But still a lack of personal responsibility. Let me explain.
I recently read an article from Real Clear Investigations, "Night Train to Oblivion:Anatomy of an American OD". They hit on some good points, and they missed on a few others, but there is an extreme lack of personal responsibility in this story.
There is a lot of blame to go around in the current Opioid Epidemic. The blame doesn't rest soley on the back of the Sackler's from Purdue Pharma, or for that matter, on pharmaceutical companies in general. Of course, Big Pharma has a big share of blame, but so does the FDA, doctors with organizations who pushed "pain as the fifth vital sign", pharmacies who were more interested in making a profit, even when they knew they were seeing suspect prescriptions, and the patients and their families. (Although some families tried their best to fight the idea that long-term opioid use was perfectly okay.)
I encourage you to read the article, but I'm going to tackle a few things they brought up.
Adam Rashid, the addict who died of a Fentanyl OD, was seen in a San Francisco Hospital, and released in the morning on the day he died. I believe the doctor who released him was wrong. According to the article Adam was a schizophrenic, which means, any threat he makes needs to be taken seriously. He should have been placed on a 72 hour hold and evaluated, regardless of his drug status. (He was seeking Klonopin, which is a pretty heavy anti-anxiety). However, that didn't happen. I agree with the article that this doctor failed in his duty. However, Adam most likely would have been released in 72 hours, and then, odds are, he eventually ends up the same way. (more explanation on this later.)
The article goes on to say his parents picked him up from the hospital, but on the way to their house he became paranoid, demanded to be let out, and threatened to kidnap (?) his little brother, whom he had done drugs with in the past, and take him to New York. So the parents let him out of the car just a few blocks from the Tenderloin, and for good measure gave him $30 to get food. The Tenderloin is a well-known population center for homeless drug addicts, and dad gave him cash. Dad is wearing really dark rose-colored glasses, is really stupid, or is seriously naive to the world of addicts, even though he's apparently been dealing with one for years. You don't give an addict cash, especially not when you just dropped him off within easy walking distance of a drug haven.
Apparently, Adam did what anyone with any knowledge of addiction could have guessed. He bought Fentanyl, smoked it, and passed out in a GAP store. An ambulance was called, but the paramedics were able to wake him up. They had to keep waking him up on the way to the hospital, but at no point was he not breathing, and they could actually wake him up. At the hospital he was released a couple of hours after arrival. The article makes mention of the fact that paramedics didn't give him narcan. Okay. He wasn't in the physical condition to receive narcan. They could and did wake him up. Opiods, especially strong ones, have the effect of putting people into a deep sleep. I promise you if he had actually overdosed they would not have been able to wake him up. Narcan wasn't called for, and if they had given it to him, it would have sent him into immediate withdrawal. The most likely outcome for that scenario would have been him refusing to go anywhere with the paramedics and ... he probably ends up the same way.
The article goes on to delve into how bad the system is when dealing with addicts, and I agree. It is bad. It is even worse when dealing with addicts who have mental health issues. However, by all rights, everything the article says about Adam doesn't lead me to believe had any interest in getting clean. He supposedly told a doctor there at the second hospital he visited that day, but nothing he had done up to that point hinted at him being interested in getting clean. Especially not asking to be let out of the car right near a place he could easly get drugs.
An addict has to want to get help, and the fact is, most of them don't really want to give up their addiction. Opioids make a person feel good, and a lot of addicts don't want to go back to reality. On top of that, once you have true opioid use disorder, your brain is now rewired to require those drugs, and if you don't have them, you will absolutely feel like you are going to die, and depending on your level of disorder, you may actually die. It's hard for a person who really wants to get better to actually succeed (look up the statistics on relapses for opioid use disorder). You can't force people into rehab (which this article tiptoes around, but it's there), because they will most likely go back to using the second they leave.
Does this mean we should give up on addicts? No, absolutely not. I have seen people who didn't look like they'd be alive another day, and 6 months later they are clean, working, and getting back to life. Some people can quit opioids cold turkey and not relapse, but it's not the norm. Suboxone, and to a lesser extent, methadone, have a better track record.
Today we push for safe injection sites, places to get clean needles, narcan vending machines, and safe drug kits with crack pipes and needles in them. These things are, most times, paid with taxpayer funds. What if we took more of those taxpayer funds and invested them in Medication Assisted Treatment for addicts? That would actually help people stay alive.
I say this, because if we keep giving people the ability to get high "safely" all we are doing is counting the days for that person until they become Adam... riding a subway line back and forth, dead from an overdose. I think that's just not good enough.
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