Services for substance use in Oregon face widespread gaps, study finds

Oregon needs to double the services it offers for substance abuse treatment, recovery and harm prevention, according to a new study by researchers at the Oregon Health and Science University and Portland State University School of Public Health.

The study, published Sept. 30, focused on three areas, including workforce, to understand the gaps and barriers to services. In the research, “substance” was defined as alcohol and other drugs including cannabis, but not tobacco/nicotine.

Among its findings, the study revealed an acute shortage of qualified drug prevention specialists in Oregon.

“We only actually have 62 people in the state with that certification and we estimated that we need over 900,” said Katie Lenahan, the study’s lead author and a research project manager at the OHSU-PSU School of Public Health.

Lenahan and her team conducted surveys with more than 160 organizations across all 36 counties in Oregon that provide substance use disorder services, and found that many of them were unable to provide culturally relevant services to clients.

“Only 16% of organizations that we talked to offered services specific to the LGBTQIA community, and we know that that’s a community who is disproportionately affected by substance use disorder,” Lenahan said.

The surveys also revealed transportation as a key barrier to care, especially among nearly 90% of organizations providing services in Southern Oregon.

Katie Lenahan spoke to “Think Out Loud” host Dave Miller. Click play to listen to the full conversation:

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

Dave Miller: From the Gert Boyle studio at OPB, this is Think Out Loud, I’m Dave Miller. For years, we’ve heard that Oregon faces a huge gap between the need for substance use disorder services, and the availability of those services. Now, a new study has quantified that gap. It is 50%, meaning that statewide, we only have half of the treatment, prevention, recovery, and harm reduction services that Oregonians need. Katie Lenahan is a research project manager at the OHSU-PSU School of Public Health. She’s also the study’s lead author, and she joins us with more of the details. Thanks very much for joining us.

Katie Lenahan: Hi, Dave.

Miller: So you looked at gaps in a lot of different aspects of this, in facilities, in the workforce, in the work that these places are actually doing. Let’s take these one by one to start. What did you find in terms of the gap in facilities?

Lenahan: We see overall a 54% gap in the facilities available specifically for substance use disorders in Oregon.

Miller: More than half. What about workforce, the people who should be staffing these places?

Lenahan: In that, we saw more than half as well with about a 66% gap. And I want to call out some of the bigger gaps, which include people who are certified prevention specialists, where we saw a 94% gap in people with that qualification. And then a 93% gap in the qualified mental health professionals certification.

Miller: Meaning we need twice as many people who have those specific qualifications as we currently have?

Lenahan: In those specific qualifications, much more than twice. So for example, prevention specialists, we only actually have 62 people in the state with that certification, and we estimated that we need over 900.

Miller: It’s an unbelievable gap.

Lenahan: Correct.

Miller: How did you figure out these gaps, broadly? How did you actually create the data that you needed to sift through to see what the gaps were?

Lenahan: We utilized the tool that was created by another expert in the field of substance use disorder. And we worked very closely with this researcher to make sure that this tool fit what was actually happening within Oregon, what kind of tools and certification that we utilize for substance use disorders. Essentially, this tool takes some basic information about a county’s demographics, the number of people in different age ranges, as well as other information about the estimated number of people who use drugs or alcohol, and an estimated number of people who have substance use disorders.

And so, taking all of this information together, they utilize an equation that helps us create the estimated need for either facilities or people in the workforce.

Miller: What did you find out about the offerings of these various facilities and what’s available and what’s needed?

Lenahan: Something that we want to point out about our research is that while this tool offers a number of services needed, it doesn’t speak necessarily to the quality of those services or other issues in access or health equity. We also conducted a survey where we talked to over 160 different organizations that provide some kind of substance use disorder service to learn more about what kinds of gaps they’re seeing, and other kinds of programming that they offer.

So in addition to finding with this tool that we have huge gaps in services, we also heard from organizations that they also sense that they have an inadequate capacity to really serve all the clients that they are seeing. Over half of the organizations we talked to said the capacity for services does not meet their demand for services. And then in addition to that, over 60% stated that their staffing was inadequate to really meet the demand of their organization.

However, when they have open positions, 80% of the organizations we talked to said that they have challenges filling positions that are open. So this really points not just to gaps in the number of services, but also to gaps in our workforce across Oregon to even hire the people into the positions that are needed.

Miller: That’s especially important given something we can get to as we move further, which is that a lot more money is currently going to a lot of different service organizations with the hope that they could be hiring people. You’re saying that actually hiring may be a challenge.

I want to focus on another aspect of this, which is another thing that you and your team looked at, which is access to culturally or linguistically relevant services, for various underserved communities. What did you find?

Lenahan: We asked organizations about services that they offered specific to people in a protected class. And we defined a protected class as services specific to people of certain religions, veterans, the LGBTQ community, people with disabilities, gender specific services, or culturally specific services. And 40% of the organizations that we survey were not able to provide services specific to one of these protected classes. That’s not to say those folks were not allowed to receive services, but we’re speaking about services that might incorporate indigenous values into their recovery, or have recovery groups that are meant for folks who are LGBTQ. One of the ones we want to call out is that only 16% of organizations that we talked to offered services specific to the LGBTQIA community. And we know that that’s a community who are disproportionately affected by substance use disorders.

