In this Sundays Boston Globe, there is a front page article outlining the opiate epidemic in Massachusetts. I consider myself to be pretty knowledgeable in most things opiate related in regards to finding and obtaining help, but even I learned something. The premise of the article is about giving the hospitals the power to hold addicts. Currently if an addict comes in overdosing, the addict is revived with narcan and treated until they are no longer a danger to themselves. At that time, which could be hours or days depending on the severity of the overdose, the addict is discharged with a list of numbers, information about detox beds, and a fairly-well as they bounce out the door on their way to score again. Allegedly. I would say that is probably a true depiction of what happens. I would also say that it has been my experience that if the amount the patient consumed is dangerously high, they will hold the patient anyway. Case in Point #1: One of the many times we brought Miss JoDee to the emergency room, she was barely conscious. Barely. I mean, a grunt and a possibly lift of the eyebrow was the only reaction you would get from her, though, let’s be honest, at least she was alive. After the ER doctor evaluated her, and ran some blood work, and gave her narcan with little to no improvement, he told AC and me that he did not believe this could be recreational use. There was too many different drugs and so much of them, in her system, he believed it was a suicide attempt. I kept my mouth shut. I could have said you have no idea what they cut into heroin now-a-days. That she probably did not knowingly take Vicodin, Percocet, k-pins and adderol (I also did not mention the adderol was prescribed though she was probably abusing it). I kept my mouth shut when he said he was questioning whether she should be section on a three day evaluation because he was concerned about her wellbeing. I kept my mouth shut while he spoke more to himself than to anyone in the room when he said her heart rate wouldn’t come up over 53. I kept my mouth shut, until I realized, it might be the only way to keep her locked up long enough to get her to see that her life was worth living. Then, I spoke.
I told the ER doctor that she told me she tried to commit suicide. This was a lie. Technically. Theoretically I believe that all addicts are slowly killing themselves and I rationalized that while she didn’t say it out loud to me, I could understand that she was a walking pharmacy because she was in pain at a level that we couldn’t understand. The reality is I would have sworn under oath that she was suicidal if I thought it would save her life. I mean, every mother of an addict that I spoke to would have done worse than that if it meant giving her child a chance. It’s just the way it is. The proposal will give the hospital power to hold addicts in what the article states as coerced treatment, which would help eliminate the need for lies like mine. It is trying to steer addiction into the hands of mental health, and away from criminal justice system. It references that families can already go to court to obtain a section 35 which will detain a patient for a 90-day civil commitment. Let me tell you what the article doesn’t say. It doesn’t say that no one stays the full 30 days. An addict is lucky to string out 14-days before they throw you out. Shorter, when your insurance refuses to pay for it. As was the case with JoDee. JoDee was getting discharged before we could even have the required family meeting. While still at the court, the doctor on record there told us she would probably be held for no more than 30 days. I probably would have been happy with that. 14 days is a joke, and 30 days is no better. JoDee may have had a fighting chance if she actually got the 90-days I fought for, but that isn’t the case.
