AHEAD OF GROUNDBREAKING CITIZEN DECRIMINALIZATION INITIATIVE TO REFORM AND FUND EFFECTIVE TREATMENT, OREGON COMMITS TO LONGSTANDING FAILED ADDICTION TREATMENT SYSTEMS PERPETUATING EPIDEMICS
Within weeks of passing, Measure 110 treatment standards are undone in closed meetings by lawmakers and addiction industry advocates to protect those failed systems from change, a prominent opponent of 110 pleased with the outcome
By Clark Miller
Published May 28, 2021
Oregon’s history and image are of a progressive state out in front of the rest of the nation in areas of policy and social justice over decades in areas including direct democracy, environment, human rights, health issues, and drug and mental health policy.
But Oregon’s status as a progressive state is not a lock, certainly not for the areas of public health policy and practice, uncovered and examined, where, as highlighted in this PBS NewsHour report, “For years, Oregon has had among the worst rates of substance use disorders and mental health conditions in the country, while ranking among the lowest for access to treatment services” and where the business-model managed healthcare experiment has spawned Coordinated Care Organizations (CCOs) like Care Oregon and Columbia Pacific, with a record of apparent malfeasant misuse of public healthcare funds predicting harm to vulnerable Oregonians –
1) dedicated public healthcare funds to New Age remedies lacking any evidence for effectiveness, for lethal substance use problems
2) failed to review related research pointing to lack of effectiveness before “training” medical clinics to provide nicotine replacement therapy (NRT) as first line treatment for the lethal condition of tobacco use
4) populated a regional advisory committee on clinical approaches to the lethal opioid crisis with employees, community members, others without background or expertise in evidence-based treatment of problem substance use
5) created “model of excellence” opioid substitute (MAT) treatment programs for opioid dependence designed by medical professionals, those programs without evidence-based treatment elements and with treatment staff without background and training in treatment of substance use problems
6) banned a vetted and approved presentation on current practices and the status of evidence for effective substance use treatment from an opioid conference in immediate response to and retaliation for release of material pointing to gross malfeasance appearing to constitute Medicaid abuse by Columbia Pacific.
7) failed in additional ways to protect vulnerable Oregonians trapped in medical-model-generated lethal substance use and opioid epidemics from continuing harm and from ineffective, substandard clinical practices.
. . . under medical models and management and direction provided by Columbia Pacific CCO, none of the behavioral health services planned and provided at either of these MAT programs constitutes evidence-based treatments for opioid abuse or substance use disorders – none predict benefit for the problem of opioid dependence.
Those accomplishments earning Columbia Pacific approval from Oregon’s Health Authority, OHA, to continue to manage public healthcare funds depended on by Oregonians trapped in increasingly lethal substance use and mental health epidemics.
And not so progressive a state, where
rural areas are hard-hit by national substance use and opioid crises, like the northern coastal rural areas served by Columbia Pacific, consequences of those epidemics in Oregon among the most dire nationwide. The rural counties of NW Coastal Oregon whose use of public healthcare funds for Affordable Care Act (ACA) patients is overseen by Columbia Pacific CCO rank high as problematic among counties in Oregon, where the problem is described as a “public health crisis” and “epidemic”, with more prescription opioid pills (280 million) prescribed than in any other state and 150 deaths annually attributed to overdose by prescribed opioids.
More recent findings identify Oregon with the highest rate of older adults hospitalized for opioid use problems . Tillamook County is fifth among counties for continued prescription of opioids, with Clatsop County, also in the region, in the top ten. Annual opioid overdose deaths in the three counties in this rural Oregon region exceed national rates by up to 40 per cent.
And where
Columbia Pacific’s development in two regional clinics of Medication-Assisted Treatment (MAT) with the prescribed substitute opioid Suboxone is branded as a model program, a “hub” and “center of excellence” for opioid crisis response.
But as described in related posts, under medical models and management and direction provided by Columbia Pacific CCO, none of the behavioral health services planned and provided at either of these MAT programs constitutes evidence-based treatments for opioid abuse or substance use disorders – none predict benefit for the problem of opioid dependence.
For example, at Rinehart Clinic, patients on Suboxone were placed in and billed for AA-type support group meetings as part of the “treatment” programming. Instead of therapies supported by research as effective (“evidence-based practice”) these programs substitute and bill for: self-help groups, “check-in” groups, and “process groups”, none of which constitute a form of treatment for a substance use disorder, constituting apparent Medicaid abuse and perpetuating public harm in the opioid crisis.
In that context of failed and unethical apparent misuse of public healthcare funds, it was perhaps predictable that Oregon and its business-model healthcare system would endorse and celebrate an event in August of 2018 that encourages perpetuation of treatment as usual (TAU) for substance use problems, TAU established by decades of evidence as predicting at best no benefit, more likely harm and continued worsening of substance use and opioid epidemics.
The event, with endorsement by governor Kate Brown and promoted by ACCBO (now MHACBO), Oregon’s Addiction Counselor Certification Board, was branded “Hope 2018: Building a State Recovery Strategy”. It was advertised as being organized around practices and treatment models of the Hazelden Betty Ford system of rehab industry “treatment” programs for substance use disorders, with featured speakers from the Hazelden Foundation along with other “Local, national and state leaders” to “discuss . . . practices that will help Oregon forge a successful path to becoming ‘the recovery state’ . . . [by] learning about “strategies utilized in key states to combat the addiction crisis”.
What was not likely presented at the event was an explanation of the fact that the Hazelden system, like all other programs in the U.S. providing TAU in residential, or “rehab” programs, functions as a criminal scam, with no peer-reviewed, published evidence for effectiveness, instead a long history of ignored exposé as very expensive sham treatment, as here, and here, and here.
And here, in this remarkable documentary film, where the benighted Hazelden reps are interviewed, unable to account for or support the sham “treatment” they provide
to vulnerable Americans trapped in substance use crises – crises that their archaic practices unsupported by research predictably worsen –
In a cooperative spirit, one of Oregon’s watchdog media outlets, the Statesman Journal, honored Dr. Marvin Seppala, a participant in ““HOPE – Building a State Recovery Strategy” and chief medical officer of the Hazelden Betty Ford Foundation with a guest column. Dr. Seppala, an Oregon resident, graciously noted another participant and speaker, Oregon’s governor Kate Brown, as a “thought leader” on the treatment of substance use disorders and on measures needed to stem lethal substance use epidemics. Perhaps out of modesty for the Governor, Dr. Seppala did not review the achievements nor outline her training and background that establishes the Governor as qualified to evaluate and identify what are research-based effective clinical approaches to treatment of the life-threatening condition of compulsive substance, versus not effective.
