How worst-in-the-nation treatment access looks for two Oregonians

Oregon has the second highest rate of substance use disorder in the US. And at the same time, the state ranks last in the nation for its access to addiction treatment options. And the inability for people to get treatment when they need it fuels the addiction crisis itself. We hear how this is personally affecting Kelly Hernandez, the mother of a son struggling with substance use disorder. And we talk with Fernando Pena, the executive director of NW Instituto Latino, which offers culturally specific addiction recovery support services.

Note: The following transcript was created by a computer and edited by a volunteer.

Dave Miller: Oregon has the second highest rate of substance use disorder in the US, but the state ranks last in the nation for its access to addiction treatment. Experts say that the gulf between the need for help and the help that’s actually available is only making the addiction crisis worse. We’re going to hear what this means right now for one family and for one nonprofit. Kelly Hernandez has a son who has a substance use disorder and is in active addiction. Fernando Pena is Executive Director of NW Instituto Latino, which offers culturally-specific addiction recovery support services. Welcome to you both.

Fernando Pena: Thanks for having us.

Kelly Hernandez: Thanks.

Miller: Kelly, when did you first learn about your son’s substance use?

Hernandez: He came to me when he was about 21 and told me that he was having trouble with pills, opiate pills, pressed pills with fentanyl in them and didn’t know what to do. And I have no idea what to do.

Miller: How long ago was that when he was 21?

Hernandez: Well he’s 27 now.

Miller: So six years ago you said you didn’t know what to do? What was your first reaction when he came to you and said, “I’m having a problem with pain pills.”

Hernandez: Honestly what I thought was maybe this was a phase he was going through. He was young college age. I had no idea how addictive they were. I had no idea how dangerous they were. I guess in my mind I kind of compared it to drinking or smoking pot or something like that, but he was in despair and I had no idea what to do.

Miller: How long after that did you realize the severity of the situation?

Hernandez: When I started to watch his life fall apart. He had a job and was renting a house and had roommates. He had cars, he liked to go do ATV riding. He had a bunch of fun stuff and just slowly started to sell things and with a little more distance, I didn’t talk to him as much. And then I had another mom come to me, whose daughter was friends with my son, and she told me that she thought that’s what they were doing, that they were using fentanyl.

Miller: So even six years ago you were aware of fentanyl, a synthetic opioid that people are paying a lot more attention to just in the last one or two years. It’s not new to you.

Fernandez: Well, I think in the beginning I probably just called it opiates or maybe oxy. Now I know it better as fentanyl.

Miller: How is your son doing right now?

Hernandez: I saw him last night actually. He’s sick. He’s using it every day all day. He uses blues, which is just a pressed fentanyl synthetic pill that he smokes. He has to do it to feel well and to feel his normal. He stays with friends. He doesn’t have a job. He has physical problems because of it. His teeth are in bad shape. He’s thin. It’s very hard to see.

Miller: Do you know where he is on any given day these days?

Hernandez: I do. I do. He has a phone that I pay for and that’s a gift that I give myself so that I can get ahold of him. He’s in Portland. I know the area of town that he’s in and I’ll start texting him and try to set up a meet up times. I talked to Trevor probably every two or three days.

Miller: Has he sought treatment at any points over the last six or seven years?

Fernandez: He completed a 30-day program. I think that was four years ago. It wasn’t long enough. As soon as he got out and was placed in sober living, he relapsed within a matter of days.

Miller: Does he say that he wants treatment right now, that he wants to change his life?

Fernandez: He doesn’t want to do drugs. He doesn’t want to be addicted to drugs. He, in his mind, would love treatment. But that’s how addiction works. His mind is sick. It’s hard for him to make that decision. Detoxing, I don’t know if you’re familiar with detoxing. Detoxing is a really horrible thing for people that are addicted to strong opiates like fentanyl. There’s panic attacks, vomiting, diarrhea. It is beyond horrible, and so that it scares them. It scares him. He has done it before, he has detoxed before, but I think that’s one of the things that keeps him from accessing treatment.

Miller: Kelly, I want to hear more from you about your story and your son’s story, but as I noted, Fernando Pena is with us as well, the Executive Director of the NW Instituto Latino. Fernando, what’s the mission of Instituto Latino?

Pena: Well, our goal is to provide a low barrier and no-cost recovery support services. What that really looks like is we’re here to meet people where they are on their journey of recovery and then make sure that we don’t leave them there if they maybe haven’t decided or if they’re struggling with the process of maintaining that long term sobriety, kind of like Kelly mentioned with her son. And then because Latinos in the state happened to be the second largest demographic, and making them the most underserved in the formal treatment and recovery system, we have a special focus on them. But we don’t really turn anyone away.

Miller: How important is it to have culturally specific services when it comes to something like addiction support?

Pena: Oh, it’s vitally important. It’s impossible to separate out culture from the recovery process. And then with my community specifically, we also have the language barrier issue and then the documentation status issue and lack of insurance. But you know, often the formal treatment system was not really designed for communities of color. So that’s part of the reason why treatment completion rates are not great in those communities.

