Drug vs Detox: A Civil War in the Mind

With lazar focus and his eyes on detox, rehab, and reclaiming the joys of pre-substance use life, he called me at 6:00am.  We developed a plan for me to pick him up and take him to a specific detox facility.  The people there are wonderful.  They care like no others I've encountered in other Medicaid level health care facilities. In a perfectly reasonable time frame, he was greeted, interviewed, given a basic medical exam, and offered a detox bed right then and there.  Each step along the way was awash in dignity and respect for this child of God.  I was thoroughly impressed![1]

There was one minor medical issue that needed further review and so we went to the nearest emergency room.  The R.N. at the detox assured us that this issue was nothing that would prevent this young man from coming back for the beginnings of his detox experience. 

The hospital staff was great.  Within a couple hours, we were heading back to the detox facility.  Final admissions paperwork was completed and within a few minutes this young man, still laser-focused on detox, ascended the steps at 6:00pm for the beginnings of his whole new life.

At 9:00am the following morning, this laser-focused child of God called me from his cell phone.  I knew right away what he was going to say.  

"I left and am already home." 

He told me that he was given no comfort care through the night as his fears and feelings of dope sickness[2] were growing and so he had to leave to find his own 'medicine' and bring comfort back to his being. 

***** 

This issue of signing out of detox or even the intake process itself is an all too common issue that is literally leading to the deaths of thousands of people each year.  

Why? 

The human brain in that moment of decision for detox is in something resembling a civil war.  One side[3] of the brain wants healing while the other side wants drug.  Each side of the brain has its own artillery to fight this battle in the brain.  

The side of the person's brain that wants detox and healing has the determination of the person with that brain and the expertise of medical professionals who have committed their careers to the ideals of Hippocrates.  

The side of the person's brain that wants the drug has knowledge of the extended orgasmic nature of a "good high" and knowledge of how unpleasant and painful dope sickness can be. 

While this person waits for hours during the intake process or for hours through the night for the doctor to return the next morning so as to prescribe suitable comfort care medications, thoughts of that "good high" which will bring relief from growing dope sickness take over.  The civil war in the brain is being won by the side that wants the drug.  Determination for detox is beginning to lose the battle. 

As dope sickness grows and determination for detox fades, the side of the brain seeking the drug reminds the person of the final piece of its artillery that is needed to win this civil war in the mind.[4]  This side of the brain reminds the person that they can leave the facility and for only $5.00 they can buy a blue packet and inject its contents.  The "good high" will be found and even if the high is not all that "good," this injection will end dope sickness for the time being.  That's all that matters in this civil war of the mind. 

Sometimes pictures help us understand the issue. 

Here are pictures[5] of three facilities within Philadelphia that provide Medicaid level health care to patients of Substance Use Disorder who are seeking detox: 

Gaudenzia: 

Kirkbride: 

The Net: 

These buildings house all of the medical wherewithal and employ the medical personnel who have committed their careers to the ideals of Hippocrates that is needed to provide detox and rehab.  These great buildings and those who work within are up against a mighty enemy: 

The Little Blue Packet:  

Barely the size of a couple of pennies placed side by side, these little blue packets contain within them all the artillery that is needed to win the battle of the mind in favor of the drug. When the medical professionals[6] fail to provide prompt and dignified care to that patient with Substance Use Disorder who has come to them for detox and rehab they allow the little blue packet to win the battle.[7] 

It is way past time for the medical professionals and all persons in positions of policymaking to put their minds together to further develop their artillery.  

Little blue packets are the artillery for continuing addiction in this civil war.  Little blue packets can't think on their own.  All they have to offer is their presence on the battlefield of this mental civil war.      

Medical professionals are the artillery to interrupt addiction in this civil war.  Medical professionals can think on their own.  Medical professionals can determine to strengthen their artillery and in so doing help their patients of Substance Use Disorder win this civil war of their mind and find healing.                                                                                                                                           

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[1] Please contact me privately if you'd like to know exactly where we went.

[2] Symptoms of dope sickness – and their intensity – can vary by person, the drug of choice, and the amount of drugs used on a regular basis. However, common signs of dope sickness include Nausea, vomiting, diarrhea and/or constipation, Loss of appetite/huge return of appetite, Hot and cold flashes, muscle aches and spasms, The sensation of bugs crawling on or under the skin, Hyper-awareness, Dry mouth, Headaches, Insomnia, and Sweating.  These physical effects are often accompanied by mental and emotional symptoms. Those who are dope sick may also experience: Agitation, Anxiety, Paranoia, Frustration, Depression, Despondency 

[3] Not literally 'side' as in right vs. left.