Miller: The work on this survey started before voters passed Measure 110, and the actual survey and the interviews you were talking about happened during the time when groups that were going to get money were being identified. I’m curious, given what you were able to find out from this survey, what you think about the initial allocation, the first two years, of Measure 110 money. We’re talking about almost a third of a billion dollars in state grants. Are they going, do you think, to the right kinds of institutions?

Lenahan: Well, I would say that our report definitely highlights the need for additional funding and resources to allow these organizations to offer more culturally relevant or linguistically relevant services. In no way are we calling out organizations to say “you are the problem.” We have these organizations that are stretched so thin and have a hard time meeting just the basic day-to-day needs that the organization has to do.

And so in order to offer culturally relevant services, in order to offer interpretation and translation services, organizations need the staffing, they need the funding, they need the resources to really do that adequately. And so the funding coming from Measure 110 is absolutely needed to support those types of things.

Our report doesn’t analyze whether or not the funding is going to the right places. And unfortunately, this was not available in time for Measure 110 to really utilize this information to determine how funding was distributed. That being said, we do believe that our work provides a very important baseline about our service capacity and these gaps in health equity that can be used to measure progress going forward

Miller: In some ways, this just seems like an unfortunate issue of timing that was absolutely out of your control, as well as the Drug and Alcohol Council that asked for you to do this in the first place. It does seem that the exact information that you and your team were putting together could have been very useful if it had been requested two years before it was. It could have been very useful for the Oversight and Accountability Council, the group that was administering these Measure 110 grants. They could have looked at your information and used it as part of the basis for grant making. Is that fair to say?

Lenahan: Sure. And you mentioned the Oregon Alcohol and Drug Policy Commission. This work comes directly from their statewide strategic plan, which is a five year plan starting 2020 to 2025. Certainly lots has changed since that plan came out. The plan was released right before COVID. But this project is really a critical first step to better understand these gaps to help drive that plan forward.

Miller: Let’s go through some of your recommendations. One of them has to do with taking advantage of various kinds of encounters at different venues in Oregon, including places like emergency rooms or shelters. What exactly are you suggesting?

Lenahan: There’s a lot of opportunity for screening for people with substance use disorders to make sure that people know there are resources available to them. If someone shows up in an emergency department, in a hospital, or in a shelter, and these screening tools are utilized and people can be connected to community treatment, then that’s an opportunity for a person to really learn about resources available to them and understand the pathways in which to utilize those.

These places are also really important locations to share harm reduction resources, things like naloxone distribution or drug checking kits, other harm reduction strategies to make sure people can stay safe in between getting support and help and treatment for their use disorder.

Miller: What did you find in terms of access to harm reduction techniques and availability of them?

Lenahan: We definitely see gaps in harm reduction access. Syringe exchange programs, we have less than half of the number that are necessary to really meet the need. Naloxone distribution, we see a 28% gap, so the need for much more access to naloxone And then fentanyl test strips so people can test and make sure their drugs are safe, we saw about a 35% gap in facilities that offer that resource.

Miller: Let’s turn back to workforce questions, because you noted that there is a gigantic gap, especially in some aspects of staffing that may require more training. But it seems like across the board not nearly enough people to do the jobs that are required, and then not even necessarily the people to fill those positions if there were money to hire them. So what could or should the state do to address this workforce shortage?

Lenahan: One of the other workforce shortages is also the number of prescribers that have a buprenorphine waiver. This is essentially a way that allows physicians, nurse practitioners, physician assistants to prescribe buprenorphine.

Miller: Could you remind us what that is and why that’s important?

Lenahan: Thank you, yes. Buprenorphine is a drug to treat opioid use disorder that is very important as part of a treatment mechanism for people with opioid use disorder. And so really addressing some of these access to medications for opioid use disorder through more provider training, as well as other ways to access care for people like improved telemedicine, mobile treatment services, and reducing wait times for people can also really increase access to these very important medications for people who have an opioid use disorder.

Miller: If I’m hearing you correctly, the list you just mentioned seems like ways to not specifically address the workforce shortage, but to almost get around it, to make it so people who are already in various aspects of health care or social services can actually do some of the jobs that they can’t currently do. Is that a fair way to put it?

Lenahan: Sure, yeah, that is one way. And then to address the workforce shortage directly as well, an investment in making sure that both of these certifications are available to people, as well as making sure that people within these professions are able to make a living wage within these jobs is also very important.

Miller: My understanding is, and my hope is, that the Oversight and Accountability Council, which is administering hundreds of million dollars of grants every two years under Measure 110 will do some version of accountability themselves. Will you as well? Will your team be tasked with following up on this gap analysis to see what difference a big infusion of state money is making?

Lenahan: Right now, we’re continuing to work with Oregon Health Authority to also understand a different, similar piece of this puzzle, which is around co-occurring disorders. These are people who have both a substance use disorder and a diagnosed mental health disorder at the same time. And it is incredibly important that people who have this co-occurring disorder are able to access treatment that looks at both the mental health component and the substance use component of their diagnoses.

So we are already embarking on that next step to dig into that work, and are hopeful that there will be continued work moving forward so that we can measure changes and improvements, hopefully, in this system going forward.