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.

 

—–

The Gift of Sobriety


“I know my limit,” one young man kept saying, his bloodshot eyes and pale complexion seemingly at odds with his statement, as he held his energy drink, hands trembling. We were both in line at a store, he and his friends rehashing last night’s alcohol-soaked party.  They boasted to each other about last night’s consumption, getting through hangovers, and the drunk friend who “overdid it”.

 

Addiction doesn’t care.

 

“It reverberates through the whole family, affecting entire generations for years,” a friend recently told me. “Our kids saw that, and it affected each of them. Some were drawn to drinking like a moth to the flame; others were repulsed, and became angry and bitter about their childhood.  The devastation was so widespread, and we are still dealing with it.”

 

Give the gift of sobriety this season.

 

This gift is not a gift to someone else.  It is a gift to you, from you.  Others won’t respond to your preaching and your nagging, except to become even more entrenched in their behavior.

 

Give sobriety to yourself.  Put some distance between you and the behavior, the “stinking thinking”.  Enjoy the quiet when that clutter has been moved to a safe distance away from your corner of the world.

 

Take care of yourself.  Nurture yourself.  Spend some quality time with the real you.  Surround yourself with the things you truly enjoy.  Indulge in the simple pleasures that you hold dear and treasure. Know your limits for addictive thinking and action.

 

Find acceptance in the silence, away from the chaos and noise.  Find the genuine you; that person is an old friend. Honor the innate, fundamental goodness that is your very essence.  Love yourself, for you are worthy of that love.

 

Being sober isn’t just about one’s consumption of alcohol and other drugs.  It is about clear thinking, about avoiding the pitfalls of untruths, propaganda, and self-aggrandizement. When we adopt falsehoods and fashion our lives around deceptions and lies, we lose our direction in life, our ability to fashion a life based on reality and honesty.  Being honest with ourselves is perhaps our most challenging task, but, in the end, coming to grips with what is really true truly serves our selves and our souls.

 

At its heart, sobriety is clear thinking and the pursuit of being honest with yourself.  Recognize the agendas and intentions of others to trick you, manipulate you and tempt you to serve the ulterior and selfish motives of others. Addiction enjoys the company, but it really doesn’t care about you.

 

Be true to yourself.  Search for the truth, as brutal and loud as it may be.  Ignoring truth chips away at our souls, and keeps us from finding and loving our true selves.  Seeing one’s own truth is the path to freedom.

—-Neal Lemery 12/24/2018

Getting Sober


I’ve lived in the same small town almost all of my life, and we’ve always been riddled with the demons of addiction and wanting to find the magic wand of sobriety and recovery.

Much of my professional life in the law, and many of the conversations I have, even now, has been about people finding meaning in their lives and working on getting sober. Addiction was certainly the “meat and potatoes” in my legal career.

Our society is riddled with addiction, in all its crazy forms and actions. You say “addict” and we think alcohol and drugs. Insidious and destructive as those addictions are, there are others, equally powerful, equally destructive of our souls and our community.
The list of dangerous, habit-forming thinking and actions is long; the list of destructive results is even longer. And your list looks a lot like mine.

This cause and effect are often unmentioned and ignored. It is the elephant in our village’s living room. To some extent, we all deal with it, in our own lives. And, we see the devastation our addictions cause in the lives around us.

Much of my work in the law came across my desk because of this addictive thinking. Being the good lawyer, I worked to find the remedy so that people could find happiness and move on in their lives. All too often, the addiction was too powerful, too all consuming. And, it is hard to be clean and sober in a society where addiction, and addictive thinking is an accepted way of life and a widely accepted theology.

Yet, we’ve come a long way since the days of my childhood. As a kid, I was chastised for greeting a neighbor coming out of the liquor store, or commenting about someone being drunk on the street and asking “why”.

We didn’t have AA in our community, and there were no alcohol counselors. We knew there was plenty of addictive behavior, but addiction and complacency about its destructive ways simply wasn’t mentioned in polite society.

I am so grateful for Betty Ford coming out publicly, talking about her addiction to alcohol and opioids and how inpatient treatment transformed her life. At last, it was politically correct to talk about this taboo topic.

Recently, I’ve had deep conversations about addiction, and turning our lives around, becoming healthy and clean. It’s tough work, and we go deep with each other. Reaching out and being supportive is an essential part of the work, and the healing.

