Please Know...

As I come to know these fine people, they share with me more of their personal and sensitive stories. Their collective story is what I am trying to share with you as my way of breaking the stereotypical beliefs that exist. "Blog names" have occasionally been given to me by the person whose story I am telling. Names are never their actual names and wherever I can do so, I might use the opposite pronoun (his/her, etc.) just to help increase their privacy.


Sunday, April 18, 2021

Footprints On The Steps

I was out of water, running low on bananas and my song sheet supply was nearing depletion.  It was time to go home.  As I took one last glance around my surroundings on this warm sunny day, I was parked at East Indiana Street at Kensington Ave.  I saw April, dosing/dipping at the base of the steps that lead up the hill to the McPherson Branch of the Philadelphia Free Library.[1]  I knew I needed to go and offer all that I had left, a banana and a song sheet.

Instead, she gave me what she had left.  By the time I said "Goodbye" probably 30 minutes later, she had walked with me - no, led me - into the pure presence of God.  This moment was far better than any worship service I've ever attended - and that includes Easter at the National Cathedral!

As she dosed/dipped she began to read out loud from this song sheet, pausing only as the dip[2] did what it could to derail the moment.

She read:

Footprints In The Sand

One night I  had a dream. I dreamed

I was walking along the beach with the LORD.


Across the sky flashed scenes from my life.

For each scene, I noticed two sets of 

footprints in the sand: one belonging

to me, and the other to the LORD.

When the last scene of my life

flashed before me,
I looked back at the footprints in the sand.

I noticed that many times along the path of
my life there was only one set of footprints.

I also noticed that it happened at the very
lowest and saddest times of my life.

This really bothered me and so I
questioned the LORD about it:

"LORD, you said that once I decided to follow
you, you'd walk with me all the way.
But I have noticed that during the most
troublesome times in my life,
there is only one set of footprints.
I don't understand why when
I needed you most you would leave me."

The LORD replied:

"My child, my precious child,
I love you and I would never leave you.
During your times of trial and suffering,
when you see only one set of footprints,
it was then that I carried you."

Author: Carolyn Joyce Carty

And then she continued to read and concluded with this final blessing to and of herself:

I am an inspirational human being made in the image of God

and I am worthy of dignity, honor, respect and love.

No time of worship in any church could ever begin to compare to the Glory in this moment.  This woman who, undoubtedly had been on multiple "dates" in the last 24 hours,[3] consumed heroin - or whatever it is these days - been under-fed, under-housed and now exhausted on these steps read to herself about a God who she may or may not know.  That reading, completed by her own determination planted a seed of Heavenly Fatherly Love within her soul. 

I said "Goodbye.  Be safe."  She drowsily thanked me and fell asleep right there on those steps.  One banana served as a paperweight for her printed and divinely read poem.

Footprints on the Steps



[2] A behavior associated with current drug use… Part of the experience of being high.

[3] Times all the days, weeks, months, and maybe years that she's been out there

Saturday, April 17, 2021

She moved Home.

As the sun set on this date 2 years ago, she was looking forward to going to detox in the morning. She just needed to get through the night with one maybe two "get wells."


Morning never came. She moved Home to her Savior sometime in the night and we miss her. 

Monday, April 12, 2021

It's all well and good to have a security presence at this and other train stations along "The Ave." It would be all the better to have a medical presence made up of professionals who have vowed their careers to the ideals of Hippocrates and who will welcome each and every patient with prompt kindness, dignity, and respect.

As I sat on the open trunked back bumper of my car and conversed with Christine as if on a park bench on a warm and sunny day, we agreed about the true nature of the crisis in Kensington.  Across the street, a newly assigned uniformed Transit Police officer was handcuffing and firmly guiding a woman to a location out of sight from our vantage point.

At that moment, I could not help but think of how miss-assigned that officer is as he interacted in his official capacity with this patient with Substance Use Disorder.  I thought back to previous ponderings of how this section of Kensington is more of a patient waiting room where patients of Substance Use Disorder do what they need do to stay 'well' while they are waiting for that moment of 'rock bottom' or intellectual decision to invite sobriety back into their lives.

