Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
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
This line of argument is wrong. Just because we cannot stop one type of impairment as easily as another, is not a reason to stop the one we can stop easily. Pot in the system is easy to detect, so it is easy to catch. Can’t do much about a crying baby up on a test.
They have to plead guilty, and they have to be willing to abide by the program. If they continued to refuse to comply, they stayed locked up. Not everyone who could use one of these programs gets the chance. Before writing it off, or looking for ways to dismiss its outcomes, it might make some sense to say, “how can we take something that clearly works, and try it with more people”. Other than money, what’s to lose? Or are you so cynical, that you think just because government and courts are doing it, that it must all be a lie?
These programs have such a high rate of recovery because of the time they take and the force the apply. That is the whole point. So you agree with me, but you are busy dismissing me in the paragraph before and after this.
Forced treatment works. Support when people are not committed to change can help move the bar. In fact, no one gets into recovery on their own. Support is key. These programs, using carrots and sticks work. I have seen them work. We have precious few things that work, and you appear bound and determined to dismiss this one, and put all the work and effort back on the people with addiction.
Are you serious?
And that is the “free market” work around in response to legalization of what many see as dangerous substances.
For individual citizens and business owners to use what they know about heroin, pot, booze, even sugar, to build a system that supports a good result.
That could very well mean a company prohibiting the use of whatever things that group determines.
But the prohibition is not sourced in the government, but within individuals, businesses, even communities.
Great. I get it.
The transition to such a world will be interesting, with a fair number of casualties along the way.
I understand that prohibiting heroine, meth, even pot, infringes liberty.
But those are things a great many of people in our “community” have agreed are not contributors to a good life.
So, if you want to do that, you can’t be part of X group, business, school, community, family, whatever.
The bad and evil will not be eradicated. All we can do is hope to move away from them, and mitigate their influence on our lives. (Individual, family, business, & community)
What is being argued seems to be the goodness and value of Y to X. And Z’s ability to design R for the good they desire for Q.
X= people
Y= things or actions
Q= (X+X+X…)
Z= (Q+Q+Q…)
R= Laws
We are trying write code using if then statements that permit X to form Q, and function in harmony.
I don’t think this idea of writing code is a new concept.
There are 10 pretty good ones.
But when humanity discards the very first line of that ancient code, the rest of the equation goes haywire.
I’m just saying…
It’s within the employer’s rights to dismiss the employee for having smoked pot, but that doesn’t mean it’s smart for the employer to do. Especially, as I hear, employers are having a lot of trouble finding anyone who can pass a drug test in the first place. Maybe it’s because having smoked pot recently is so highly correlated with being a terrible employee, but I’d imagine at some point something has to break. Employers, or the companies that insure them, will have to become more lax/understanding about pot smokers, or they’re going to suffer in the marketplace.
I highly doubt it. Insurers will always favor testing for anything that highlights conduct that leads to impairment, because impairment leads to accidents for which the insurer has to pay. If liability insurers were allowed to use medical records to identify alcohol-induced liver decline, they’d make employers use that information in addition to sobriety testing. Employers and their insurers will continue punishing pot smokers until government prohibits them from doing so.
And they are right: mind-altering drugs in the work environment mean accidents, so any history of use of mind-altering drugs raises the odds of accidents. In many professions, very expensive accidents. I’m with Bryan: any business that fails to discipline/fire pot smokers will not be allowed to work on anything I care about.
This was in no way a problem for my healthcare organization.
And we also had rules that you could not go drink at lunch. Who drinks at lunch these days, anyway? Is that common outside healthcare? If a doctor returned to work with alcohol on his breath, there would be a call to HR. We did emergency screens on people and fired them for it.
It seems, and I am not expert, that most people have to hit bottom. Some people are high functioning drunks, but I don’t know any that do dope regularly that are highly produtive. That is anecdotal, perhaps there are some, like Charlie Sheen. The average person is not benefitted by drink or drug stupor. Our banker said about 40% of those that apply for teller jobs flunk drug tests. Panhandlers stand outside in the driveway of Walmart beside the help wanted sign, and a nephew who works there says they have trouble finding people who pass the drug test. Legal or not, jobs generally require a clear mind and health.
Most of us just don’t have time, money or resources to use to try to help those who abuse drugs and alcohol. But it isn’t that we don’t care, but that we also have struggles of life to content with. When that druggie busts into our business, smashes and steals things, we are not amused or filled with compassion. It costs us dearly and we were law abiding people. The local police tell us many of the property crimes and rising home invasions are motivated by drugs. So we have alarms, and take home laptops.
If those that want to do drugs only destroyed their own worlds, but they don’t. I have also read where pregnant women are using pot to help with morning sickness. After all, it’s legal. An assault on the developing embryo at an early stage means the risk of disabilities for these children raises. The most preventable type of retardation is alcohol and drug abuse. So, in a few years, when those children attend school, will we need more resources to help them? Probably. The idea that something is legal does not take away the danger.
Something interesting concerning alcohol; if your dog drinks anitfreeze, you treat it by giving vodka in a pinch. I think a dr. noticed that college students that were drunk survived accidental antifreeze poisoning better than those that weren’t so drunk.
Maybe, maybe not. How can one know? Is smoking pot, in general, a risk factor in performance or behavior? A marker for character? Perhaps it is useful as a substance for medical treatment. I don’t see how it would be considered a positive by an employer for an employee to be a user.
