Under Oregon law, public intoxication isn't a crime, but police are obligated to take severely intoxicated people who could endanger themselves to a safe place — home, a treatment center or a hospital. Portland, Salem, Eugene and Medford have sobering centers designed to be that safe place.
"They're pretty expensive for smaller communities," said Jim Bradshaw, regional coordinator for the state Department of Human Services' office of mental health and addictions.
Detoxification and rehabilitation centers for people seeking treatment are more prevalent, and are regulated by the state, he said.
"Our office has no rules for sobering stations," Bradshaw said. "It's just a place for people to be safe off the streets."
Downtown Portland's Hooper Center, Bridgeway in Salem and the Buckley Center in Eugene all have medically supervised detox centers, which provide five- to seven-day stays to get people through withdrawal before entering a rehab program, in the same building as their sobering centers.
"We intervene in a physical emergency at the sobering center," said Richard Harris, executive director of Central City Concern, the consortium that operates the Hooper Center as well as other programs dealing with homelessness in Portland. "It's pretty hard to do an addiction intervention if they are dead. We have to keep them safe so they can make the choice."
Hooper admitted 9,000 people last year and the Buckley Center admits between 5,000 and 6,000 people annually. The Moore Center in Medford admitted about 2,300 people last year. The majority of people in sobering centers are brought by police, although Hooper and Buckley both have outreach teams that work the streets. Bridgeway only takes people who voluntarily agree to enter the sobering center, even if police bring them to the door, so it admits only eight to 10 people a month, said Ken Rush, program manager with Cascadia Behavioral Health Care, the Portland-based company that operates the Salem center.
Bridgeway's sobering station is a single room that can hold up to three people. Hooper has a group room for women, two group rooms for men and four isolation rooms; it can accommodate up to 40 people at once, Harris said. The Buckley Center has a group room that can lodge up to 20 people and two isolation rooms. The Moore Center has a group room for up to five people and three isolation rooms.
Medford is the only sobering station of the four that uses a Breathalyzer test to determine who should be admitted.
Harris said Hooper only uses a breath test if obviously drunk people deny drinking. "It's not appropriate to make medical decisions," he said. "It can be misleading because it doesn't measure all the intoxicants people might have used."
The other centers reported that they rely on technicians to evaluate people's physical symptoms of intoxication.
A trained technician can determine how intoxicated someone is and on what substance by examining a person's breathing rate, pupil dilation and reaction time, said Liz Gaffney, detox coordinator at the Buckley Center in Eugene.
When someone is admitted to Buckley, technicians also ask them about recent drug and alcohol use and their medical history and take vital statistics, including blood pressure, pulse and blood sugar in diabetics.
At the Moore Center, technicians take blood pressure and pulse readings, along with the blood-alcohol breath test, and collect a brief medical history. They can consult an on-call county medical officer or send people to the emergency room for medical clearance if they have concerns, said ARC Executive Director Christine Mason.
Bridgeway technicians use a checklist to collect a medical history and evaluate possible risk, said Teresa Fudge, a nurse who works at the center full time. They also take vital signs and won't accept anyone who has been recently hospitalized, has a seizure disorder, a heart condition or history of vomiting blood, she said.
Technicians at Hooper aren't medically trained, but they provide a cursory physical exam, taking vitals, checking for injury, looking for needle tracks or other signs of drug use and search possessions for drugs and paraphernalia, Harris said. They also complete a survey asking about medical history and recent drug and alcohol use.
An emergency medical technician serves as supervisor on every shift and can be called in to make medical decisions, Harris said.
Based on the initial assessment, each person is assigned a monitoring protocol, he said. A person with added health risks or if techs can't determine what drugs were used might be monitored every five to 10 minutes, while most people are checked every half hour.
At Buckley, people in isolation rooms must be checked every five minutes, while those in the large room are checked every 15 minutes, Gaffney said.
Technicians do hourly checks at Bridgeway, while Medford's Moore Center requires half-hour checks.
At all centers, the check can be as simple as looking through a window to see if a person has moved and listening for breathing.
The Buckley Center holds people for a minimum of four hours, or until they can pass field sobriety tests. Most are released in six to eight hours, Gaffney said.
Bridgeway keeps most people six to eight hours and can't hold them longer than eight hours.
"That would be against our standing order from our medical director," Fudge said. "We don't want them to go into withdrawal where they would have a risk of DTs (delirium tremens), seizures or death."
Hooper also usually sends people on their way "as soon as they are able to manage their affairs" to reduce the chance they will enter medically risky withdrawal stages at the center, Harris said. For many, their first order of business upon release is finding their next drink, self-medicating to stave off withdrawal.
The center sometimes keeps people longer, up to 12 hours overnight, in winter when they have nowhere else to go and would be at risk in the elements, he said.
The Moore Center holds people for a minimum of eight hours and can hold them up to 18 hours. It won't release people until they have a blood-alcohol level of .05 or less.
Both Hooper and Buckley centers report deaths in their sobering units. Gaffney said the most recent at Buckley was more than three years ago. Hooper has had four deaths in its sobering center since opening in 1982.
"This is a tough business to be in," Harris said. "These are people at risk. You try to guard against unnecessary risk, but this stuff happens — an undisclosed drug overdose, a heart attack."