Speaking in general terms here[1], that handcuffed patient with Substance Use Disorder most likely comes from a childhood of some form of abuse.  She may have been 'played with' in ways that would make your heart bleed with tears if you knew the details.  She has sought detox and been treated hideously as was "George" in this blog.

One day, she overdosed on the steps of this same train station.  She was revived by Narcan.  She was taken to a very local hospital.  She was told by the Registered Nurse to "Get out of my Emergency Room!"   She's now dealing with Krokodil.

Family atrocities and professional neglect by representatives of Hippocrates are the foundations of why so many of these street-bound patients with Substance Use Disorder remain where we find them.   

Christine herself told me in our hour-long conversation that if she could just go to a health care facility and get the care she needs promptly and respectfully, she would have gone long ago.  But she knows as does this newly handcuffed patient that the system is broken and it's far easier to keep consuming and dating and risking all manner of health crisis than it is to seek help.

It's all well and good to have a security presence at this and other train stations along "The Ave."  It would be all the better to have a medical presence made up of professionals who have vowed their careers to the ideals of Hippocrates and who will welcome each and every patient with prompt kindness, dignity, and respect. 


[1] I am combining stories here to make a point.

[2] Kensington Avenue

Monday, April 5, 2021

Amputations During the Civil War

Amputations During the Civil War in the 1860s were very common and saved lives.  Here's a video that looks at this topic.

Arms and legs were lost from one's body as a consequence of battle.  Artillery penetrated the limb and the result was often the loss of that extremity.

 **********

What does this have to do with Substance Use Disorder on the streets of Kensington?

As I've already written, there is a Civil War in the Mind occurring within patients with Substance Use Disorder.  This civil war's conflict within the patient causes this person to battle between wanting healing and wanting drug.

There is a drug making itself known more and more in Kensington.  It is called "Krokodil."  You can read about it here.  Look in the endnotes of this blog for the most critical part of this article.[i]

Unlike the artillery of our National Civil War of the 1860s where the bullets and cannon balls (etc.) claimed limbs in an instant, Krokodil claims limbs slowly by rotting it's victim's arms and legs from the inside (Warning: Graphic imagery!).  

The victim who is a patient with Substance Use Disorder is torn between desiring detox and craving drug.  Rotting of flesh, muscle and bone progresses while the patient intellectually understands the consequences of a rotting extremity - potential amputation - and yet hears with stunning clarity the inaudible call of the opioid.

I've recently interacted with two people who I love from those streets who are facing this issue.  One's battle with Krokodil is very advanced with self reports of seeing their own bone.  The other's battle has only just begun with a dime sized black hole and a whole bunch of localized infection and swelling. 

For anyone else facing such a critical situation, the answer for entering healing would be simple:  Go to a doctor, clinic or emergency room!

For patients with Substance Use Disorder who are reliant on Medicaid, it's not that simple. 

Unlike the soldier on the Civil War battlefield who just happened to be in the wrong place in that moment the enemy artillery came calling, the patient dealing with Substance Use Disorder and now Krokodil can make the decision to go for health care before amputation becomes the only viable avenue to renewed health.  Sadly, there are unreasonable, and medically neglectful[ii] hoops created by far too many medical professionals who had dedicated their careers to the ideals of Hippocrates that must be jumped through while each patient is dealing with their own internal psychological civil war of healing vs. drug.  One side of their brain cries in literal agony for healing while the other side of the brain makes arrangements for income and then acquisition and consumption of their next drug supply. 

Rotting of flesh, muscle and bone continues while the mental battle plays itself out to a possible conclusion of amputation.

Krokodil, just like heroin, is an inanimate substance.  As an inanimate substance, Krokodil is incapable of creating the massive crisis that exists right now on the streets of Kensington.  It is just being what it is, nothing more and nothing less.  The Medicaid healthcare system adds to the crisis with its lack of prompt dignity and respect filled connectional medical care.

