humane to live homeless in Portland, it turns out, has not moved people in large numbers off the streets. Nor has it kept those who have found housing from being replaced by people in yet more donated tents and more battered RVs.

⯁⯁⯁

South of the Columbia River in an industrial section of north Portland, not far from Delta Park’s bustling soccer and softball complex, another RV encampment lines a side street that juts off the main drag. Many of the camp’s inhabitants have parked here for years and are protective of their turf. Group leaders hold down the numbers — no more than 20 or so RVs. And they enforce tidiness rules, sometimes using physical force, so as not to draw undue attention from city code enforcement.

“We’ve maintained a symbiotic relationship with the businesses here,” said Jake Caldwell, 38, who lives in an RV with his girlfriend, Sarah Bennett. “We keep it clean and orderly, and they let us stay.”

Nearly all those interviewed in the encampments said they have noticed a sharp increase in the number of people living out of RVs in Portland, a trend playing out up and down the West Coast. Some of the newcomers lost their jobs in pandemic-related shutdowns and couldn’t keep up with rent or mortgage. Others, already living on the edge, described being kicked off couches by family or friends as covid made cramped living situations dangerous.

They’ve joined the ranks of the more entrenched homeless and people who can no longer afford to live here. Minimum-wage earners who grew up in the region only to be priced out of the housing market as wealthier people moved in. People who lost their financial footing because of a medical crisis. People struggling with untreated mental illness. People fresh out of prison. Street hustlers content to survive on the proceeds of petty crime.

And an overwhelming theme: People left numb and addled by a drug addiction. Some lost jobs and families while struggling with drug and alcohol use and ended up on the streets; others started using after landing on the streets.

“It’s like a hamster wheel — once you get out here, it’s so hard to get out,” said Bennett, 30, a heroin addict. “My legs are so swollen from shooting heroin into the same place for so long, I’m worried I have a blood clot.

“I feel like I’m wasting my life away.”

Most of the RVers interviewed in these north Portland encampments openly discussed their addictions. But they routinely cited a lack of affordable housing as a key factor in their predicament, and blamed homelessness for exacerbating their mental and physical ailments.

“You get severe depression and PTSD from being out here,” Bennett said.

Still, she and others consider themselves lucky to have scored an RV, which even broken down can cost a few thousand dollars. One camp dweller said he bought his using unemployment funds after losing his job in the pandemic. Caldwell and Bennett, who both use and deal heroin, said they purchased theirs with help from drug money. Some RVs are stolen; others were donated or simply taken over after being abandoned.

The benefits, RVers said, are innumerable compared with tent-living: Portland weather is notoriously soggy, and RVs offer more reliable shelter. They have doors that lock instead of zip, so you’re not ripped off as often. Women feel less vulnerable. It’s easier to organize possessions.

They also spoke of downsides. With the exception of the “high rollers” who can spare a few hundred for a portable generator, most of the RVers have no electricity. Nor hookups for the septic systems. The city comes by on occasion to pump out the waste, but more often it’s illegally dumped into rivers and streets. Most of the RVs are no longer drivable; occupants have them hauled from site to site. Bennett was among dozens of people who complained about the rats that regularly chew up through the undercarriages.

“A lot of people out here are criminals, flat-out,” said James Carter, 60, who became homeless after losing his job as an automotive refinish technician early in the pandemic and now lives out of a cargo van. “Stolen cars get dropped on this road constantly. There have been dead bodies.”

Carter, too, uses heroin. He and others said they support their habit by using food stamp benefits to purchase palettes of bottled water, then empty the water and recycle the bottles for cash. Some said they steal electronics from big-box stores and resell the goods. They say the retailers generally don’t try to stop them, worried about the risk of violence to their employees.

“We call it getting well, because you feel like shit until you get high,” said Carter, describing a heroin habit that costs him about $40 per day. “There’s a lot of people who need help out here.”

⯁⯁⯁

Laurelhurst Park is a forested oasis in east Portland. Situated south of the Columbia River with the mighty Willamette to the west, it spans 32 acres and features a spring-fed duck pond, running trails, tennis courts, horseshoe pits, and a playground.

But the recreational areas are often littered with debris from a homeless encampment in the park that ballooned during the pandemic and has proven difficult to disband despite a series of law enforcement sweeps. Many homeowners in the surrounding neighborhood, a historical enclave of Craftsman and Colonial Revival-style homes, say they’ve been thrust into the role of vigilantes, leaning on the city to do something about the mess.