Governor Brown, in turn, dutifully and no doubt gravely characterized compulsive substance use as a medical condition, a disease, and likely none of the participants or media present corrected that, none likely pointed out that the disease model of compulsive substance use is invalidated by all relevant lines of longstanding evidence, or that belief in that fiction is a key predictor of relapse.
The event was promoted by Oregon Recovers (more on them later) and Oregon’s Addiction Counselor Certification Board (ACCBO) an entity whose function is to protect the entitlement system that supports monthly stipends for individuals who are neither qualified nor trained to provide the indicated, required treatment, or treatment of any type for the complex, refractory, life-threatening psychological conditions that drive the behavioral symptom of compulsive substance use.
Consider: to save enormously on salary costs, a managed healthcare system of primary care clinics replaces all MDs, nurse practitioners (NPs), all licensed medical providers (LMPs) entirely with medical assistants (MAs) to diagnose, provide clinical treatment formulation, and provide primary treatment for medical conditions, including complex, life-threatening, difficult-to-treat issues – medical assistants those clinic staff who “room” you on your visit, taking vitals, reviewing medical history, drawing blood. Think of the savings! MAs have about 2 years of formal (college) education in their field, more than is typically gained by the “addiction professionals” (in Oregon – Certified Alcohol and Drug Counselors, CADCs) who are employed in current systems to treat complex, life-threatening, clinically challenging problem substance use issues. That’s the pathological system we have, endorsed by Oregon Health Authority, celebrated by “Hope 2018” and protected fiercely by Oregon’s lucrative addiction treatment entitlement industry, including Hazelden, Oregon Recovers, and MHACBO.
There are a limited number of ways to legitimately and responsibly characterize those absurdly wrong situations and the policy and management supporting them – one situation (replacing licensed medical professionals with medical assistants) hypothetical, the other the reality of “addiction treatment” in Oregon and nationally: vulnerable Americans paying for grossly unqualified “addiction professionals” to provide sham treatments that lack effectiveness. Most directly those characterizations would include “criminal” and “criminally disordered behavior”.
That’s not progressive Oregon, and it’s not Hope, nor Recovery. It’s harm-predicting,
epidemic-friendly, entitlement-protecting. Criminal.
The Doomed, False Promise of Measure 110
That’s the context and history of forces working against effective healthcare
in Oregon that has ensured Oregon’s status as one of the worst in the nation for providing effective substance use services. Forces, failures and lethal epidemics acutely highlighting the need and driving the remarkable victory won by proponents and voters passing Measure 110 to provide funding to begin to move toward a reformed, effective treatment system. And the same forces that would set up Measure 110 backers and vulnerable Oregonians to be betrayed by legislators and “members of Oregon’s addiction and recovery community” in closed meetings to eliminate the measure’s mandate aimed at providing accurate clinical evaluation of needs and barriers, along with eliciting motivation and psychological readiness for positive changes and outcomes in initial contacts with Oregonians who have not benefitted from the revolving door of current addiction systems. That mandate – for professional evaluation of treatment needs as provided by a skilled licensed professional capable of using therapeutic approaches to help individuals used to failure in failed systems motivate for change – was replaced by the beneficiaries of those failed systems with the provision for first contact for Oregonians trapped in lethal substance use epidemics to be with someone with no training or background to provide competent evaluation, motivation, instillation of expectation for benefit, or understanding of effective versus sham treatment, instead by other beneficiaries of those failed systems, “peer mentors” or “peers”.
The conflict – between protecting the health and lives of vulnerable Oregonians by funding new treatment that helps rather than harms versus protecting current systems that got Oregon where it is now – was aptly summarized in a Salem Reporter piece by Rachel Alexander and Saphara Harrell – “Oregon is poised to dramatically expand an addiction treatment system that already consumes millions of dollars each year with no clear results”.
What about these “peers”, or “peer support specialists”,
the beneficiaries of the discarding of language protecting treatment standards in the measure Oregonians voted for, language discarded in closed-door meetings?
In a piece appearing in Filter online magazine, the writer along with Jessica Gregg, chief medical officer at DePaul Treatment Centers, unwittingly explain why involvement of “peer support specialists” or “peer mentors” predicts harm to vulnerable Oregonians.
To Gregg, one way to help people navigate these labyrinthine systems is simple: “Peers, peers, peers.”
Measure 110 and SB755 repeatedly emphasize the importance of peers, echoing decades of evidence that shows how they increase engagement and retention in SUD treatment. Hopefully the infusion of funds into the system will enable more peer hires—though there are whispers of a looming behavioral health shortage due to low wages, a situation that could, in theory, be mitigated by the extra funds.
“evidence that shows how they increase engagement and retention in SUD treatment”
Yes exactly, the role of these peers is to ensure that captive substance users are ushered to “SUD treatment”, that is, the same failed systems that have been harming Oregonians for decades by providing sham treatments that are not effective. We know they’re not effective and we know why, we’ve known for decades.
A “peer” professional is someone without any meaningful training, qualification, understanding, or capacity to provide the evidence-based supports and navigation to access community resources that are effective for substance use problems. If that function was the real intent of using “peer mentors”, then it is clear that the existence of that constructed title and employment opportunity – for individuals whose qualifications are based on “lived experience” i.e., having had periods of life that were poorly controlled and dysfunctional – is superfluous and unneeded, serves some other purpose. Because there already exist professionals who are in fact trained and competent to help individuals in need to access the wide variety of community resources and supports needed to put a life back together. They are called “Case Managers” and are employed and available in nearly all existing mental health and healthcare programs. Their competence comes from education and experience in all areas of accessing community resources – what individuals with problem substance use need – not restricted to what they gained from having used some subset of resources when they were struggling with a substance use disorder. Having had a substance use disorder has no bearing on their development of competence in providing case management.
In fact it would be a liability, a risk factor, because those individuals, typically “in recovery” or in a “recovery community” almost predictably are involved in the religious subculture Alcoholics Anonymous (AA) or NA, Narcotics Anonymous and hold the instilled belief that part of their recovery is in “giving back”, getting other “addicts” into the program. Practically, speaking from going on two decades of direct experience in these systems and to slightly (but not by much) exaggerate, a “peer mentor” is someone who drives you to your AA meetings, to ensure you get there. That’s how it works.
