Fast, cheap and ubiquitous, heroin is engineered for the streets. That’s where Saphire Harris lived, homeless, with her brother and mother.
Harris started using as a teenager, but she was trying to get clean, said her mother, Marie Kelley.
“My daughter went from doing $80 to $100 (in heroin) a day down to $10 a day,” said Kelley. “She was struggling with it. She was trying to hold on: It’s just her body got tired.”
Kelley said the addiction discouraged her daughter from getting the kidney dialysis she needed to keep her alive. She had also watched her grandmother die on dialysis, her mother said, and she was afraid to go near it. She developed endocarditis after taking an infected shot of heroin, which caused blood clots. Her body gave out on Jan. 29 at a camp at Southeast 118th Avenue and Couch Street, the spot now marked by an elaborate and lovingly crafted memorial. She was only 21.
Kelley lives in a tent community about a mile away from the memorial.
Her daughter had mental health issues, including depression, suicide ideation and the beginning signs of schizophrenia, but she was a caretaker in the community, and the community accepted her because they lived with similar “disabilities,” her mother said. Which meant they also self-medicated in similar ways.
“She took care of a lot of people out here,” said Kelley. “If somebody needed something, she found a way to get it for them. Her memorial was from the tree all the way out to the road. From kids all the way to the elderly, she was just that way.”
One of the people she took care of was her older brother, Timothy, who was autistic, and also a heroin addict. He was inconsolable after Saphire died, Kelley said, and three months after her death, he died at age 26 of an overdose. Kelley sat outside the large tent the three of them lived in together and nodded to a place in the street a few feet beyond its front door.
“My son died right here,” Kelley said. “He died of a heroin overdose and basically a broken heart. He and his sister were really close. They were like best friends, and so without his sister, he just gave up on living.”
Timothy’s name and pictures were added to the memorial at 118th Avenue.
“He just gave up and wanted to be with his sister. I look at it now that maybe he’s found some peace now that he’s with his sister.”
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As personally tragic as their story is, Saphire and Timothy Harris’ deaths are not unusual among the hundreds of people who have died on Portland streets in the past five years. More than 90 people died homeless on the streets of Multnomah County in 2019 alone. In more than half of the cases, drug or alcohol toxicity caused or contributed to their death.
Nearly half of the people living unsheltered on Portland’s streets last year reported living with substance abuse issues, either alcohol or drugs. One in four people sleeping outside reported having both a mental illness and substance use disorder.
This isn’t just a street problem. This is a national problem, with Oregon ranking among the states with the highest substance abuse and mental health challenges, and among the lowest for access to care.
According to the state Alcohol and Drug Policy Commission’s 2020-25 strategic plan, released in June, nearly 330,000 Oregonians were estimated to need treatment for a substance use disorder in 2016-17 based on national data. (There are no state data resources to adequately capture that information, according to the report.) During that period, however, only 5% — approximately 18,000 people — in need of any kind of substance use treatment received it.
And yet, Oregon’s spending on substance use disorders more than quadrupled since 2005, consuming nearly 17% of the entire state budget in 2017. According to the ADPC, only about 1% of those funds, however, were used to prevent, treat or help people recover from substance abuse. Most of the money went to covering the cost of “health and social consequences created by the lack of investment in prevention, treatment, and recovery.” According to ADPC, of the $6.3 billion in state funds spent on issues related to substance misuse in 2017, including alcohol and tobacco, 94 cents of every dollar paid just for the burden to public programs because of the lack of prevention.
Substance abuse is well documented as a contributor to homelessness, but it’s also established as a byproduct created by the trauma of living on the streets. Likewise, recovery and housing are inextricably linked.
In March 2018, Gov. Kate Brown declared alcohol and substance abuse addiction a public health crisis in Oregon, acknowledging that a “person who suffers from addiction often requires low-barrier housing to achieve the safety and stability necessary for recovery.”
Permanent housing, regardless of prerequisites for sobriety, is recognized by federal and state agencies to alleviate conditions that negatively affect health, including addiction.
“There is plenty of evidence that helping people get into homes helps them better address any other challenges that they might have,” said Sarah Saadian, vice president of public policy with the National Low Income Housing Coalition. “Once you’re stably housed, you’re much better able to address other challenges, including mental health issues or other health issues, substance use disorders, other things going on in your life, it’s much easier to address if you’re housed. If you’re unhoused, as you can imagine, everything becomes that much more difficult.”
