Did you know domestic violence is the leading cause of homelessness for women? Rose Haven is a trauma-informed day shelter for women, children, and marginalized genders. Its new space opened on March 8, 2022, after nearly two years of operating from tents in the COVID era.
PDX Local interviews Liz Starke, Development Director for Rosehaven.org.
As a day shelter, what services do you offer?
Rose Haven is a safe place designed with a trauma informed lens where you can go during the hours when many overnight shelters are closed. We offer a secure mailing address, access to meals, showers, restrooms, clothing, first aid, financial assistance and one-on-one advocacy for our guests. Most importantly, we offer community and dignity to a population facing extreme stigma and isolation. Currently, Oregon has the second highest rate of literally unsheltered people in the country- that is our neighbors living outside, in cars or in tents. All of the night shelters are full with wait lists, so we play an important role by bridging the gaps in services and offering help to all those folks not lucky enough to get a shelter bed. For example, if we had 40 beds that would mean we could help 40 people, in our model we are able to serve thousands of women and children a year.
What is the story of Rose Haven? How did it get started?
Rose Haven has been an important resource for women and children experiencing trauma in Portland for 25 years. We were founded in 1997 as a program of Catholic Charities after our founding director, Sr. Cathie Boerboom conducted a survey where she walked the streets of Portland and asked women what they needed. The overwhelming response was a safe place to go during the day, where they could take their children and access resources. Twenty-five years later we are still offering programs based off of our guests’ self-defined needs; offering a low-barrier and accessible community resource center where women can meet physical and emotional needs, access social services and find community. Although not a religious organization, Rose Haven operates under the Good Shepherd value system which embodies “Compassion”, “Individual Worth”, “Reconciliation” and “Zeal”.
What special challenges do women and children face when they are homeless?
For women, it is especially dangerous to live outside and constantly be exposed. Women are sometimes referred to as “the hidden homeless”, because they go to great lengths to stay out of sight and not look vulnerable in order to stay safe. Domestic violence is the leading cause of homelessness for women, and unfortunately once they are outside they are even more likely to experience violence. This is why a sanctuary specifically for people marginalized by their gender is so important, because otherwise these women have to face their predators just to receive help in a co-ed space.
How have your mission and service offerings changed in the era of COVID?
COVID made our jobs really hard, but ultimately forced us to move into our dream home. Prior to the pandemic, we were functioning out of a very cozy ( some might call it cramped) church basement…where we were serving about 3,700 people a year- about 100 people a day! Needless to say we couldn’t socially distance in that space – so we had to make the really hard choice to push supply distribution to the sidewalk in order to keep our guests safe. For nearly two years we served up meals and clothing on the sidewalk, even doing first aid under a tent. Our guests only came inside to use the restroom, take a shower or meet one on one with a social worker – and for many this was their only opportunity to come indoors at all, as many agencies closed entirely during the lockdown. We knew Rose Haven was needed now more than ever before, and we had to expand. We launched a grassroots fundraising campaign and with the support of the community we opened our new home for the haven on March 8th 2022. We now have a beautiful 10k square ft facility that was designed with a trauma informed lens so our guests can feel at ease and heal when they are here. The visibility of our new location has brought attention to the issues our guests are facing and given them a home they can feel proud of.
What is the number one thing that people in Portland can do to make life better for our neighbors without homes?
Be compassionate. The most dangerous thing our guests face is stigma and isolation. They tell me they feel invisible and on display at the same time. It is so much easier to walk right past a person that is starving in front of you if you think of them as “other” than yourself. For example when you think of someone who is going through a hard time as a homeless person, rather than your neighbor that does something on a subconscious level to separate you from them. Unfortunately as more people are displaced, more of us know someone in our personal circle who has fallen on hard times, but we are not defined by our worst moments. I think the more we can do to bust myths (such as the magnet myth- which is the idea that people move out here to become homeless, when the truth is more than 80% of chronically homeless folks in Multnomah county went to high school here) and humanize our houseless neighbors, the better off we will all be. Just be kind to each other, and don’t be afraid of people if they are sick or hungry. Sometimes a smile can really change someone’s day, especially for someone who is used to being ignored or having people cross the street to avoid them.
True change often starts with one person willing to take a stand for what they believe in. When individual passion aligns with a commitment to bettering the world around them, the ripple effects can inspire others to take notice and join the effort. Within communities, this spark of action is often the first step toward creating spaces where collective voices can grow stronger. Harnessing personal values to champion meaningful causes not only deepens your connection to those around you but also reinforces a shared vision of progress and possibility.
Make a Difference Through Volunteering
Volunteering offers a direct and impactful way to engage with causes that matter most to you while strengthening the fabric of your community. Giving your time and skills creates opportunities to connect with others who share your values and foster positive change in meaningful ways. Whether working on a community project, supporting local organizations, or lending a hand to neighbors, volunteering transforms good intentions into real-world results. The experience often leads to personal growth and a deeper understanding of the challenges and triumphs faced by others.
Volunteering through a faith community is one of the most impactful ways to create meaningful change while fostering lasting connections. Many individuals choose this avenue because it often provides a stronger sense of community support and deeper relationships compared to one-time events like park cleanups or serving at a soup kitchen. Faith communities, especially in diverse and dynamic cities like Portland, offer a wide range of opportunities to serve—many of which extend beyond traditional notions of religious involvement. From organizing food drives to mentoring youth or providing resources for unhoused neighbors, faith-based volunteering allows you to work alongside others who share a commitment to improving lives. These ongoing efforts not only address immediate needs but also build a foundation of trust and collaboration that strengthens the entire community.