It’s important to adequately deconstruct the addiction industry/media fabrications to get to an accurate, reality-based picture of these constructed entitlements and their consequences. Lives are at stake. Employed peers are often rationalized as having the lived experience to help others “navigate these labyrinth systems” that someone overcoming problem substance use might need. What exactly are those systems?
It turns out, intuitively and accurately, that the endless types of individual stressors, barriers, and needs that are critical factors to be addressed in reconstructing a life that supports diminished inner distress and drive to compulsively use substances (a “recovery ecology”) is unique to each individual with problem substance use, demanding case management competence (the type acquired by professionals known as “case managers”) over the entire range of environmental and community resources and barriers, not any subset that would be gained by virtue of being a peer exposed to failed addiction treatment systems. Substance use is not a “stand-alone” condition or, least of all, disease, instead is clearly a symptom of the underlying distress driving it and multiple challenges in functioning and living. Problem substances users are impacted by not only medical and mental health needs and the complex community and environmental needs associated, but challenges in many other areas including employment, socialization, transportation, education, insurance etc. etc. A professional trained and qualified to link others to the needed resources and with the competence and training to do so is the professional who is qualified in case management.
Anyone with experience with or in the failed, sham addiction treatment systems like those that have driven lethal outcomes in Oregon over decades knows that in practice, a “peer” hired as a mentor or support specialist is someone who more likely than not is enmeshed in the religious subculture AA or NA, invested in those established-as-countertherapeutic, relapse-predicting prescriptions, and advocating for the participation of others. That is, being a “peer” with “lived experience” in this field generally constitutes a risk factor, rather than protective, when vulnerable substance users are subjected. “Peer”, substituted for an adequately trained behavioral health professional, is not a thing clinically, professionally, or ethically, predicting harm.
It has been established for decades that the bizarre, established-as-countertherapeutic prescriptions of those religious subcultures, AA and NA, predict at best no benefit for those exposed to the meetings, more likely harm, that is, predict increased risk of return to problem substance use, consistent with 85 to 95 percent failure rates for those coerced or convinced to participate.
Use of “peers” functions to increase exposure of vulnerable individuals to the same failed, sham “treatment” systems that have been driving epidemics and deaths for decades. To the extent that peers lead Oregonians trapped in problem substance use back into these systems, they increase risk of continued use, treatment failure, and deaths. The substitution of peers for qualified professionals in the measure Oregonians voted for, in closed door meetings, served another function – provision of entitled employment to members of Oregon’s “recovery community”, employment historically preferentially provided to individuals “in recovery” over the evolution of Oregon’s failed, harm-predicting sham addiction treatment systems. Those beneficiaries gained in those closed-door meetings when the clinical mandates voted in by supporters of Measure 110 were eliminated, to protect jobs for peer support specialists.
But more about “lived experience”, what “in recovery” means, and the power of Oregon’s “recovery community” below.
To more fully understand the betrayal and derailing of the intent of the measure to provide access to effective treatment, let’s start with the description “members of Oregon’s addiction and recovery community” in this piece on the history of Oregon’s attempts at progressive health care change and on Measure 110:
Oregon has a long history of progressive health-related measures, says reporter Tatiana Parafiniuk-Talesnick. She reports on things like COVID-19, poverty and Measure 110 for the Register-Guard newspaper in Eugene.
“There’s just a strong legacy of counter-culture culture here,” she says. “I think most people familiar with some of the bigger cities here know that.”
Oregon became the first state to decriminalize marijuana use in 1973. Eugene, the third-largest city in the state, deploys healthcare workers, not police, when someone is having a mental health crisis. And it was the first state to enact a Death with Dignity Act in 1997, which allows terminally-ill people to end their lives on their terms, using lethal medications.
. . .
Now, if you’re caught with one or two grams of what some refer to as “hard drugs”, you won’t be charged. Instead, you’ll either pay a maximum $100 dollar fine, or complete a health assessment within 45 days at an addiction recovery center. This new system for services will be funded through the state’s marijuana tax.
But the measure is still controversial, and members of Oregon’s addiction and recovery community are split on if it’s a good idea. So how did we get here?
As explained in the Science Friday piece, key members of that “addiction and recovery community”, who would be involved directly or indirectly in the closed-door elimination of Measure 110 clinical mandates, are Mike Marshall of Oregon Recovers and Tera Hurst, executive director of the Oregon Health Justice Recovery Alliance:
Mike Marshall was one of the loudest voices against Measure 110. He is executive director of Oregon Recovers, an organization that serves and advocates for people in recovery for addiction. He’s in recovery himself, for alcohol and crystal meth.
Marshall supports decriminalization, but he says Oregon’s recovery services system is fractured and incomplete. People often have to wait several weeks for a treatment bed, and many service centers are outside of the traditional healthcare system.
“There’s nothing in 110 that prepares the healthcare system, or expands capacity,” he says. “They simply deconstructed one system,” the pathway through treatment through the criminal justice system, “without recognizing the healthcare system isn’t prepared for them.”
Marshall says that previously when people got arrested or written up for possession, many were court-mandated treatment. The system wasn’t perfect, but it helped some people get into recovery. Now, Marshall says a lot of people will be cut off from that support because small level possession will now be treated as essentially a speeding ticket.
. . .
Tera Hurst, executive director of the Oregon Health Justice Recovery Alliance, says this is only the beginning for bringing service to Oregonians.
“The Oregon Health Justice Recovery Alliance is actively engaged with the legislature to ensure that the low-barrier, culturally responsive treatment and recovery services promised to Oregonians through the measure are swiftly and adequately funded,” Hurst said. “The additional funding outlined in the measure, which will be distributed as grants to community organizations throughout the state, will greatly expand access to services that have been historically fractured and underfunded.”
Hurst, someone who is also “in recovery”, is clearly intent on being “engaged with the legislature” to ensure that the new funding generated by Measure 110 is distributed to existing systems, systems that are “underfunded”, that is, treatment as usual (TAU), the systems associated over decades with worsening, increasingly lethal substance use epidemics. The failed systems that preferentially employ members of her and Mike Marshall’s community, the community of individuals “in recovery”.