That philosophy, embodied in Housing First initiatives adopted in Portland and across the country, have been applied for two decades to move people into housing without qualifying prerequisites.
The Trump-appointed homeless czar favors a reverse approach — treatment before housing. Robert Marbut, head of the Interagency Council on Homelessness has said he believes in “housing fourth,” using a place to live as incentive to compel sobriety. His previous employer, the homeless shelter Haven for Hope in San Antonio, Texas, required clients to prove sobriety before graduating from sleeping in the outdoor courtyard to the “transformational campus.”
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Marbut’s position follows the Trump administration’s 2019 report that downplays Housing First’s contribution to improved health and recovery. His stance, and that of the administration, has been rebuked by national housing advocates who cite better housing retention rates among Housing First clients compared to housing as a reward.
“Many of us in this field thought we were beyond these conversations, whether or not Housing First works. We know it works,” said Saadian. “And it’s really perplexing that this administration would pick somebody who is looking so far back into past policies that had been debunked for a long time.”
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In 1979, the year Central City Concern was founded, alcoholism, not heroin or meth, was the leading health problem on Portland’s streets, and the organization’s work focused on recovery. But CCC soon realized that for recovery to stick, housing had to be a part of the solution. It began working with the city to rehabilitate old single-room rentals in Old Town into recovery and non-recovery-focused housing.
Today, CCC is one of the metro area’s primary housing programs for people leaving homelessness, including those with mental health and substance abuse issues. It operates more than 1,600 units of affordable and permanent housing, with both recovery housing and a harm reduction Housing First model. Depending on the particular facility, abstinence is not required.
“Frankly, the more that the evidence is coming through, the more combining our recovery housing options with really good outpatient support which includes medications as a treatment, the more these lines become very blended,” Hubert said. “You start moving away from that traditional abstinence-based (model) to what recovery housing looks like.”
Portland’s JOIN also works to house people first, prior to recovery. Last year, the organization housed nearly 1,350 people, and it boasts an 83% retention rate after one year. The organization’s staff works closely with landlords and property managers because the majority of their clients are housed in private market rentals. The philosophy, according to JOIN’s executive director, Katrina Holland, is housing first, get your basic needs met, and then we’ll deal with the rest.
“The research has shown this,” Holland said. “Somebody’s ability to sustainably manage a behavioral health concern is better supported when they have a place to live. Somebody’s ability to recover from the disease of addiction is better supported when they have a roof over their head. Research has told us this over and over and over and over again.”
It’s also more cost effective compared to the chronic criminal and emergency approach. According to figures compiled by Multnomah County, the average cost to visit an emergency department is $500. A night in the Multnomah County Jail will cost you north of $200. But a night in a supportive housing unit runs between $59 to $64.
‘A Ripple Effect’
Danielle McEvers lost her housing to her addiction. On the day Street Roots met McEvers, she was sitting on a quiet stretch of the I-205 bike corridor outside of her tent, sorting through a collection of DVDs.
“Tell her what you’re doing,” a man’s voice called almost jokingly from under the tarp nearby. She laughed and looked embarrassed but told the story.
“One way we support ourselves is to go canning, and in one of the recycling bins, I found somebody’s porno collection, and so I’m cleaning it off because we know someone who will buy it. So I’m just going to sell it. That’s really embarrassing.”
“That’s worth money,” called the voice from the tarp, laughing.
McEvers said she initially got evicted from her apartment because she violated the lease agreement by having her partner, who was not on the lease, stay there. More recently, she lost housing through a recovery program for relapsing.
“I was doing well, and then I slipped up and I relapsed, and that just put me right back out on the street because I lost my spot there,” she said. “That’s a hard pill to swallow. I’m really mad at myself about that. That’s one of the main contributing factors to why we’re homeless.”
Her addiction fueled a self-destructive streak, McEvers said, and kept her from participating in programs that could help her post-traumatic stress disorder and kept her from staying employed and from staying housed.
“It was a ripple effect of all of my actions.”
McEvers believes that support programs are key — programs that help people with addiction and mental health issues, and make sure they take their medicines, stay engaged in their care, get to appointments and keep their housing.
“It’s amazing how many people out here don’t know how to seek out resources or advocate for themselves when it comes to something like basic needs,” she said.
Just as important as having programs to help people get off the streets are networks to help people stay off the streets, that period she calls “afterwards,” when housing is fragile.
