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
I don’t spend much time on this topic but hasn’t drug testing of welfare recipients, like Foodstamps, already been a controversial political subject? It sure seems to me something that should be totally absent if government funding is present.
One tricky element there is that most welfare programs were designed and intended to help families (such as Aid to Families with Dependent Children). If mom is smoking weed, and you take away her foodstamps, how will she feed her children?
Now I’m the sort of heartless conservative who thinks we should end all federal welfare programs and leave it up to the states — or better yet, private charities. I’m just telling you what the counter-argument to drug testing of welfare recipients would likely be.
I agree with you. The funding should be local, with testing, and follow up by local social workers to work out the situation you describe. One really bad part of things being federal is that it pretty much removes any chance for local oriented action. For mothers with children, they need to get off drugs.
That would explain their inability to spell people’s names.
I have one of the more common names in Western Civilization, the name of two of the major figures in the Bible. Even so, I usually get “Joesph,” or sometimes “Joeseph.” Lately I’ve given up and just give my name as “Joe,” they can usually manage that…
lol, if I drink during the day, it knocks me out.
That’s fair, it’s just that having pot in your system may not be that highly correlated with being high on the job. It’s a problematic test because it basically penalizes you, even if you are a safe weekend only or less user.
Guilty of having a lot of trouble spelling Joseph…
Tough.
“Libertarians” expressly denied? I’d love to see quotes on this. Do you believe this was a monolithic position? The libertarians on Ricochet, if I recall, saw this kind of thing coming, thought SSM was a lesser evil nonetheless, and pledged to do what they could to protect the rights of the religious. (As if libertarians somehow affected the outcome in the first place)
Being shut down how? Because they’re being denied money from the state?
I don’t follow.
I believe at least one state adopted laws prohibiting all adoption agencies from “discriminating” against same-sex couples, regardless of whether or not they receive public funds. Adoption agencies have closed rather than comply with these laws.
Did this reduce the number of adoptions? Meaning: I’m sure there was an impact, but on whom?
The libertarians on Ricochet were not monolithic on SSM either, although most thought imposing SSM via Obergefell was wrong. Some were conflicted on SSM as such, and at least one was stridently opposed to SSM.
Mollie Hemingway (not the one I mentioned, incidentally) had already left Ricochet for The Federalist by the time of Obergefell, but those who remember her from before that remember her as a libertarian who wasn’t sanguine about SSM.
In the case of some drugs, that would work. For others, it might be lethal.
My stepfather, A”H, liked to quote the Grand Inquisitor’s line from The Brothers Karamazov: “You may choose not to suffer, but it may be the last choice you ever make.”
Update: @vicrylcontessa, I don’t mean that the addicts you see in your ED aren’t suffering, but that they view not using the drug as worse, more unbearable suffering than stopping. It’s my understanding of the neurochemistry of addiction that the first experience of the drug is irreproducible – and the user keeps fruitlessly chasing that experience no matter what horrible things ensue. Losing the possibility of repeating that experience because they stopped is more intolerable than dying.
But because they chose to “live” in a state embalmed in pursuit of a replay of their virginal experience addicts have chosen death (viz. Deut 30:19.) Life is necessarily, – mortals are not exactly the same from one instant to the next – change.
In the runup to the Exodus, the Torah tells us that Pharaoh defies “let my people go” and hardens his own heart. Later it tells us that G0d hardens Pharaoh’s heart. After all, Pharaoh was, in his own system, god (and eternal life meant being embalmed.) Who did this foreign so-called deity think he was to mess with Egypt’s divine ruler? At that point, defiance of the Creator of Heaven and Earth would have meant that Pharaoh would say “now you are messing with me by presuming to harden my heart? [Expletive] off!”
Had Pharaoh truly wished to be his own man (or god) he would at that point been free to let the Jews go. But continuing to subjugate the Jews was more important to him.
For some people (me, for instance) a couple of glasses of wine with the Shabbat afternoon meal affected my work on Monday and sometimes Tuesday. I was doing a pretty subtle offshoot of osteopathic cranial technique and I could tell I was “off”. More distractable, my touch was less sensitive, and my responses not as well timed. No wine, no problem. I’m sure there are surgeons whose work suffers in a similar manner.
That wouldn’t surprise me, but the first hit I got from a quick Google search was a Catholic adoption agency in Illinois who closed after losing state funds.
Fine, my only point is that “Tough” can go both ways concerning the free market.
Great post VC. I’ve had this arguement with proponents of drug legalization before. Yes,you should be able to put into your own body what you want, but unless you live on a desert island using drugs does effects other people and the larger society. Mental health problems seem to be legion these days and the homeless problem seems to be getting worse, and most of the people on the streets are addicts.
The issue is what do we do with these people? Should we open the should we open the Psyciatric instituions back up, but with better oversight? Is that even possible?
The homeless and drug problem is a really big issue particularly in cities, but I don’t think making it easier to get drugs is the solution.
Mental health issues cause drug use as well as the other way round.
Yes, many addicts are self medicating.
If the root cause is mental illness then perhaps just deal with that directly rather than by proxy with drug laws?
In many cases that would require forced treatment which would violate the civil rights of the mentally ill.
But forced incarceration for possession would not violate any civil rights, so throw them in the pokey!
Exactly! They’ve been due processed.
Well, they did, in point of fact, break the law.
But don’t worry, plenty of people with MI get thrown in jail for breaking the law too, as a result of their mental illness.