Here’s how OPB’s (Oregon Public Broadcasting) Dirk VanderHart described recovery community advocate involvement in the closed-door elimination of Measure 110’s intended mandate for behavioral health professional involvement in initial contacts to support Oregonians’ access to effective treatment: as pushed for or with the direct participation of Hurst and Marshall, to replace those mandated licensed professionals with members of Marshall and Hurst’s community of persons “in recovery”. The result will ensure additional funding of employment (a concern expressed openly by Hurst) of those individuals employed by virtue of being “in recovery”, branded as “peer support specialists” but without behavioral health credentialing, training, or competence to evaluate complex, life-threatening disorders. An additional critically important effect: placing those clinically uneducated and unqualified “peer” members of the “recovery community” in control of how vulnerable Oregonians at risk of harm and death are steered, or not, toward treatments – the traditional failed systems Marshall and Hurst are protecting, versus something else, something more effective as in the intent of Oregon voters passing 110.
That’s how that got worked out.
But let’s go back. Let’s not get too far ahead.
From the news accounts about Measure 110 and it’s hijacking by advocates who are not healthcare professionals collaborating with legislators, it would be possible to gain the impression that just about everybody with an authoritative understanding and with influence is “in recovery”! Let’s think about that.
“Addiction” (not a thing), has been branded as a chronic disease (a necessary and invalidated fabrication) and equated with other chronic diseases, most commonly diabetes. What about other chronic diseases and conditions that we are assured by trusted medical authorities and mass media are, as models for understanding the brain disease of addiction, medical conditions with medical treatments? Like diabetes, heart disease, chronic pain, and hypertension. Are there very public, politically involved “recovery communities” for those conditions? I’ve never heard of one. Are there individuals who identify themselves as “in recovery” from those conditions? I’ve never met one. Are there individuals who identify as “in recovery” from those conditions and by virtue of that identity are preferentially hired in programs, or clinics using “peer recovery specialists” or as “diabetes treatment professionals” after a year or two of training?
I have met individuals whose blood sugar levels were in the prediabetic range or diabetic range, made important changes in their health behaviors and lifestyle, stopped having blood sugar dysregulation problems, and don’t identify as having diabetes or being “in recovery” from diabetes. They get on with their (healthy) lives. They may have accessed a support group for a limited time, but not generally. Same with hypertension and chronic pain. They change their behaviors, often with the help of a qualified behavioral health professionals for a limited time, maintain those behaviors, and then no longer have or identify as a victim of a chronic disease.
It turns out the same is true for substance use problems,
a truth successfully hidden for decades, described and explained here. A large body of epidemiological data and analysis, starting with and following individuals at some point in their lives diagnosed with a substance use “dependence”, that is as having the more severe form, the disease, of addiction, find consistently – for all substances looked at including alcohol, opioids, cocaine, and tobacco – that a large majority of those individuals:
- Stop using the substance, or frequently with alcohol change to use in moderation
- No longer have problems in life related to use of the substance, i.e. would no longer meet criteria for dependence, no longer have the “disease”
- Do not return to use that constitutes dependence
They quit. Like individuals with those other chronic conditions, they quit by changing their thinking; their reflective assessment of personal values and costs and benefits of changing behaviors; their behaviors and their health habits. Most of them do that without any support or treatment at all. They are not in recovery communities, or dependent on supports by virtue of their identification as “addicts” and “in recovery” – supports like entitled, preferential employment as “addiction counselor” or “peer recovery specialist” despite lack of training or qualification to treat life-threatening compulsive behaviors driven by complex often hidden underlying psychic conditions – because they are capable of engaging in employment in which they are competent, rather than entirely out of scope of competence.
Here’s something else, remarkably different about those other chronic conditions compared to persons in recovery from addiction: not only are they not in recovery communities or identify as in recovery as a necessary life-long need for support, they also are not involved, let alone almost uniformly involved, as members of a religious subculture in which they are trained to believe they are powerless over their conditions; that they therefore must rely on the beneficence of a magical power outside of themselves; that they must identify as always continuing to have the condition or disease; that they must continue indefinitely to regularly attend meetings of the religious subculture, where the use of tobacco, smoking, is culturally normed, socially reinforced, often encouraged as it is in the literature of the recovery program. Individuals outside of the addiction recovery community culture learn the opposite: that change toward health and freedom form their condition is possible; that it is self-directed and they are capable of it; it requires focus on self-initiated changes in behavior rather than belief in a higher power; and use of tobacco is a barrier to change, a threat to their health and freedom from the condition.
Here’s another difference. There are no individuals identifying as “in recovery” from one of the other chronic health conditions, like diabetes or chronic pain, or heart disease, and without any meaningful training, qualifications or capacity in the relevant areas – medicine, public health, psychology, mental health, endocrinology, cardiology, disease, physiology, etc. – who nevertheless find themselves in closed-door meetings with legislators deciding how public healthcare funds will be used for treatments and approaches to lethal disorders and associated public health epidemics.
No, of course there are not individuals like that. Ha! Funny. That would be absurd, wouldn’t it?
Actually, not funny at all. Pathological. Lethal.
Well. That was a bit of a digression.
Let’s get back to the likes of recovery community advocates like Mike Marshall and Tera Hurst, and their collusion with Oregon legislators and other players to discard parts of the measure passed by Oregonians intended to ensure a more effective treatment system for individuals trapped in increasingly lethal epidemics , using qualified professionals.
It turns out their public comments are telling – they tell us, or should, something important.
Again, from the Science Friday piece –
Mike Marshall was one of the loudest voices against Measure 110.
. . .
“There’s nothing in 110 that prepares the healthcare system, or expands capacity,” he says. “They simply deconstructed one system,” the pathway through treatment through the criminal justice system, “without recognizing the healthcare system isn’t prepared for them.”
Marshall says that previously when people got arrested or written up for possession, many were court-mandated treatment. The system wasn’t perfect, but it helped some people get into recovery. Now, Marshall says a lot of people will be cut off from that support because small level possession will now be treated as essentially a speeding ticket.
“I think the largest unintended consequence is that the overdose rates are going to shoot up,” Marshall says. “There’s going to be more people on the street using drugs, and no mechanisms to either interrupt that or direct them out of that.”
Tera Hurst, executive director of the Oregon Health Justice Recovery Alliance, says this is only the beginning for bringing service to Oregonians.
“The Oregon Health Justice Recovery Alliance is actively engaged with the legislature to ensure that the low-barrier, culturally responsive treatment and recovery services promised to Oregonians through the measure are swiftly and adequately funded,” Hurst said. “The additional funding outlined in the measure, which will be distributed as grants to community organizations throughout the state, will greatly expand access to services that have been historically fractured and underfunded.”