“It’s easy to go to treatment and be clean for that time, but it’s when you are sent out on your own again,” McEvers said. “It’s learning basic skills in how to pay your bills or take care of stuff like that.”
Skills like how to find a job when you have a criminal record, she said. Jobs that pay well, that match the housing market and the cost of living. Otherwise, it’s trading one scarcity for another.
“I could either stay homeless or stay unemployed and get food stamps or have a job but get my food stamps taken away and not be able to feed myself but I have housing.”
Holland, with the homeless-to-housing program JOIN, said people are mistaken when they write off people who are homeless because of a substance abuse issue.
“It’s a very frustrating thing to hear when people always describe our neighbors as folks who have behavioral health or drug issues and that that is the cause of their homelessness, when in reality it could have been the trauma of becoming homelessness that instigated that,” Holland said. “And furthermore, who are we to judge somebody’s coping mechanisms, when they don’t have access to other forms of — not necessarily recovery from addiction and behavioral health issues but recovery from the trauma impacted, one that they have continuously experienced every single day.”
“Nobody prepares you to be homeless,” she added. “The basic things that we think about, taking a shower, putting food into the refrigerator, putting medicine in a temperature-controlled space, all the things that are necessary to keep your livelihood — all that’s gone when you lose a house. We are more than that. People are more than that.”
The Lessons of Rat Park
If you are of a certain generation, a singular clinical study probably left an indelible mark in your understanding of drug addiction. It’s the rats on cocaine.
An isolated caged rat is given access to cocaine and proceeds to use it to such extreme until the rat willfully overdoses and dies. The message was that cocaine and other drugs used in similar tests are so powerful that they override an individual’s willpower and common sense. The Partnership for a Drug-Free America even built a campaign around it in the 1970s and with a disturbingly graphic television ad for the times.
Bruce Alexander saw those ads and examined those studies and saw something other than the drug. He saw rats that were socially, sexually and mentally deprived, with only the drug to keep them company. So the Canadian psychologist (an ex-pat from America via Portland) and some colleagues set up their own experiments — on one hand re-creating the environment used in the previous studies, and on the other, creating communal environments that were a veritable rat heaven, complete with toys, great food and cozy corners for romantic interludes. Both sets of rats were given the same options of straight water or water laced with morphine, and the rats in the isolated cages followed the same pattern of relying on the drugged water and increasing their intake of the drug as time went on.
But the rats in “Rat Park,” as it became known, hardly used the morphine water at all. Even rats induced to addiction, drinking morphine for two straight months, eschewed the drug and cleaned up once they moved into Rat Park.
“These guys (in Rat Park) have a complete, total, 24-hour supply” of morphine, Alexander told author Johann Hari for his 2015 book on the drug war, “Chasing the Scream.” “And they don’t use it.”
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The environment, not the drug, was driving the behavior, concluded Alexander and his colleagues. Addiction is a product of what our lives around us provide.
They published their results in peer-reviewed journals in the late ’70s and ’80s, and in 2010, he wrote “The Globalization of Addiction: A Study in Poverty of the Spirit.”
Today, Alexander is professor emeritus of psychology at Simon Fraser University in British Columbia. He’s written extensively to condemn the puritanical notion of a “demon drug” controlling people’s body and minds, a condition of the weak-willed, which releases society of its collective responsibility for addiction.
“We’re having a paradigm shift because we’ve been locked for more than a century into what I like to call the temperance mentality,” Alexander told Street Roots. “The way the temperance movement looked at alcohol, it’s got to be one of two things, a very bad, evil choice or it’s got to be that they can’t control it. We’ve gone a long way from the temperance mentality.”
The world is in a process of change, Alexander said. But the United States as a whole is lagging behind in its attitudes around addiction.
“The change is very visible in places like Portugal, and in Northern Europe, in Scandinavian countries and the Netherlands. Even in Great Britain and in Canada, there’s a move, a move which does recognize much more fully the importance of housing, but not just housing and not just having an adequate income, but also the importance of having a community, having a stable way of living and meaningful life. … They’re accepting the fact that people aren’t going to get off drugs right now, so they make sure they have a safe supply and clean needles and the amount of support that people need to live, to survive their addiction. But they’re also saying if people are going to get off (drugs), they’re going to need a place to live.”
Still, focusing on the drug is the great distraction, Alexander said. Addiction is much bigger than the drug and has little to do with drugs at all, in his mind. If society is to root out drug use as an addiction, it has to understand how addiction permeates all levels of our modern life, including poverty, criminal justice and racial discrimination. For Alexander, revolutionizing our approach to addiction fits holistically with the Black Lives Matter movement and police reform actions that are shaking our foundations today.