We can do better for our loved ones on the streets of Kensington.  To that end, I invite you to continue reading "Kensington Does Not Have an Opioid Crisis!"

 

End Notes:


[i] Krokodil side effects

The most recognized side effect of krokodil is scaly green and black skin that develops shortly after injecting the drug.

Based on reports, people don’t need to use the drug for long to experience permanent and serious tissue damage that extends as deep as the bone.

Let’s take a closer look at the side effects responsible for the drug’s street name as well as its other side effects.

Skin necrosis

According to reports Trusted Source, people develop significant swelling and pain in the area where the drug is injected. This is followed by skin discoloration and scaling. Eventually large areas of ulceration occur where the tissue dies.

The damage is believed to be at least partly caused by the toxic effect of the additives used to make the drug, most of which are erosive to skin.

The drug is also not purified before injection. This may explain why the skin irritation happens almost immediately after injection.

Muscle and cartilage damage

The ulcerated skin often progresses to severe muscle and cartilage damage. The skin continues to ulcerate, eventually sloughing off and exposing the bone underneath.

Krokodil is 10 times Trusted Source more potent than morphine. Because of its pain-relieving effects, many people who use the drug ignore these side effects and put off treatment until extensive damage has been done, including gangrene.

Blood vessel damage

Krokodil can damage the blood vessels that prevent the body’s tissues from getting the blood it needs. Blood vessel damage associated with the drug can cause gangrene. It can also lead to thrombophlebitis, which is inflammation of a vein caused by a blood clot.

Bone damage

Bone infections (osteomyelitis) and bone death (osteonecrosis) in parts of the body separate from the injection site have also been reported.

Bacteria are able to enter the bone through the deep tissue wounds, causing infection. Bone death occurs when blood flow to the bone slows or is stopped.

Amputation is sometimes needed to treat this type of damage.

Use of krokodil has been associated with a number of other serious side effects and complications, including:

·         pneumonia

·         meningitis

·         sepsis, also referred to as blood poisoning

·         kidney failure

·         liver damage

·         brain damage

·         drug overdose

·         death

Takeaway

Krokodil (desomorphine) is a dangerous and potentially fatal drug that causes a number of side effects.

Its toxic effects are experienced immediately after injecting it and progress very quickly.

If you or someone you know is using krokodil or misusing other opioids, here’s how to get help.

Last medically reviewed on August 6, 2019 

 

[ii] neglect

1. Failure of a health care provider or caregiver to observe due care and diligence in performing services or delivering medicine or other products so as to avoid harming a patient.

2. Generally, indifference or inadequate attention to one's responsibilities in regard to self-care, care of others, or other aspects of one's personal or professional life.

Wednesday, March 24, 2021

Even in the most elegant of detox/rehab settings, people walk away AMA.

Even in the most elegant of detox/rehab settings, people walk away AMA[1].  It's a sad reality that the civil war of the mind can be won in favor of the drug even within the realm of excellent and luxurious medical care.

There seems to be two realms of reality in this civil war toward health and away from active drug use for patients with Substance Use Disorder.  This blog will focus on one realm.

The first part of the battle is experienced by patients with Substance Use Disorder who are reliant on Medicaid for their treatment of this officially recognized condition. 

Regardless of their insurance coverage, a patient with Substance Use Disorder must get to that point where they determine to be 'ready' for detox. 

The patient reliant on Medicaid who has reached that 'ready' moment will experience the following:

Mental Rot as they sit "ready" in a jail cell

Damaged Determination as they are treated for a secondary medical condition and not for dope sickness.

Absurdly Slow steps in securing a bed for a person who truly wants to be done with addiction.

And the worst of all atrocities against these Medicaid reliant patients with Substance Use Disorder…

Being told by a registered nurse in the minutes after their Narcan saved overdose to "Get out of my emergency room!"

These four examples represent some of the obstacles to a new life that patients with Substance Use Disorder who are reliant on Medicaid experience day in and day out.  When you multiply these issues by the hundreds of patients on the streets of Kensington, you can begin to see how these atrocities lead to what is being experienced in Kensington today.  Kensington Does Not Have an Opioid Crisis!