Marshall and Hurst clearly want traditional treatment systems to be protected and to gain increased funding, those traditional treatment systems serving as something close to closed shops or cronyism systems for individuals without qualifications or training to provide any type of services for vulnerable individuals with life-threatening behavioral conditions of compulsive substance use, but are in fact preferentially hired by virtue of being “in recovery” or having “lived experience”. Marshall knows, as does anyone who has worked in the field, that judges (serving key roles in the army of useful idiots perpetuating lethal substance use epidemics) can be counted on to order substance users who come before them (and in clear violation of their constitutional rights) to attend meetings of the religious subculture AA, exposure to which has been established for decades as increasing risk of return to problem substance use, that is, of causing harm. And those judges can be counted on, instead of supporting choice of substance users in accessing effective, evidence-based treatment, to mandate them to community mental health or traditional treatment systems, again predicting harm and explaining substance use epidemics worsening over decades. But those court orders fuel the failed systems that provide entitled employment for members of Marshall’s recovery community, who are hired preferentially by virtue of being “in recovery”.
As noted in a Willamette Week piece prior to the November vote, the impetus for Marshall’s opposition was clear – protection of the traditional, coercive mandates forcing drug-involved Oregonians into failed treatment systems that are major employers of individuals “in recovery” and into the religious subculture that is a key unifying identity of Marshall’s “recovery community” –
Oregon Recovers’ opposition is counterintuitive because the group has spent the past three years building political support for greater spending on addiction treatment, an area in which Oregon regularly ranks behind nearly every other state. It’s also notable because many groups involved in the mental health and addiction services fields have endorsed the measure.
. . .
Anthony Johnson and Janie Gullickson, who are co-chief petitioners for Measure 110, say they are disappointed in Oregon Recovers’ decision.
They both took issue with Oregon Recovers executive director Mike Marshall’s defense of the existing pathway to services, which, for some people, involves getting arrested and ordered into treatment by a judge.
But that defense isn’t counterintuitive at all. Oregon Recovers does want more spending on addiction treatment, but that spending has to go to the right places – the failed systems of “rehab”, “addiction treatment” programs, and community mental health – whose failures to provide actual treatment are driving increasingly lethal epidemics, but who function as the entitlement system employers of members of Marshall’s recovery community.
Tera Hurst expressed how these systems work just as clearly in her remarks for a story in the Salem Reporter –
Tera Hurst, executive director of Oregon Health Justice Recovery Alliance, which advocated for Measure 110, said Oregon hasn’t seen what it looks like to have an adequately funded system to address substance abuse. She said many of the system’s flaws stem from a lack of money and addressing that problem is the first step in fixing the system.
Hurst, who’s in recovery, said there is some unfounded fear that the measure will in fact reduce addiction services.
. . .
Hurst equated the coming infusion of cash for substance abuse programs with careful feeding of a starving person.
The problem for Hurst and Marshall is a “lack of money” for existing systems – systems providing services over past decades while Oregon’s substance use epidemics have worsened – and she seems frustrated and threatened like Marshall, at the prospect of changes in treatment approach, in shifts to treatment provided by qualified professionals, because that would overturn the current workforce. She is very concerned that “peer mentors” are being laid off – a “peer mentor”, someone without required training, background, or competence related to the treatment of life-threatening compulsive substance use, yet who nevertheless is constructed as having competence and awarded a monthly salary by virtue of identification as being “in recovery”. That has to be protected.
Oregon is poised to dramatically expand an addiction treatment system that already consumes millions of dollars each year with no clear results.
– Rachel Alexander and Saphara Harrell, Salem Reporter
It has gone unnoticed that Marshall and Hurst’s visions of addiction treatment that include desired elements of criminal justice system pathway to treatment, with adequate funding and peer-delivered services has, in fact been implemented and provided in Oregon for decades, under the Oregon Department of Corrections (DOC) Alternative Incarceration Program, implemented in multiple correctional settings in the state.
Treatment services are provided by local community traditional addiction treatment programs, with funding and oversight provided by the state, and DOC contributing to provide integrated post-release supports including housing and employment.
In the program I had direct observation of, essentially all of the treatment staff including direct practice, supervisory, and management, were “in recovery”; the state provided adequate funding for services; and there was a significant peer-delivery component.
One way to evaluate recovery advocates’ demands for continued and increased funding for Oregon’s traditional treatment models would be to access outcome measures for these programs, to evaluate their success.
The PORTLAND BUSINESS JOURNAL got it right about Measure 110, noting reasons for Mike Marshall’s opposition.
“The nonprofit Oregon Recovers, as well as former Gov. John Kitzhaber opposed the measure, arguing that it would destabilize the existing addiction recovery system.”
destabilize the existing addiction recovery system
That is accurate – for the preferentially hired, self-identifying “addicts” who are “in recovery” and benefitting from those identities in entitlement systems, the “existing addiction recovery system” must be protected.
And this piece in USA Today gets it right, headlining that “rehab” will be offered to “addicts” when the Oregon’s groundbreaking Measure 110 is implemented.
“Rehab”, or traditional residential substance use treatment with the same elements as in outpatient treatment programs – those programs that thanks to the efforts of “recovery community” advocates like Marshall and Hurst will be protected – are established by decades of consistent evidence and research to constitute criminal, sham treatment scams.
“What we simply need is a a nice bulldozer, so that we could level the entire industry and start from scratch . . . There’s no such thing as an evidence-based rehab. That’s because no matter what you do, the concept of rehab is flawed and unsupported by evidence.”
– Dr. Mark Willenbring, former director of treatment and recovery research at the National Institute of Alcohol Abuse and Alcoholism (NIAAA)
Watch the trailer to the documentary, or watch it again. Really. It’s key to understanding perpetuation of lethal, untreated substance use epidemics in Oregon.
Then there is this revealing piece, in Filter online outlet, by Oregonian Morgan Godvin –
Implementation of Measure 110’s health care aspects has many more moving parts—not least the Oversight and Accountability Council (OAC), which was mandated to be formed by the date decriminalization took effect. The Oregon Health Authority voluntarily raised the number of council members to 21, above the minimum of 16 set out in the measure.
I was appointed by the Oregon Health Authority to the Council because of my lived experience with repeated incarceration for heroin possession, my less-than-pleasant experiences in drug court, and my current public health expertise and my drug policy research position at the Health in Justice Action Lab.