Be an Active Participant
Engaging in community meetings and public forums is a vital way to stay informed and make a meaningful impact on issues you care about. These gatherings, often hosted in accessible venues like libraries or schools, offer a platform for diverse voices to address pressing community matters, such as health challenges or local development projects. By attending these forums, you not only gain insights into the community’s strengths and potential challenges but also have the chance to influence decision-making processes. Skilled facilitators guide discussions to ensure they are productive and inclusive. Check out Portland’s upcoming City Council meetings so you can get involved.
Engage with Local Officials
Building relationships with local officials provides a valuable opportunity to advocate for meaningful changes in your community. Sharing your perspectives directly with decision-makers ensures that the needs and concerns of those around you are heard and considered. Open communication fosters collaboration, creating space for actionable solutions that address pressing challenges. Attending meetings, participating in discussions, or writing thoughtful messages can help highlight issues that might otherwise go unnoticed. These interactions encourage accountability and strengthen the connection between leadership and the people they serve. In addition to attending City Council meetings, you can use this form to reach out to the local official most closely connected to the cause that’s important to you.
Become a Nurse
Pursuing a career in nursing offers a meaningful way to create lasting change by addressing the health and wellness needs of your community. Nurses play a vital role in promoting compassionate care, educating patients, and advocating for better access to healthcare resources. With the flexibility of online nursing programs, earning your degree becomes more accessible, allowing you to balance your studies with other responsibilities. For those already in the profession, advancing your education through RN to BSN programs provides an opportunity to deepen your expertise and elevate patient outcomes. This commitment to growth not only enhances your career but also strengthens the quality of care delivered to those who need it most.
Raise Money Through Crowdfunding
Crowdfunding platforms offer a dynamic way to rally support for nonprofits and local causes that hold personal significance. These tools provide a space where compelling stories and heartfelt missions can reach a wide audience, turning awareness into tangible contributions. By leveraging these platforms, you can connect with like-minded supporters eager to make a difference through shared goals. Every donation, no matter the size, adds to the collective effort, demonstrating the power of community-driven fundraising. For example, there are lots of different individuals, groups, and formal organizations looking to get projects started in Portland on Kickstarter. Whether you want to donate to local artists trying to get their art seen in the community, pitch in for a local community center, or help a local startup launch, you can make a direct impact with your dollars (no matter how much you choose to spend).
Create Online Petitions to Promote Change
Creating an impactful online petition is a powerful way to mobilize support and advocate for change in your community. By crafting a clear and engaging message, you can connect with a broad audience and inspire them to become active participants in your cause. Use personal stories and testimonials to make your petition relatable and urgent, transforming passive observers into passionate advocates. Promoting your petition on social media platforms can expand your reach.
Encourage Youth Activism
Engaging in youth activism by joining or starting a club that aligns with your passions is another great way to make an impact. Collaborating with peers who share your interests allows you to tackle critical issues like race and gender equality, fostering meaningful discussions among students and faculty. A supportive teacher can be crucial in bridging generational gaps and navigating school bureaucracy, ensuring your club’s success. By organizing creative activities, such as events or inviting speakers, you can draw broader participation and raise awareness about important topics. These clubs not only serve as platforms for advocacy but also foster a sense of unity and empowerment among young activists.
Engaging with your community through purposeful actions can lead to profound transformations. By channeling your skills and passions into initiatives that matter, you not only contribute to the well-being of others but also inspire a collective movement toward positive change. Your efforts can ignite a chain reaction, encouraging others to join in and amplify the impact, creating a more vibrant and resilient community.
Portland ranks among the Top 10 Most Surveilled U.S. Cities, according to Cybernews. Atlanta tops the list.
We live in a world where surveillance is a fact of life. Any encrypted software product may be backdoored, and even if it is not, you have no guarantee that the person on the other end does not have spyware such as keystroke monitoring or screen video capture running on their system. Encryption enthusiasts and amateur hackers, no matter how valiant, simply cannot compete with a nation-state in this game. Cf Pegasus.
Sneak and Peek, or “No Knock,” Warrants have been around since the Patriot Act was passed in 2001, but they receive scant attention from the media. What they mean is that you may have your home searched, and items removed from your home, without any official notice from law enforcement. Ditto for electronic files. If you file a FOIA request and the investigation in which you are named is still ongoing, you will not receive any confirmation that a warrant exists. (Pat Eddington, Cato Institute)
The most frightening aspect of these warrants is the potential for planting false evidence. The second most frightening aspect is the potential for planting surveillance devices for tracking and listening — as if cell phones were not effective enough.
“Nothing to Hide?”
Like roughly 2/3 of the U.S. population, I reside within the 100-mile “border zone” where Border Patrol agents are granted additional authorities and the Constitutional protections of the Fourth Amendment no longer apply. You may think all of this is irrelevant if you are a law-abiding citizen.
The problem is that who you know can get you put on a list.It can also make you a target. To put it another way, we all know somebody who has a cousin who is a drug dealer.
Laws in this country are changing, and not (in my opinion) for the better. Roe v. Wade is gone, and civil rights for gays and lesbians may soon disappear as this country takes a hard shift right. Remember ICE? Children in cages? Forced sterilizations?
Come 2024, they may all be back.
If you don’t feel like being a freedom fighter, if your first priority is keeping your family safe and saving for your children’s college tuition, I am not here to judge. Just remember that in a world where power rules in place of law, abuse of that power is an inevitable consequence.
Get in a traffic accident with somebody employed by the surveillance state? What if one of them rapes your daughter? Or your son? When a large class of individuals are above the law, nothing good will come of it. This is especially true when the same individuals fear consequences from their actions. They tend to lash out and do everything they can to harm and intimidate witnesses and injured parties.