This category of obstacle is very much within the realm of medical professionals who have vowed their careers to the ideals of Hippocrates and elected officials to institute changes in how we serve these patients. 

The reward of initiating these changes will be renewed health to these patients and to the community of Kensington and far beyond.

Let it be so.



[1] Against Medical Advice

Monday, March 22, 2021

My Loved One is Ready to Go to Detox! Where should I take them?

This question in a variety of forms floods Facebook groups that focus on issues of Substance Use Disorder and family support.

Here's the scenario:

A loved one has finally found that moment of being ready for a detox.  The window of opportunity for healing has opened and will close at any moment.  Two hours is the typical amount of patient accepted toleration to wait as the civil war in the mind battles on.  There must be a sense of progress toward detox being made very soon and every step of the way or that window will slam shut and shatter any hopes for that day and for months to come.

Where should I take my loved one?

Finding an answer to this question, if a plan is not already in place, can absorb your entire two-hour window.  Have a plan in place!

Once we get there, how long will we wait for a bed?

Registering at that identified place may or may not be a fairly quick process. 

Waiting for a bed can take 16 or more hours.  At the end of those hours, your loved one might be told that there are no beds available across the entire city and to go home and try again tomorrow.  

The window of opportunity for detox may have slammed shut and most likely will slam shut at any point during those 16 hours of sitting.  From your loved one's perspective, it's far more comfortable to give up waiting and leave to buy that little blue packet of medicine than it is to continue to sit there with no definite hope for healing in sight.

If a bed is obtained, how long will it be before comfort care for detox related symptoms to be alleviated will pass by?

If your loved one does get a bed and the doctor has gone home for the day, no comfort care will be prescribed until the doctor returns the next day.  Your loved one will most likely sign out AMA[1] to find their own source of healing: their much-needed 'medicine.'

The above scenario describes the health care process within the world of Substance Use Disorder patients who are reliant on Medicaid.

**********

The following scenario for a patient with Substance Use Disorder who has private insurance is a follows:

  1. Your loved one tells you that they are ready for a detox.
  2. You call a selected 800 number and explain what's going on.
  3. Your loved one's insurance is approved.
  4. Your loved one is picked up by car service or brought in by a family member or friend.
  5. Your loved one's dope sickness is treated to the highest medical extent possible upon arrival.
  6. Healing begins.

**********

In the world of Medicaid provided health care for patients of Substance Use Disorder and that loved one receiving care there unwaveringly towers "Medicaid Mountain" to be traversed by an already weakened patient who must hike it's narrow cliffside trails in hopes of getting to the other side and arrive at healing.

Those of us who know the intimacies of the private insurance side of health care to patients with Substance Use Disorder must find ways to plow down "Medicaid Mountain."  To do so, we must identify every obstacle to health care that is created by that mountain, address those issues and remove those issues. 

In so doing, we will save a million lives[2]!


[1] Against Medical Advice

[2] Our children, our mothers, and fathers, our spouses and lovers, our best friends, and every other combination of relational loved ones

Friday, March 19, 2021

The Somerset Station Closure is a Side Effect of a Larger Crisis in Kensington.

The Somerset Station closure is a side effect of a larger crisis in Kensington: the Provision of Health Care to Patients with Substance Use Disorder who are Reliant on Medicaid!

The Somerset Station is reportedly being closed due to the 'dangers' that are prevalent there.  Allison was, from this limited perspective, one of those 'dangers' and an obstacle to patrons of the El one day as she laid on those steps turning blue with overdose. 

With two doses of Narcan in her system, she was taken by ambulance to Episcopal Hospital.[1]  The care that she received in those minutes following her near-death experience was provided by a registered nurse who had vowed her career to the ideals of Hippocrates.  That nurse perverted her oath and told Allison to "Get out of my emergency room!"

To this day, Allison floats between housing and street life with all of the hazards that come with that lifestyle.  She frequents the Somerset Station and would be considered by a non-understanding member of the public to be one of the 'dangers' at that station.

