Drug Addiction in North America

Drug addiction, especially the opioid epidemic has been in focus for the last couple of years in the States and Canada. When you have about 150 Americans and about 10 Canadians dying per day because of opioid overdoses, it is difficult for the alarm bells not to ring. Healthcare professionals and governments are scrambling to get a grip on the crisis. Meanwhile, there have been a patchwork of solutions from just letting the Emergency Room (ER) staff handle the extra work to illegal harm reduction sites popping up on city property. I came across an opinion piece from Virgina Pelly in BRIGHT Magazine on how ER staff could be more sympathetic to the frequent flyer OD addicts and what could be done to mitigate the problem. The following is an excerpt from the article and my thoughts on the problem.

Kelly D. says that when she was 21 years old and using heroin, she woke up in emergency rooms more times than she can count. Regaining consciousness in the hospital after an overdose was unpleasant enough, but the lack of compassion made the experience even worse.
“All I got in the hospital was an IV and judgment,” says Kelly, who asked that her last name not be used. She is now 30, drug-free, and a musician and receptionist in Santa Cruz, California. She recalls that nurses would sometimes ask her, “Know how you got here?” alongside snide remarks about her drug use.
“It was always an alienating experience because the ER staff was so cold,” she says.
Worse than the judgment, she says she was never offered any help or information about treatment options. Thousands of people are spit back into society — sometimes over and over — after the trauma of a drug overdose and an emergency room visit, without getting information about where to get help. Like Kelly, thousands of them are young people.


Let’s repeat her statement, “More times than she can count.”

Medicine and treatment for what ails a human is complicated. It is a mixture of the ‘feel good’ so called bed side manner which Kelly D. lamented the lack of during her innumerable ‘treat and streets’ and precise, proven treatments such as the dosage of Narcan the ER staff was able to administer to save an OD patient’s life.

So, let’s inject some real world numbers into exactly why those nurses were a little grumpy with a frequent flyer. I will use California statistics as this is where Kelly D. is from. As for opioids in America, they have been the hardest hit of all countries and have the highest rate of use per person. Canada is not that far behind.

As for the statistics I used for the following analysis, click this link for California Emergency Department Visit Rates For Medical Conditions, 2005–11. Scroll down to the Supplementary Data section and click on the data table link.

Let’s crunch some hard numbers to see what California ERs were coping with even before this latest opioid drug epidemic. In seven years, ER visits climbed close to 18%. With a 2011 population of 37.68 million, that was close to 12 million ER visits representing a one in three visit rate per resident. Of all the hospital admissions, the entirely preventable conditions of Alcohol & Drug Abuse (nobody accidentally puts a needle full of heroin into their body) came to 12.1% of the total.

Of the 350 California hospitals, 2 out of 3 have ERs, or about 231 giving roughly 52,000 visits each per year or 142 per day. Of course those are all averages and an ER in Los Angeles, such as Huntington and County-USC will have 500 visits per day but will have more resources compared to a smaller center. Huntington and County-USC is probably typical with the amount of beds available for a larger ER unit with 130, of which I’m guessing more than the 12% of admissions had to do with Alcohol & Drug abuse. Hospital wait times are now legendary in scope and well documented. The time that could easily be seen as ‘wasted’ on a repeat client like Kelly D. would be have been incredible. This one hospital was reporting 14 hour waits to admit someone to a bed back in 2014.

It’s easy to slag ER staff for being less than sympathetic to patients with self-inflicted maladies. Each and every one of those detractors has never been a nurse on the front lines of an inner city ER department having to deal with the sheer volume of broken humanity rolling through their doors. Dewey eyed compassion for some junkie is an early casualty especially after the umpteenth return visit.

As described in the Virginia Pelly piece, advocacy programs like the one in Boston make sense. But those types of programs cost money and necessitate hiring more staff. If you look at the California State Debt Counter, you’ll see that the state is rapidly closing in on half a trillion dollars USD in debt. How exactly is that going to get paid off, let alone squeeze more dollars out for ‘feel good’ programs to get people off of opioids, which again are voluntary actions that they self-inflict upon themselves? When comes the point of society accepting drug related summary state execution as advocated by the late Mao Zedong or the present Philippine government? Somebody eventually has to pay the piper. Sentimental liberalism will eventually meet the hard rock of reality and fiscal obligations.

Dealing with the Western drug issue has gone sideways in the States and Canada for about a century now ever since drugs (and for a brief time alcohol) was made illegal. I wrote an extensive article, The Ridiculous War on Drugs, from my enforcement perspective experience of 20+ years. I fully agree, that as with most health related issues, putting education and some early programs at the start of the cycle will pay huge dividends compared to treating people at the back end. Society also needs to decriminalize drugs so that the users are not afraid to seek help for fear of the police.

People like Kelly D. obviously took some self-responsibility to sort out her life. But when I was moonlighting with the Vancouver Coroner picking up the OD deaths on the Lower Eastside, we got pretty good at guessing who of the bystanders would be bagged next and wheeled out on our gurney. It is extremely difficult to pull yourself back when you have fallen that far but people with bad addictions need to step up and take some personal responsibility. Society will fast become tired of being their brother’s keeper.

Here is a last question. If you were an ER nurse, (or the government official doling out the yearly health care budget) who would you be more sympathetic towards, a junkie who ODs every welfare payment day or a little kid with a chronic disease?

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Blair is a personification of a ‘Jack of All Trades and Master of None’. He has held several careers and has all the T-shirts. Time to add the title Blogger to the list.


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