A new way to treat addiction in Salem

Josh Lair is the Oregon community outreach coordinator for Ideal Option, a network of medication-assisted addiction treatment clinics that expanded to Salem in 2020 (Rachel Alexander/Salem Reporter)

Josh Lair knows how difficult it is to detox from drugs.

After becoming sober over a decade ago from methamphetamine and alcohol, Lair became a drug counselor in Salem and worked at a detox facility, where he’d watch people violently ill as heroin or meth left their system.

He’s now working at a Salem clinic that’s trying to do things differently — giving people same-day prescriptions for medication to help them transition off illegal drugs, and using treatment protocols that minimize the time people have to spend in withdrawal before getting help.

Salem’s Ideal Option clinic opened in April 2020, just as the pandemic took hold, and remains something of a secret even in the addiction treatment and social service circles Lair works in.

“I had no idea this was a thing,” he said, echoing a sentiment he often hears.

His job is to change that.

Before joining Ideal Option as a community outreach coordinator in August 2021, Lair worked for Marion County’s Law-Enforcement Assisted Diversion program, meeting with people referred by local law enforcement agencies who are facing charges for low-level crimes and helping them get help with housing, treatment and other needs. He now uses those connections to let people know their clinic is an option.

The pain and illness that can come with kicking a drug habit are one of the reasons it’s difficult to get people into treatment — even when they’re ready to make change, Lair said. Medication-assisted treatment, where people take a legal prescription drug like buprenorphine that helps them transition off more dangerous opioids, is highly effective. But it generally requires sobriety for at least a day, at which point drug users are well into the worst symptoms of withdrawal.

“A huge reason people choose not to go on Suboxone (is) because they don’t want to feel like crap,” Lair said, using a common brand name for buprenorphine. Long wait lists and other hoops to jump through also reasons people are hesitant, he said.

Many drug treatment programs are counseling-based, requiring people to participate in groups or meet one on one with counselors. Ideal Option focused on medical treatment first, with same-day appointments and prescriptions designed to get people to use drugs less often.

“It’s not that I don’t believe that counseling is great,” Lair said. But convincing someone to sit through a session when they’re in withdrawal doesn’t always work as intended.

“They feel like crap, they don’t want to talk to you. They want to get the medicine and feel better so they can go home,” he said. Ideal Option connects people to other drug treatment services in Salem that offer counseling, like Bridgeway and Great Circle Recovery, Lair said, and those programs refer to their clinic for medication.

Ideal Option was founded in the Tri-Cities region of Washington in 2012 and now operates clinics in 10 states, according to their website, including five in Oregon. More are in the works, including a planned west Salem location.

The Salem clinic had about 220 active patients as of early July, with about 10 new people starting treatment each week, according to data provided to Salem Reporter.

The Salem Ideal Option addiction treatment clinic on Liberty Road Northeast on Monday, July 18 (Rachel Alexander/Salem Reporter)

Across Ideal Option Oregon clinics in 2021, about half of patients who came to a second appointment remained in treatment one year later, according to the company’s annual report. Those who stuck with treatment longer-term reduced opioid use by 93% and meth use by 88% in 2021, the report said. The clinics take most private insurance and Oregon Health Plan, the state’s Medicaid plan.

Rhonda Woodside is a nurse practitioner at the Eugene clinic who also virtually sees patients in Salem. She said the clinic can offer treatment to people who can’t access inpatient treatment because of a lack of space or life circumstances that won’t let them complete a 30-day program.

“It’s hard to find a bed. And then other people, on the other side of the coin, they have a job, they have kids. If they go to treatment they’re going to lose their job,” she said.

Ideal Option prescribes buprenorphine for people using opioids, and has treatment protocols allowing someone to gradually start a prescription in small doses while tapering off other opioids. That minimizes withdrawal and can make it easier for someone to begin treatment.

“If they have a bad first experience they’re not going to come back probably and then they’re at risk for dying because fentanyl’s in everything now,” Woodside said. More of her clients are using multiple drugs together now, she said, and the rate of fentanyl use has also climbed, she said.

The clinics also offer medication-assisted treatment for meth, using a combination of wellbutrin, an antidepressant, and naloxone, an opioid overdose reversal medication. It’s a newer, off-label drug use and a service few other clinics provide.

“We’re having some success with at least getting the amount that they’re using down … Over years and years, meth use really damages their heart. We have people in their 40s having strokes because they’ve been using meth for 20 years,” Woodside said.

Woodside said stigma remains a challenge for a lot of her patients. Many began using drugs to cope with mental health conditions, and some were raised by parents who abused drugs and gave them their first doses, she said.

“A lot of these people feel very shameful. They’re judged at the pharmacies, they’re judged by their primary doctors, they’re judged in the ER. A lot of them are treated very poorly even by other medical professionals,” she said.

Lair and Woodside said there’s also a stigma associated with medication-assisted treatment because some people mistakenly believe it’s replacing one addiction with another. While buprenorphine is an opioid, it carries a much lower risk of overdose and alleviates withdrawal symptoms, allowing people in recovery to replace the quest to buy street drugs with a safe medication they can get prescribed.

“Would you tell someone who’s diabetic they’re addicted to their insulin? Would you tell someone with asthma they’re addicted to their inhaler?” Woodside said. “We look at Suboxone as a maintenance medicine for a disease that you have, just as if you’re diabetic.” 

And getting people to cut down on drug abuse is “still so stigmatized,” Lair said. “We should be wanting people in medication-assisted treatment, because the alternative is crime to support the habit, DHS involvement,” he said.

The Salem clinic takes walk-ins and can generally get someone an appointment the same day or day after, Lair said.

Located at 863 Liberty St. N.E., it has a bright sign but nothing on the outside indicating it’s an addiction treatment clinic. That’s intentional, so people don’t fear walking in off the street.

“They put enough shame on themselves. They don’t need anybody putting it on them too,” Woodside said.

Contact reporter Rachel Alexander: [email protected] or 503-575-1241.

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