[4] and end all prospects for detox on this day and maybe forever if an overdose is found first

[5] From Google Maps Street View

[6] who have committed themselves to the ideals of Hippocrates

[7] And the war if an overdose is found before determination for detox is found again

Substance Use Disorder is a disease process like no other. It does not fit neatly inside a box labeled "Diseases people can get."

When a person has a cold[1], that person has symptoms of that disease process.  That person will probably take some medicine that will reduce or completely wipe out whatever is going on inside them.  The cold gets neutralized in some way by the medicine and the person feels better. 

Almost always, the person is instructed to take their medicine once every four hours.  If they don't follow the instructions to take their medicine this way, the cold starts to take over again and those horrible symptoms come back making the patient feel crappy.  The virus that is causing the cold is present in the body of the patient and the medicine alleviates the discomfort and eventually evicts or kills the virus.  The absence of medicine allows the virus to build back up and continue creating symptoms.  

Substance Use Disorder is similar and yet completely backward from this model of disease.  In the absence of their 'medicine,' the person dealing with Substance Use Disorder will have horrible symptoms.  They take their 'medicine' approximately every four hours (at a minimum) so as to avoid these symptoms.  In this sense, Substance Use Disorder has the characteristics of a cold.

The presence of Substance Use Disorder in a person is not the same as the presence of a virus that causes a cold.  There is no virus that causes Substance Use Disorder and yet to not take one's 'medicine' is to, without exception, invite withdraw symptoms to come back and create discomfort beyond the wildest imaginations of those of us who have never experienced them.

With Substance Use Disorder, it is not the presence of the virus that causes the discomfort that is eliminated by the consumption of the medicine.

With Substance Use Disorder, it is the absence of the medicine that causes the discomfort that is eliminated by the consumption of the medicine.

But wait…

Maybe, just maybe…  

Is it possible that the "virus" does exist but not within the standard definition of virus[2]?  Could it be that the "virus" in the Substance Use Disorder patient IS:

• the generational continuance that is often seen
• the agony to the soul created by that family member who knew this patient in their childhood in a way that no adult should ever know a child?
• the family tragedy that pushed this person to find an emotional pain killer.
• Etc…

If we as a larger society could begin to see the consumption of their 'medicine' by the person with Substance Use Disorder as exactly that - consuming their medicine so as to eliminate the symptoms of their virus - and stop adding stigma, then maybe, just maybe we could open our hearts, honor our Hippocratic Oaths and find the solutions to eliminate this outside the box virus from the patient and bring healing once and for all.

**********

For the record, I am not a medical expert by any means.  This blog is my humble interpretation of observations I've made during my few years of serving to the best of my ability on the streets of Kensington (a community in Philadelphia, Pennsylvania).

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[1] a viral infection of the nose, throat, and bronchial tubes, characterized by sneezing, nasal congestion, coughing, and headaches

[2] a submicroscopic parasitic particle of a nucleic acid surrounded by a protein that can only replicate within a host cell. Viruses are not considered to be independent living organisms.

Melanie Walking Alone and Looking Lonely

In the past few weeks, as I was driving down a particular street in Kensington in my luxury vehicle provided by Recovery Centers of America where I am employed as a driver, I was about to pick up a person who has private insurance and wanted to be done with his Substance Use Disorder issues. 

As I was driving, I saw Melanie walking alone and looking lonely.  I so much wanted to stop and spend a bit of time with her to let her know she's loved and cared for.  The only thing that stopped me was the lack of parking and the long line of cars already stacked up behind me. 

And so, I drove on to meet this person who had called 1-800-RECOVERY a few hours earlier, had his[1] insurance cleared and scheduled a time to be picked up at an address of his choosing.  As I did so, I thought about Melanie:

• the times we had chatted on these same streets and under bridges and in my car as we dined at McDonald's
• as we sat side by side in the visitor's area at the woman's jail while she, as a patient of Substance Use Disorder, sat next to me in her one-piece orange jumpsuit as a prisoner of the city and developed a plan for her future.
• the time I spoke under oath on her behalf at one of her court sessions
• and more.

When I arrived at the address that this new (potential) RCA patient had requested for pickup, we saw each other.  He looked at me and stated that since it was "Banana Man" picking him up, he would go even though he was hesitant to do so.[2]  And so, off we went toward RCA and the high-quality care that comes with private insurance detox and rehab.

