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Addiction, Homelessness, and Healthcare
I’m really tired today after coming off of working three days in a row. That may not seem like a lot to the regular work-a-day folks, but when you’re in healthcare, the hours are often long and arduous. I’ve worked about 40 hours in the past three days, and I work in a busy Emergency Department in Portland, OR. Every day that I worked, the ED was on divert — meaning ambulances were directed to not come to us because we were so busy.
When I left work last night, there were 30 patients in the waiting room. Many had been waiting three to five hours just to be put in a room; the wait time to see a physician after being roomed was even longer. Staff scurried about looking haggard, pulled in a million directions. At one point I counted 17 patients in the department that had been admitted to inpatient services waiting for a bed, but since the hospital was full they continued to board in the ED. Multiple patients were there with mental health crises that had landed them with psych holds.
Over the past week, many of the patients I cared for were in the hospital because of drug abuse — usually heroin and meth — or mental health or some combination thereof. Most of those patients were also homeless. Another nurse’s patient was put up for discharge back to the streets after she faked an illness in order to come in and sleep indoors, and as I walked by the open door of her room I saw her rummage through the cabinets, stuffing her patient belongings bags full of hospital supplies. She asked me for a fourth cup of coffee and a third boxed lunch when I pulled the hospital pillow out of her bag and told her that she can’t steal supplies from the hospital and she needed to leave. “I just need another cup of coffee, man! I spilled my last one. I need coffee with like four sugars and six creamers.” I told her it was time to leave.
Another homeless guy on heroin came in with some respiratory complaint and was kept overnight for observation. When the provider went to discharge him, he claimed he was going to go kill himself once he left. Social workers were called to talk to him about mental health resources in the community — it was pretty clear he did not actually have any suicidal ideation — but he threatened to jump off a bridge if we discharged him. He ended up staying four days in the ED between his stay for observation and the time it took to arrange his admission to the psych hospital.
Earlier last week, a patient came in for treatment of her abscesses due to daily heroin use. She said she really wanted to get clean, and she was worried that she couldn’t get into rehab if she had an infection. This was one of many admissions to our ED. Multiple times she tried to leave the department (IV in place) to “go to the cafeteria” and the “gift shop.” When she was told that wasn’t allowed, she started yelling and swearing at us, as though we were abusing her. Her son and his friend came to visit, bearing a Pop Tarts box. Another nurse noted some suspicious activity, and when she went in to investigate, the patient was drawing up heroin into a syringe her son had brought. She tried to say she had changed her mind and wasn’t going to shoot up after all, but when the nurse said that she would be calling public safety, the patient stuck the needle into her arm, making eye contact with the nurse the whole time. She then ripped out her IV and told her son they needed to get out of there now.
These are just a couple stories from all that I dealt with this weekend. I estimate about 33-40 percent of the patients I see are drug addicts, homeless, and have serious mental health problems. Injection is the most common way of using, which leads to all sorts of health problems that send people running to the ED for help. Many of these patients present to the ED over and over again with the same infections. IVs have to be placed using ultrasound because even the most experienced ED nurses can’t get a line because the patient’s veins are so sclerosed.
After about 24 hours since they last used, they go from cooperative and apathetic to antsy and abusive as they start jonesing for their substance of choice. I am constantly yelled at for not treating their pain, for letting them suffer, thinking that the hospital should be providing enough oxycodone to satisfy their two or three gram a day habit. Often these people have a “family emergency,” leave against medical advice, or just leave while no one is looking. Our social workers work tirelessly to help people get off the streets and into rehab. I cannot tell you how many times I have had patients decline placement in a shelter in favor of being on the streets. Much of transitional housing has high vacancy rates because of the no drugs and no drinking stipulation.
Walking in downtown Portland is not safe. I personally know two people that have been stabbed by homeless guys on the street with no provocation. A man was arrested for a stabbing after he said that his wife, Taylor Swift, told him to kill the guy that happened to walk by. Tent cities are everywhere, and one cannot drive through downtown without seeing shopping cart after shopping cart being pushed by someone mumbling to themselves.
