Opioid Summer Energizes Community Response


 

 

 

by Neal Lemery

(Published by Tillamook County Pioneer on 10/20/2019

“Tillamook County is Number One!”

Who doesn’t like to hear that statement about one’s community?  There’s that sense of pride, and a feeling of accomplishment. Time for some applause and even a cheer, except when you are at a conference of about 200 medical professionals and drug treatment experts, and the topic is the national opioid addiction crisis.

Tillamook County is the worst, with the highest death rate in a state that has the fourth highest overdose rate. While we Oregonians are proud of our innovation and progressive thinking, leading the nation on many challenging issues, Oregon is dead last, at the very bottom, #50, in the availability of drug treatment.

This 2019 Opioid and Substance Abuse Summit in Seaside on October 14 is the fourth annual gathering of regional health care providers, and others involved in and concerned about our substance abuse crisis. Organized by the Columbia-Pacific coordinated care organization, the Summit marshalls resources and educates the community on how to respond to the deepening opioid addiction crisis that is ransacking our communities. Columbia Pacific coordinates health care under the Oregon Health Plan and the Affordable Care Act for Tillamook, Clatsop and Columbia counties, and is part of Care Oregon, a non-profit organization focused on health care services.

“It has been a tremendous honor to host these community opioid and substance use disorder summits over the past four years. We have seen such amazing work happening within the region, in terms of expansion of access to medication to treat substance use disorder at TCCHC and Rinehart clinics, drug take back boxes at some pharmacies, improved opioid prescribing, and the start of needle exchange and harm reduction programs in Clatsop and Columbia Counties. We have more work to do to address overdose deaths and improve lives of those suffering with substance use disorder, but events like this can be a space to re-ignite the fire and passion in coming together to continue to make things better.”

—Safina Koreishi MD MPH, Medical Director, Columbia Pacific CCO

 

The Oregon coast is on the front lines, with drug usage, resulting death rates, and low levels of treatment services at the top of public health statistics.

In Oregon, one to two people a day die from drug overdoses.  Five people die from the effects of alcohol every day.  That’s over 2100 Oregonians a year.   Oregon has the fourth highest drug addiction rate in the nation. And, in neighboring Clatsop County, 40% of teens vape tobacco or pot, compared to the statewide usage rate of 16%. The Oregon coast leads the state in sales of alcohol per capita.

The costs of drug addiction is staggering. The collective emotional pain is inconceivable. The economic cost to Oregon in terms of loss of earning capacity and economic value is $5.8 Billion a year.  That’s Billion with a B.

There was other dismal, alarming news.  Yet, the room was alive with energy, enthusiasm to respond, and a strong desire to meet the needs of our families, friends, and neighbors.

“We can do this, and we are taking this epidemic on,” was a frequent statement.

Doctors, counselors, emergency responders, and other community professionals took the stage to discuss new medications, response protocols, and a variety of treatment regimens — programs that are up and running in rural communities, including our county, number one in drug deaths.  Lively discussions were had on the interrelated high rates of intimate partner violence, suicide, illiteracy, and people underserved by the health care system. The crisis is complex and multi-dimensional, and touches all of our lives.

In the background was the disappointing recent news that Oregon Governor Kate Brown has ordered state government to delay implementation of the legislatively mandated strategic plan for a recovery-oriented system of care.  The plan was developed by a large and diverse team of treatment professionals using best practices and current medical science.

We had frank, direct, and often deeply disturbing discussions, often with personal and family stories of addiction, despair, hopelessness, and, ultimately, with awareness of the anxiety and loneliness which fuels the drug use. There can be redemption, there is hope, and there is a growing diverse and empowered recovery community.

Drug and mental health courts and outpatient and residential treatment facilities in rural communities are opening. Peer coaching, 12 step programs, and health insurance plans willing to fund many forms of treatment are springing up. First responders and concerned citizens are arming themselves with the opioid antidote Naloxone, which can take the form of a nasal spray safely administered by a lay person and available without prescription.  The drug neutralizes the drug causing an overdose and saves people from certain death. Other drugs now becoming available tackle the wide range of addictive symptoms and conditions.

“There is hope,” one physician said, “and there also needs to be compassion, understanding, and awareness that addiction is a medical problem, not a character flaw. This is a crisis of culture and education.”

Effective response to this epidemic involves trauma-informed care, focusing on a person’s response to trauma experienced throughout life. Adverse childhood experiences (ACEs) cause the brain and the body to retain trauma throughout our bodies; the trauma response paralyzes our coping mechanisms, and shuts down healthy and healing responses. The more trauma we experience, the less the mind and body are able to deal with and enjoy life.