As I write this blog, this private insurance patient of Substance Use Disorder has gone through the process of rediscovering life on a healthy path.  Melanie, also a patient of Substance Use Disorder but reliant on Medicaid for her detox and rehab is trying to be found on the streets of Kensington by her caseworker who has some exciting news...

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[1] As a way of further adding anonymity and privacy in my blogs, pronouns (his/her, etc.) are very often switched up.  This story, while very real, may or may not be about a man who I brought to RCA.

[2] Our paths had crossed only a bit at some point in the past.  This person was not one of my "regulars" but I did recognize him as having seen him before.

43 Minutes

In my blog Song Sheets and Pop-Top Lids…, I shared with you the results of resources given to me to benefit the people of Kensington.  This theme continued yesterday (Sunday, December 13, 2020) partly involving these exact items and also the gifts of prepared dinners that I witnessed being distributed by an outreach group.

I had parked my car at the corner of Kensington and Somerset, pulled my cooler with its water, bananas, song sheets, and several items from the food cupboard out of my trunk.  As I strolled down "The Ave" as it's called, I walked past a pickup truck.  The back hatch was down and being used as a table as several people were distributing premade hot meals in black bowls with tight-fitting lids.  I continued to visit the people along that block that includes Martin's Deli (home of the best bacon cheeseburger I've ever had) and eventually made my way back to my Nisan Altima.  I sat on the back bumper with the trunk opened and that's when it happened…

A man, perhaps in his forties, walked up to me and opened his paper bag so I could give him two bottles of water at his request.  He showed me the two black bowled chicken, rice, and corn dinners that were at the bottom of that brown paper bag.  He then said this with a tear of thankfulness running down his cheek… 

                        "My son and I will be able to have Sunday dinner together today."

As I sit here writing this blog, from my desk, I'm looking out my living room window.  In front of me is the Concordville Inn and a sign that references their "Sunday Brunch."  Sunday brunch at the Concordville Inn is a glamorous experience with the fanciest of all possible breakfast (and more) related items. 

The Concordville Inn's Sunday brunch is a common post-church destination for many of the suburban faithful here in the Glen Mills area.  After attending church those who can afford the prices of this lunch occasionally make their way to this feast.

Why do I tell you about the Concordville Inn's Sunday Brunch and the tearful man with the two chicken dinners who is happy to know that he and his son will be able to have dinner together on this one day?

Here's why…

This morning, our drive from one point to the other is 43 minutes and a psychological world away… 

It's high time that those of us in the suburbs recognize that the mission field, the land of hunger and suffering is not far away.  Kensington is a community of homeless Substance Use Disorder patients AND deeply impoverished homeowners/renters AND blessings beyond your wildest imagination.  I invite you to consider making the drive to meet the people who - I guarantee you - will awaken your heart for the anguish of the suffering forever.

**********

For further reading on this topic of outreach, I invite you to read my recent blog: 

Start Right Here In The Name of Jesus

Song Sheets and Pop-Top Lids…

In the past couple of weeks, I've had two suburban blessings of material items and supplies come my way in support of my efforts in Kensington. The first was/is from an individual who has taken it upon herself to do some fundraising and item gathering.  Out of this has already come one printer cartridge and 1,500 sheets of 8.5x11 paper for the song sheets that I distribute.

The second is a local church here in Delaware County that has opened their food cupboard to me for items that I can take with me. I'm focusing on non-perishable canned goods with pop-top lids. 

Oh, dear…  This was supposed to be a short post and yet I'm slipping into blog mode… 

Song Sheets and Pop-Top Lids… 

30 minutes from your Delaware County home address, a grown man and businessman by college degree drowns out the agony of losing his wife and children to an unspeakable tragedy by consuming an emotional pain killer that he buys multiple times each day on a street corner.  I gave him a song sheet, printed with your donated ink and paper that dared to tell him that he's an inspirational human being made in the image of God and worthy of dignity, honor, respect, and love… 

30 minutes from your Delaware County home address, a grown woman and former neurosurgeon intern hops out of a car having completed her most recent of  'dates' and pops the lid on that cold can of Campbell's Chunky soup and consumes it as the first food she's eaten in two days. 

Now I'll admit that these two examples are compilations of real life experiences that I've had and yet, please know this…  Your donated ink and paper… Your donated pop-top soups…  Both feed the souls and bodies of people who are inspirational human beings made in the image of God and worthy of dignity, honor, respect, and love.  

Neither of these and None of the hundreds on the streets of Kensington who these two represent WANT to be where they are.  Song Sheets and soups with pop-top lids are vitally important in feeding souls and bodies.  Just as important are the desperately needed policy and procedural changes that MUST be determined and initiated by the powers that be within societal leadership.  