Allison is not the reason for the closure of the Somerset SEPTA El stop.

Allison represents hundreds and maybe thousands of real-life human beings in Kensington who have been mistreated by the inadequacies of Hippocrates-committed medical professionals within our local Medicaid system. 

She and those other hundreds/thousands of people are patients of the officially recognized diagnosis of Substance Use Disorder.  As such, they should be treated accordingly, with prompt and dignified care.  They are not.  The collateral result is the closure of the Somerset Station that we wrongly blame on the mislabeled "Opioid Crisis."

I fully believe that there is hope for this situation.  This hope will bring renewed healthy life to these patients with Substance Use Disorder and to the community of Kensington and make the closure of the Somerset Station nothing more than a misinformed idea.

I invite you to click on the following link to continue reading on this vital topic:

There is a way to provide prompt, dignity, and respect-filled detox to Medicaid-reliant patients of Substance Use Disorder! 



[1] Episcopal Hospital is the hospital closest to the bullseye of the inaccurately labeled "Opioid Crisis." This inaccurately focused crisis is the greatest of its kind on the entire east coast of the United States of America.

Tuesday, March 2, 2021

There is a way to provide prompt, dignity and respect filled detox to Medicaid reliant patients of Substance Use Disorder!


In these several days since writing the blog titled Kensington Does Not Have an Opioid Crisis!, I've been thinking about 'Allison.'  I wrote about her experience with the Medicaid level health care that she had in her first hour after a near-fatal overdose in this blog:  Allison at Episcopal: A Story of Medicaid Vs. Private Insurance.

Here's a quick synopsis:  On May 6, 2020, Allison overdosed and was saved by Narcan.  She was transported to Episcopal Hospital.  The registered nurse told her to "Get out of my emergency room."

Allison remains street-bound, addicted, and increasingly traumatized by life on the streets.  Her children remain without their mother and her family without their loved one.

**********

This Registered Nurse does not hold the blame for all the ills of the Medicaid system of health care provision for patients of Substance Use Disorder who are financially reliant on it for their health care.  She does serve as a painful and all too common example of the faults within the system. 

Would Allison's outcome that day have been one of healing if that Registered Nurse had demonstrated the care and compassion expected of her by the Hippocratic Oath upon which she had vowed her career years earlier?

From Allison's perspective, this Registered Nurse's lack of care and concern for her as a human being worthy of dignity and respect only echoed previous experiences of run-ins with other representatives of Hippocrates. 

Any and all of the following accounts of Medicaid level shortfalls in the delivery of health care to patients of Substance Use Disorder could apply to Allison's street bound journey:

Read about the patient who was desperately seeking detox and needed to be admitted to a medical hospital for an infection.  She was treated for that infection and not treated for her detox-related symptoms.  She signed out AMA.

Read a firsthand account that includes a brilliant summary by a patient who very much wanted detox and healing.

Read about the damage caused when a patient with Substance Use Disorder is not given comfort care in a timely manner - even after admission to a Medicaid level facility.

Read about the "mental rot" experienced by patients of Substance Use Disorder, as they sit in a jail cell, described as an "oversized toilet stall with cots.

**********

The good news is this:

There is a way to provide prompt, dignity and respect filled detox to patients of Substance Use Disorder!  

The following link is a blog that compares the two models of health care.  Let us, with a spirit of urgency, find a way to bridge the gap between these two models of health care.  Let us plow down 'Medicaid Mountain', the heights of which and cliffside paths of which are far too high and far too narrow for any patient of any diagnosis to navigate on their own...

Read a story that compares Medicaid provision of health care for patients with Substance Use Disorder with private insurance doing the same.

 Let us find a way...

Wednesday, February 24, 2021

Kensington Does Not Have an Opioid Crisis!

Kensington[1] Has a Crisis in its Provision of Health Care to Patients with Substance Use Disorder who are Reliant on Medicaid!

**********

Heroin[2] is an inanimate powder.  It is delivered to the customer in an inanimate little blue wrapper and sometimes in an inanimate little zip lock bag[3].