Paul Carr writes in the Wall Street Journal about his struggles to become sober (March 19, 2012). He didn’t choose AA, but he says each of us has our own path:

“If it worked for me, it can work for anyone, right? Wrong. The chances that any of the advice here will work for you are vanishingly slim. So, too, are the chances that reading “How to Win Friends and Influence People” [Dale Carnegie’s classic book] will result in your doing either of those things. In truth, all self-help guides are guaranteed to work only for one person: the person who wrote them.

“The real secret to getting sober, and to repairing all the broken aspects of your life, is to take the time (probably through trial and error) to figure out the causes of your addiction and the aspects of your character that can be pressed into service in curing them. To do that, you’ll have to figure out your own list of things you enjoy about drinking (for me: adventures, reckless spending, dating, etc.) and how you can keep those things alive through sobriety. Then you need to figure out what part of your personality will drive you to stay sober (for me: ego).

“And then, as every recovering addict will tell you, it’s simply a question of taking one step at a time.”

—Adapted from Paul Carr’s “Sober Is My New Drunk”.

Today, my community has an active, visible AA community and a variety of mental health professionals. Sobriety and addiction are respectable topics of polite society’s conversations. We even greet neighbors at the liquor store and openly support people in recovery.

Yet, in our search for economic viability, our community is busy funding and promoting brew pubs, and beginning to enjoy the tax revenue from the local marijuana stores. Every bar promotes its state lottery games, and the game terminals are conveniently located next to an ATM, with the bartender happy to refresh your drink while you gamble. Casinos advertise their first class celebrity entertainment, luring us inside for your Las Vegas experience. The Legislature depends on the state lottery to fund our schools and improve parks.

Money talks.

And, opioid addiction is at its highest level ever, as folks who have become dependent upon opioid pain killers then look for cheaper highs after the prescriptions run out. And, heroin is so much cheaper. A loaded syringe of heroin goes for $5, maybe less, right here in my town, cheaper than the black market for Big Pharma’s opioid pills.

100 million opioid pills are prescribed in Oregon, and one out of three Oregonians has received a prescription for an opioid. Oregon ranks near the top nationally in opioid use and in deaths. More people die from opioid overdoses here than car crashes. (Medicine in Oregon, Oregon Medical Association, Winter 2016, page 12.)

Big Pharma deluges us with TV ads, urging us to ask our doctor for medications and pain relief. Where are the ads about addiction; the social conversations about our addictive culture?

The addiction machine in our society is doing well.

And, you know good and well this scourge isn’t just here in the form of the strung out street person. This addiction is alive and well everywhere. It’s alive and well with neighbors, friends, and, yes, even family. It’s an uncomfortable truth.

We’ve responded by turning the addicts into criminals, with the criminal justice system busy making felons out of addicts, and locking them up in our jail for twenty days or so at a stretch. Our judges order them into treatment, and the system collects the court ordered fees for all that. But we don’t take on the tough conversations about really getting sober, or changing our culture’s addictive ways.

I don’t have a magic wand, and I don’t have a “cure all” solution. I wish I did; lives are literally at stake. But, I do know that one person, one conversation, one relationship can alter the course in a persons’ life, and begin the change toward how we as a community can heal.

It takes a village, you know.

Let’s start that conversation. Let’s get sober.

–Neal Lemery, May 25, 2016

Letter To My Son


March 2, 2014

Dear Son:

I struggle with this language. Greek has seven words for love. We have one. Often, what I really want to say doesn’t have a word that fits. Often, the better word is in another language. What I really want to say is still inside of my guitar, waiting for my fingers and my lips to get into gear, and write a really good song.

The best things in life don’t suddenly appear. They quietly show up, and slip into your life, until, one morning, over coffee, you realize they are there. The best things don’t make a lot of noise, and don’t draw a lot of attention. Yet, they become part of the foundations in your life, just part of the granite that you build your life on.

And when you need that strength, that presence of those things in life that are truly good, truly part of your heart, you realize that they are simply there, and have become a big part of who you are, and who you want to be, that what you’ve been dreaming about, has softly become a part of your life.

You quietly came into my life. And, looking back, I realized you were now part of my life, part of who I was, and who I was becoming. And, to be part of who I will become later on.

Living my life is sometimes like a jigsaw puzzle, looking for that particular piece, searching out patterns, trying to find a match, so that things that don’t fit together, can fit together. Often I don’t see the whole picture, until some pretty big pieces of the puzzle come together, and then, I get it. I see what I’ve been working on, what is really going on.

I was helping you, yet in that, I saw myself, and figured out some things that I needed some help on. But, that is how life works; helping others helps the helper, especially when you don’t realize what is going on.