We self-medicate, trying to ease the anxiety, the pain, and the emptiness we have experienced.  Advertising and social expectations point us in the direction of drugs. Tobacco, alcohol, and opioids are the most poisonous, the most deadly substances we use, yet they are our legal drugs and the most highly marketed and available drugs.

The real “gateway drugs” are freely available at the neighborhood store and where we gather to “relax and have a good time”.

Drugs and alcohol affect the brain’s neural receptors for levels for dopamine, a pleasure inducing chemical the brain releases. Trauma inhibits the body’s ability to feel joy and contentment, and we turn to chemicals in order to reconnect with our natural desire for a sense of well-being and tranquility. Yet, the temporary pain-killing effects of our drugging fades with continuing drug use, moving our desired feelings of joy and contentment even further away from being in our lives and limits our healthy response to dopamine and other endorphins. Drugs are a self-fulfilling prophesy of pain and emptiness despite our desire to heal and feel “normal” again.

Traumatized kids are 46 times more likely to develop substance abuse disorders than kids who have not been traumatized.  Schools now are implementing educational practices and activities that are trauma-informed, approaches that help heal and restore a sense of personal well-being and emotional health.

One physician who shared her story of addiction, chaos, and near death spoke of her first use of heroin as generating a sense of peace and relief she had always sought, but had never achieved. Heroin made her life bearable and the traumas in her life faded away at last. Life became beautiful, until her life spiraled down into deeper chaos.

The tool chest of recovery and health is gaining new tools, yet we are a culture of drug use, instant gratification, and often unattainable expectations of perfection and acceptance. Medically assisted treatment  (MAT) is becoming part of the new standard of care for treatment providers, along with education, peer coaching, and the community gaining understanding that addiction and trauma are interwoven, that addiction is best understood as a medical issue, a condition that can be effectively treated.

Access to treatment remains a critical issue, and is very often a barrier to getting help.  Yet, widespread availability of naloxone, educated emergency responders and health care professionals, and a broader application of medically assisted treatment are making a difference. Trauma-informed responses by the criminal justice system and social services are being implemented.

At the end of the day, after dozens of stories of agony, despair, hope and redemption, there was a spirit of hope in the room.  We are taking on this epidemic, we are finding the tools, and we are able to respond and attack this problem, this epidemic.

We can be number one, not in the number of deaths, but in the availability of remedies, of treatment, and salvation.

 

—–

Wanting Change: How Does That Happen?


By Neal Lemery

 

Often, I react to the news with despair, anger and frustration.  I remind myself that the “news” is often sensationalized, that the news business is a business, and that almost all the “good news” is not included in a news program.  Yet, what much of what is “news” stirs me up to wanting change, a different approach to old problems.

If I want change, I have to act.

If I am passive, then others will make changes, or not.  And those actions or inactions will likely not be what I want to see happen.  I will not have a voice.  My silence, my inaction diminishes my soul and my purpose in life.

“You must be the change you want to see in the world,” Mahatma Gandhi famously said.

Yet, to borrow a phrase from Al Gore, it is an inconvenient truth.

If I don’t like what I read in the news, then either I am an instrument to change the world, or I do nothing.  My inaction assures that I lose my right to express my disagreement with what is going on. After all, actions speak louder than words.

I am in charge of how I react, respond, how I am an instrument of change, putting action into my beliefs, and thus creating change, building a better world.

If I don’t like what I see in my community, my neighborhood, my family, then I need to step up and get involved, and become an instrument of change.

A healthier community starts with me. Put up or shut up.  It’s all on me.

The simple acts are the easiest and the most effective.  They have the greatest impact long term.

Here’s a list of actions for me, and, hopefully, you:

  • Invite a friend to coffee.
  • Play music, and teach someone else, sharing music with others, creating joy and community.
  • Start a conversation with a stranger.
  • Send an inspirational note or story to a friend.
  • Reach out to a prisoner, someone who is going through a hard patch, someone in pain.
  • Acknowledge someone’s loss, or a challenge, and offer them a compliment, a few words of cheer and encouragement. They are not alone.
  • Practice patience and understanding.
  • Don’t expect a reward or recognition. Acting anonymously can be very sweet.
  • Practice forgiveness and compassion, even if another’s words or acts seem hurtful.
  • Imagine walking in the shoes of another.
  • Remember the Greek proverb: “A society grows great when old men plant trees whose shade they shall never sit in.”
  • Slow to judge, quicker to forgive.
  • Intend to follow the Golden Rule.
  • Examine your own biases and prejudices. Do some personal housekeeping. I’ve found this to be very humbling and enlightening.
  • Suspend judgement.
  • Don’t assume.