The foundational shift can be felt in the council meetings. Many of the councilmembers have been directly impacted by incarceration or addiction; others are leaders in the treatment and recovery services field. In a state that is 85 percent white (though Census Bureau race statistics obfuscate Latinx heritage), the majority of members are people of color—a damning recognition of the drug war’s disproportionate impacts.
That had to be a huge relief to the beneficiaries (employees) of Oregon’s failed addiction treatment systems – that the Oregon Health Authority would populate a group tasked with implementing Measure 110 with individuals – not due to competence, training, or background that would allow them to put forward new, evidence-based approaches to treatment to replace Oregon’s decades-old commitment to failed treatment systems – but by virtue of being employed in those failed systems, or in recovery, or with “lived experience”. That is, all stakeholders invested in preserving existing systems.
It was predictable that measure clinical mandates would be discarded so that unqualified “peers” would be hired to provide initial contact with vulnerable substance users, instead of, as mandated by Measure 110 language, qualified, licensed professionals, the mandated use of professionals with competence in the field of substance use treatment seen as a “hiccup” by the Council members.
The term “assessment” has been changed to “screening.” It was mandated in the ballot measure as being performed by a “licensed treatment provider,” meaning Lines for Life could only hire people with CADC certification and not peer mentors—another hiccup that is being rectified by the bill.
It seems that “lived experience” is the new “in recovery”, and identifying as having either is a ticket not just to employment in Oregon’s failed treatment systems, but becoming recognized as someone capable – as if having the equivalent of a necessary background in evaluation of research, in psychology and mental health, understanding of evidence based practices and therapies, of human behavior and in related areas – of collaborating with others “in recovery” to determine how public healthcare funds will be apportioned in ways that ensure effective treatments for Oregonians at risk of continued problem substance use and death.
Let’s think about lived experience and being in recovery
What is the rationale here, the justification – in selection of individuals to be employed and be signified with credibility and responsibility, because they’ve experienced periods of problem substance use and associated problems, to address treatment needs of Oregonians trapped and dying in increasingly lethal substance use epidemics? What is the justification for substituting “lived experience” – that is, having a period of life with mental status, emotions, behaviors and choices poorly controlled enough to lead to potentially lethal use of substances and associated problems – for other qualifications like training, competence, knowledge and background in the areas required to understand and guide treatment for a life-threatening condition, like: training in research methods and interpretation, psychology, human behavior, applied psychotherapy, the biology of substance use, factors and therapies that influence human motivation and choice ?
It turns out that’s the wrong question, because the practice and its justification are absurd on their face, defy reason and ethical judgment, just as employing an army of unqualified paraprofessionals whose primary understanding and approach to substance use treatment came from the 12 Steps and the long-invalidated folklore of “addiction” is absurd on its face, and criminal.
The real question is: WTF are we thinking and doing?
While more and more Oregonians suffer and die, trapped in increasingly lethal epidemics?
And what pathological levels of intellectual cowardice prevent us from changing things?
The fabricated story, the lie offered and swallowed whole, to justify these continued practices fueling a cronyism industry providing employment to persons with “lived experience” and “in recovery” as if they were qualified to treat complex, life-threatening behavioral conditions goes something like this: through their experiences of inability to regulate behavioral choices with associated problems with substance use and of overcoming those deficits in order to reach the status of being “in recovery”, they demonstrate an understanding of overcoming addiction through direct experience in ways that do, in fact, qualify them to provide effective services to others.
Right.
There should be no need to belabor this, or even to lay it out, but there is, and it’s a matter of life and death for Oregonians exposed to a sham workforce in the addiction treatment industry – a sham workforce of individuals whose “lived experience” and a couple of years of training within that existing treatment system, absurdly, lethally, is taken as a substitute for the undergraduate, advanced degrees, additional training, and licensure required in any other area of healthcare to qualify someone to evaluate, formulate clinical approach, and treat serious health conditions, let alone complex, life-threatening behavioral health conditions – like substance use – driving increasingly lethal epidemics. It is a sign of social pathology and of institutional abdication of responsibility to protect public health, of criminality.
Anyone with direct experience in the field knows what I know
and directly observed, what I have “lived experience” of – that in Oregon and across the nation, “rehab” and addiction treatment generally has been and remains staffed preferentially by hiring of individuals “in recovery” and more specifically who are acolytes (participants) in the religious subculture Alcoholics Anonymous (or NA), programs at times functioning essentially as closed shops.
Hard to believe? Ask around. Parts of my lived experience include, just as examples, being turned down for a position in an addiction treatment program after declining in interview to commit to attending (with other staff all “in recovery” and in AA) in lunchtime AA meetings. Yes, that’s right. And termination from a program after declining to participate in the opening prayer of each staff meeting, staff in that program essentially all identifying and aligned with the AA religious subculture. My complaints that required participation of patients in the secure residential treatment program in prayer violated their constitutional rights and of the substitution of in-house AA meetings for the Cognitive-Behavioral group curriculum mandated by the state probably contributed to my termination. Those are not anomalous experiences; they represent the reality of the evolution of failed treatment systems in Oregon and elsewhere.
So, what about the competence and capacity of those preferentially hired individuals, members of Marshall and Hurst’s recovery community, whose qualifications are rationalized as being based on their success in overcoming addiction?
I don’t want to over-generalize, and don’t take my word for it. Ask around. Take a look around within addiction treatment programs. An objective look. I’ve been in direct practice in dedicated addiction treatment programs or larger programs with addiction treatment programs in a variety of roles, in 8 to 10 settings around the Pacific Northwest. I can say from direct observation, about the staff members hired preferentially because they are “in recovery” or have lived experience, that with exceptions of course –
- They tend to have and express something ranging from insecurity to disdain, to angry rejection of evidence-based therapies established as effective in substance use treatment
- They tend to be emotionally dysregulated, suspicious of professionals with college degrees and who are not “in recovery”
- They tend to be smokers often, that is, dependent on what is arguably one of the most lethal and addictive substances known – nicotine – and consistent with social reinforcement and normalization of that “addiction” in meetings of their religious subculture
- They tend to be often overweight to morbidly obese, that is, tend to experience the adverse health effects of compulsive misuse of food, a substance use disorder no different diagnostically or clinically from opioid use disorder, alcohol use disorder, etc., with one very significant difference
Let’s explore those last two points. It’s important. But again, don’t take my word for it, take a look around the addiction treatment industry, and ask around. For example, you might ask a manager of an addiction treatment program employing persons “in recovery”, if you know one you trust to provide honest answers. Ask that manager whether their program, as an employer, pays about the same rates for health insurance for their employees as the average employer. Then ask why they are paying high rates, how that relates to the insurance industry’s assessment of health risk for that employee population and why. Then ask the manager if there is any difference in rates for professional liability insurance in that program – insurance for defense of the program against charges of unethical or other behaviors resulting in allegations of harm to clients by staff. Ask the manager to explain.