They feel Portland’s charm ebbing, as the lives of the unhoused collide with the lives of the housed.

“This used to be the most beautiful, amazing city — now people’s houses and cars are getting broken into, and you can call 911, but no one is going to come,” said TJ Browning, who chairs the public safety committee for the Laurelhurst Neighborhood Association.

“We’re a progressive city, I’m a progressive, but the worst part is I can feel the compassion leaving,” she said. “I recognize people are self-medicating mental illness with drugs, but so many people like me just don’t care anymore. We want the criminal element out, even if it means taking people to jail.”

It’s her job to collect neighborhood complaints, and there has been no shortage as the city has allowed the amorphous encampment to take root in the park and smaller offshoots to pop up on surrounding streets. Every so often, when the neighborhood has complained enough, authorities sweep the camps, only to see them take shape once more.

One night, a propane tank exploded, causing a fire. Children have picked up used needles. Some of the homeless campers rant at parkgoers and wade into traffic. She fields calls from neighbors concerned about nighttime prowlers.

“It’s just not safe anymore,” Browning said. “It’s hard to feel compassion for the person creating the problem, when the problem is a threat to you or your family.”

Like many residents interviewed, Browning is a longtime Democrat who has watched in dismay as her liberal values give way to frustration and resentment. And she understands the good intentions, spawned by liberal policies, that brought Portland to this tipping point.

They include a dedicated effort to decriminalize low-level drug possession; a shift toward “harm reduction” programs that offer addicts shelter and medical care without coercing abstinence; court rulings that make it difficult to clear homeless encampments if the city can’t offer beds to the people displaced.

The problem is not so much the policies, in theory, as it is how they play out in Portland’s broader reality. Drug users stay out of jail, but Oregon has too few drug treatment programs and no easy way to mandate participation. Advocates for the homeless ardently protest efforts to roust the encampments, arguing people have nowhere else to go.

And cuts to police services have left housed residents feeling they are on their own to deal with the repercussions.

In recent years, Portland has made major cuts to police funding, spurred in part by the movement to “de-fund police” and shift resources into economic development and social services. In 2020, the Portland Police Bureau took a funding cut of $26.9 million, and eliminated officer positions assigned to a gun violence reduction team, narcotics, organized crime, neighborhood safety, schools, and traffic patrol.

There are 774 sworn officers in Portland today, down from 934 in 2020.

“The Police Bureau is the smallest it has been in modern times, with fewer sworn members than any time in anyone’s memory,” said Sgt. Kevin Allen, a spokesperson for the bureau.

“It is not surprising that people believe they aren’t seeing as quick a response, or as many officers on patrol — because there aren’t as many. We have to prioritize what we can do based on our resources.”

With crime on the rise — property crimes are up 33% over last spring, and homicides last year eclipsed a three-decade record — Mayor Wheeler has restored some of the funding as part of a broader investment in public safety. But residents say they can’t rely on police to respond to emergency calls.

“If nobody is dying,” Browning said, “no police officer is going to show up.”

In some ways, Portland’s liberal constituency is at war with itself, the devout at odds with the disillusioned.

“We want a more holistic solution to support people out here, and for this neighborhood to be livable regardless if you are housed or unhoused,” said Matchu Williams, a volunteer with the Mt. Scott-Arleta Neighborhood Association.

Williams is helping lead efforts to bring in more public restrooms, free shower services at a community center, and “community care cabinets” with donated items like toothbrushes and canned vegetables. “This is just neighbors coming together buying what they can to put in here, and it’s usually stocked full,” he said. “It’s small, but meaningful.”

Williams gives voice to another core constituency in Portland who say the city has a responsibility to ease the burden of living homeless, while also investing more energy and resources to address the affordable housing shortage he sees as the genesis of the problem. On a brisk spring day, walking past the slick coffee shops and brew houses that have made Mt. Scott-Arleta a draw, he recounted the city’s difficult slog pushing through a 100-unit affordable housing complex in his neighborhood.

Portland residents are quick to approve funding for homeless services, he noted, but more resistant when it comes to supporting sites for low-income and homeless housing.

“There’s been a lot of frustration with how slow things are moving,” Williams said. “It’s important to understand how we got here, but also how we get out of it.”

Others, like Cindy Stockton, whose north Portland neighborhood sits at the confluence of the Willamette and Columbia rivers, wonder if there are lessons to be gleaned from more conservative cities. Phoenix, for example, takes a less accommodating approach to encampments. People living homeless are steered to a loosely designated encampment in the city center that is cordoned off by chain barriers and patrolled by police. Campers are supplied with food, water, sanitary facilities, and medical treatment. But the arrangement comes with the understanding that camping generally is tolerated only within those boundaries.