 

My ego gets in the way in this work, but if I am honest, I learn more about myself and the world, and I move forward to be a better human being.

 

And, the world changes, just a little.

 

9/21/2019

Being Present


 

 

 

is often the greatest gift, the

highest act of friendship.

No expectation of conversation,

yet the richest communication

(communing — action).

 

The most difficult, the most awkward

the most challenging

is simply to just be

be in the lives of another

suspending opinion, commentary,

judgement. Breathing in the quiet.

Saying it all, without voice.

 

In the quiet, much is conveyed

and what is hard becomes

eased, relaxed, now flowing

back and forth

communicated.

 

Silence is love in action

an opening, a sharing

relational, transformative

soul changing.

 

—Neal Lemery 9/13/2019

Open Mic


 

 

A place of personal courage, testing

Out new ideas, new expressions, a new

Part of ourselves, making our private, secret inner work

Public, part of the community.

 

Giving what is inside ourselves some air, the stage

Intimidating, yet distinctly our own

Space, space to make a statement –

Welcomed by acceptance, community in open arms – a

Declaration of who we are, giving voice

To what has been stewing, churning, fermenting

Inside

Finding its wings, finding its audience

Being heard.

 

This old space, sacred, the past hundred years,

Here others stood here, sharing their souls, over the years,

Voices and music reverberating on old Grange Hall wood, generations past

Giving to the community, making community, building

Relationships, embolding ourselves, our art, our

Creations.

 

I grow, often against my will, on this stage, exposing my private

Self, shyness and private musings somehow

Put on hold.

 

–Neal Lemery, 9/9/2019

The Birthday Rose


We never celebrated Mom’s birthday on the actual day.  It always fell during the first week of school, and the following Sunday became the official celebration. We took turns replacing Mom as the chief planner, cook, and baker for family celebrations, and tried to make her a cake that was at least edible, though we could never achieve her skill and standards of perfection.

She would just be happy we thought of her and made the effort, and took the time to gather together to enjoy a meal and laughter.

Today, the Sunday after the first week of school,  would be the day we would celebrate her, though she passed many years ago.  One way I honor and remember her is my tending of her favorite rose in my garden. The bush hasn’t bloomed for about a month, the dry summer and warm days obviously not to its liking.

Yet, we’ve had two days of rain now, and the rose decided this morning that it was time to send forth a blossom. School had started, fall was coming, and it was time, once again, to celebrate.  She would have smiled at the gift.

 

Happy birthday, Mom.

Small Miracles


 

 

 

 

 

 

by Neal Lemery

 

I often forget about the small miracles in my life until the world of nature gently reminds me with a new discovery, or a new awareness of something rather ordinary in my world.

The other day, we were walking on the familiar trails of the Kilchis Point Reserve, next to Tillamook Bay, taking in the late summer peace and beauty of land that a century ago was a busy mill site and heavily logged over. Today, large spruce and young cedars, and a rich understory of plants filled with birdlife and native plants offers a welcome respite to the hectic summer traffic of the Oregon Coast in the height of tourist season.

It was all familiar to me, the plants, the birds, the smells of the dry summer in the woods as I walked along, unaware, not really living in the moment.  That is, until something new and strange appeared at my feet, an unusual fungi at the edge of the path, frothy and lacy. My hiking companions spotted it first, calling out for me to pay attention to this new addition to the area’s botanical richness.  Its beige tones and intricate structure almost didn’t catch my eye, yet it is an amazing and wondrous delight, stopping me midstride.

Coral fungi was its name, according to a friend with great botanical expertise and one of the stewards of the Reserve. Apparently it has emerged in mid August the last several years in these parts of the woods.  It is native to the coast, but obviously still quite rare. But, fungi emerging in the middle of the dry season? I think it is a miracle.

 

 

My awakening to the miracles around me continued, as I found myself at a Master Gardeners workshop on propagation.  Our small group gathered around our fellow gardeners, who happily shared their wisdom in the creation of new plants.  Buckets of cuttings from their gardens, a bucket of a light soil mix, pots and containers, and magic powder in the form of rooting hormone gained our attention.

With a few snips of our pruning shears and scissors, a dusting of rooting hormone powder, and a gentle insertion into the dirt, we started the process.  A little mist from a spray bottle, a plastic bag, and the gift of time promised to provide us with a wide range of new plants to grace our gardens and add to the plants for next spring’s Master Gardener plant sale.