I am not an America-hater. Far from it. The country I grew up in gave me 40+ years of freedom in its purest form: freedom to explore, to create, to love and befriend amazing people, to work as much or as little as I liked. Freedom to just be. I am a GenXer. I don’t mean to talk like a crusty old-timer, but I believe I’ve seen this nation at its absolute best.
Or maybe the best is yet to come.
Nothing is fixed. Nothing is certain.
The combined 2022 budget of Homeland Security, the Department of Justice, and the 17 different United States spying agencies (of which CIA and NSA are only two) is over $150 billion.For comparison, that is roughly one fifth of the Department of Defense 2022 budget of $742B. But remember, the DOD budget covers submarines, fighter jets, aircraft carriers, helicopters, tanks, nuclear weapons, and anti-missile defense systems, not to mention an active network of bases around the world. That’s a lot of people and hardware.
What exactly are we paying for? This remains largely unclear. Marijuana is now legal in 19 out of 50 states, but the DEA’s funding continues to grow. If you were an officer monitoring wiretaps and running undercover operations in Colorado or Washington State, where and to what were you reassigned? And as far as truly terrifying threats to health and safety, the surveillance state could be doing a much better job. We read about mass shootings in the news practically every week. It failed to prevent the violent attempted coup at our nation’s capitol on January 6, 2021.
Your tax dollars at work, my friends.
Government salaries range from $20K (GS-1) to $147K(GS-15) — much less than the equivalent in the private sector. If we assume that wages (including benefits) average $100,000 per year, we would expect that the surveillance states employs as many as 1.5 million people in the United States. Keep in mind, that is not accounting for slush funds to be distributed overseas, James Bond style gadgetry, server space, or the cost of buildings and operations.But if we slash that number in half, that is still one federal domestic spy for every 440 U.S. citizens.
And that’s a lot.
Regarding terminology, “federal domestic spy” includes FBI informers, often recruited under duress or experiencing economic hardship. It does not include state or local police forces.
I am an extremely law-abiding citizen. That has protected me to some extent, but not completely. Somebody who has cheated on their taxes or who runs a warez server with their friends is at high risk of being “turned” and pressured by law enforcement to inform on others and further widen the surveillance network.
2023 is a work of fiction, set in Portland. All characters are composites. Any resemblance to real persons is purely coincidental. This first chapter was originally published on pdxlocal.net on July 19, 2020.
Michelle decides to organize a resistance after her girlfriend Lauren is taken in the middle of the night by a sinister government organization known as the Sentinels. They both live in Portland.
Michelle is short with spiky hair, bleached blond at the tips. She has a quick temper and wishes people would take her more seriously. Her girlfriend is a few years older. Lauren is medium height, with shoulder-length light brown hair. She is the grown-up of the couple — has the car and the office job. The lease is in her name.
Lauren works for a nonprofit, and Michelle works for a Starbucks in a supermarket. Lauren’s only “crime” was going to one Antifa meeting and participating in a bunch of marches, including Queer Pride. Michelle feels mega guilt because she hid when the secret police came to their apartment, so she decides to organize a resistance to free her girlfriend.
The one other hacker Michelle knows in Portland won’t help her, so she writes her own game mod (for a first-person shooter, very primal and raw) as a recruiting tool. She attracts a fair number of followers, many of them ex-military. The kind of people who play paintball on the weekends. They decide to plan a raid.
They are successful at breaking into one of the three detention facilities at a camp outside Spokane and freeing prisoners, but it turns out not to be the one where Lauren is held. Michelle is even more guilt-ridden because the experienced soldiers would not let her lead the raid. They told her she was too green and also too valuable. She watches the action play out from a hilltop, with two guards for protection.
People died because of her. She has a movement on her hands and the Sentinels are on to her…
2023
Part One: “Taken”
I had insomnia that night. Got out of bed, left Lauren sleeping. Raided the fridge. Pistachios, gummy bears, and queso. Hit the boards, played the new Star Wars game past the point of idiocy, and was counting the hours until my shift began when I heard a knock at the door.
No doorbell. Just loud, insistent knocking.
I checked my phone. It was 3:53 AM, exactly. That’s not a good time for anybody to be knocking at your door. Not that fall. I’d heard the rumors. I’d heard the stories.
I was going to run back to the bedroom and warn Lauren. I swear I was. But I just froze.
Then she came down the stairs, an angel in a blue bathrobe, and answered the door. WTF? Why would she do that?
And I am so ashamed of myself, but this is what I did. I hid.
Not any place fancy. We didn’t have any secret bunker. No safe rooms or go boxes. It was a $1200 / month Victorian walk-up off Alberta. I hid in the coat closet. Shut the door behind me so fast. Would they hear the sound? There I was, trying to breathe through Polartec and GoreTex, while they took my baby away.
I couldn’t see at all. Even the words were muffled.
They asked her name. They asked her for identification. I remember her saying:
“Why are you taking my picture?” “Why won’t you read me my rights?” “Am I under arrest?”
They never identified themselves. Never said what agency or branch of government they were with. They wouldn’t answer her questions directly. They never asked about me. Queer invisibility is worth something, I guess.
They just said, “Come with us, ma’am. And there won’t be any trouble.”
They called her ma’am! Lauren is 27. She went quietly, I guess. I didn’t hear much of a struggle.
The last words I heard her say were, “I want to speak with my lawyer.”
A muffled shout. Feet shuffled out, and then the front door slammed.
I was shaking. My heart was racing. I could barely breathe I was so scared. I was crying and I think I thew up a little bit in my mouth but I was trying my best not to make any sound. I had my phone with me the whole time but I was too scared to use it. I mean, what if they could track that? I stayed inside that closet until I could see gray daylight filtering through the crack at the top of the closet door.