In watching you work through the tasks you have had to get where you wanted and needed to go, I saw my own journey, and gained perspective on what that time in my life was like for me, and how I managed. I saw you struggle, and I gained wisdom on my own struggles. You gained wisdom, and shared it with me. In that, you held up a mirror and I saw myself, in ways I hadn’t noticed before.

Around my birthday each year, I try to take some time to “count my gold” in my life, to take inventory, and to reassess. Who am I? What am I becoming? Am I on the right path?

Seeing you on your path, hearing of your adventures, watching you face your challenges and move on with your life, realizing your dreams, brings a big smile to my face. You share all that with me, and bring me into your life, opening your heart.

That is a great gift, to me.

You may think I give a lot to you, and that what we have between us is a one way street, all flowing to you. But, the street goes both ways.

You show me courage, determination, how to love one’s self and strive to walk towards your dreams and challenges, shoulders back, ready to face the day head on. You show me the joy in challenging one’s self, and in going out in the world with determination, with strong values.

You don’t take no for an answer very easily. You question, you challenge obstacles, and you look for solutions.

And, I learn from that. I take notes. I look at who you are and who you are becoming, and I mirror that back to me, and assess who I am , and where I am going, and who I am becoming.

I take a bit of your strength, your energy, your mojo, and I grow it inside of my heart, and I try to share it with others. You probably do that with me, and what you get from me. But, this is a two way street, and we both are challenged and we both grow.

I expect both of us to be challenged in what we are to each other. I expect us to butt heads, to argue, to struggle at times. In that, we both become stronger, and we both have to confront who we are inside, and what our relationship really is. Yet, that is the power of a healthy relationship.

A real, a strong relationship has those struggles. Such a relationship will only grow stronger, and deeper. Out of those conversations comes strength, and a knowing, a deeper understanding of who each of us truly is, deep inside. Such a relationship makes each of us journey deep into our souls, and truly realize who we are inside.

I want you to have those struggles, and those challenges in the important relationships in your life, and with your relationship with your own soul. This is work, but it is good work. It makes you stronger, deeper, more complete.

Such is the journey of a real man, a complete person.

The Maori in New Zealand have a word for this value, this attribute of a healthy man, mana. The Aborigines of Australia, native Americans, and most cultures throughout the world have a sense of this value, this journey, this aspect of character.

This week, President Obama talked about this, as he talked about the crisis of African American young men, growing up fatherless and aimless. He shared about how he would smoke dope as a teenager, struggling with a father who abandoned him and his mother, about trying to find his way into manhood, as a Black kid on the streets, not sure where he wanted to go in life.

It is a familiar story, and an uncomfortable one. Most people don’t want to hear it. But, when the President of the United States tells that story, and says that it is his story, I hope that a lot of people listened.

It was a powerful speech, and his initiative is a powerful, thought provoking message to our country. He called for a conversation about how we raise kids, and how we need to bring boys into their manhood, and offer them a role in this world, and a purpose in their lives.

In my little town, heroin is the most popular street drug, and many of the people in jail are junkies. Our dropout rate in school is substantial, and a lot of young people are unemployed, under-employed, and not challenged to be a vibrant part of our community. Most of them are lost, too, just like the young men President Obama is talking about. The issues aren’t abstract, and they aren’t just a “national” issue. These are the issues in my neighborhood, too. The President could give the same speech right here on our Main Street, and just refer to what is going on here, right here in my “hood”.

Yesterday, I was a guest at “J’s” 21st birthday party (he is an inmate at the prison where I mentor young men), and we had a similar conversation. And, I saw such a hunger in the room, young men seeking direction and purpose in their lives, young men doubting their journeys and questioning their strengths. And, how they listened to the three mentors in the room, and to each other, talking about strengths and talents, and directions to take in their lives.

“J” wept at the words of others, words of value and admiration. And, when he spoke of his own strengths, and his own value in the world, we all wept.All of us needed that conversation, and needed to hear those words, and feel the pain and the love that was part of that conversation. I needed to hear a young man, talking about his values, and his strengths.

I felt honored to be in the room, to hear those words, to have that conversation, to talk about what really matters in life. And, if President Obama and “J” are on the same page, maybe this country is changing.

Son, I felt you in that room, your spirit of guidance and courage. You have journeyed in those questions and doubts, and you have found direction and answers, and wisdom.

And, when it was my turn to speak and offer wisdom and guidance to those young men, I heard your voice in my heart, and I felt your guidance and your wisdom in the room. And, I was filled with gratitude, gratitude for what you have brought to my life.

Thank you, son, for all of that.

