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No clear-cut solution to pain, addiction fight

Readers' Letters
by: CHRISTOPHER ONSTOTT,

The article "Multnomah County's tough prescription" (May 10) highlights the difficult balance of appropriately treating pain in the midst of an escalating opiate overdose crisis, and increased deaths in our community.

There is no clear-cut answer. Instituting a policy of limits and increased restrictions on prescribed opiates for pain has met with contention, but this decision follows both the evidence around opiate prescribing (acknowledging the lack of good data), and attempts to address real societal harm.

The lack of alternatives to opiates and heroin is real. One other prescribed option that went unmentioned is buprenorphine. This is prescribed in primary care and specialized addiction settings for the purpose of treating addiction and does not have many of the same troublesome issues as methadone. For example, overdose is extremely rare.

The solutions for dealing with prescription opiate and heroin addiction ought to include the range of medications (such as methadone, buprenorphine, antidepressants and neuroleptics) as well as the many behavioral approaches (addiction counseling, groups, acupuncture and intensive lifestyle change, and sober housing).

Heroin is not the only answer.

Cat Livingston, MD, MPH

Nick Gideonse, MD

OHSU Richmond Clinic

Southeast Portland

Involuntary commitment no addiction cure

Not to be cynical, but it does not surprise me that a prosecutor (Multnomah County Deputy District Attorney Ryan Lufkin)'s version of compassion for drug addicts is to propose the police state solution of involuntary commitment (Welcome to Heroin City, May 3).

I also fail to see how commitment would be cheaper, which is always the real argument lurking behind the facade of "compassion." Secure hospital stays cost tens of thousands of dollars per week, and they're staffed by medical doctors and nurses, not people drawing a corrections officer's salary.

You can lock up an addict. You can take away his smack. You can break his needles -- but you can't make him give up his habit by simply shuffling him from one institutional setting to another. Drug users need to have reasons to be drug-free beyond merely staying out of the joint.

Justin Teerlinck

Beaverton

Heroin photos inflammatory, in poor taste

Informative article. I agree with the idea of treatment, but the photos were inflammatory and unnecessary (Welcome to Heroin City, May 3).

I work in drug rehab and had to remove the Tribune papers from the client area -- pretty poor taste. Also, I don't think kids need any ideas about getting heroin, cooking it and shooting it.

If the author was advocating for treatment options for addicts, the photos and personal account of "hanging with heroin user," did not support the cause.

Despite your best efforts, the article was an example of sensationalism, and the writer is lucky the dealer didn't turn on him.

It kind of felt like I was listening to a Fox News story -- not a compliment.

Kathryn Wright

Southeast Portland

Legalizing drugs will reduce crime

History should have taught us that making a substance illegal only increases its use (Welcome to Heroin City, May 3). Prohibition was a prime example of this, plus it gave birth to organized crime and a lot of violence that never needed to happen.

The war on drugs was lost before the first battle. Supply will always meet demand, whatever the risks, as the rewards are high. If you really want to stop the violence on the streets and reduce crime, make all drugs legal. Make it so anybody 18 or older can walk into a pharmacy and sign a waiver and get what he wants. He gets a cheap price and high-quality drugs. The people benefit by not being robbed or mugged.

The laws for alcohol abuse will do just fine for drug users as well, so no need for new laws.

I think putting a drug user in jail is a waste of bed space, if that is all they were caught for.

Think of all the taxes that the city, county, state and feds will reap for legal sales of drugs, too. Business will hire more people, newspapers and TV stations will see artisan ads for drugs. The list goes on.

There also will be a reduction in violence. Hood rats won't need to kill over the best corner to deal, as that business is gone. Who is going to buy street drugs when they can walk in and get the best stuff for a cheaper price?

Use the taxes we reap to fund rehab programs, just like we do for alcohol and gambling.

What we are doing now obviously isn't working on any level, from street to federal, so why keep throwing money away?

George Thomas

Southeast Portland

Courts must hold dealers, users accountable

People smoke crack, snort coke and shoot heroin for one reason, and one reason only: to get high (Multnomah County's tough prescription, May 10).

This is nothing more than an alcoholic drinking to relieve pain. It's to get away with coping with their reality.

Most of them know no better than to get as high as they can for as long as they can. They are so wasted, they have no idea what is ahead of them -- either seriously sick or seriously dead.

I have seen these addicts operate for more than 20 years. I know how they want to blame everything on someone else, or something else. There are a few drug treatment programs that can work, but like everything else in life, you have to want it to make it work.

Drugs and alcohol have no place in jail. Jail is a place of confinement for criminals awaiting trial. Many heroin addicts aren't criminals other than the fact that heroin use is a felony crime in itself. The ones who need to be in jail and stay in jail and prison are the ones bringing (drugs) across the borders and selling it. This deportation thing is garbage and never solves a thing. They just get more drugs and come back for another round of selling.

I don't see Multnomah County doing anything better or different in dealing with these types of people. Jail just gets them probation. Probation officers are so overloaded that the low-level drug dealers and users are at the bottom of the list for keeping tabs on people.

But if you had a local society that took pride in itself, took responsibility for its actions and cared about its future, you wouldn't have this mess that we are stuck with here in Portland.

Believing that it's always someone else's fault that you smoke pot, believing it's someone else's fault that you snort cocaine and even saying it's someone else's fault that you got caught and may go to prison.

These are the types of people that Portland is breeding. And nothing will change until the courts decide that enough is enough and hold every one of these people accountable.

Bruce Giggers

Clackamas

Assess each case for pain medication

This makes it hard for people who do need medication (Multnomah County's tough prescription, May 10). Because I had "clean" urine, my doctor decided I was not taking my pain medication and selling it instead.

This is a great assumption on his part. I try not to take it unless I really need it. I have arthritis and cannot take NSIDS, so there is not much else I can take.

Rachel Solotaroff, Central City Concern's medical director, isn't a "big fan of prescription painkillers, even for patients suffering chronic pain." This is judgmental on her part -- I was a nurse and you can't judge others by what you think is right.

There should be a case-by-case look at who needs pain medication against people abusing it.

Beckie Granville

Northeast Portland

Addicts blame all but themselves

Informative article, but slightly mundane and conventional (Welcome to Heroin City, May 3).

Interesting how many hoops were jumped through, and how contorted and twisted the logic that was used to blame everyone but the person making the choice to be an addict.

Wanting to get high is not a "mental disorder;" it's called human nature.

Most folks beyond sixth grade quickly figure out the "war on drugs" is a total joke. Prohibition is a pernicious and regressive tax.

Geoff Rode

Southeast Portland