The rooting hormone is magic personified.  In essence, it is powdered willow bark, the plain and generally uninspiring scrubby willow becoming the catalyst that creates new life and allows us to turn a twig into a new plant.

I need to pay attention to these new creations in the next few months, but we’ve taken the steps needed to bring new life and new beauty to the world.  Again, a miracle right in front of our eyes, requiring but a small effort to enrich our lives and the world around us, allowing us to be the bringers of life into the world.

Small miracles are all around us, in the bees enjoying the flowers grown from a seed packet that I’d haphazardly strewn in an untended corner of the yard, in the swallows soaring above the deck, and the turkey vultures, hawks, and the occasional eagle, flying their air patrols over the neighborhood, inspiring us to take flight and travel the world, to see things from a new perspective.

Another miracle comes when the latest descendant of Grandma’s lilac bush blooms, after just barely hanging on for five years.  We thought it was a goner, until one year, it decides to take off, producing a riot of vibrant purple and putting on a growth spurt. Now it is the centerpiece of that flowerbed’s spring show. Snippets of lilac twigs made it into my propagation project, with my hope of continuing the legacy.

Just when I think I’ve reached my quota of miracles for the week, the rather ordinary sky of a summer’s day suddenly turns into a carnival of brilliant oranges, reds, and yellows fading to magenta and vermillion as evening comes, nature’s way of telling me that the real shows in life don’t come from civilization.

“The fact that I can plant a seed and it becomes a flower, share a bit of knowledge and it becomes another’s, smile at someone and receive a smile in return, are to me continual spiritual exercises.”    Leo Buscaglia

All I have to do is open my eyes and take notice, taking the time from all the human busyness of modern life and pay attention.  Miracles are all around me.

 

 

Those Lazy, Hazy, Crazy Days of Summer


 

 

By Neal Lemery

 

 

When I was a kid, Nat King Cole made this a popular song, and the lyrics still seem to sum up summertime on the Oregon coast, with an increasingly strong emphasis on the “crazy”.  My good intentions this year were lots of reading on the deck, working in my flowers and vegetables, and plenty of time for friends, taking it easy.

Summertime is paved with good intentions, yet the calendar has filled up with friends and relatives who live in other states “just dropping by”, numerous parades, festivals, concerts and fairs, and a steady pace of casual get togethers. The idle hours of reading on the deck by my flowers has become a rare hour here and there between all of the scheduled and unplanned activities. The dread of being caught in bumper to bumper traffic on the highway and too many people at my favorite haunts has cut into my summer plans, motivating me to cross off a number of calendared “fun” to dos. Instead, my reading chair on the deck is my refuge, my hiding place from the mob.

We paid the price for a visit to a friend’s open garden tour with an hour and a half of stop and go traffic on a Saturday afternoon.  What were we thinking? We even skipped our customary treat at a local dessert shop as that would have required making a left turn. This is, after all, “No Left Turn Season” and tourists are definitely in their “bubble of oblivion”.

My classic example of no thinking this summer occurred in front of me on the Wilson River Highway, with both lanes completely crammed full and traveling at 25 mph.  The out of state car ahead of me suddenly skidded to a stop and pulled a U-turn, forcing the oncoming car and me to burn rubber.  In their frenzy, they had to back up in order to fully turn around and head in the other direction, oblivious to the chorus of our collective repertoire of swear words.

I fantasized about a robotic State Trooper flying a drone, forcing them over with tractor beams and issuing a multitude of traffic tickets. Can I apply for a “tourist tax” grant to supply that needed addition to local law enforcement?

A friend calls the syndrome “tourist brain” and swears there is scientific evidence in support of that psychological condition. I know the local anecdotal evidence is overwhelming.

I wonder what all the emergency responders call it, but I probably couldn’t repeat their phrases here.

A long overdue class reunion challenged me to deal with a restaurant on full tourist overload, and spurred me to politely discourage a gaggle of out of town visitors intent on their ice cream cones at the Creamery.  I’m not up for dealing with 10,000 people clamoring for sugar on a summer day, preferring a quiet conversation on the deck with some iced tea, no parking lots and lines. After all, I’ve planned ahead and have a nice stash of ice cream in my freezer.

It’s time I take a deep breath, and look at the calendar.  Time is on my side. It’s only a few weeks until Labor Day. That Tuesday is our traditional visit to our favorite beach, as we celebrate “Take Back the Beach” day, my favorite summer holiday. We might even be bold and make a left turn.

 

8/14/2019