Last summer, I shocked you, telling you that I don’t want a perfect son. I still don’t. But, I do want a son in my life who uses his brain, and is comfortable in his own soul, and who dares to question himself, and where he is going. I want a son who takes on a challenge, and who confronts his dragons and demons.

I want a son who isn’t afraid of saying no, who isn’t afraid of his weaknesses, and doesn’t run from the possibility of “failure”. I think the only time a person can “fail” is when you don’t even try.

I want a son who embraces his journey into manhood, and takes life’s challenges head on, and who is not afraid to ask for some tools and help as he goes about his work. I want a son who reaches out to the stars, and who lives life to the richest and fullest.

I’m not perfect either. I mess up, I run from challenges sometime, and I’m not the perfect father for you. I am on my own journey, and need to have my own challenges and make my own mistakes.

I’ve made mistakes in our relationship. I’ll make more. And, I expect you to call me on those, to be critical, to be a good observer, and a good communicator. I expect us to have rich dialogues about who we are, and who and what we are to each other. In that, our relationship will grow.

I’ll try to show you how I do my own journey in life, warts and all. I’l try to be open about my blunders and my errors, as well as my achievements and my successes. I won’t be perfect for you, but I will try to be honest with you. I’ll try to be open and transparent.

Let this journey continue!

Love,

Neal

Learning Gratitude


Learning Gratitude

I always seem to learn my lessons in the most unexpected places.

This week, I was with a number of young men who are prisoners in my town. They have long sentences, locked up for crimes they committed when they were anywhere from twelve to seventeen years old. Their home lives were chaos, riddled with the violence, drugs, and sexual behavior that is the seed bed for most of our society’s woes, and the root of our country’s high rate of putting people in prison.

Much of what we might think of as “normal” just not existing in their youth, before they came here. And, many become abandoned by their families; no one comes to visit them. So, a few of us come, to listen, to just show up in their lives.

Rather than really dealing with those issues, society locks these boys up, without much regard for who they really are, the prison terms computed by a chart of numbers, devoid of any sense of compassion, or rationality.

At least we can boast that we are “tough on crime”. And, tough on souls.

We are, after all, the leading country in the world as far as locking up our population. Yes, more than Russia, more than China, and other places we think are oppressive, undemocratic countries. The prison industry is growing, and is a significant chunk of our economy, eating up more tax dollars than what we spend on schools.

The subject of gratitude came up, as we talked about the real meaning of Thanksgiving, and how that holiday came to be part of our heritage and one of our biggest holidays, full of food, family time, and, yes, expressing gratitude.

One by one, these young men spoke humbly of the things in life they were grateful for. The list was long, and ran deep. People who cared about them, support for their treatment for their sexually inappropriate behavior, their attitudes about drugs, violence, manipulation of others, degrading their own self worth, their work on getting an education, and improving their lives, and their relationships with their family.

They also spoke of being thankful for getting in contact with their heritage, and finding a place in a culture that supported their sobriety, their healthy thinking, and their hunger for healthy, balanced, and emotionally satisfying lives, lives filled with purpose and decency. They were finding their souls, moving into manhood whole and complete, their wounds healing.

As I sat there, I recalled listening to the radio on my drive over to the prison, the “news” filled with the latest political sex scandal, and the latest celebrity drug and alcohol crazed dysfunctional public spectacle. I’d come from the grocery store, where piles of cases of beer are arranged in recognition of this weekend’s big college football game, just before aisles of cheap Christmas decorations and gifts.

A billboard along the highway invited me to come gamble and drink on New Year’s Eve, and the usual gaggle of misfits stood outside of the local dive bar, smoking cigarettes and dealing a little weed and heroin.

Yet, inside this prison, these young men calmly talked about how grateful they were for their lives, their sobriety, their hard work in dealing with their pasts, and the strengths and wisdom they now had in their lives. They were strong men, preparing themselves for going back “outside”, into our crazy, addiction tempting society.

The midday boozers and smokers outside of the bar weren’t talking much about what they were grateful for, and gratitude wasn’t the focus of the talk show radio show that came on after the “news”.

And, apparently, Thanksgiving doesn’t do much for the retail stores. Gratitude and thanks and personal achievement aren’t something you can wrap up in paper, next to all the glitz and sparkle.

I listened, listened hard to those young men, realizing that I really was in class, that I was the student and they were the teachers that day. I go there to be a giver, an offerer; my role being a mentor, a teacher, a leader, a person of wisdom. Yet, now they were the mentors, the teachers, the wise men imparting their truth, and their knowledge, their experience.

Wisdom and gratitude were spoken, and I was grateful I took the time to open my heart and hear the truth tellers in my life.

–Neal Lemery 11/17/2012