The people currently trapped on the streets of Kensington by an incompetent Medicaid system of health care provision are 'us' not 'them' or 'they.'  We can eliminate a lot of our unnecessary agony by plowing down Medicaid Mountain.  In so doing, that businessman can get back to business and that intern can find her way back to surgery. 

Song Sheets, Pop-Top Lids and Medicaid Policy and Procedural Changes…

Start Right Here In The Name of Jesus

Start Right Here

Song by Casting Crowns 

We want our coffee in the lobby
We watch our worship on a screen
We got a Rockstar preacher
Who won't wake us from our dreams
We want our blessings in our pocket

We keep our missions overseas
But for the hurting in our cities
Would we even cross the street? 

Huh but we wanna see the heart set free and the tyrants kneel
The walls fall down and our land be healed
But church…  If we want to see a change in the world out there

It's got to start right here
It's got to start right now
Lord, I'm starting right here
Lord, I'm starting right now 

I'm like the brother of the prodigal
Who turned his nose and puffed his chest
He didn't run off like his brother
But his soul was just as dead
What if the church on Sunday
Was still the church on Monday too?
What if we came down from our towers
And walked a mile in someone's shoes? 

Hmm 'cause we wanna see the heart set free and the tyrants kneel
The walls fall down and our land be healed
But church if we want to see a change in the world out there 

It's got to start right here
It's got to start right now
Lord, I'm starting right here
Lord, I'm starting right now 

We're the people who are called by His name
If we'll surrender all our pride and turn from our ways
He will hear from Heaven and forgive our sin
He will heal our land but it starts right here
We're the people who are called by His name
If we'll surrender all our pride and turn from our ways
He will hear from Heaven and forgive our sin
He will heal our land 

It's got to start right here
It's got to start right now
Lord, I'm starting right here
Lord, I'm starting right now
It's got to start right here
It's got to start right now
Lord, I'm starting right here
Lord, I'm starting right now

Source: LyricFind

Songwriters: Mark John Hall / Bernie Herms / Seth David Mosley / Matthew Joseph West

Start Right Here lyrics © Kobalt Music Publishing Ltd.

 

Do you see those larger letters in the song lyrics?  Therein lies the topic of this blog… 

We keep our missions overseas
But for the hurting in our cities
Would we even cross the street? 

If there's anything I've come to understand about the church of the suburbs, it's this… 

You do prefer that your missions are somewhere 'oversees' or at least not so close that you can drive there in under an hour.  You are not willing to drive up a highway and get to know those people who used to live in your suburban neighborhood and are now trapped on the streets of Kensington by active Substance Use Disorder and homelessness because to do so would, well, you fill in the blank… 

I grew up in your suburbs…  You've forgotten me and that I still live in your suburbs…  Two or three days each week, I visit Kensington and sit with our misplaced neighbors.  Even in the absence of their[1] daily shower, as they sink into their 'high,' they are a joy to sit with as they share their lives with me.  

It's a joy that I can't explain.  It's not a happy joy like being at a suburban birthday party.  It's a joy in knowing that this person knows that someone cares and loves them for who they are: an inspirational human being made in the image of God and worthy of dignity, honor, respect, and love. 

There's a deep pain in this joy that I'll try to explain here by combining stories that I've already shared with you in their individual pieces… 

Imagine if you can, sitting on a Kensington sidewalk celebrating the birthday of a young woman who used to attend NA meetings in your suburban church building.  Before focusing on the celebration of her birthday, she MUST give herself an injection of her 'medicine' so as not to be dope sick during the party.  Getting her 'medicine' today was extra challenging as she, a few hours earlier, had no money.  She stood on a street corner and waited to be picked up by some unknown to her 'man', provide him with sexual services, get paid and then buy what she needed.  Here's a quote from such a setting: 

"One was an important lawyer who picked me up in his Cadillac, took me to a center city hotel, tied me to the bed, had his way with me, got dressed, untied me and left the room.  I had to use some of the money he gave me for public transit just to get back here to buy my medicine."   

Only after injecting herself with heroin and as she started to 'dip' in her high could this birthday girl focus on her party as the corner dealer looked on in confusion as to why the white guy (me) was sitting on his section of sidewalk… 

I'm not sharing this with you to build me up in any way.  God knows I've been told by many a professional pastor that I have nothing to offer in actual ministry.  I tell you this so that you know that within one hour of where you are sitting and reading this blog, there are your actual, and factual, and real and former and now misplaced neighbors waiting and wanting to be loved by you: a representative of God's Church in the Name of Jesus. 