Let's look at the word:  Inanimate

Definitions include:  not in a physically live state and not active, energetic, or lively

Synonyms include:   Lifeless, dead, non-living, inert, dull, and unresponsive

As an inanimate substance, heroin is incapable of causing a crisis.  It just sits there waiting to be used for its purpose by an animate (living, alive, breathing, conscious) being, in this case, patients with Substance Use Disorder who are homeless[4] on the streets of Kensington. 

We cannot reason with an inanimate substance.  We cannot yell at heroin, scold it, put it in time out nor any such action that will encourage it to change its ways and start to behave.  It's just being itself!

Heroin is incapable of changing its ways and so we must change our ways in response to it.

Nearly 100% of the people on the streets of Kensington dealing with substance use disorder are reliant on the Medicaid system for the financial coverage of their health care.   That one simple fact alone makes it very obvious to any informed observer that this issue is not so much an opioid crisis as it is a crisis in the provision of healthcare to patients of a recognized disease known as substance use disorder.

Solve the Medicaid-related issues and you will greatly reduce the opioid issue.

**********

Here are a few examples in blogs that I've written that show how the Medicaid system has failed these patients with Substance Use Disorder:

Read about the R.N. who told a recently overdosed (and saved by Narcan) patient to"Get out of my emergency room!"

Read about the patient who was desperately seeking detox and needed to be admitted to a medical hospital for an infection.  She was treated for that infection and not treated for her detox-related symptoms.  She signed out AMA.[5]

Read a firsthand account that includes a brilliant summary by a patient who very much wanted detox and healing.

Read about the damage caused when a patient with Substance Use Disorder is not given comfort care in a timely manner - even after admission to a Medicaid level facility.

Read about the "mental rot" experienced by patients of Substance Use Disorder, as they sit in a jail cell, described as an "oversized toilet stall with cots."

Read a story that compares Medicaid provision of health care for patients with Substance Use Disorder with private insurance doing the same.

These true accounts of life in the world of Medicaid level health care provision for the patient with Substance Use Disorder make it very clear that we must change how we respond to this inanimate substance called heroin.

 **********

In a TED Talk by Johann Hari, he concludes with "The Opposite of addiction is not sobriety.  It is connection."  

Herein lies the key to ending Kensington's health care PROVISION crisis that has for so long been mislabeled as an opioid crisis.

**********

I recently asked members of a Facebook group whose members have been directly affected by this issue for their thoughts on all of this.  Here's a snapshot of their responses:



Notice that the three highest vote items all involve how  professionals who have dedicated their careers to the ideals of Hippocrates have failed within the realm of Medicaid to provide needed and very much wanted services.

**********

We must do better…

The inanimate 'opioid crisis' cannot be won because it does not exist. 

The true crisis is very much within the animate world of health care provision to Medicaid reliant and street-bound patients with Substance use Disorder and can be won.

To that end, I propose the following as described in this recent blog.

                                  

 





[1] The situation at hand goes far beyond the geography of Kensington.  For the sake of discussion, I focus on this amazing community.

[2] And it's mystery additives

[3] Originally meant to hold buttons for high-priced suits and dresses.

[4] Some in subsidized housing

[5] Against Medical Advice and is still on the streets

Sunday, February 21, 2021

If you heal the customer/buyer/patient of Substance Use Disorder, there is no drug market.

From the Philadelphia Inquirer:


Opioid Addiction

Philly City Council members announce new police station, other initiatives in Kensington


When I read this article online today, I knew I needed to respond.  I've done so in this document that I've saved as a PDF file.  I hope you'll take the time to read and consider my thoughts...



Sunday, February 7, 2021

Calming The Storm

On December 31, 2016, I visited the people of the streets of Kensington for the first time.  I have written about that experience here.

On October 1, 2018, I began employment at Recovery Centers of America (RCA) in Devon, Pa. as a driver.