The apartment was empty. Lauren’s unmade bed. Her work clothes set out neatly for the next day. Jeans, black velvet top, brown ankle boots. Her lunch in the refrigerator. Her car in the driveway.
I felt so guilty, and so sad.
I wished I’d had a gun. I would have used it. Wouldn’t have made any difference in the long run, but we could have made it to the getaway car, gone out like Thelma and Louise, in a blaze of glory.
I wished I’d just fucking gotten myself together and run up those stairs to warn her in time. Maybe we both could have hid. Maybe it would have been better if they’d taken us both.
I didn’t want to go home. Fuck, maybe they were waiting for me too.
Shit.
I had to tell her family.
Her mom. Her brothers.
But the only way I knew to reach them was Facebook. And that was a no-no. Just trust me on that one!
Did she have an address book hidden away somewhere? We’d only been going out seven months. Would I know if she had a written record of her contacts, apart from her phone? I started to look, rifle through drawers and bookshelves like the Sentinels hadn’t even bothered to, but then I realized it was all just fucking pointless.
They were coming for all of us, or they weren’t.
They had the power. They had the data. They had the money and the numbers. This wasn’t one of my games. There was no Rebel Alliance. I was on my own. Dragging anybody else in was too dangerous.
So I did what I had to do. I locked up, grabbed my bike from outside, and went to work.
Made it there on-time, with seconds to spare. I don’t know what it says about me that no one much noticed that anything was wrong. It’s true I was insomniac and/or hung over and/or stoned a good 70% of the time. How much effort does it really take to press a button that says “Espresso”? I never tried to make the little hearts with cappuccino foam. Mine always came out wobbly and asymmetrical.
And it’s so funny, nobody at work even noticed anything was wrong.
There was no, “Michelle, are you ok?” “Michelle, you look kind of out of sorts?” “Michelle, are you feeling all right?”
We all just went along our way. Happy robots as usual.
I could only think of one person to call.
I had to think really hard about this. I didn’t want to get anyone else involved. I had an inkling of where this was going. And the outlook didn’t look good for anyone.
Plus Michael’s girlfriend was always really, really jealous! Even though I was a dyke, with really short and spiky hair, and like 10 years younger than both of them. She hated my guts.
#cisgirls #whatever #workonyourownissues Except they never do that. They just pop out kids and pass on their insecurities to the next generation. I watch that slow-motion train wreck every day of my life.
So I pulled up Signal on my phone when no one was looking.
> What are you doing after work today?
We made plans to meet at the Bye & Bye, at 5 PM. At least Happy Hour wasn’t illegal yet.
No cocktails for me that night. Kind of wanted a beer to steady my nerves, but then I was like, what if the Sentinels came at that very moment and I had to snake my bike through traffic in the wrong direction (no helmet) and onto side streets to lose them? No way was I taking that chance.
We sat down. Michael got some bowl with rice and avocadoes. I had french fries. Lauren’s last lunch (untouched) had been dolmeh, hummus, and carrot sticks. In honor of her, I was thinking of turning vegan.
“They took her,” I told him.
“What?”
“The Sentinels took Lauren, in the middle of the night.”
“No fucking way!!! You’re shitting me.” Michael was incredulous.
“I wish I was. I was hiding in the coat closet. I didn’t see it, but I heard the whole thing.”
Michael lowered his voice. “Was Lauren into anything, you know, radical?”
I laughed and shook my head. “She went to an Antifa meeting once. And she marched in, I guess, six or seven protests. Climate change. Women’s equality. And of course, Pride.”
I gave him a long stare.
Michael backed up pretty quickly. “I didn’t mean to imply anything. It’s more just like…”
“You wanted to know, was she cooking up bombs in the pantry?”
“Pantry?”
“We–she–has–had a really nice pantry. And honestly, it would be really more my style to build a bomb. And think about what room of the house would be best for bomb making.”
“Uh huh?” Michael asked quietly.
“But I haven’t done that either! Puh…leaze. I don’t even visit your warez server.”
Michael broke in. “Michelle, this is serious. Are you sure this is the best place to talk about it?”
We’d all had the paranoia discussion, so many times online. In a sense we believed in it, but none of it seemed remotely real. All the ways *they* could be listening: the microphones on cell phones, video cameras on monitors, smart TV’s. I never “X’d” out the cameras on my monitor with tape. But that was because all I had in the way of hardware was a beat-up Sony Vaio laptop. And my phone. And the Xbox I bought Lauren. (That was a bowling ball named “Homer,” if ever there was one.)
“Can you think of a better place?” I replied.
“Fair enough.”
Michael sipped his beer, and paused before speaking again.
“So you think they were Sentinels?”
“I do. I didn’t see them, but it’s how they operate.”
“Michelle, how much do you know about the Sentinels?” he asked me.
“I know they were created after the quote-unquote Terrorist Dirty Bomb Attack of 2021. Created the very next day. And they aren’t answerable to anyone except the Oval Office.”
“Rump and Pants. Our President and Vice President.”
“Yes, them.”
“Their raids are nearly always in the middle of the night, and they target U.S. citizens suspected of quote-unquote terrorist activity,” Michael intoned, then stopped himself. “Am I mansplaining?”
“No, I’m interested. Keep talking.”
Michael continued. “What is interesting is that the Sentinels have no ties whatsoever to the criminal justice system. They do not charge individuals with a crime. They simple seize them and hold them.”
“America’s home-grown Gestapo,” I chimed in.
