PENDLETON — Situated at the end of a quiet street, the Pendleton Treatment Center occupies the middle slot in a small commercial building.

It’s not a particularly impressive structure, but what goes on inside has the potential to change lives.

Since opening in 2019, the center has combined medication with counseling to treat more than 600 patients battling addiction.

This kind of medication-assisted treatment approach has emerged as a beacon of hope as the nation struggles with an addiction crisis of historic proportions.

But MAT, as it’s known for short, is not yet widely available in the state — and the Pendleton Treatment Center is the only facility in Eastern Oregon where you can get a full range of anti-addiction meds including methadone, according to John McIlveen, who heads up opioid treatment programs for the Oregon Health Authority.

“The need is pretty overwhelming, and absolutely more resources need to be committed to it,” McIlveen said.

A state in crisis

Oregon ranks at or near the top among U.S. states in drug use and overdose rates, McIlveen said, with an average of 90 Oregonians dying every month from drug overdoses.

Those numbers are up sharply in recent years, from a total of 280 fatal ODs from opioid narcotics in 2019 to 956 in 2022, according to the most recent data from the Oregon Health Authority.

The final tally for 2023 is not yet complete, but it already includes 1,049 fatalities.

What’s driving the spike?

The answer is simple, according to McIlveen.

“Massive … quantities of illicitly manufactured fentanyl that have basically flooded every corner of the state of Oregon,” he said. “From top to bottom, coast to desert, mountain to valley, everything. Fentanyl — the whole state is awash in it.”

A recent arrival on the illicit drug scene, fentanyl is cheap, easy to manufacture, widely available — and 50 to 100 times stronger than heroin or morphine.

“In Oregon, about 92% to 94% of opioid-related deaths are caused by fentanyl,” McIlveen said. “So that is a stunningly high number.”

While fentanyl has been grabbing the headlines lately, heroin also remains a factor in Oregon’s opioid addiction crisis, as do prescription pain relievers such as oxycodone, hydrocodone, codeine and morphine.

Opioids cause overdoses by overloading the body’s opioid receptors and then starting a chain reaction, ultimately reducing respiration to the point where the user is unable to breathe.

Narcan, or naloxone, can bring someone who is overdosing back from the brink of death — if it’s administered quickly enough. But it won’t stop that person from using drugs again if they have an addiction.

The most effective method to treat opioid use disorder, the clinical name for dependence on opioids, is medically assisted treatment, McIlveen said.

“Because what it does is, in a measured, medically monitored fashion, it replaces the opioids in the opioid receptor that would normally be in a drug user,” he explained. “It removes withdrawals and cravings and it allows people to stabilize, basically.”

However, there are only 27 facilities in the entire state that offer a full suite of medication-assisted treatment options — and only one of them is east of Bend.

Treating the problem

The Pendleton Treatment Center’s approach to addiction recovery is using medications to physically stabilize patients while using counseling to decrease the likelihood of relapse.

The center treats people with opioid use disorder, and in many cases the first challenge it has to overcome is withdrawal — the body’s physical reaction to taking away a drug it has become dependent on.

For people coming off the use of opioids, withdrawal can cause severe pain, hot and cold flashes, nausea and diarrhea, a reaction that can cause a patient to continue using in order to prevent those symptoms, said former director Nicole Pantley, who recently left the Pendleton Treatment Center for another job.

“The medication helps stabilize somebody’s physical symptoms,” Pantley said. “When you’re in all of those physical symptoms, it’s very hard to make different choices because you’re at the mercy of your body that’s screaming.

“And then, as they stabilize on the medication, we can start having them participate in the groups that we do here,” she added. “They start having individual therapy right off the bat.”

The three medications used to medically treat addiction at the center are methadone, buprenorphine and Suboxone.

All three are agonist medications — drugs that bind with the same neural receptors and in the same manner as the illicit drugs a patient used. They help to control cravings and can blunt the effects of other opioids used by the patient, according to the National Institute on Drug Abuse.

Dose, duration, and frequency of use are all crucial factors in determining which medications to use for treatment. The type of drugs used by the patient and their physical health are other considerations.

Although widely considered to be effective, MAT therapy remains controversial. Using drugs to fight drug use seems counterintuitive to many people, and the stigma surrounding addiction is part of the reason this type of treatment is so heavily regulated.

Like the illegal drugs they are used to treat, buprenorphine, Suboxone and methadone fall under the Controlled Substances Act, the federal law regulating the manufacture, use and distribution of all controlled substances nationwide.

“MAT treatment is far more highly regulated than any other treatment modality,” Pantley said. “Especially since we’re not like physicians who are prescribing medication. We do medication management with an on-site pharmacy. You have to deal with accreditation bodies, DEA, OHA.”

That stigma can get in the way of a patient’s recovery, Pantly said, but one way to address it is to be open and honest, and thereby humanize patients in recovery.

“Most of us here are in recovery,” she said of the center’s staff. “We know what you’re going through.”

Policies and procedures

Everything the Pendleton Treatment Center does is governed by a strict set of policies and procedures.