Miller: What kinds of services do you think are most important to provide an Oregon right now and most lacking?

Pena: Oh, that’s a wonderful question. Well, I think that we need to start thinking of recovery as a long term process. Addiction is a relapsing and remitting disorder and so what we need is early intervention services around harm reduction. So when a person is maybe still struggling with controlling their use or is not ready to go into treatment or into detox, we need to provide them with supplies that they may be able to use in a safer manner so they don’t get any kind of blood borne illnesses or STI’s. And then we definitely need to expand just treatment across the board, all levels of care from regular outpatient to residential services. And then we also need the support services that need to exist after someone completes treatment. It takes a lot of years of living a certain way and a certain lifestyle to get this sick. And it also takes years and years of support, mentoring, housing support, education and job support to be able to kind of maintain the recovery that is so needed.

Miller: In other words, in response to the question ‘what’s most needed,’ your answer is everything: support for people who are still in active addiction in terms of harm reduction, classic addiction recovery services, and then long term ongoing support in various ways. You’re saying we need everything in Oregon right now.

Pena: Yes, honestly this is one of the most treatable disorders. I think the big problem we have with the system is that we think that treatment fixes everything but people, there’s more support for the needs. If you’ve been living a certain lifestyle for two or 10 or 20 years and then now you’ve taken away the thing that has taken up all that time and then go, ‘okay, now go back into the world’ and we’re not providing them with housing support and educational support and job support and then surrounding them with a recovery community, people who are working in the recovery process themselves and who have experience managing those hard situation managing, figuring out how to make new friends, managing how to reconnect with your family and with your culture, then that’s one of the biggest things that contributes to relapse is, is that that kind of isolation and that overwhelmed feeling when you get back into the world.

Miller: Kelly Hernandez, you’ve created a group with other moms called Oregon Moms for Addiction Recovery. What are you calling for? What do you want the state to do differently?

Hernandez: Oh, that’s a great big question. First of all, Fernando, everything you said just touched me. That’s exactly what I want my son to have. And you’re so right. That’s what’s needed in Portland. Let’s see. What we would like the state to do is to provide immediate care for when someone’s ready to go into treatment so they can have a bed immediately. When Trevor went into treatment, it was about 10 times that we had to show up. I had to get him there, knock on the door, see if they had a bed and get him in there. And it needs to be immediate because there’s such a small window of time before they start to get sick and then they don’t want to go. So my part in Oregon Recovers is to just share my story to reduce stigma for other moms that are going through this. My child is sick. If my son had cancer, that would be treated differently. There’s so much stigma around addiction.

Miller: How are you coping with this uncertainty and fear year after year?

Hernandez: That’s a good question, too. I remember when Trevor first got sick, I would talk to other moms and they would say ‘take care of yourself, just take care of yourself first.’ And I would think that’s impossible for a mom. This is my job. I have to fix this. I have to fix this. He’s my child. He’s my responsibility. And it’s really easy to get stuck in that place and it’s taken a long time to try to work myself out of that place. Right now, I’m in trauma therapy. I have a wonderful therapist who is helping me work through some of the things that I’ve seen and experienced and had to face through my son’s illness. Plus, I have my moms in my group. Talking to other moms and knowing that they have experienced and they’re feeling the exact same thing that I’m feeling have saved me. They’re lifesavers.

Miller: Fernando Pena, I understand that two of your clients have died just this week. What do you think would have made a difference for them?

Pena: Yeah, just real quick, it wasn’t this week. It was … we had two people die within a week, just about three weeks ago. Last year we lost about 25 clients. And so far this year we’re up to around eight or 10. What would have made a difference? Well, similar to what Kelly just said is that the most dangerous part for someone who’s trying to get clean is once they’ve managed to detox for some time and then they go back to using it because they’ve not been able to get to a safe place that can support those early stages of recovery. And that is that process in the Latino community that’s especially pronounced, where there’s really only one residential treatment program for the entire state. And they have room for 10 men, and so once they’re full, and they’re always full, we’re just in that waiting game. It could be months before someone can get in. And so we just need expanded access to services.

To be 50th in the states … we’re literally worse than states that didn’t expand Medicaid. So we need the whole system to kind of be built back up to be able to meet needs when they arise. And then also other things that might help is that, when people leave treatment because treatment is an intervention much the same way that medication is an intervention, but it’s a symptom management thing, it’s preparing people to actually start the work of getting into recovery, which is a long term, lifelong process. We just need to really support recovery community organizations like ours and some of the other ones that exist in the state whose job it is to to fill in that breach, that gap, in there so that people have a place to go, that they have case management to help them connect to school and jobs and clothes and all the other services that are going to be needed that they weren’t getting while they were in active addiction.

Miller: Fernando Pena and Kelly Hernandez, thanks very much for your time. I really appreciate it.

Hernandez: Thank you.

Pena: Thank you.

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