“I’m afraid you’re right. Nobody knows who they are. Nobody even knows what their budget is, or how many of them there are,” he said.
“What I want to know is where they took her,” I told him. “So I can break her out.”
“Michelle…”
“Don’t try to talk me out of this.”
“Ok, then. How are you going to do it?”
“I don’t know yet. But there’s got to be a way.”
“Michelle, these facilities are heavily guarded…”
“No system is uncrackable. How many discussions have we had about that?”
Michael looked flummoxed. “Sure, in theory. But do you know what the consequences would be if you got caught?”
“Do you know what the consequences were for Lauren? Who had done absolutely nothing?” I whispered in a hoarse stage whisper, since I couldn’t shout in the crowded bar. “Sooner or later they’re coming for all of us.”
Michael was shaking his head.
And this was where I lost my cool, I admit it. “Look Michael, I know you’ve got a good job. I know you’ve got a lot to lose. I know you’re a straight white male. But you’re not immune.”
Michael got really defensive, then. “Don’t play that victim card on me! You could get a job as a programmer too. You have the chops. I’ve seen your code. Just go back to school.”
“This isn’t about that, Michael. You are acting like we’re still living in 2019. We’re not. This is the new world. Nobody is safe.”
Michael’s face just froze up. He wouldn’t talk to me. At the Bye & Bye you pay at the counter, but I saw him glancing around as if maybe a waiter could rescue him.
“I’m sorry, Michelle. I don’t know what you’re looking for. But I can’t help you.”
I stared at him, incredulous.
“Look, Michelle. You should be more careful. Just try not to attract attention. You’ll be fine.”
“But. What. About. Lauren?”
Michael was talking faster now. I could tell he was nervous. “And you know, really do think about a coding bootcamp. You’re a very bright young woman! I hear there are some where you don’t even have to pay anything up front. They just take 30% of your salary until the tuition is paid off.”
Now was my moment to get up and push my half-empty water glass and plate of cold fries away.
“Michael. Don’t give me advice.”
And then I made my daring getaway by bike. I was weaving in and out of traffic because I couldn’t see through the tears. The only person I had trusted to help had just let me down.
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I am concerned because while I was in Phoenix, AZ earlier this month I encountered a dangerous piece of malware allowing an outside entity to take control of a phone.
The thing that complicated matters was that my cell phone locked up on me. Nobody ever touched it — I hadn’t clicked on any links recently or installed any new apps. It just went dark, with a tiny bit of purple visible. Occasionally it would come back to life, but not reliably.
The source of this vulnerability is almost certainly Bluetooth. I recommend turning off Bluetooth on your phones as a precautionary measure.
Not everyone knows that the actual dosage of generic drugs may legally vary between 80 and 125% of the prescribed dosage, according to FDA regulations. In most cases, this is considered safe, but for certain classes of drugs, known as NTI’s, this variance falls outside of clinical guidelines. Be aware that abrupt discontinuation of medication carries serious risk. Always consult with a doctor before changing your medication.
In the World War II historical drama The Imitation Game, Alan Turing and his team manage to decode a radio transmission warning of an imminent Nazi attack to an ocean freighter. They are anguished, knowing that if the British Navy acts upon their warning, it will tip off the Nazis to the existence of this newly developed ENIGMA decoder machine, potentially resulting in far greater loss of life. The information they have gleaned is too dangerous to be used.
Public discussion of the issues with the safety of generic Lithium raises a similar paradox.
For many patients, there is no good alternative treatment available. Reports that the drug was unsafe would cause many patients to abruptly stop taking the drug, putting them at high risk of withdrawal symptoms. While the issues surrounding the safety of generic Lithium are well-known to clinicians and pharmacists, they may be hesitant to raise the alarm in the media because the consequences to patients from abrupt withdrawal may be even worse.
Yet over the border in Canada, a safe and effective prescription may be obtained for approximately $30 US per month. Closer to home, new laser measurement techniques make routine quality screening possible and affordable for every prescription filled–if there were only a market incentive to make this technology widely available.
All Lithium prescriptions in the United States have been generic since Eskalith (formerly manufactured by GlaxoSmithKline) was discontinued. The drug, still widely used to treat bipolar disorder, is on the World Health Organization’s list of essential medicines and is the 205th most commonly prescribed drug in the US. Over 2.6 million Lithium prescriptions were filled in the United States in 2019.
The problems with the generic drug supply in the US have been well documented in such books as Bottle of Lies: The Inside Story of the Generic Drug Boom, by Katherine Eban. This New York Times editorial does an excellent job of summarizing Eban’s main arguments.
However, the pitfalls of generic Lithium are even more severe, due to the drug’s narrow therapeutic range.
For a Narrow Therapeutic Index (NTI) drug like Lithium, the dosage required to be effective is very close to the amount that is toxic and potentially fatal. This poses a problem for the FDA’s current drug regime, known as bioequivalence, because the strength of generic medication in each dose is permitted to vary between 80% and 125% of the prescribed dosage.
This means that an individual who is prescribed a safe-but-high dose of Lithium (for instance, 1500 mg daily) might in fact, on any given refill, find themselves taking a daily dose of 1875 mg… a dose high enough to cause symptoms of Lithium toxicity and organ damage.
End “Lithium Roulette.”
Taking daily medication should never be a gamble. But that’s exactly what people experience when taking Lithium, one of the oldest and most trusted medications for treating mood disorders. Lithium is only available in generic form in the US, and FDA regulations allow the actual dosage of generics per pill to vary between 80 and 125% of the prescribed dosage. This “one-size-fits-all” approach, known as bioequivalence, ignores the fact that certain medications, such as Lithium, require precision dosage. Dosage fluctuations produce toxicity at the high end of the range, and trigger withdrawal symptoms and relapses at the low end. As far back as 2010, the FDA voted to tighten the allowable dosage standard for Lithium and other Narrow Therapeutic Index (NTI) drugs, but these recommendations were never enacted. It is time to hold healthcare providers and generic drug manufacturers accountable.