“I’m a lifelong Democrat, but I find myself wondering if we need to elect Republicans,” Stockton said. “We’ve been Democratic-led for so long in this state, and it’s not getting us anywhere.”

Browning, in Laurelhurst, described a similar transformation: “I look in the mirror, and I see a hippie — but a hippie wouldn’t be advocating for more police. I sometimes can’t believe I’m having these thoughts: ‘Why don’t these people get hauled to jail? Why can’t they get a job?’

“I wonder, what the hell happened to me?”

⯁⯁⯁

Buffeted by the political crosswinds of Portland’s homeless dilemma, Mayor Wheeler is looking to adjust course. Wheeler, who took office in 2017, was elected as part of a wave of progressive politicians seen as standard-bearers for a more socially conscious approach to social ills.

That has meant a focus on police reform, and a host of programs anchored in the concept that people living homeless, addicted, or with untreated mental illness are victims of a broken system. Rather than blaming them for their plight, the idea is to meet their immediate needs with sensitivity while working to get them services to address the issues that put them on the street.

In vogue is a push to create permanent housing options with wraparound services that can start before someone is stable or sober; frowned upon are the old-school emergency shelters with curfews and drug bans that many advocates denounce as warehousing.

But it takes time — and funding and zoning changes and neighborhood buy-in — to design and approve sites for the longer-term programs. Portland’s homeless population has outpaced the city’s efforts.

“Fentanyl is making the rounds, and we have a major meth and heroin problem,” Wheeler said. “There are a lot of people living on the edge, and more and more are living in their RVs. It’s a catastrophe for people living on the streets, and they are absolutely traumatized, but we also acknowledge that this creates a problem for the entire community — for public safety and the environment.”

In the short term, Wheeler said, Portland is trying to address the public health risks by installing public restrooms and hygiene stations and offering RV sewage services. And, he has riled some liberal allies by adopting the stance that the city has an obligation to clear out more encampments and move people into emergency shelters for their own health and safety.

Wheeler’s budget for the coming year, recently approved by the city council, calls for 10 new shelter programs offering nearly 600 beds. He wants to reserve 130 apartments for people living homeless and 200 motel rooms for older homeless people with chronic conditions, and to expand drug treatment options. Most controversial, the city would funnel $36 million over two years to help create eight “safe-rest villages,” a mix of tiny homes and RV parking with support services and space for up to 1,500 people.

The proposal is mired in controversy, with many neighborhood groups opposed. At the same time, Wheeler said, “I am hearing overwhelmingly from the people in this city that they do not want to simply criminalize homeless people and throw them in jail because they are homeless. I don’t think that’s a real solution.”

Larry Bixel, who lives in a 1987-issue Fleetwood Bounder near Delta Park, has his doubts about the city’s ability to put a dent in the homeless numbers, much as he’d like a real house. “I don’t recognize Portland anymore,” he said. “There’s tents all along the freeway. It’s the pills and drugs everywhere.”

A former car salesman, Bixel, 41, said his free fall into homelessness started after he got addicted to painkillers prescribed for a shoulder tear sustained while playing softball at Delta Park nearly 20 years ago. He progressed from Vicodin to OxyContin to heroin, a cheaper habit that his wife also took up. Life spiraled as he wrecked his car and racked up felony convictions. Over time, the couple lost their jobs, their home, and custody of their three young children.

“I went from painkillers after the accident to addiction taking over my life,” he said.

But Bixel hasn’t given up on himself. He thinks with the right opportunities — a job, a landlord willing to take a chance on him — he could find the motivation to get clean again.

“My wife and I, we’re looked at like scum now,” Bixel said. “But honestly, this is also one of the best things that has happened to me. I used to look down at homeless people for not having a job, and if somebody asked me for change, I’d say, ‘I worked hard for this.’

“Now, if someone asks me for a cigarette, I’ll give them two.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

Sobering Lessons in Untying the Knot of a Homeless Crisis

The homeless tragedy in Portland, Oregon, now spills well beyond the downtown core, creating a crisis of conscience for a fiercely liberal city that has generously invested in homeless support services.

PORTLAND, Ore. — Michelle Farris never expected to become homeless, but here she was, sifting through garbage and towering piles of debris accumulated along a roadway on the outskirts of Northeast Portland. Farris, 51, has spent much of her adult life in Oregon, and has vivid memories of this area alongside the lumbering Columbia River when it was pristine, a place for quiet walks.