Right.
But what about tobacco use disorder and food use disorder?
It’s established by survey and objectively observable that individuals “in recovery” tend to be smokers, and it seems entirely observable that compulsive use of food leading to overweight is also characteristic of those programs, that is, the “addiction” of food use leading to obesity. What’s the big deal? Everybody knows that when you stop one addiction, of course you need something else for comfort, to ingest, to take in, that’s why AA groups tend to support continued use of tobacco, if not encourage or at least socially reinforce at meetings – for those “in recovery”.
Here’s the big deal. The potential health risks and public health costs of compulsive-food-misuse-fueled obesity (Food Use Disorder) eclipse those related to opioid, meth and alcohol addiction combined. The same is true of Tobacco Use Disorder.
That is to say, as a group (not generally or universally) persons “in recovery” tend to be, disproportionately, dependent on the two abused substances in their culture with, by far, the most predictable health risks and health costs eclipsing those of other substances. That is, many or most of these preferentially hired individuals are modeling addictive use of substances because, instead of successfully overcoming compulsive, harmful use, they have failed to do so. As individuals likely to be enmeshed in AA or NA religious subculture, they have never accessed actual, evidence-based therapies for the help needed to quit, instead hiding out in the meetings of a religious subculture whose bizarre prescriptions include normalization and social reinforcement of their lethal tobacco habit. That is, their “lived experience”, for many or most, is of a history and continued failure to regulate harmful behaviors and choices.
That’s whose employment in failed addiction treatment systems was just protected in closed-door meetings by elimination of clinical mandates written into Measure 110.
Lived Experience and Profiles “In recovery”
My lived experience doesn’t include being “in recovery”. It does not include being recognized by institutions as credible or qualified to help guide the direction of treatment for problem substance use. That’s despite having about 12 years of college education including training as a research scientist in biology and training in mental health, and peer-review publication in two fields, including original research and critical analyses of research methods and interpretation in the field of substance use treatment.
My lived experience does include direct experience and observation of how the addiction and mental health treatment industries in the Pacific Northwest operate. And it includes being terminated from employment, or leaving positions to avoid termination, repeatedly over close to two decade in multiple settings, resulting from my obligation as a social worker to report instances of unethical, illegal, or otherwise harmful practices in programs.
Those observations include, in a recent position, a colleague, “Helen” (name changed) in training and soon to become a CDP, chemical dependency counselor. Helen is morbidly obese and dependent on nicotine, by smoking. Several times each day, she would step outside the main office of the community mental health program and stand near the street to smoke a cigarette. Clients coming into the program building from any direction, clients soon to be provided “addiction treatment” by her, would see her there, obese due to unregulated misuse of food, and smoking. That’s what was modeled for patients entering the program to attempt to control their addictive behaviors. Helen was okay with that program’s collusion with the local DA, public defender’s office and court to knowingly violate vulnerable clients’ rights to due process, including clients with major mental illness, holding them in jail indefinitely, without charges until they could be coerced to be sent off to “rehab“, because the violation of their rights “got them into treatment”.
Brian, in recovery
In a program in a facility staffed almost entirely by individuals “in recovery”, I remember “Brian” (name changed) well. He was somewhat of a celebrity in the residential program, having been through it himself and then held up as an inspiring example of success of the programming, with feature articles in the local paper to that effect. Brian related to the involuntary clients in the program, fit in as “one of us”, in fact spending his time strolling through the unit, or sitting with clients, in casual conversation. In staff meetings when Brian described his work with clients, eyes would roll, because it was apparent that the work required by his job description as a certified drug and alcohol counselor (CADC) – including requirements to regularly meet face-to-face in an office session to provide counseling to his caseload of clients, to document sessions and treatment plans, other requirements of the program and the state of Oregon – was simply not being performed.
The absence of any apparent performance of job duties was apparent enough that I decided to keep a record of any client counseling sessions over a period of sharing an office with Brian. After a couple of months there was no longer any point in tracking it, there simply were no sessions occurring. I got more curious and looked at paper charts of his clients to see what was being documented. There were no treatment plans, a core requirement in any behavioral health or addictions program. Then, after announcement of an audit coming up, treatment plans appeared, but with dates going back months prior. I checked the dates records of the Word documents and found the expected – Brian had rushed to create treatment plans in the days prior to the audit, then backdated his signature on them, and then had his clients backdate their signatures. This was in a program with two areas of clinical focus: substance use and criminal thinking errors by the clients. Do you follow? Brian really was “one of us” to the involuntary clients. They had each other’s backs, forging documents to feign compliance with basic standards of treatment.
Brian was, of course, “in recovery” and proud of it. His comfort zone was violated when addiction programming specialists from Salem (the state) came out to implement a treatment curriculum that would utilize evidence-based practices in CADC counseling interactions with clients. You know? Practices for which there is evidence of some actual benefit in preventing future problem substance use, as opposed to, say, working through the 12 Steps and the other bizarre, established-as-countertherapeutic prescriptions of the religious subculture AA. Brian was not feeling it, in fact his frustration would erupt in aggressive utterances about the PhD state addiction manager from Salem, “That bitch doesn’t know shit about recovery”. Brian never caught on to evidence-based practices, never provided them, instead messaged to his “community” of clients that “The only program I know of that helps overcome an addiction is a spiritual program”, alluding to AA and its practices. Brian’s spiritual program apparently didn’t provide guidance on the modeling, ethics, and effects of engaging criminal justice clients in collusion to forge documents to fabricate appearance of meeting treatment requirements, or of failing to meet basic job performance requirements as a CADC.
Brian would become the manager of that program for a period and has for many years served as a member of the Board of Directors of ACCBO (Addiction Counselor Certification Board of Oregon, now MHACBO). MHACBO, like Oregon Recovers, is an organization whose primary task is to protect the entitled right of persons “in recovery”, like Brian, to a monthly salary for a task they are not remotely qualified or able to perform – providing effective treatment for a behavioral/mental health condition (or disease of the brain if you prefer), let alone for a complex, life-threatening behavioral health condition.
