Dr. Amanda Risser took over recently as Central City Concern’s new chief medical officer, even as proposed cuts threaten funding that is critical to the health care, recovery and housing programs at the heart of the nonprofit’s mission.
That financial precarity looms even as the number of people experiencing homelessness continues to rise, and untreated mental health and substance use disorder remain seemingly intractable problems on our streets. Central City Concern is the region’s largest homeless service provider, reporting nearly 16,000 clients served in 2024 alone.
Risser brings to her new position certifications in family medicine, addiction medicine and public health and preventive medicine. I it’s a comprehensive background that aligns with the widespread needs of the community Central City serves. She joined the nonprofit in 2019 as the senior medical director of substance use disorder services, and went on to serve as the senior medical director for primary care from 2023 to 2025. Before that, Risser was an assistant professor of family medicine at Oregon Health & Science University for nearly 15 years.
Risser has led most of organizations clinician teams; she supported the Letty Owings Center for young mothers, Hooper Detox Stabilization Center, and also worked with the nonprofit’s infection prevention and outbreak response teams during the COVID pandemic.
Her roles placed her on the front lines in the battle against rising fentanyl and methamphetamine use. She helped to update nonprofit’s withdrawal management protocols and expand methadone stabilization services at Hooper. More recently, she helped lead the development of a 74-bed residential treatment facility known as the 16 x Burnside Recovery Center.
The Lund Report talked with Risser about federal cuts, the weak links in the health care and housing network, and how her organization is preparing for the challenges ahead. This interview has been edited for clarity and brevity.
The Lund Report: Your career seems to keep taking you closer and closer to working with marginalized populations.
Amanda Risser: It's always been what I’ve been drawn to, even before I came to Central City. I worked at a federally qualified health center for my first job and my second job. Community health has always been an interest. And then I've always been very interested in the areas that are at risk. So, abortion care, substance use disorder treatment services — folks whose health care is often deprioritized or at risk is an area that I'm really passionate about.
TLR: As Central City’s work shows, mental health issues, substance use disorder and housing concerns are often connected and need to be treated at the same time. Where are the weak links in our state’s health care and housing network to help the most vulnerable Oregonians overcome unmet needs?
Risser: There are just so many weak links. It starts even when the folks are children. If you think about prevention, really effective prevention programs, programs that prevent folks from using substances and becoming homeless, it starts in infancy: the kinds of programs that support people in effective parenting and maybe overcoming some of the things that they experienced as children.
When I think about preventing illness, I think all the way back to pregnancy, honestly. And that's why I'm really proud to be part of programs like Letty Owings, where we admit patients who are pregnant and who have young children. That feels to me like very, very effective prevention. If we're helping to treat substance use disorders in pregnant individuals, it really, hopefully, prevents intergenerational substance use. For so many of our patients, it's really common for me to talk to somebody about their substance use history and for them to say they started using drugs with their parents when they were young, you know, like 10, 12, 14,
We need more opportunities for families to get support. We need more opportunities for folks to feel loved and welcomed, and have some sense of achievement and get the educational support they need, the mental health support they need in schools, etcetera.
And then, in terms of the folks that we care for who are experiencing homelessness or substance use disorders, a lot of what we find is that folks that we care for who would like to receive substance use disorder services are not accepted into programming because their mental health issues are considered too acute, or the physical health issues are considered too complicated to fit into kind of a standard level of care in terms of residential treatment or outpatient treatment.
I just don't think we have the continuum that we need. There's just so many transition points for folks to fall through the cracks.
At CCC, we recently [completed] a 74-bed treatment program called 16 x Burnside to address the level of service mismatch we were seeing from folks leaving Hooper. And there wasn't a residential bed that would accept them because maybe they were a little too complicated from a psychiatric standpoint or a physical health standpoint, and they were just getting discharged back to homelessness. They end up in a spiral where things get worse and worse. Building out the continuum would be really helpful. I think increasing access to really effective medications that help people not use fentanyl would be really helpful. And then I think just more places where people can be inside, and sleep inside, live inside. We don't have quite enough of that yet.
There's more homeless folks than we have beds available to them in either shelter services or transitional housing. I think that's our most glaring need. Having places that folks can go with mobility issues, health issues, mental health issues that have been untreated, that are really equipped to take care of them, I think is really important.
TLR: Recuperative care is a big focus for Central City Concern. Can you explain what that is, and its significance in filling the gaps in care faced by vulnerable Oregonians?
Risser: The recuperative care programs serve a really specific need. Anytime somebody is in the hospital and they have an issue and they maybe don't need to be in the hospital anymore, but they still are recovering from their illness or their surgery, there's usually a point in the hospitalization where they're evaluated and determine whether or not they meet criteria for a skilled nursing facility. And it's really pretty specific whether or not you would get that stay covered or not, or whether you need that level of care or not, and it's a pretty high bar.