It’s definitely a step in the right direction to begin a process that involves addicts being treated for the medical/mental disease that they have and not seen as pariahs of society. I like the idea that addiction in of itself is seen as a reason to hold someone on a section 12. I like that parents, like me, don’t have to lie to doctors to say that a child is suicidal, and instead, see addiction as a slow form of voluntary death. Those are all great strides but it’s not enough. Part of the program proposes $27.8 million dollars in addiction related funding as part of a bill in front of legislature right now which in part would move the female rehab beds from Framingham women’s prison to a more appropriate venue. That is a good step but still not enough. And let me tell you why…JoDee was one of the “lucky” ones. When we sectioned her she had a bed available at WATC (Women’s Addiction Treatment Center) in New Bedford. In the years of chasing recovery with (and dragging her through) JoDee, this was the first time she got actual treatment. Many, many times she did stints in McLeans hospital, Leland, Bayridge, Danvers CAB. You name the detox or program and she did it. The only time an actual psychiatric doctor treated any underlying illness that drove her to addiction was at WATC. They sent her on her way, after 14-days (6 of which was spent in detox so medications weren’t even administered until days 7 and 8) with a regime of meds that was a cocktail to guarantee continued clean time. Yup. That happened. For about 4 months. There was no follow up, there was no continued help. WATC had made an appointment at a program that would continue to manage her meds were she was outcast, embarrassed and left in tears. I called in a favor with a practice I was familiar with to get her in immediately. They would only administer her naltrexone to curb the cravings but she had to wait longer for an appointment for the rest of her mood stabilizing meds. And because she is an adult I was not able to help follow up with the physicians for her, something that I think truly needs to be addressed. Part of the bigger problem is that addicts are truly fighting to get through every day without using, and the smallest tasks, like a flat tire on a day that you had an appointment and the doctor not being able to reschedule until after your meds will have run out for 10 days, is overwhelming. One of the biggest problems I see with adolescent and young adult addictions is that they mentally are stuck at the age the begin using. My daughter may have a number 21 over her head as her age but she really lingers around the age 16 or 17. There is no room in the healthcare regulations to account for the mental stability of the patient.
I understand the worry about forcing addicts into coerced treatment because when someone is forced to do something there is no commitment. Addicts are likely to do what they need to do to get out from under the thumb of the system long enough to dope up. But that is about the delivery. If the 3-day hold is used to help addicts see that there is a life outside of addiction and they can have that if they reach out and grab it that would be great. That would begin by not medicating them until they are obliterated. I have said before I think JoDee got more drugs and easier in detox than on the street. Then it needs to be followed up with LONG TERM REHAB. Long. Term. Rehab. Long term is not 14-days. It is not even 30 or 90-days. Medical experts have testified on more than one occasion that heroin changes the composite of the addicts brain. This happens within the first use. We need to find a way to get real long term rehab that holds the patient in a safe and educating place long enough for their body to not believe that heroin is one of the essentials of life. I can tell you that my daughter has had every single opportunity available to her. And still, she relapses. Right under my nose. I recently said to a friend that I almost felt like a rookie, when I didn’t see it coming. I am no rookie, and she is no pariah but at this point I have vacated all my options. I tried having her sectioned again, they won’t do it. She is not desperate enough, she isn’t homeless, and she hasn’t overdosed. To use exact words “she is sustaining herself so not a danger.” Take a minute to let that sink in. Which sort of brings me to my biggest issue with this particular proposal…. A person has to OD, go to the ER, and live to get the help they need. That’s great for those that meet that requirement, but what about the addict that wakes up one day and says I have had enough. Or OD’s at home and someone savvy and not high enough hits them with narcan thus saving their life and not going to the ER. With narcan readily available, something I support, I am sure there are staggering number of overdoses that are no longer reported. I know of situations where a person overdosed, someone gave them narcan which saved their life but made them immediately dope sick, so they went out to use again. And thus start the cycle all over. The program Gloucester has put in place allows an addict that has had enough to walk in, and surrender for help. I think both of these programs are a start. We need to expound on that. We need to take these as baby steps to a bigger leap.
Lastly, I find it bitterly ironic that the story about Baker and his programs shared the front page with a story about a family who suffered traumatic losses at the hands of mental illness. The story outlines how a woman’s twin sister walked into traffic on 495 with her niece and nephew on each hip. All three were killed. Previously the woman had done a stint at McLeans for a mental break. The family was unaware how mentally ill the sister was, and due to health regulations that prevents sharing such information, the couple lost not just a sister but two children. Shouldn’t we be asking ourselves whom we are protecting by not sharing vital information with families and support systems?
*** I tried to google today’s paper to add the link but I’m not electronically intelligent. I receive the actual paper so if anyone would like a copy, I would be happy to scan and email you one.***