There is a big call for legalization of drugs by the left and the libertarians. But how does that work? If we legalize drugs, making them easy to obtain and removing the stigma, how will that decrease the number of people coming to the ED with MRSA abscesses and endocarditis? While I agree that people have the right to make their own choices in life, how do we handle the stress placed on the country by these addicts? This patient population rarely has health insurance, or if they do it’s Medicaid, and they rack up tremendous hospital bills for their 48-hour stay in the ED to get treatment for their infections. The taxpayer pays for it any which way.
While decriminalizing drugs might save money from the prisons, courts, and police, it does up the cost of healthcare. We cannot turn patients away from treatment. There is no “three strikes and you’re out” policy in the hospital that allows us to tell a patient that we’ve already treated them three times before for injection-related infections so we can’t treat them again. Hospitals, nurses, and doctors would be sued six ways to Sunday if we did.
I’m all for individual freedoms, but I cannot see how legalizing drugs will do anything but hurt our society.
Published in General
Again, if something can be sold at the Quicktrip then it is more likely to be bought. Being illegal causes more people to try it.
Saying people will be less likely to OD is also not really supported by facts. People will OD on well made Heroin. Also, the idea that black markets will go away is priceless. Of course they won’t. Smoking is legal right now in all 50 states. Guess what? Organized Crime is still involved heavily. Ever see the show Moonshiners? Running shine is still a thing. How is that? Alcohol is legal, and easily obtainable everywhere. Yet, people run shine.
Crime cartels also still grow pot in Colorado. Imagine that.
Exactly. I get the arguments that the War on Drugs has been a costly endeavor and has circumvented the Constitution in many ways, but the argument “The War on Drugs has failed therefore legalization is the only other option!” comes off as a false dichotomy.
Then, to raise my earlier point, why aren’t more people trying ‘huffing’ spray paint? It’s available at the corner store. Yet somehow most people are not walking around with silver faces…
Because people don’t socially huff paint. Not to mention, it is a lousy high.
Ending the war on drugs without legalizing anything would be such a massive improvement over the status quo I’d probably just shut up about the whole thing.
Because there’s still a market for it. That’s what will happen if the regulations and/or taxes are too high for something desirable.
And that will happen with other drugs too.
I hate to break it to the libertarians, but there will never be any such thing as a totally free market. There will always be regulations and taxes.
One thing that I’ve seen happen with the legalization of marijuana up here is the lack of understanding that just because it’s legal doesn’t mean you are excused from the consequences of using it. I’ve had many people complain that since weed is legal, they shouldn’t be fired for popping positive on a drug screen. They don’t understand that just because it’s legal doesn’t mean employers can’t prohibit its use. We’ve also seen a big uptick in car crashes where the driver had weed on board. There’s lots of data on drunk driving but almost none on high driving. That’s why my hospital is doing a big study on MJ and motor vehicle crashes.
Is it going to be one of those studies where if weed was found in either car, or even if the person not at fault had weed in their system, it will be categorized as “weed involved” accident and leave everyone with a false impression of the magnitude of the problem the same way they do with “alcohol involved” accidents?
The Left tends to believe that guns are drugs, but they’re especially magical since you don’t have consume them. Instead, they are psychoactive objects turn the bearer into a killer.
However, they tend to want to legalize the drugs that one uses by inhalation, injection, ingestion, etc. and of course almost always want to “ban” or “eliminate” guns; the logical consequence of the latter position is that they want door to door raids to confiscate guns.
If they haven’t already thought of it, please encourage them to seek additional funding to freeze samples for long-term storage and possible reanalysis; I wouldn’t be surprised if over time patterns of phytochemicals and metabolites in the blood become useful tools for identifying being under the influence in a legal sense rather than merely having some present in the system. If all they’re looking for now is THCa, THC, and direct metabolites, they might miss something.
I completely agree with Bryan’s assessment that the way these drugs work on the brain changes them in a way that alters the person’s ability to think rationally. Yesterday was my Friday (thank the Lord!), and I spent two hours getting yelled at and fighting with drug addicts that we were trying to discharge. How can I describe what it’s like arguing with a an addict? If you take the irrationality of a 5 year old, the free will of an adult, and the vocabulary of a sailor, mix those together. Add some facial piercings and tattoos. Now tell that person that you’re not giving them a prescription for pain medicine and they need to leave the comforts of the clean bed, free food, and cable TV for the streets from whence they came. But remember they have the irrationality of a child, so this is like walking down the cereal aisle after they just had Coco Puffs at a friend’s house for the first time the other day- all they want is Coco Puffs, and you’re saying no. And the meltdown ensues. The threats to go hurt themselves, the name calling, the yelling, the crying, the whining. Things no grown adult would normally do. The drugs seems to make them revert to the reasoning ability they had as kindergarteners.