Abstract
This document describes an issue with drug safety which has played a role in more than 20,000 deaths in the United States since 2008. If not addressed, it will unquestionably result in many more deaths. Because these are deaths by suicide, they tear apart families and bring anguish to loved ones like nothing else
The vast majority of these deaths are preventable.
Improving the quality, safety, and dose consistency of generic Lithium is inexpensive and attainable with current technology.
Bureaucratic apathy and medical negligence are to blame for the current crisis.
Once prescribers, psychiatric associations, and generic drug manufacturers are held accountable, those affected may be able to receive compensation and rebuild their lives. Most important of all, an essential and lifesaving medication may again be made safely available in our country.
Witnesses
I am aware of three doctors, all MDs with years of experience in the practice of psychiatry, who may be contacted to provide testimony that generic Lithium is unsafe.
The FDA recommended stricter bioequivalence standards for Lithium as early as 2010.
Source:https://fda.gov “Quality and Bioequivalence Standards for Narrow Therapeutic Index Drugs,” p. 24. An archived PDF file for this presentation may be viewed and downloaded here.
Midway through the first term of the Obama administration, the FDA announced its intention to adopt stricter standards for generic Lithium and other drugs with similarly narrow therapeutic ranges. In 2010, an FDA committee voted 11-2 that the current bioequivalence standards were not sufficient for Narrow Therapeutic Index drugs [including Lithium] and it was suggested that the standards need to be stricter.
Sadly, we find no evidence or public record showing that these recommendations were ever enacted. Faced with little public awareness of the issue, lack of professional engagement and interest from doctors, their professional associations, and other potential “watchdogs,” it would appear that the FDA never followed through with their stated intention.
Here is a firsthand account of what this type of Lithium poisoning looks like:
“…two years ago, my nurse practitioner (psych) discontinued my Depakote and started me on Lithium due to unrelenting depression. I was okay for three days on the 300 mg twice a day, but when I increased it to 600 mg twice a day, according to her instructions, I became very ill, very suddenly.
I was so ill I didn’t recognize it myself and never attributed it to my change in medication. I was totally confused, couldn’t walk in a straight line, and was vomiting several times a day. I know now the green haze that I saw is due to Lithium toxicity but thought it odd at the time.
Needless to say, I had to go to the ER and they kept me in. I had Lithium poisoning and had five times the level in my blood. Nearly died. I was very sick indeed for two days in hospital, then released home with two new diagnoses: hypertension and kidney disease which are now being treated with medication, but not welcome diagnoses at all.”
– Sally Alter, on Quora.com
The author of the post does not realize it, but the symptoms she describes are entirely consistent with being prescribed generic Lithium at the high end of the current dosage range allowed by the FDA. It is especially telling that she was able to tolerate Lithium at an earlier period in her life and encountered no problems.
Prescribers who know of these risks and do not inform their patients, insist on the necessary blood tests, or advocate for stricter standards are in violation of their Hippocratic Oath.
Lithium toxicity, while the most dramatic byproduct of the current negligence in bioequivalence standards, is only the tip of the iceberg.
Bipolar disorder affects about 5.7 million adults in the United States, and the fatality rate is staggering–as high as 20 percent. Nearly 12,000 lives are lost to bipolar suicide each year. Lithium remains the first-line treatment for many individuals experiencing bipolar disorder. We see evidence of its declining effectiveness in the population at large. Success rates of 70 to 85% were once expected with lithium for the acute phase treatment of mania, however, lithium response rates of only 40 to 50% are now more common.
Using the most conservative assumptions possible, we should assume that over the past 14 years, generic Lithium was a factor in at least 20,000 of these deaths. This figure is derived from 12,000 bipolar suicide deaths per year x 12 years x reported Lithium usage rate of 14.3% = 20,592 deaths. For data on rates of Lithium usage for patients in the United States from 1996-2015, see https://pubmed.ncbi.nlm.nih.gov/32739706/
This estimate is low, since it does not include those people who discontinued generic Lithium after experiencing toxicity or relapse.
Why would generic Lithium be a culprit? Because variation in dose strength leads to relapse.
Relapses lead to acute mood swings: bouts of psychotic mania and extreme depression that may themselves lead to suicidal actions, or to the words and actions that destroy relationships, marriages, and careers. Even if the first relapse does not kill somebody, it may leave them dangerously isolated and vulnerable. The effect is to decrease an individual’s belief in the effectiveness of medication and increase stigma in the population at large.
“There is no cure for bipolar illness” is one of the most harmful and misleading statements ever coined. For many individuals, including myself, name-brand Lithium with precise dosage was effectively a cure. Now it can only be obtained by venturing outside the United States.
How often does this happen? Remember that Lithium is a maintenance drug. Even if a significant fluctuation in dosage happens with only one drug refill out of 10, if you are bipolar and taking generic Lithium, the odds are that this “yo yo effect” will happen to you at least once every year. If you have a relapse, you will likely wonder what you did wrong and blame yourself, never realizing the role played by drug manufacturers and clinicians who knowingly allowed an unsafe product to remain available to consumers.
Conclusion
If you are prescribed Lithium, you should expect to have your blood drawn several times each year in order to determine whether your Lithium blood level is in the therapeutic range, or whether the serum level is too low or too high. That is what is entailed when prescribing and monitoring a potentially toxic drug with a narrow therapeutic range. The experience is painful and inconvenient, but medically necessary. Dosage fluctuations have transformed this established medical procedure into an empty ritual.