It was in those weeks in October 2018 that the beginnings of a storm front developed in my soul.  The cold air of the Medicaid system of health care for patients of Substance Use Disorder clashed with the warm air of health care for patients of the same exact medically recognized condition who have private insurance.

Allow me to brag a bit about RCA and what a patient with Substance Use Disorder experiences upon arrival…

When a person arrives at RCA, they are greeted by the receptionist at the front door with words similar to:

"Hello (First name).  Welcome to RCA. I'm glad you're here. Would you like water, soda, or a snack?"

They enter a pleasantly decorated reception area and begin the process of registration.  They are offered water, soda, or Gatorade and a snack.  A full dinner prepared by on-location chefs can be made available very quickly to those who need it.  Within a short time of entering and completing the registration process, they are guided to their five-star hotel quality room and the process of detox and healing begins. 

If this patient is already experiencing dope sickness upon arrival, comfort care is made available as soon as possible and to the fullest medical extent possible.  To better understand why this expediency is so critical, please read my blog: "Drug vs Detox: A Civil War in the Mind"

Such is not the case for people on the streets of Kensington.  You can read a comparative blog here that looks at both approaches.

It is time for us to extend the best of the model of health care demonstrated by RCA to the needs of the patients of Substance Use Disorder who are on the streets of Kensington. 

I am envisioning a storefront on Kensington Avenue.

1.  It would be decorated in a warm and welcoming style.

2.   It would not be inside a larger facility.  This welcoming area would be visible from the street.  By entering one door, the patient of Substance Use Disorder would be walking into a welcoming environment to learn more about their options and, if they are ready to do so, an expedited dignity and respect filled entree into detox.

This storefront has large windows through which passersby can see a warmly decorated, well lit and welcoming environment staffed by caring people who are prepared to register anyone who is contemplating detox/rehab services.  Further back in the storefront would be the private offices and exam rooms.

1.       Anyone who is contemplating:  For various reasons, an individual may not be ready to go to detox.  They may be ready to have their contact and insurance information on file for that time when they are ready to go.  This storefront would gather this information and be ready to expedite the patient's entry to a detox facility when the patient decides they are ready.

2.       Partial registrations would be acceptable.  If someone wants to give just their street name and nothing else, so be it.  They would be encouraged to come back any time and keep an eye on the storefront window that will display how many beds are available throughout the system.

3.       Staff on site would make every reasonable effort to greet this person by name whenever they see each other at or near this storefront. 

4.    A staff member would be available outside the storefront chatting with people letting them know what this is all about and building relationships and trust.  

5.    Partnering with the Kensington Storefront and Prevention Point employees/volunteers with their already established community connections would prove very worthwhile. 


As referenced above, staff would know the availability of beds throughout the city and suburbs for patients reliant on Medicaid.  There would be in the window a continuously updated bed availability sign.  Bed availability would already be a known factor.

1.       Philadelphia based Medicaid and that of the suburbs require two different processes for admission to detox.  The staff of this storefront would understand these differences and provide services accordingly.  It would not be a requirement of a Philadelphia based Medicaid patient to go to a crisis center for this process.  This storefront would meet this requirement.

2.       One of the delays for a Medicaid reliant patient in a crisis center is the process of that center's staff calling around to find a bed.  This can take many hours.  Having a system in place where bed availability is a known factor would greatly reduce this waiting time and eliminate experiences as related to me in this blog.

3.       Patients with private insurance would enter the private insurance health care system.  

An expedited registration system would be in place so that a person can be evaluated.  

1.       If there are no additional medical conditions to be dealt with prior to admission to the detox facility, the person would be registered and taken by designated car service to the facility that will be detoxing the patient.  Every reasonable effort will be prearranged with local facilities to streamline the "warm handoff" process between the storefront and the facility, therefore, greatly reducing the wait time between initial intake and the first steps of detox care.

2.       If the patient needs medical evaluation, they will be taken by this same car service to a hospital that has agreed to take these patients and WILL treat them with dignity and respect.[1] 

3.       If at all possible, the driver will wait with the patient and transport them to the awaiting detox facility upon medical clearance.  There would be no need to come back to the storefront.

