The Confederated Tribes of Grand Ronde celebrated the imminent opening of its second opioid treatment facility Monday, this one in the tribe’s homelands in Portland.
In April 2021, the tribe opened its Salem location of Great Circle Recovery, the first tribally run opioid treatment clinic in Oregon. There, a team of nurses treats people who come to the clinic every day for a dose of medication that helps them quit or reduce their use of illicit drugs.
The current roster at Great Circle Recovery in Salem includes approximately 250 people who visit the clinic on a daily basis to access one of two medications: suboxone or methadone.
That’s not all they get. Operations Director Jennifer Worth says the tribe is committed to providing what it calls “whole person” care. That means patients have access to counselors, case management and a variety of medical services.
Unintentional opioid overdose deaths in Oregon nearly tripled in 2021 over 2019 numbers, according to a state assessment, from 280 in 2019 to 745 in 2021. Complete data from 2022 is not yet available.
Native Americans are the group at highest risk of dying of an accidental overdose, according to the report.
The tribe hopes its new Portland clinic, on S.E. 82nd Avenue and Powell Boulevard, will treat twice as many patients as the Salem clinic does.
Kelly Rowe, executive director of health services for Grand Ronde and an enrolled member of the tribe, said the tribe sees the clinic as an opportunity to serve both its own members and the larger Portland community.
“These are our ceded lands, so we have a lot of tribal members here that we will be able to help,” Rowe said.
Both clinics are open to everyone: Grand Ronde tribal citizens and members of other tribal nations, as well as non-tribal community members. Out of the 250 people who visit the Salem clinic each day, only 12 are Grand Ronde members.
For new patients at the Salem clinic, the first stop is at the urine analysis lab, to determine whether the patient is using stimulants, opioids or other substances.
“A lot of what we see is polysubstance abuse,” Worth, the operations director, said. “Opioids plus methamphetamines or cocaine. I see a lot of cocaine.”
A nurse and a counselor talk with the patient about medication-assisted treatment. If the person decides to take that route, they will visit the clinic at least six days each week, to see staff and pick up their medication.
“We call it an ‘induction,’” Worth said.
The clinic dispenses methadone and suboxone. It doesn’t provide prescriptions, so patients must come in every day so the clinic can monitor them. Nurses make sure the dosage is working and adjust until the client reaches a stable maintenance dose. That’s the amount that lets people avoid symptoms of withdrawal.
“You don’t want to give somebody a prescription for suboxone that’s not ready for it,” Worth said. “Somebody who might sell it or divert it.”
Although the clinic has seen over 500 patients since it opened, the current number of people accessing services is just half that. One reason for the difference is that few agree to treatment, Worth said.
“For every 10 intakes you do, you hook maybe two people,” Worth said.
Another reason is the prevalence of the synthetic opioid fentanyl.
“It’s so powerful, the medicine you can give them doesn’t help them feel better,” Nurse Supervisor Laurie Pierson said. “The number of milligrams we can give them on day one doesn’t even touch fentanyl.”
In addition to opening the first tribally run opioid treatment facility in Oregon, Grand Ronde also launched the first tribally run mobile clinic. Started in July 2022, the mobile clinic operates out of a repurposed mammogram van.
With the van, the team can reach people who don’t have transportation to get to the clinic.
“Those are people that normally couldn’t get treatment,” Worth said. “Now they can.”
On Wednesdays, a doctor rides along to do full intakes.
“Even if they’re using, we still need to see them because it takes people some time to stop,” Worth said.
‘Together is the only way I think we’re going to succeed’
For Tribal Chairwoman Cheryle A. Kennedy, Grand Ronde’s connection to this land is part of what motivates her to share resources like the services offered at Great Circle with people beyond her tribe. Kennedy said generosity is a cultural value that is interwoven with some of the tribe’s most difficult time periods, like the first decade living on the reservation, and the years that followed termination.
“This is our homelands,” Kennedy said. “You look at the place names that are here, you probably never knew they were from our tribe. The Multhomahs, the Clackamas, the Mollalas, all from this area. That’s where they come from, my people.”
“In this place, we know something that affects all people,” she added. “And that is substance use disorder. And there’s no boundaries in addiction. It’s everyone who is struggling.”
Kennedy said the tribe’s deeply held value of generosity was on display in the 1860s, when white men living on the Grand Ronde Reservation would leave their wives and children in Oregon and travel across the country to go fight in the U.S. Civil War.
“Our people took care of those women and children,” Kennedy said. “We made sure they had deer meat, fish, roots, all of that. We made sure they had wood cut.”
And it’s a value that was strengthened over the decades when the U.S. government terminated Grand Ronde’s formal status as a federally recognized tribe.