Now for miles in both directions, the roadside was lined with worn RVs and rusted boats doubling as shelter. And spilling out from those RVs, the trash and castoffs from this makeshift neighborhood also stretched for miles, making for a chaos that unnerved her.

Broken chairs, busted-up car parts, empty booze bottles, soiled blankets, discarded clothes, crumpled tarps. Every so often, it was more than she could bear, and she attacked the clutter around her own RV, trying furiously to organize the detritus into piles.

“Look at all this garbage out here — it used to be beautiful nature, but now it’s all polluted,” she said, as a stench of urine and burned rubber hung in the damp air. “The deer and river otters and beavers have to live with all this garbage.”

She paused a moment, glancing in the distance at a snow-capped Mount St. Helens. A line of RVs dotted the horizon.

Portland’s homeless problem now extends well beyond the downtown core, creating a crisis of conscience for this fiercely liberal city that for years has been among America’s most generous in investing in homeless support services. Tents and tarps increasingly crowd the sidewalks and parks of Portland’s leafy suburban neighborhoods. And the sewage and trash from unsanctioned RV encampments pollute the watersheds of the Willamette and Columbia rivers.

The RV encampments have emerged as havens of heroin and fentanyl use, a community of addiction from which it is difficult to break free, according to interviews with dozens of camp inhabitants. Even while reflecting on their ills, many of the squatters remarked on the surprising level of services available for people living homeless in Portland, from charity food deliveries and roving nurses to used-clothing drop-offs and portable bathrooms — even occasional free pump-outs for their RV restrooms, courtesy of the city.

Giant disposal containers for used syringes are strategically located in areas with high concentrations of homeless people. Red port-a-potties pepper retail corridors, as well as some tony family-oriented neighborhoods. In parts of the city, activists have nailed small wooden cupboards to street posts offering up sundries like socks, tampons, shampoo, and cans of tuna.

“Portland makes it really easy to be homeless,” said Cindy Stockton, a homeowner in the wooded St. Johns neighborhood in north Portland who has grown alarmed by the fallout. “There’s always somebody giving away free tents, sleeping bags, clothes, water, sandwiches, three meals a day — it’s all here.”

Portland, like Los Angeles, Sacramento, and much of the San Francisco Bay Area, has experienced a conspicuous rise in the number of people living in sordid sprawls of tents and RVs, even as these communities have poured millions of tax dollars — billions, collectively — into supportive services.

Portland offers a textbook example of the intensifying investment. In 2017, the year Mayor Ted Wheeler, a Democrat, took office, Portland spent roughly $27 million on homeless services. Under his leadership, funding has skyrocketed, with Wheeler this year pushing through a record $85 million for homeless housing and services in the 2022-23 fiscal year.

Voters in the broader region of Multnomah, Washington, and Clackamas counties in 2020 approved a tax measure to bolster funding for homelessness. The measure, which increases taxes for higher-income businesses and households, is expected to raise $2.5 billion by 2030.

But as debate roils about how best to spend the growing revenue, Portland also offers a sobering lesson in the hard knot of solving homelessness, once it hits a crisis level.

What Portland has not managed to do is fix the housing piece of the homeless equation. The city has about 1,500 shelter beds, not nearly enough to meet the need. It lacks ready access to the kind of subsidized permanent housing, buoyed by case managers, medical care, job placement, and addiction treatment, that has proven successful in cities such as Houston in moving people off the streets.

Nor has Portland come close to replenishing the stocks of affordable housing lost as its neighborhoods have gentrified and redeveloped.

Wheeler rejects claims that Portland has attracted homeless people to the region with its array of day-to-day services. But he acknowledged that the city does not have enough housing, detox facilities, or mental health care options to meet the need: “We are not appropriately scaled to the size and scope of the problem.”

“And, you know, is that our fault?” he said, calling for more state and federal investment. He pointed to “a foster care system that delivers people to the streets when they age out,” and a prison system that releases people without job training or connections to community services.

Meanwhile, the mission has grown more daunting. The 2019 homeless count in the Portland region, a one-night tally, found more than 4,000 people living in shelters, vehicles, or on the streets. This year, that number stands at roughly 6,000, according to the mayor’s office, a 50% surge that is, nonetheless, widely considered an undercount.

Making it more humane to live homeless in Portland, it turns out, has not moved people in large numbers off the streets. Nor has it kept those who have found housing from being replaced by people in yet more donated tents and more battered RVs.