This is not an issue of side effects or isolated incidents of poor quality control. This is an issue of systematic negligence which has rendered one of the most important and trusted treatments for a life threatening disease to lose its effectiveness, and in some cases be worse than no treatment at all. Because of the risks from abrupt Lithium withdrawal, those most directly impacted cannot even safely cease taking the medication. We are looking at a situation where a serious and well-known safety issue was ignored for over a dozen years. Care providers, drug manufacturers, and professional associations who should have been motivated to act on behalf of patient safety instead did next to nothing. Apathy and inaction led to death.
Many people have experienced Lithium toxicity and preventable manic or depressive episodes due to negligent bioequivalence standards, but the most tragic harm rests with the individuals who have lost their lives, and with their families. Potentially, the pool of people harmed includes anyone with a family member who took generic Lithium and then had one or more episodes before ultimately committing suicide. These stories number in the tens of thousands. Practices, prescribers, professional associations, and generic drug manufacturers all bear responsibility.
Stigma is a major factor that keeps successful, high-functioning bipolar people from organizing for better care, more research, and treatments that actually work! We remain closeted and are busy living our lives until the moment when illness strikes us down. Earlier in this document, I alluded to an anecdote from Alan Turing’s life. Readers may be aware that Turing died by suicide, driven largely by homophobia and repression from the British government. Unless you have actually lived through prejudice, it is very difficult to comprehend the experience of being hated and shunned for something you cannot control. This was certainly the hardest lesson for me to learn as a wellness coach. I had never before had to face hatred head-on.
This barrier of ableism may be the greatest challenge to restoring justice and safe standards for an irreplaceable medication. I believe it is surmountable. Lives are at stake.
If you or someone you know is in crisis or experiencing suicidal thoughts, please call 988 or contact one of the many Crisis Resources listed on our site.
This post first appeared on Medium on January 3, 2017. It has been edited from the original version.
Gender nonconforming while a Scorpio
by Rose C.
I went to a queer support group here in Portland and, for the first time ever, asked the people in the group to call me Jack.
And they did!
And I was blown away. It kind of made my night. I was inwardly beaming. Having trouble paying attention to others’ heart-rending stories, I was so inwardly thrilled to be recognized as Jack.
Me, a large-breasted girl with painted fingernails, longish hair, full lips, and a sweet, heart-shaped face. I was Jack! I had claimed some essence of my masculine self, and people had listened.
Not sure what to do about pronouns and the rest of it. Genderfluid and trans. “They/them” works nicely, for those that bother to ask. I’m not getting tied up in knots about this. I mean, I still carry a purse.
Where this goes next, I have no idea. But here is a bit of backstory.
Last Monday night I decided to try an experiment. There was this young dude (30, great body, worked out all the time) who had expressed an interest in me that was more than purely professional. About a month and a half ago we ended up making out past 2 AM in some downtown bar whose name I don’t even remember. We took an Uber to his place but stopped just short of having sex.
I wanted to think through my current relationship, long distance and already polyamorous in theory, and decide whether I really wanted to open it up to somebody new. I also figured I should get re-tested for STDs, just to be safe.
The answer I came to was emphatically, yes. So last week I sent Young Dude a text to see if he wanted to catch the Warhol exhibit in town. Four hours later, we ended up eating vegan mozzarella at a punk rock dive bar, then singing karaoke (my performance was unimaginably bad), then back to my place. The night was comically ill-timed (the smell of burning rubber alerted us that the tea lights were melting the blinds, even though not directly in contact) and a cold shower almost gave my date hypothermia.
The interesting part of the experience was that even though I knew I might be getting laid that night, I made no special effort to femme it up. Legs remained unshaven. I wore out the same bulky black hoodie that I wear everywhere. This was intentional (even though I did clean up the apartment some, with the thought that somebody might be coming back).
I decided, just that once, to act like a man — which is to say, just be me.
No special outfit, very little makeup.
This is me at 40, folks. I wanted to not apologize for it or cover it up. I wanted to see what would happen. No regrets.
Face it: my body will probably never look the same in lingerie as it did five years ago. I lost a lot of weight after my divorce — got to experience about seven years of having pretty much my ideal body. But then one day, metabolism and time catches up with you. You start to wonder, what exactly does the future hold in store for average looking women in their forties and fifties who don’t have kids?
I am viewing this unavoidable process of aging as an excuse to explore my more masculine side. Which is weird, because I really love my body. I can’t imagine having chest surgery. I could fantasize about a deeper voice, chest hair, all the other effects of “T”. (And yes, I’ve done the research about transitioning in midlife.)
I have no idea how other people experience gender. I just know that I almost never feel like a girl. Even when I did femme it up, it felt like a costume, or a video game avatar. A really fun and sexy costume, but something contrived and separate from the essence of who I was.
I know that I’m also a very nurturing and empathic person, and that those traits put me in the bucket of “feminine.”
But then… this is also me. Leader. Builder of things. Entrepreneur. Somebody who prefers to call shit like it is and isn’t afraid of conflict. Somebody with an unflagging code of loyalty to my peeps, even when they don’t return the same. Somebody whose idea of a perfect evening is just having two beers with a buddy. Really. That’s it.
Interests: comics, rock and roll music, computers, science fiction.
I think about why I have so many more guy friends than female friends, and it’s easy to just chalk it up to women being busy with children and partners, or women’s internalized jealousy and mistrust of other women.
But sometimes I wonder. Maybe something is clicking for me on a deeper level. I’ve never been a tomboy, never been super butch although I did shave my head in my early 20s. I’ve only ever been with two women in my life.