After arriving at the facility, a client will use government ID to verify their identity. Next the client will be given an admission packet that explains the client’s rights and responsibilities, the fees they’ll be expected to pay and the treatment center’s policies.

The client must undergo a urine drug screen, and women of childbearing age get a pregnancy test. Next, the client will meet with a counselor to complete various assessments and arrive at an initial treatment plan.

The client will then be seen by the physician, who will perform a physical exam and order the initial dose of medication, as well as bloodwork and tuberculosis testing.

When all that’s done, the client can be approved for admission to the program and receive an identification card.

Then the client will proceed to the dosing window to obtain the initial dose of medication. The nurse will begin to educate the new client on the medication being ingested and have the client sign an acknowledgement form. Once the client has given consent, the nurse will give the client their medication.

The client will be monitored for adverse reactions to the medication for a minimum of 30 minutes for methadone and an hour for buprenorphine. Should the client have any adverse reactions, the nursing team will notify the physician.

“Once all items have been completed or scheduled, the client will be given an opportunity to ask any final questions for the day,” said Emerson Bevington, the Pendleton Treatment Center’s new director. “If there are no final questions, then the client may leave to return the next day and the intake process is then complete.”

More centers needed

Despite a proven track record of effectiveness, medically assisted treatment is still not available to most residents of Eastern Oregon.

McIlveen said OHA is aware of that service gap and is looking at options for filling it.

“That’s definitely one of the gap areas that we’ve talked about as being an area of need,” he said.

Ideally, McIlveen said, Oregonians struggling with opioid use disorder should be able to access a treatment center within a 45-minute drive of their homes. If the nearest center is hours away, that simply isn’t going to do them any good.

He said Eastern Oregon could easily have six treatment centers operating in strategic locations such as Burns, John Day, La Grande, Baker City and Ontario, in addition to the one in Pendleton.

“What we find, especially with increased methadone access, is if it’s not there, people can’t access it,” McIlveen said. “When it is there, they will access it.”

There are obstacles to opening medically assisted treatment centers anywhere, some of which can be more pronounced in rural communities such as those in Eastern Oregon. Those include finding a qualified workforce, gaining access to funding, and laws that prohibit siting a treatment center within 1,000 feet of a school or day care facility.

But companies like Oregon Treatment and Recovery Centers, the Bend-based outfit that runs the Pendleton Treatment Center and six (soon to be seven) others in the Pacific Northwest, have shown the ability to overcome those obstacles when the demand for services is strong enough.

What happened after the Pendleton Treatment Center opened in 2019 is a perfect example, Pantley said.

“Our Tri-Cities location was a direct result of this clinic,” she said. “So this clinic opened up and then they realized that there were so many patients coming from the Tri-Cities that they opened one up in the Tri-Cities.”

Something similar is going on now on the west side of the state, said Kirsi Kirk-Lewis, the company’s director of systems management.

“We already have a treatment center in Springfield,” Kirk-Lewis said. “We looked at where the patients were coming from and we had around 90 clients who were actually in the Eugene area. So we decided to go ahead and open a treatment center in Eugene to help service those clients.”

At the moment, the company has no plans to open a second location in Eastern Oregon, but that could change if the demand is there.

“We are always looking for opportunities for growth within our organization,” Kirk-Lewis said. “We work closely with the Oregon Health Authority to see where there are opportunities to open new locations.”

“Fentanyl — the whole state

is awash in it.”

James McIlveen, Oregon Health Authority

“Most of us here are in recovery.

We know what you’re going through.”

— Nicole Pantley, former director, Pendleton Treatment Center

Measuring success in addiction treatment

Measuring success in addiction treatment

For many people with opioid use disorder, there may never be a time when they are completely free of the craving to use drugs.

But multiple studies have shown that medication-assisted treatment — the use of agonists such as methadone, buprenorphine and Suboxone in conjunction with counseling and other forms of therapy — can significantly reduce fatal overdoses, hospitalizations and serious complications during pregnancy while increasing the ability of patients to function effectively in society.

In spite of this, however, the stigma surrounding drug addiction can be a serious barrier to treatment for many people. And it’s not just the stigma from society, but often the internalized stigma that can keep people from getting the help they need.

“They moralize symptoms,” said Nicole Pantley, former director of the Pendleton Treatment Center. “You’re late coming to treatment or you can’t get here on time because you used the night before. You don’t feel well the next day, you’re hungover, or whatever it is. But, really, that has nothing to do with morals. It has to do with a symptom of the illness.”

The definition of success and failure for a patient in recovery may differ markedly from the common understanding of the term.

“If a person has diabetes and they don’t take their insulin and their blood sugar skyrockets and they have to go to the hospital, or they eat a bunch of sugar, a bunch of carbs and they’re not supposed to, do we say they failed?” Pantley said.

“So, you see what we’re up against because recovery is a chronic illness of both the brain and the body. So, really, are we gonna say it’s a failure? And not only that, but it changes as people go through their changes in recovery. So relapse is really part of the process.”

For many patients, having an accepting place to access treatment is a valuable resource on the road to recovery, Pantley said, and that’s what the staff at the Pendleton Treatment Center tries to provide.

“Recovery can be messy,” she said, “and incredibly beautiful.”