⯁⯁⯁

South of the Columbia River in an industrial section of north Portland, not far from Delta Park’s bustling soccer and softball complex, another RV encampment lines a side street that juts off the main drag. Many of the camp’s inhabitants have parked here for years and are protective of their turf. Group leaders hold down the numbers — no more than 20 or so RVs. And they enforce tidiness rules, sometimes using physical force, so as not to draw undue attention from city code enforcement.

“We’ve maintained a symbiotic relationship with the businesses here,” said Jake Caldwell, 38, who lives in an RV with his girlfriend, Sarah Bennett. “We keep it clean and orderly, and they let us stay.”

Nearly all those interviewed in the encampments said they have noticed a sharp increase in the number of people living out of RVs in Portland, a trend playing out up and down the West Coast. Some of the newcomers lost their jobs in pandemic-related shutdowns and couldn’t keep up with rent or mortgage. Others, already living on the edge, described being kicked off couches by family or friends as covid made cramped living situations dangerous.

They’ve joined the ranks of the more entrenched homeless and people who can no longer afford to live here. Minimum-wage earners who grew up in the region only to be priced out of the housing market as wealthier people moved in. People who lost their financial footing because of a medical crisis. People struggling with untreated mental illness. People fresh out of prison. Street hustlers content to survive on the proceeds of petty crime.

And an overwhelming theme: People left numb and addled by a drug addiction. Some lost jobs and families while struggling with drug and alcohol use and ended up on the streets; others started using after landing on the streets.

“It’s like a hamster wheel — once you get out here, it’s so hard to get out,” said Bennett, 30, a heroin addict. “My legs are so swollen from shooting heroin into the same place for so long, I’m worried I have a blood clot.

“I feel like I’m wasting my life away.”

Most of the RVers interviewed in these north Portland encampments openly discussed their addictions. But they routinely cited a lack of affordable housing as a key factor in their predicament, and blamed homelessness for exacerbating their mental and physical ailments.

“You get severe depression and PTSD from being out here,” Bennett said.

Still, she and others consider themselves lucky to have scored an RV, which even broken down can cost a few thousand dollars. One camp dweller said he bought his using unemployment funds after losing his job in the pandemic. Caldwell and Bennett, who both use and deal heroin, said they purchased theirs with help from drug money. Some RVs are stolen; others were donated or simply taken over after being abandoned.

The benefits, RVers said, are innumerable compared with tent-living: Portland weather is notoriously soggy, and RVs offer more reliable shelter. They have doors that lock instead of zip, so you’re not ripped off as often. Women feel less vulnerable. It’s easier to organize possessions.

They also spoke of downsides. With the exception of the “high rollers” who can spare a few hundred for a portable generator, most of the RVers have no electricity. Nor hookups for the septic systems. The city comes by on occasion to pump out the waste, but more often it’s illegally dumped into rivers and streets. Most of the RVs are no longer drivable; occupants have them hauled from site to site. Bennett was among dozens of people who complained about the rats that regularly chew up through the undercarriages.

“A lot of people out here are criminals, flat-out,” said James Carter, 60, who became homeless after losing his job as an automotive refinish technician early in the pandemic and now lives out of a cargo van. “Stolen cars get dropped on this road constantly. There have been dead bodies.”

Carter, too, uses heroin. He and others said they support their habit by using food stamp benefits to purchase palettes of bottled water, then empty the water and recycle the bottles for cash. Some said they steal electronics from big-box stores and resell the goods. They say the retailers generally don’t try to stop them, worried about the risk of violence to their employees.

“We call it getting well, because you feel like shit until you get high,” said Carter, describing a heroin habit that costs him about $40 per day. “There’s a lot of people who need help out here.”

⯁⯁⯁

Laurelhurst Park is a forested oasis in east Portland. Situated south of the Columbia River with the mighty Willamette to the west, it spans 32 acres and features a spring-fed duck pond, running trails, tennis courts, horseshoe pits, and a playground.

But the recreational areas are often littered with debris from a homeless encampment in the park that ballooned during the pandemic and has proven difficult to disband despite a series of law enforcement sweeps. Many homeowners in the surrounding neighborhood, a historical enclave of Craftsman and Colonial Revival-style homes, say they’ve been thrust into the role of vigilantes, leaning on the city to do something about the mess.

They feel Portland’s charm ebbing, as the lives of the unhoused collide with the lives of the housed.

“This used to be the most beautiful, amazing city — now people’s houses and cars are getting broken into, and you can call 911, but no one is going to come,” said TJ Browning, who chairs the public safety committee for the Laurelhurst Neighborhood Association.

