For Amber Richards, life after overdose starts with compassion

Kandra Miller has struggled with addiction to alcohol, heroin, and meth for seven years. In that time, she lost everything, rebuilt her life during two successful years of recovery, and lost it all again when she relapsed last year and became houseless, she says. 

In June, Ms. Miller felt ready to reclaim her life again. But this time, she wasn’t alone. When she joined the line for a detoxification clinic just after sunrise one morning, standing with her was Amber Richards, a peer support specialist whose job it is to transition people using drugs to treatment, housing, jobs, and – hopefully – sobriety.

By early September, Ms. Miller was housed in a sober living facility, attending 12-step meetings and, after some slip-ups, approaching 30 days without using drugs.

Her goal: “Stay sober for the rest of my life,” she says. 

Ms. Miller is one of hundreds of people supported by a unique program showing promise in suburban Clackamas County, Oregon. The program, Project Hope, is a coordinated public health response that funnels people at risk of dying by drug overdose into the care of Ms. Richards, a former heroin user and an expert on recovery. If someone overdoses in this large and diverse locale east of Portland, they’ll likely receive a visit from Ms. Richards or a specialized firefighter within the week, who offers resources and support.

In Oregon, advocates of Project Hope say it’s a model method of closing gaps between social services, first responders, hospitals, community hubs, and jails. Ms. Richards and her team have helped hundreds of clients find help, from detox to housing and counseling, since the project’s inception in 2018. 

But Ms. Richards and her colleagues are up against a historic spike in drug-related deaths. Fatal overdoses exploded in Oregon at more than double the national rate between 2019 and 2021, according to the National Center for Health Statistics, and Clackamas County is following the trend. 

“We can’t keep up,” says Apryl Herron, a Clackamas County public health coordinator who co-founded Project Hope. 

The spike is driven by methamphetamine and fentanyl, a powerful synthetic opioid flooding Pacific Northwest drug markets for the first time. Fentanyl is 50 times more potent than heroin and can be pressed into illicit pills or mixed into other drugs, authorities say.

Oregon has responded to this crisis with a nonpunitive approach. In 2020, voters approved a landmark law that decriminalized small amounts of illicit drugs and earmarked hundreds of millions of dollars for addiction treatment and community-driven responses. Counties and cities across the state are beginning to experiment with big plans. That’s fueled some optimism among addiction experts and advocates, and some are taking inspiration from Project Hope.

“She had tears in her eyes”

Before the program debuted, the response to a nonfatal overdose in Clackamas County was typical of the status quo in most of the United States, Ms. Herron says. If someone overdosed and did interact with first responders or a doctor, which is far from guaranteed, they might have been given a hotline to call. Otherwise, that person was free to continue using until their next overdose, she says.

Ms. Herron co-founded Project Hope with Amy Jo Cook, a community paramedic with Clackamas Fire who works with unhoused people with substance use disorders. In 2018, Ms. Cook began visiting the homes of people who had overdosed and offering them opportunities, such as an immediate spot at a detox. 

But the opioid crisis exploded during the COVID-19 pandemic, and Project Hope ramped up. Its small staff of four people, of which Ms. Richards is the only full-time employee, became a nexus for a slew of organizations in Clackamas County that interact with people using drugs, including hospitals, health centers, emergency services, police, and the county jail. That means Ms. Richards is often bouncing between courtrooms, fast-food restaurants, hospital beds, and the Clackamas County Jail. 

Her goal is to break down barriers to treatment. She begins by listening and sharing her own experience. 

Ms. Richards began taking prescription opioids 10 years ago. She later progressed to heroin. Her own path to recovery involved almost 10 trips to detox and numerous relapses. “I know all about it because I went through it,” she says. 

If she can win a client’s trust, it’s off to the races. She transports clients, who are often impoverished and without vehicles, to the doctor’s office, detox, and treatment centers. And she’s waiting for them in the parking lot when they’re finished. She navigates health plan bureaucracies with a part-time case manager and provides clients phone numbers for sober-living residences. She buys meals and hands out “harm reduction kits” that include naloxone, a medication that reverses opioid overdoses. 

And she picks up the phone when her clients call. That was welcome and unusual, Ms. Miller says; she was used to being ignored.

“She had tears in her eyes when she was talking to me,” Ms. Miller says. “She understood what was going on.” 

It’s hard work. One client Ms. Richards supports who lives in a tent and has overdosed in the past only began committing to detox after speaking with Ms. Richards for a month. Often, they simply meet in a parking lot and hug, Ms. Richards says. Another client recently accepted help but disappeared, only to resurface with criminal charges. 

Between December 2020 and December 2021, Project Hope staff members made 140 referrals, in which they connect clients to supports such as peer mentoring programs, housing, and jobs. Staff also made 60 referrals for treatment. 

But Project Hope doesn’t keep data on whether someone enters recovery or stays clean after receiving help. In fact, sobriety is not the project’s goal, Ms. Herron says. She judges its impact by whether clients accept help. 

That mission is partially a product of the tragic environment staff members work in, and their small team. Almost 70 people died due to drug use in Clackamas County last year, compared with a death toll of about 40 people in 2019. Accordingly, Project Hope’s goals were “refined over time to become realistic,” Ms. Herron says. Anecdotally, a few former clients have stayed in recovery for more than a year and keep in touch.

Not giving up

Project Hope is a model of “harm reduction,” a public health philosophy driving drug policy in progressive jurisdictions across the U.S., including Oregon. Harm reduction advocates say people using drugs can’t reach sobriety if they’re dead, so health care must provide support and safety supplies such as clean syringes and naloxone – not incarceration and stigma.

After a voter-approved windfall for substance use treatment in 2020, the state of Oregon is set to dole out $265 million in taxpayer funds over the next two years. Part of that funding will create an “army” of peer mentors like Ms. Richards, says Tony Vezina, chair of the state Alcohol and Drug Policy Commission. 

But Mr. Vezina says Project Hope is notable because it built cohesion between organizations that have historically not focused on addiction treatment, such as local police and fire departments, jails, and hospitals, with a peer mentor at the center.

“[Project] Hope really is that unique,” Mr. Vezina says of the program.

Todd Korthuis, an addiction medicine specialist at Oregon Health & Science University in Portland, tells the Monitor that organizations elsewhere should be building bridges like Project Hope has in Clackamas County. He emphasizes that opioid use has reached the level of a crisis in Oregon.

“We just haven’t seen anything like fentanyl in the past,” he says. “It’s going to take all of us working together to respond.” 

Ms. Herron is thrilled Project Hope has helped so many people. The small program is set to expand, and she is particularly excited to bring on another full-time peer mentor who will work as Ms. Richards has. 

On the ground, Ms. Richards is animated by the progress she sees individuals make every day. She’s deeply proud of Ms. Miller.

“I’m seeing more hope than I’m seeing hopelessness,” Ms. Richards says.