“It’s all interrelated, isn’t it?” Alexander said. “If something is done about structural racism, that’s a way of doing something about addiction. If something is done about providing reasonable health care, that’s a way of doing something about addiction. It’s all interrelated.”
Which means addiction has to be approached on a larger, cultural level, he said, all the way to corporate control of our environment and addictions to money and power. From the streets to the board room, dissatisfaction with life is what fuels the need to turn to substitutes to feel better. Just like the rats in Rat Park, a satisfactory life is key to overcoming the need for substitutes, Alexander said.
But there’s no formula for a particular human being to find peace so that they don’t have to turn to something extreme or dangerous to ameliorate their unbearable lives, Alexander said. And so the pursuit of “curing” people is a fool’s errand.
“We’re talking about a need which surpasses all understanding,” he added. “The formula for what makes a satisfactory life for a human being is not well known. All we can do is provide a society in which people have maximum opportunities to grab the bits and pieces of a fragmented world and put them together in a way that gives them the best chances of doing fine without addiction.”
‘They Need the Love’
On a stretch of path where nothing — certainly not tents or dwellings or families — belongs, Misty seems especially out of place. During her conversation with Street Roots, she was honest and hopeful, a contrast to the roar of indifference coming from I-205 below us.
She wants to help people, and that’s why she went to school to become a nurse. She got her nursing license and became a certified nursing assistant. She had done drugs when she was younger, like a lot of people, but she mostly drank alcohol. Then she got two DUIs within 10 years, and it all fell apart. She was made to “voluntarily” surrender her nursing license. That was in 2009, and it still stings.
“For two DUIs,” she said. “I didn’t steal meds; I didn’t neglect anybody. I was really a good CNA, and I would have been a good nurse. But they took it, and it kind of broke my heart. I was drinking a lot then, and I just went right back into drugs. It was an easy transition. I was really bummed out. I’m still heartbroken.”
After she lost her job, housing became a problem. She couch-surfed and lived with a boyfriend, before that relationship ended. When we talked, she had been outside for about a year. She’s had a few other jobs, but she dreams of going back to nursing. She said she won’t, though, unless she’s entirely clean and sober. She’s tried methadone, which is given to abate heroin use, and stayed sober through drug court. But she reaches a point, she said, where she eventually loses her drive and relapses.
“It’s really hard to do once you’ve been in this kind of a mentality. It’s really hard to be on the clean and sober level. Everything in life is really hard to deal with clean and sober. It’s hard, too, on drugs, but for some reason it seems easier. I don’t know why, but it does.”
As of our conversation, Misty was looking into other treatment, including medication-assisted treatment, or MAT, which bundles medication with behavioral therapy. MAT has been shown clinically effective in sustaining recovery, decreasing the need for inpatient treatment for opioid users, decreasing illicit opiate use and helping people gain and maintain employment, according to the federal Substance Abuse and Mental Health Services Administration.
MAT’s popularity has increased in the past 20 years, specifically the use of the drug buprenorphine, and Congress has taken measures to increase its availability. Still, according to the Department of Health and Human Services, only 20% of the more than 2 million Americans who have been diagnosed with opioid use disorder who need treatment will ever receive it. Of those receiving treatment, only about a third will receive medication to help suppress drug cravings and aid recovery, according to HHS.
“I want a sober mind, a good job and a place to stay. And I want to be a productive member of society again,” Misty said.
But you can’t force sobriety, she said, speaking from experience. You can, however, coax someone. “You can show a person that you care and show them what it’s like on the other side and be that person to help them. … We are much better led than forced — into anything.”
“I think love is really what it comes down to. Love and understanding and care. Care about somebody. Really give a shit,” Misty said. “Nobody really knows what it’s like out here. Nobody knows what happened to the person to get them out here. And there’s been a lot of bullshit that’s happened to people out here — a lot. There’s not very many people who came from a good family and had a really good upbringing and just decided to go out and do drugs and live on the streets. Very few. There’s been something very traumatic that’s happened.”
“I think they need the love,” she said. “They need to feel appreciated and cared for. Everybody does. We all need love and compassion, and if you’re just going to shun everybody for being homeless and drug addicts, then we’re all going to die out here, lonely. And what’s going to happen then? I don’t know. The world’s going to be a bad place.”