“We’re a progressive city, I’m a progressive, but the worst part is I can feel the compassion leaving,” she said. “I recognize people are self-medicating mental illness with drugs, but so many people like me just don’t care anymore. We want the criminal element out, even if it means taking people to jail.”

It’s her job to collect neighborhood complaints, and there has been no shortage as the city has allowed the amorphous encampment to take root in the park and smaller offshoots to pop up on surrounding streets. Every so often, when the neighborhood has complained enough, authorities sweep the camps, only to see them take shape once more.

One night, a propane tank exploded, causing a fire. Children have picked up used needles. Some of the homeless campers rant at parkgoers and wade into traffic. She fields calls from neighbors concerned about nighttime prowlers.

“It’s just not safe anymore,” Browning said. “It’s hard to feel compassion for the person creating the problem, when the problem is a threat to you or your family.”

Like many residents interviewed, Browning is a longtime Democrat who has watched in dismay as her liberal values give way to frustration and resentment. And she understands the good intentions, spawned by liberal policies, that brought Portland to this tipping point.

They include a dedicated effort to decriminalize low-level drug possession; a shift toward “harm reduction” programs that offer addicts shelter and medical care without coercing abstinence; court rulings that make it difficult to clear homeless encampments if the city can’t offer beds to the people displaced.

The problem is not so much the policies, in theory, as it is how they play out in Portland’s broader reality. Drug users stay out of jail, but Oregon has too few drug treatment programs and no easy way to mandate participation. Advocates for the homeless ardently protest efforts to roust the encampments, arguing people have nowhere else to go.

And cuts to police services have left housed residents feeling they are on their own to deal with the repercussions.

In recent years, Portland has made major cuts to police funding, spurred in part by the movement to “de-fund police” and shift resources into economic development and social services. In 2020, the Portland Police Bureau took a funding cut of $26.9 million, and eliminated officer positions assigned to a gun violence reduction team, narcotics, organized crime, neighborhood safety, schools, and traffic patrol.

There are 774 sworn officers in Portland today, down from 934 in 2020.

“The Police Bureau is the smallest it has been in modern times, with fewer sworn members than any time in anyone’s memory,” said Sgt. Kevin Allen, a spokesperson for the bureau.

“It is not surprising that people believe they aren’t seeing as quick a response, or as many officers on patrol — because there aren’t as many. We have to prioritize what we can do based on our resources.”

With crime on the rise — property crimes are up 33% over last spring, and homicides last year eclipsed a three-decade record — Mayor Wheeler has restored some of the funding as part of a broader investment in public safety. But residents say they can’t rely on police to respond to emergency calls.

“If nobody is dying,” Browning said, “no police officer is going to show up.”

In some ways, Portland’s liberal constituency is at war with itself, the devout at odds with the disillusioned.

“We want a more holistic solution to support people out here, and for this neighborhood to be livable regardless if you are housed or unhoused,” said Matchu Williams, a volunteer with the Mt. Scott-Arleta Neighborhood Association.

Williams is helping lead efforts to bring in more public restrooms, free shower services at a community center, and “community care cabinets” with donated items like toothbrushes and canned vegetables. “This is just neighbors coming together buying what they can to put in here, and it’s usually stocked full,” he said. “It’s small, but meaningful.”

Williams gives voice to another core constituency in Portland who say the city has a responsibility to ease the burden of living homeless, while also investing more energy and resources to address the affordable housing shortage he sees as the genesis of the problem. On a brisk spring day, walking past the slick coffee shops and brew houses that have made Mt. Scott-Arleta a draw, he recounted the city’s difficult slog pushing through a 100-unit affordable housing complex in his neighborhood.

Portland residents are quick to approve funding for homeless services, he noted, but more resistant when it comes to supporting sites for low-income and homeless housing.

“There’s been a lot of frustration with how slow things are moving,” Williams said. “It’s important to understand how we got here, but also how we get out of it.”

Others, like Cindy Stockton, whose north Portland neighborhood sits at the confluence of the Willamette and Columbia rivers, wonder if there are lessons to be gleaned from more conservative cities. Phoenix, for example, takes a less accommodating approach to encampments. People living homeless are steered to a loosely designated encampment in the city center that is cordoned off by chain barriers and patrolled by police. Campers are supplied with food, water, sanitary facilities, and medical treatment. But the arrangement comes with the understanding that camping generally is tolerated only within those boundaries.