I feel dorky for embarking on this “voyage of self discovery” at the cusp of middle age. But I also feel like to try and fit a mold I outgrew sometime in the last few years might be literally dangerous to my health.
I had plenty of years to play the “cute girlfriend.” Am I now going to be the “less cute girlfriend?”
I guess for me the essence of masculinity is being perceived for my talent, strength, and ability rather than for how I look or my relationship to others. It has very little to do with having a penis or chest hair. And yet, projecting this self while outwardly feminine can be threatening to some.
I have thought about this shit for years, but never expressed it publicly before. I don’t know where it will lead. At this point in my life I am used to feeling like an outcast, even while deftly maneuvering professional and social situations and keeping casual acquaintances at arm’s length. Adapting a less traditional gender presentation might change that. It might make me, finally, a bit less closeted in my multifaceted “otherness.”
And honestly, that might be a change I am looking for.
Growing a garden can be a great way to spend more time outside, learn valuable new skills, and even reduce your family’s grocery budget. Furthermore, you can also help feed those in need in your community simply by growing fresh produce in your backyard.
Remember that whenever possible, it’s better to shop locally. Buying from small and local businesses helps support the entire community and promotes a sense of shared responsibility. Look for who is helping to get the word out in your area, like PDX Local in Portland OR.
Steps to Starting Your Garden
If you’ve never planted a garden before, you might be confused about where to begin. Whether or not you’re a green thumb, getting acquainted with the soil and the various types of produce has huge payoffs. But first consider these ideas as you set out on your gardening venture.
Building raised garden beds will help you protect your crops from tunneling pests.
To plant, tend, and harvest your vegetables, you’ll need some durable gardening tools.
Test your soil to see what level of acidity and nutrients you’re dealing with, then address high or low levels with appropriate treatment, such as adding nitrogen.
Once you have all of the tools and supplies you need, you’re ready to plant. Follow the helpful tips below on growing vegetables, herbs, trees and more!
Tend to your garden each day to ensure that your plants are healthy and promptly harvest fresh vegetables.
If you’re stumped on where to begin, consider hiring help from a local gardener or landscaper. You can survey backyard landscaping companies to help pave the way for your garden.
Preserving Your Delicious Harvest
It’s possible to plant and grow just enough in your garden for you and your family to consume, plus a little for friends, too. But if you end up with more fruits and vegetables than you know what to do with, these methods will allow you to preserve them so that they don’t spoil.
Canning your surplus vegetables is a great way to keep them fresh for months.
Incorporate your canned vegetables into one of these healthy recipes!
Stock your freezer with frozen fruits and vegetables for soups and other dishes.
Whip up homemade jam to make your breakfasts taste a little sweeter.
Serving People in Need
Food insecurity exists in every community. In addition to selling your produce at the local farmers market for a discount of what the grocery store charges, here’s how to ensure that your extra produce goes to the people who need it most.
Offer to drop off your extra produce and some non-perishables at one of Portland’s community food pantries.
Encouraging your children to help you distribute food to vulnerable people can teach them about the root causes of poverty and other forms of injustice.
Host a food swap to exchange produce and canned goods with your neighbors!
Consider working with others in your neighborhood to establish a community garden where people can tend their own plots and share fresh produce.
Gardening on a Small Scale
Perhaps all this sounds great but you’re looking around at your small apartment and thinking there’s no way you can maintain a garden in such a small space. Think again! Granted, you obviously can’t feed an army in a small space, but there are plenty of people who maintain successful gardens from apartments.
When you begin your garden, you may have to go through some trial and error as you learn the ropes. But when you’re cooking up delicious dinners with your veggies and helping your neighbors put food on the table, you’ll be happy that you took on this rewarding project!
PDX Local is an all-volunteer organization dedicated to helping get the word out about important community resources and small business. Call 971.412.2493.
If you have parents or grandparents who live far away, you may be worried about the fact that you can’t help them with daily tasks. Luckily, there are many ways to help your senior loved one maintain a great quality of life, even if you can’t be there yourself to provide hands-on care. Read on for resources that can help the elderly in everyday life.
Find Tools to Help Your Senior Loved One with Important Financial Decisions
Finances are often a primary concern for persons in retirement. Make sure your parents or grandparents are managing their money wisely with some helpful tools.
Your senior loved one may want to sell their house to cover the move to a nursing home. Use the RedFin calculator to figure out what they’ll make if they sell.
Make sure they have the essential estate planning paperwork done.
Provide practical tips to help them save in retirement, like downsizing.
Leverage Technology to Help Your Loved One Navigate Everyday Challenges
Technology can make life easier and more enjoyable for seniors in many ways.
Get them a senior-friendly cell phone to stay connected.
Provide them with a smart assistant so they can do things like adjusting lighting and music hands-free.
Invest in a medical alert system with fall detection to bring you both peace of mind.
Find innovative ways to connect from afar, like virtual game nights.
Connect with Third-Party Providers to Ensure Your Loved One’s Needs Are Met
When you can’t provide hands-on help yourself, knowing there are others nearby to assist can bring you and your parents or grandparents peace of mind.
Find a senior-specific transportation service to help them get to appointments.
If cooking is a hassle, get a meal delivery service for them.
For seniors who need more hands-on support, get a caregiver.
If they are struggling with mental health issues, connect them to a virtual wellness practitioner. PDX Local offers a roundup.
Living far away from your senior loved one can be emotionally and practically challenging. However, there are many resources and tools to help you care for them from afar. Let the above guide inspire you.
Have a local business, artist, or service provider that you love? Let us know.
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