4.       If the patient needs to be admitted, this hospital WILL assure (through prior established agreement) that comfort care for all detox/dope sickness related symptoms are promptly and completely addressed to the fullest extent medically possible simultaneous with medical interventions specifically associated with the direct reason for admission.  Here is a blog that looks at this issue of treating the primary reason for hospital admission and not treating symptoms of dope sickness.  It is titled "Damaged Determination."

5.      In the event that this patient needs a multiday admission, representatives from this storefront will call and/or visit the patient each day to offer encouragement and address any issues that the person identifies - therefore serving as their advocate during this time of medical provision prior to entry into an actual detox facility.  All clearances related to HIPPA will be appropriately addressed so as to assure that this storefront representative can freely discuss the patient's situation with representatives of the hospital.


Patients of Substance Use Disorder who are reliant on Medicaid for their detox/rehab needs are incredibly underserved, neglected and, on occasion, verbally abused by a system of health care staffed by professionals who had dedicated their careers to the ideals of Hippocrates.  It is WAY past time for us who love these street bound patients of Substance Use Disorder to identify new ways to serve them and save their lives.  In so doing, we will greatly reduce[2] suffering and the tragedy of overdose, reunite families, and slow the increase in the population of orphans created by this ongoing tragedy.

Calming the storm of the clash of the warm air of private insurance with the cold air of Medicaid is a very viable way to bring further healing to this population of people who have a great desire for healing and no significant professional support for achieving it.

Let us fine-tune and further develop this proposal and make it happen!



[1] Episcopal Hospital has such a bad reputation among this population of people that arranging with some other hospital would prove adventitious.

[2] Sadly, never totally eliminate

Tuesday, January 19, 2021

The people on the streets of Kensington are not nor have they ever been nor will they ever be 'zombies.' The people on the streets of Kensington are inspirational human beings made in the image of God and are worthy of dignity, honor, respect and love.

Our dear friends on the streets of Kensington endure many inappropriate and derogatory titles from people who know no better and take no time to better understand what's going on in that person's world.  I won't repeat any of these titles here with the exception of the one I'd like to address in this blog:

 Zombie

According to Wikipedia, A zombie is a mythical dead person who has returned to life as a walking corpse. Mythical things that have been "re-animated" are called undead, and a group of them can be called the living dead. The Zombie myth came from the Caribbean.

To the stigma focused eye of a person traveling down Kensington Avenue, the men and women of the streets might seem to be zombie-like with their mannerisms and behaviors.  "Dipping" is not the behavior of a zombie.  It is the evidence of being high in an addiction, (more properly known as Substance Use Disorder), that has no easy way of escape.

Incoherence to the world around them, wobbling rather than walking, laying on the sidewalk in all kinds of obviously uncomfortable positions, uncontrollable drooling,…  These are some of the outward behaviors that lead the stigma focused onlooker to refer to these men and women as "zombies." Without getting out of the car to actually meet one of these people, the idea of them being "zombies" will only continue. 

By taking the time to step out of your car and comfort zone and talk to one of these people, you will discover that the person of your displeasure is actually a real person who had a real childhood and who lives in their adulthood with hopes, feelings, and dreams for the future.

Rather than explain this point further, allow me to reintroduce you to "Melanie."  In this blog written on July 27, 2018, you will see misconstrued behaviors of a 'zombie.'  Look closer.  Read about her embarrassment in front of 'Dad,' her desire to dress beautifully, her love of McDonald's and chocolate milkshakes, and having her hair brushed while watching Saturday morning cartoons. 

"Melanie" represents hundreds of other people on the streets of Kensington who are not nor have ever been nor will ever be 'zombies.'

"Melanie" represents hundreds of other people on the streets of Kensington who are inspirational human beings made in the image of God and who are worthy of dignity, honor, respect, and love.

P.S.:  With the judicial system and the Medicaid level medical system having failed her miserably, Melanie remains on the streets 2.5 years after I wrote the blog titled:  "Before The demon Came Calling….