“I’m a lifelong Democrat, but I find myself wondering if we need to elect Republicans,” Stockton said. “We’ve been Democratic-led for so long in this state, and it’s not getting us anywhere.”

Browning, in Laurelhurst, described a similar transformation: “I look in the mirror, and I see a hippie — but a hippie wouldn’t be advocating for more police. I sometimes can’t believe I’m having these thoughts: ‘Why don’t these people get hauled to jail? Why can’t they get a job?’

“I wonder, what the hell happened to me?”

⯁⯁⯁

Buffeted by the political crosswinds of Portland’s homeless dilemma, Mayor Wheeler is looking to adjust course. Wheeler, who took office in 2017, was elected as part of a wave of progressive politicians seen as standard-bearers for a more socially conscious approach to social ills.

That has meant a focus on police reform, and a host of programs anchored in the concept that people living homeless, addicted, or with untreated mental illness are victims of a broken system. Rather than blaming them for their plight, the idea is to meet their immediate needs with sensitivity while working to get them services to address the issues that put them on the street.

In vogue is a push to create permanent housing options with wraparound services that can start before someone is stable or sober; frowned upon are the old-school emergency shelters with curfews and drug bans that many advocates denounce as warehousing.

But it takes time — and funding and zoning changes and neighborhood buy-in — to design and approve sites for the longer-term programs. Portland’s homeless population has outpaced the city’s efforts.

“Fentanyl is making the rounds, and we have a major meth and heroin problem,” Wheeler said. “There are a lot of people living on the edge, and more and more are living in their RVs. It’s a catastrophe for people living on the streets, and they are absolutely traumatized, but we also acknowledge that this creates a problem for the entire community — for public safety and the environment.”

In the short term, Wheeler said, Portland is trying to address the public health risks by installing public restrooms and hygiene stations and offering RV sewage services. And, he has riled some liberal allies by adopting the stance that the city has an obligation to clear out more encampments and move people into emergency shelters for their own health and safety.

Wheeler’s budget for the coming year, recently approved by the city council, calls for 10 new shelter programs offering nearly 600 beds. He wants to reserve 130 apartments for people living homeless and 200 motel rooms for older homeless people with chronic conditions, and to expand drug treatment options. Most controversial, the city would funnel $36 million over two years to help create eight “safe-rest villages,” a mix of tiny homes and RV parking with support services and space for up to 1,500 people.

The proposal is mired in controversy, with many neighborhood groups opposed. At the same time, Wheeler said, “I am hearing overwhelmingly from the people in this city that they do not want to simply criminalize homeless people and throw them in jail because they are homeless. I don’t think that’s a real solution.”

Larry Bixel, who lives in a 1987-issue Fleetwood Bounder near Delta Park, has his doubts about the city’s ability to put a dent in the homeless numbers, much as he’d like a real house. “I don’t recognize Portland anymore,” he said. “There’s tents all along the freeway. It’s the pills and drugs everywhere.”

A former car salesman, Bixel, 41, said his free fall into homelessness started after he got addicted to painkillers prescribed for a shoulder tear sustained while playing softball at Delta Park nearly 20 years ago. He progressed from Vicodin to OxyContin to heroin, a cheaper habit that his wife also took up. Life spiraled as he wrecked his car and racked up felony convictions. Over time, the couple lost their jobs, their home, and custody of their three young children.

“I went from painkillers after the accident to addiction taking over my life,” he said.

But Bixel hasn’t given up on himself. He thinks with the right opportunities — a job, a landlord willing to take a chance on him — he could find the motivation to get clean again.

“My wife and I, we’re looked at like scum now,” Bixel said. “But honestly, this is also one of the best things that has happened to me. I used to look down at homeless people for not having a job, and if somebody asked me for change, I’d say, ‘I worked hard for this.’

“Now, if someone asks me for a cigarette, I’ll give them two.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

Gov. Whitmer signs bills aimed at combatting the opioid crisis

Michigan to receive nearly $800M in settlement funds

JUN 1, 2022

GRAHAM JAEHNIG
Staff Writer

LANSING — Gov. Gretchen Whitmer on May 19 signed a bipartisan package of legislation that will invest $800 million in treatment, prevention, mental health and other abatement efforts in response to the opioid crisis, according to a release from her office.

Michigan is set to receive nearly $800 million in opioid settlement payments over the next 18 years from major pharmaceutical distributors Cardinal, McKesson and AmerisourceBergen, along with opioid manufacturer Johnson & Johnson, said Senate Bill 994 sponsor, state Sen. Mark Huizenga, R-Holland.