“Our people signed a treaty on Jan. 22, 1855 with the United States of America,” Kennedy said. “We were told through the treaties that there would be certain exchanges for our land. Number one was that we could have a place that we could live peaceably, without being harmed, that we would be provided for health forever, that we would be provided education forever, that we would be provided a place where we could be self-sufficient. Those are all languages that are in our treaties. Are they upheld today? No.”
But at least the tribe had its reservation. That changed in 1954, when Congress passed the Western Oregon Indian Termination Act.
“Termination means that the government took whatever responsibility that they entered into — all those agreements — and said: ‘No. All of that’s stopping. As a matter of fact, you’re no longer Indian, and your reservation land at Grand Ronde? We’re taking all of that,’” Kennedy said.
“Everything was gone,” she said.
Kennedy served on tribal council before the federal government restored Grand Ronde’s status as a federally recognized tribe in 1983. She worked to get the tribe’s status restored and was also elected to the first tribal council after restoration.
“The thinking was always recognizing that when the land was fully taken, there was no place for us to be,” Kennedy said. “So many people scattered. Many went to other tribes and other reservations. We have members all over the United States and in other countries.
“We thought, we have to recognize that our people are all over and there have been a lot of intermarriages with other tribes, other peoples,” she continued. “So how do we address that?”
Kennedy was the health director during the years that followed the tribe’s restoration.
“We wanted to open up a service that will serve our whole community,” Kennedy said. “That was always our thought.”
In the 1980s, Grand Ronde installed its first health clinic inside a decommissioned train depot. Exam rooms were partitioned using hanging bed sheets.
“I thought, well, it’s humble but we’ll get there,” Kennedy said.
Soon, the tribe was able to upgrade by moving into a modular building.
And today, Kennedy says, the tribe runs a “full-blown facility,” complete with a pharmacy, a radiology lab, skilled nursing, physical therapy, dental services, mental health and more. The building is shaped like a traditional cedar hat and adorned inside with clay imprints of the hands of Grand Ronde children.
“We call it one-stop shopping,” Kennedy said.
That clinic is at the Grand Ronde Community, an 11,500-acre reservation in Yamhill County. It’s separate from the tribe’s Great Circle Recovery location in downtown Salem. But the clinic’s mobile van meets patients at spots in the community, including in the parking lot of the health clinic at Grand Ronde.
Mike Marshall, executive director of Oregon Recovers, said both the “whole person” model Great Circle uses and the mobile van approach are unusual and sorely needed.
“That level of engagement has been severely lacking,” Marshall said.
An analysis by OHSU and the state of Oregon in January found that Oregon needs to double its number of clinics like Great Circle, often called medically assisted treatment or MAT clinics. And that analysis didn’t include the number of MAT clinics needed that provide culturally specific services, like Great Circle does.
“That’s where this is so extraordinary,” Marshall said.
Tony Vezina, executive director of the peer-based recovery support system 4D Recovery and a member of the Alcohol and Drug Policy Commission, the state commission in charge of developing a strategic plan to address addiction, said Central City Concern is the only other place he knows of that provides such broad care in the context of an opioid treatment facility.
“This is a new, emerging model, where people really get some of their medical needs met,” Vezina said. “So I know it's going to be really useful to people.”
Addressing a major need
To open its Portland clinic, Grand Ronde worked with the city, as well as Multnomah County and the regional government agency Metro to address zoning restrictions. Then-County Chair Deborah Kafoury secured a waiver to allow the tribe to move forward even though the clinic site is located just under 1,000 feet of a preschool.
And in 2019, the same year the tribe identified the location for its Portland clinic, Multnomah County lobbied the state legislature to pass SB910. The bill expanded the availability of naloxone, made it easier to site methadone clinics and expedited drug treatment for people on parole and probation.
“The county was concerned that there was not enough places for people to seek treatment and this was one way to make it more accessible,” said Anna Allen, tribal affairs advisor for Multnomah County.
Great Circle Recovery in Portland is scheduled to open in mid-February. The tribe would like to eventually launch a van service there similar to the one it operates in Salem.
Both clinics are open to new patients Monday through Friday, from 6 a.m. until 3:30 p.m. The Salem clinic is at 1011 Commercial St. NE, and the Portland clinic is located at 3580 SE 82nd Ave. Walk-ins are welcome.
“People can still be using and come see us,” said Worth, the Great Circle operations director. “We will help them regardless. Even if they’re not ready to heal and they just don’t want to die, we’re here to help them have another day.”
Lead photo: Cheryle A. Kennedy, chairwoman of the Confederated Tribes of Grand Ronde, Kelly Rowe, executive director of Health Services for the Confederated Tribes of Grand Ronde and an enrolled member of the tribe and Multnomah County Commissioner Diane Rosenbaum participate in the ribbon cutting ceremony at the tribe’s celebration for the imminent opening of its Portland opioid treatment facility. Karina Brown / Underscore News