No, we have no way of knowing if weed was just “in the car.” The data is drawn my lab testing alone in patients that present to the ED after an MVC.
Good way to put it.
To take the other side of that argument, while I agree that technically they can, I’m not convinced in most cases they should. Clearly if someone shows up for work high and it affects their job performance, they should be disciplined and perhaps fired. Same as if they show up for work drunk.
On the other hand if my employer implemented a policy prohibiting me from drinking even on my own time after work and on weekends, I’d find another job. If an employee wants to relax on their off time using (legal) weed, why is that any of the employer’s business?
The problem with smoking weed is that unlike alcohol weed does not metabolize at a defined rate.
And this is a problem . . .
You don’t think someone can smoke a joint on Saturday night and show up able to do their job Monday morning?
Not necessarily. There’s also a cumulative effect that happens. People that smoke weed regularly have consistently slowed thinking and responses even when they’re not toking up. Alcohol doesn’t have that same effect until you get to the point of cirrhosis and get hepatic encephalopathy.
So evaluate people based on their job performance, and punish them if it degrades. Don’t try to micro-manage their lives outside work.
It seems to me the whole foundation of conservatism rests on the idea that we have to treat adults as responsible for their own choices. I realize you’re dealing with people who’ve manifestly failed in that responsibility, and that raises tricky questions. But once you start down the path of “people can’t be trusted with X” you quickly end up with the entire progressive nanny state:
Or, I can drug test and say you cannot work for me if you smoke pot.
Or do you think as a private business owner I don’t have the right to tell people they cannot come to work impared?
Pot shows up as a + drug screen for weeks. Smoke a joint on the weekend, and I can tell with a urnine screen. Get trashed on Sat night? No one can tell with blood work on Monday (unless you keep drinking).
Them’s the breaks.
Or do you want to wait until your Doctor’s performance degrades?
Thanks Marci – hadn’t seen that before, the jail program.
So if a nurse screws up and gives a fatally wrong medication or punctures an artery doing an arterial blood gas draw, then we fire them? What about the surgeon who gets a little loopy after smoking weed on his off time and botched a surgery? Or the trucker driving a semi whose reaction times are a little off after smoking up the night before? But they did it on their off time so…no harm, right?
What was the universe, in terms of patients admitted to this program? What was the selection criteria? My assumption is that the failure rate if everyone were allowed into that type of program, with no evaluations or screens, etc, no criteria to meet to get into the program, would be much higher.
I completely agree that it can’t be a short-term thing for people whose lives have completely exploded into nothingness. It depends on the degree of the destruction, how much support they might still have left from family and friends, and if they can live consistently in a place where their prior lives have no purchase.
Which is a tall order for those deep in the throes of self-destruction. That said, if they don’t show up – meaning they’re not actively committed to being sober, and changing their lives – then all the support is absolutely and 100% meaningless.
Correct.
I don’t care if my doctor smokes a joint on Saturday as long as he does his job well.
What about the nurse who screws up because she was up all night caring for a screaming baby and didn’t get enough sleep, or the doctor who’s a little loopy after sneaking a martini at lunch, or the trucker whose reaction times are off because he’s caught up in a conversation on his CB radio? Life is risky, accidents happen, we can’t adopt a zero tolerance policy towards everything that might possibly impair someone’s on-the-job performance.
Again I think we have to treat people as adults and then hold them accountable for their mistakes.
That’s the rub- holding people accountable. We don’t hold people accountable in healthcare. We fix things, and we treat without judgement, but that doesn’t hold people accountable.
True, that is a big problem. It’s also the reason we’re well down the road to socialized medicine: if we aren’t willing to deny care to irresponsible people, then we have to find some way to pay for the ever-increasing costs of treating them.
Sometimes people don’t really want to be as responsible for their own actions as they claim to.
You are out of your mind. As a patient, I want a pot free doctor. And, I will go to a company that has a drug policy. And fly airlines with drug policies.