So there are many people who are experiencing homelessness who have a chronic wound or are discharged from the hospital after a heart issue that is well enough that they don't have to be in the hospital but they need medication management. They need primary care services. They need substance use disorder services. And they're basically just discharged to homelessness, and then they just bounce right back.
So recuperative care programming creates a place where folks can go to stay, and they can get some support for coordinating the care. They can get some housing support because it's meant to be a temporary stop, and they can get some nursing and primary care support for whatever issue they've got going on. It's a place where folks who are not sick enough to be in a skilled nursing nursing facility, but for whom it would be really inappropriate and dangerous and unhealthy for them to be like discharged back to their car, their tent, where they can be for 30,60, sometimes 90 days to transition to a different place.
TLR: Does Portland have enough recuperative care beds?
Risser: We’ve got about 70 in our system, and we might be the only place that does recuperative care. So, no.
It doesn't have a very sustainable payment model. It's essentially covered by grants and monies from hospital systems and insurance companies, so we contract with them to cover folks' stay. The financial argument is, it's going to be cheaper for you to cover recuperative care than like, 12 hospitalizations this year, right? It requires a lot of work to keep it funded.
No, there probably aren't enough beds in town. I think there's a lot of people that would benefit from it.
TLR: We know cuts to Medicaid are looming, even if we may not know exactly what they're going to look like. What potential impact do you see on your work at Central City, and in general, on addiction care and care for people in the margins?
Risser: It has the potential for being devastating. Our folks are so vulnerable, and even with the incredible benefits of Medicaid expansion, the Affordable Care Act, and how helpful that was to essentially universally cover most people in the state, it has the potential for being just incredibly impactful. Given that most of our services are funded by Medicaid dollars in one way or another, even a 10% decrease in funding can have a huge impact.
I think the challenge, too, is that there's just so much unknown, but, really, any decrease in our Medicaid funding will mean that we'll have to decide what we're going to focus on and what we're going to maybe have to do less of. And it's really tough, because those are essential services that we really would like to continue to provide and a lot of things we really feel like should be expanded.
TLR: You were on the front lines during the rise of fentanyl and methamphetamine crises, and played a significant role in updating withdrawal management protocols and expanding methadone stabilization services. What have we learned?
Risser: I think we continue to learn that our patients who use drugs are really at the whim of the market — and how the drug supply is impacted by forces that are complex and out of our control.
We had been expecting fentanyl to come. If there's an epidemic, we can model the epidemic. But with fentanyl, we don't know when the market's going to shift to where. These very potent synthetic opioids are going to come into the drug supply from China. There's just so many things that we can't predict or understand about that. And we had been learning from our friends on the East Coast, who had been dealing with fentanyl for years before we were, that some things worked and some things didn't work.
I had sort of a framework and a scaffolding of what might need to happen to get ready. But it still felt like it dropped from nowhere.
It's much more difficult to withdraw from fentanyl. The medication supports are much more intensive and time sensitive. The overdose potential is so much higher.
So what did we learn? We learned that we needed to push Narcan out there. We learned that we needed to talk to our buddies. We were sharing information. We were talking to our national colleagues. We were talking to folks in San Francisco who saw it a little sooner than us, and were doing some innovative stuff. We were talking to folks on the East Coast who had it a lot worse, because their folks started injecting it pretty quickly. We learned about collaboration. We learned about innovating quickly. I learned how to really support providers in new methods of supporting folks. I learned about pushing through some really complicated workflows that made our compliance folks a little nervous. I learned about change management. I learned a lot.
TLR: What are your priorities going forward? These are challenging times with what's happening on the street, with homeless issues, with financial concerns, with federal pressure. What do you prioritize for your work and for Central City?
Risser: I always center the clients. That’s my top priority, for them to get the services and support and care they need in a compassionate, client-centered, patient-centered, way that feels good and feels connecting.
There's just so much that our patients struggle with, and I want them to come into our spaces and receive warmth and care and excellent medical care, excellent addiction care from people who really do care about them and can show it and demonstrate it in meaningful ways. That's always my priority.
I think that this year is going to be about being ready for and responding to the ways that our services will need to change with the different financial pressures, and trying to preserve core functions and core services, while also responding to what's probably going to be inevitable — the financial impacts of federal policies.
But we don't really know what those are going to look like, so another priority for me is to stay calm at CCC. We have just an incredible leadership team. We've got just these incredible policy folks that are just doing such a good job of keeping track of what's happening and how it impacts us, which informs our financial modeling and our services design and service provision. And I'm trying to work with our vice president of health services to figure out what we can keep going or maybe even expand. Because there's probably going to still be some opportunities to expand services even within the constraints.
I'm hoping that things will stabilize and be a little bit less uncertain. I hope that Medicaid, even if it sort of contracts for a minute, expands again at some point, or we figure out some other way to fund our services. But the goal of the next few years is going to be to stabilize support, shore up, respond appropriately, be ready for some contingencies.
And then just reassuring our staff that we've got this, we can get through it together, and keep connecting back to why we show up to work every day.