It has been fortunate for Brian that organizations like ACCBO and Oregon Recovers have worked to protect those entitled positions.
Jay, in recovery
Then there was “Jay” (name changed), a manager of the same program over the time Brian was employed there. Jay was obese, that is, addictively misused food, with predictable health and lifespan effects just as if the food was instead heroin or alcohol. Jay was “in recovery”, with a history of opioid misuse. What got Jay fired was his habit of repeatedly uncontrolled anger that was expressed in very cruel, denigrating verbal assaults on employees in the program. Before the dust settled, Jay had a new position in an addiction treatment program with the state of Arizona, without doubt his lived experience and status as in recover a plus in his hiring.
Jay tolerated the state of Oregon’s mandate to begin providing evidence-based treatment in the program no better than did Brian. A “12-Stepper” and acolyte in the religious subculture AA, Jay reacted poorly when state addiction specialists directed that treatment would shift away from the bizarre, countertherapeutic prescriptions of AA culture and to evidence-based practices, for example, in a fit of rage throwing copies of the AA “Big Book” at a wall in the facility accompanied by emotional histrionics. Over the time I was there, the state’s evidence-based curriculum was never effectively implemented, managers like Jay, in recovery and enmeshed in AA culture and prescriptions, substituting AA meetings for the required group sessions utilizing cognitive behavioral therapy (CBT). Jay and Brian likely were confident that clients in the facility, working AA’s “spiritual program” as they had benefitted from, could do without Salem telling them what real treatment is.
Joe, in recovery
“Joe” (name changed) was another counselor in that program, an AA “old timer”, admired and complimented by manager Jay for his vast experience in traditional addiction programs and for being “in recovery”. Joe’s “recovery”, actually, included regular, high doses of the predictably lethal, addictive substance nicotine delivered by smoking of tobacco. Every lunch break and other opportunity to get out to his car. Joe’s health did not appear to be good. He eventually had to be talked to, because clients in the program were triggered in Joe’s group sessions – essentially AA meetings, that’s all Joe knew how to do – by the heavy scent of tobacco smoke on Joe. Joe was, of course, “in recovery”.
Joe’s clients in the program were vulnerable to being triggered by the scent of tobacco smoke; it went along with their use of meth, or alcohol, or cocaine, on the outside. It is established, after all, as a gateway drug, especially for use of alcohol and opioids. That’s why the program decided to stop the regular trips very popular with the clients outside of the facility into the community to attend AA meetings – it became clear that the outside trips were functioning as an opportunity to use the highly addictive gateway drug tobacco at meetings of that religious subculture, tobacco use at those meetings . . . okay . . . right . . . we covered that already. Didn’t we.
Doug, in recovery
Then there was “Doug” (name changed), not employed by that same program, but a celebrity of sorts there nonetheless. Doug identified as being in “long term recovery” and as a longstanding acolyte in the religious subculture AA. Doug would come into the facility for evening AA meetings that he would chair, clients rising in admiration to welcome him in. He walked with a cane, because between the neuropathy and other health effects of his unmanaged diet and associated diabetes, including obesity, he was apparently unsteady on his feet, even though only middle-aged. That is, Doug, “in recovery”, celebrated as in recovery by clients in the addiction treatment program, and provided as a model of successful recovery by the treatment program, was in fact addicted to tobacco and food in ways that crated severe health conditions, debilitating conditions. In fact, severe enough to land him in the hospital within weeks of an appearance and engagement in a religious subculture meeting at the facility. By reports, he nearly lost his life and would have left a wife with several young children.
But . . . Doug was, after all, “in recovery”, a longstanding icon and pillar in the AA community, a model of success, his lived experience qualifying him to provide guidance and inspiration to others struggling with the life-threatening condition of compulsive substance use.
Wasn’t he? “In recovery”?
Another prominent and celebrated figure in recovery in Oregon is Alan Evans, CEO of Helping Hands, an organization receiving material and institutional support from the entities in Oregon controlling how public health care funds are used to provide services to Oregonians trapped in lethal substance use and mental health epidemics. Organizations like Oregon Health Authority, Care Oregon, and Columbia Pacific CCO.
Mr. Evans, like the other figures we’ve considered who are in positions to influence treatment approaches for life-threatening conditions in Oregon, is “in recovery” and has no meaningful relevant background, training, or competence in areas that would be required to have such influence. And without any such background or training, he is appointed, for unexplained reasons, by Care Oregon and Columbia Pacific CCO, to serve as a member of a working group committee to determine how public healthcare funds should be used to provide treatment to vulnerable Oregonians at risk of death related to substance use problems. Sound familiar?
Mr. Evan’s organization, under his direction, uses coercion with threat of homelessness to attempt to force homeless adults, sometimes their children with them at the shelter, to engage in religious programming at the shelters he runs. If they decline, they’re back on the streets. See examples of real victims of that religious coercion of vulnerable Oregonians here.
I could go on, and on. As could anyone with direct experience or currently working in these very sick, harm-predicting systems being protected from change in Oregon. They could, that is, if they had the courage to state what is obviously true. And don’t mind losing their jobs.
Oregon’s brand and status as a progressive state at the cutting edge of change
supporting social justice, environmental protection, and basic rights to protection of health was reinforced by citizen direct democracy passage of Measure 110, intended by those voters – in the context of worsening lethal epidemics and Oregon’s failure to respond effectively – to provide new, increased funding for change, for change away from ineffective, failed treatment systems perpetuating lethal substance use epidemics and toward more effective approaches to treatment.
That status and intent are belied and betrayed by the pathological forces that have driven and commandeered use of public healthcare funds over past decades to support entitlement/cronyism systems employing as “treatment professionals” individuals entirely unqualified to provide effective services. The same forces, legitimized and empowered by the state of Oregon through the governor’s office and Oregon Health Authority, have discarded, within weeks of passage of the measure, in closed-door meetings, important clinical standards, discarded to ensure that the entitled employment of unqualified “recovery community” members is protected, to ensure that meaningful change does not occur.
The cost of those protections of an entitlement system, protection of what function, in effect, as closed workshops, sheltered workshops, are the mounting deaths of vulnerable Oregonians who retained, against all evidence, trust in public institutions, their democratic process, and healthcare systems to help them, to protect them.
That’s not progressive Oregon.
And that’s not Hope, nor Recovery.
It’s regressive.
It’s harm-predicting.
Pathological.
Lethal.