I have long considered myself a libertarian-leaning conservative Constitutionalist. One area I’ve never been able to reconcile is destructive personal behavior that ends up placing burdens on general society. So I’ve not yet been able to pin down an exact view on drug use legality. I think that is what this OP is about.
We meaning your company, the employer, not the government…correct?
Definitely.
Well now, we, the company, in fact, were the State of Georgia’s Safety net. So, technically, it was both.
However, all of my posts on employers has had nothing to do with legalization, but the idea that regardless of it being legal, employers would still ban it. And that was challenged. See, the pro-drug people don’t really believe in freedom, they believe in drug use. Once legalized, there will soon be a right to use drugs “on my own time” and companies won’t be legally allowed so screen people out for drug use. Libertarians will be complicit in making this happen, just as much as their is blood on their hands for the bakers and florists over SSM. Those of us against SSM predicted what would happen, and it did.
Drug addiction is not simple or easy to fix. Pretending that getting the government out of the picture will make everything better is childish fantasy. Just like the idea that having SSM would magically make things better around homosexuality. How’d that work out?
I agree with you Bryan.
First – easy there, Sparky. I just asked the criteria. I didn’t “write it off”. I didn’t even say I think it sucks. Why so defensive if you’re so sure it’s a great program? It certainly sounds like one. Thanks for calling me cynical, too. That’s fantastic. Cynics don’t climb out of wheelchairs and run 38 half marathons.
I’m not dismissing you. I’m asking the criteria. Having some first-hand experience in this space, I’m not just speculating. You can say that forced treatment works, and it does work, but not in all cases, and it won’t work if the person isn’t willing to change. That’s the first hurdle to clear. Treatment of any kind is useless without that personal commitment. Is that cynical?
I’ve seen things work, and I’ve seen things fail. Sobriety isn’t achieved without some personal commitment as the first step, no matter the support structure or forced treatment imposed. Or do we need to go back to look at the data around forced treatments ordered by courts, and their failure rates? I can guarantee they’re not zero. You can probably find a lot of personalized data around this by visiting any prison.
Your healthcare organization is not the universe. Get used to the idea.
Usually they don’t. This is why IMHO democracies tend to drift towards socialism, and there are no libertarian nations.
Well, I’ve done it (while eating lunch with my boss, I might add). But then I write software for a living, reaction times are not critical and there are no lives at stake.
I agree of course that I don’t want my surgeon to get raging drunk right before the big operation, but I couldn’t care less if the barista at Starbucks toked up last night as long as he gets my order right.
Starbucks may or may not care. Hospitals and airlines will.
In the case of airlines drug screening for pilots might make sense, but does it really matter if the flight attendants or the guy at the checkin counter got stoned on their off time? Or the HR department? The guy who came up with the fare structure, he was clearly stoned out of his mind…
I’d argue that the vast majority of people work in jobs where it really doesn’t matter. I’m not arguing that drug testing should be banned, I just think the need for it is rare.
And you tell me “easy there, Sparky”?
I gave you the criteria. In your haste to write me off, did you miss it? My whole point is that forced treatment can encourage and induce a willingness to change. You seem to be willfully missing that point. Maybe cynical was too kind a term, especially based on the snark quoted above.
Just because a failure rate is not zero, that does not mean it is a bad intervention. You seem to be making perfection the enemy of something that works. I have seen something that works, that takes time, money, and investment of others, but it works for the majority of the people that go through the program. Instead of a moment of celebration, you jump to challenging it, looking for reasons why its success is suspect. Why am I defensive? It is because you are not seeking understanding, but ways to knock down what I say, as again, your “get used to it” comment shows.
People have to commit, but you do not have to wait for that to start treatment. There is a whole concept called Motivational Interviewing about this. Evidenced Based Practice even. 25 years of experience here. That, apparently, counts as nothing for you.
“Sparky”.
If I own the business, it is my call. See, this is what I am talking about. You are mere steps away from saying, “Well, since I think it does not matter that much, the owner won’t be allowed to tell someone what they can do in their own time, and therefore the law should support that”.
I suppose I am fighting a losing battle here, since libertarians have already given us bakers being run out of business at the alter of SSM. Soon, expect for specific, Federally mandated jobs, drug screens will not be allowed. Thanks libertarians for your strong stances on personal liberty that lead to more and more government regulations.
What part of the suggestion that an alcoholic might sneak a drink at an inappropriate time do you find so outlandish?
I don’t like the idea of alcoholic doctors.
Except I’m not saying that!
How is that not a straw-man argument, when you suggest I’m advocating a position that I’ve repeatedly and expressly denied?
Neither do I, but there are lot of doctors in the world, and there are a lot of alcoholics, so I’m willing to bet there are at least a few alcoholic doctors.
I don’t want them on weed either and as long as weed is illegal that process is fairly straight forward.
Libertarians expressly denied SSM would lead to people being forced to support it, and yet, here we are, with that very thing a reality. Already, any adoption services who want to place kids with a mom and a dad, a situation we know for a fact is optimal, are being shut down. This is the reality of SSM.
Legalized Pot will go the exact same way. And your sort of thinking is going to help the left move us into greater control of what relationships we are allowed to have.
Awfully broad generalization there. I was (and still am) against SSM, for the record.