The national agreement is the result of years of negotiations to resolve more than 4,000 claims of alleged misuse and abuse of opioid products and is the second largest multistate agreement in U.S. history, second only to the Tobacco Master Settlement Agreement, Huizenga said.

Senate bills 993, 994 and 995 together manage the disbursement of settlement funds as a result of opioid-related lawsuits, and create the Opioid Advisory Commission to advance policy to prevent, treat and support those with opioid use disorder.

“The opioid crisis touches families across our state, which is why it’s so crucial to ensure that (Michigan residents) facing substance use issues have the support and resources they need to get better,” said Whitmer. “The legislation I signed today will be instrumental in preventing more deaths and will provide Michigan families impacted by the devastating opioid epidemic with some semblance of relief. These funds will bring millions of dollars to support our neighbors, family and friends in treatment and recovery. I will continue to work with anyone who wants to help those who are struggling.”

According to the Centers for Disease Control and Prevention, more than 104,000 people nationwide died from drug overdoses between September 2020 and September 2021 — a 15.9% increase from the previous 12-month period. In Michigan, 2,933 people died during the same 12-month period — a 7% increase.

The American Medical Association reported on May 12 that the nation’s drug overdose epidemic continues to change and become worse.

The epidemic affects every state and now is driven by illicit fentanyl, fentanyl analogs, methamphetamine and cocaine, often in combination or in adulterated forms.

The Houghton County 2020-2025 Hazard Mitigation Plan states that Michigan has the 14th highest overdose death rate in the country. In 2017, there were 2,686 drug overdose deaths in Michigan and was 12.1% higher than drug overdose deaths in 2016. Deaths due to synthetic opioids, such as fentanyl and tramadol, increased by 48.5% from 2016 to 2017.

Most Michigan counties are under-equipped to address the needs of people who have an opioid addiction and effects from this drug epidemic. This includes a lack of nearby drug treatment programs, medication-based treatment services and transportation capability to get people who want help the necessary services they need.

“Time is not on our side when it comes to Michigan’s opioid epidemic,” said Attorney General Dana Nessel, “so I applaud the bipartisan support that got these bills across the finish line and to Gov. Whitmer’s desk. I have spent the past couple of months visiting communities and organizations around Michigan to learn more about the work being done to prevent and treat opioid use disorder, and while local governments will receive direct payments, the timely deployment of state settlement dollars is crucial in the fight against opioids in our communities. This puts us a step closer to getting the proper infrastructure in place to ensure settlement dollars can be used quickly and save as many lives as possible.”

Senate Bill 993 was sponsored by Sen. Michael MacDonald, R- Macomb, and creates the Michigan Opioid Healing and Recovery Fund in the Department of the Treasury to receive dollars from the national opioid settlement or any future opioid case. It funds abatement practices and support for opioid use disorder and substance use disorder or mental health treatment and related efforts.

“I am happy the governor signed my legislation,” said MacDonald, “as part of a bipartisan effort to allow for the effective and secure administration of Michigan’s opioid settlement funds and help support opioid-related education, prevention and treatment throughout our state. The opioid epidemic continues to have a devastating impact on Michigan families and communities — destroying lives and killing thousands of people every year. It is going to be a long, tough fight to defeat opioid addiction, but it’s one we must win.”

“The opioid epidemic has been, and continues to be, devastating,” said Sen. Betty Jean Alexander, D-Detroit. “While no amount of money from these lawsuits and settlements can bring back a lost loved one, it may help provide the funds needed to expand our efforts in combatting it. The simple fact is, there is not enough support out there to help the thousands of people affected by opioid use disorder and opioid addiction. Senate Bill 995 being signed into law is essential not only to get all the money due to the state but is also a symbolic step forward by the Legislature to recognize and actively address the severity of this widespread crisis.”

Senate Bill 994, sponsored by uizenga, creates the Opioid Advisory Commission, which would review initiatives related to education, prevention, treatment, and services for individuals and families affected by substance abuse disorders and co-occurring mental health conditions.

Senate Bill 995, sponsored by Sen. Betty Jean Alexander, D-Detroit, creates a threshold for certain civil actions related to opioids. Enacting the bill would allow the state and local governments that have settled to receive full incentives under the settlement payment plans.

“As a lead House sponsor on the opioid settlement package,” said state Rep. Christine Morse, D- Texas Township. “It was an honor to work with Gov. Whitmer, Attorney General Nessel and my colleagues in the House and Senate to bring unprecedented resources for opioid recovery and healing to our state.”