Join me some time…

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[1] As I use the words "Their" and "they" please know that "They" are NOT "they" but rather extensions of "us."

Dear Mom and Dad, …A Letter That Touched Souls

Every once in a while, I find a writing, something other than a song to hand out as part of my 'song sheet' collection.  The following letter which was written by Lorelie Rozzano[1] is one such example.  But before you read the letter itself, allow me to set the scene...

With the trunk lid open as I sat on the back bumper of my aging Nissan Altima at the intersection of Kensington and Somerset (Click on the link in the footnote to see the exact location in Google Maps[2]), a man, a bit older than most addicted patients of Substance Use Disorder who live in Kensington rode up to me on his old Schwinn Bike.  He asked for my usual stuff: bananas, water, and a song sheet.  I told him that along with my typical song sheet, I had a second handout, a letter written to Mom and Dad from the perspective of a person who did not survive an overdose.  He accepted it and began to read right then and there.  Tears started to flow from this man.  He stopped reading wiped his eyes and cheeks as he said he would need to finish the rest when he got home because he didn't want to be crying out in the street.

An hour or so later, a woman accepted the letter, saw "Dear Mom and Dad," at the top, and started to shake with whatever emotion was trying to break free from within her soul.  "I'll definitely read this later." She told me. 

Another hour passed.  By now I was outside Prevention Point.  She called out to me.  "Banana Man!"[3]  I turned around and found her sitting on the step right here (Follow the link in this footnote.[4]), noticeably emotional over what she was reading.  "I don't recall her exact words but I know that her heart was being touched in some way specific to her life journey.

In all, I handed out about forty of these letters.  If such a letter touches the soul of any person trapped in addiction and homelessness and inspires them to consider a new path, so be it.  We cannot force anyone to stop using their substances.  That decision must come from them when they are ready.  We can touch souls and in so doing connect to the healing that is silently begging to burst forth and begin the process of creating a new life.

Here's the letter:

Dear Mom and Dad,

Words can’t begin to describe how sorry I am.  I’ve put you in a position that no parent should ever face.  I left – before you.  It wasn’t supposed to be this way.  The natural order of things was skewed by my addiction.  I can only imagine the agony you must be in.  I know you’re angry, enraged, and sad, all at the same time.  If only you could reach back in time and pluck me from the path I’d chosen, but you can’t.  You never could.  God knows, you tried.  I wasn’t completely oblivious, to all that was being done for me.  I always believed I had time and the truth is – I was too dammed smart for my own good.

I underestimated the power of my disease.

I know you tried to tell me this.  But I wouldn’t listen.  After I began using drugs I became desensitized.  I thought I was immortal.  I liked living on the edge.  I felt so alive!  Drugs filled a place in me that nothing else could.  With them I was King.  Without them, I was just, well, me.

Maybe that was part of the problem.

I never did feel right, about being me.  I always needed something more.  At first, it was candy, and then video games and eventually, teenage love.  I idolized money.  I felt entitled to nice clothes and nice things.  I wanted the best.  I hated waiting for anything.  When I wanted something, it was all I could think about – until I got it, and then, I wanted something else.  There were times I felt guilty for the stress I created in our family.  But it was fleeting.  The burning need inside of me was stronger than anything else.  This need had no conscience, integrity, or morals.

This need – was my addiction.

I know I hurt you.  I rejected your love.  I rolled my eyes at you.  I called you names.  I stole from you.  I lied to you.  I avoided you and finally, I left you – for good.

I was so smug.

There wasn’t anything you could have said, or done, to prevent this from happening.  I thought I knew it all.  Death by overdose was something that happened to other people: Foolish people – people who didn’t know shit about using.  It wasn’t going to happen to me, no way, no how, not ever.

You begged me to stop.  I tuned you out.  Your words were like angry wasps in my ears.  Although they stung, they were nothing more than an annoying buzz.  When you cried, I cringed.  When you put your arms around me.  I wanted, away from you.    And now – I want back.

But there is no back. There is only forward.

Please bring me forward.  Tell my story.  Say my name.  Have conversations with me.  Include me in your celebrations.  Rejoice in the time we had together.  Cry, if you must, but not all the time.  I know you’re sad.  I know you miss me.  I know you love me.  I know you did your best.  But you were never stronger than the disease of addiction, and sadly, neither was I.

Please don’t blame yourself, or me.  It will only make things worse.  We all did the best we could.  You must believe this.  If you don’t, it will be like me dying all over again, each and every, day.  We will all stay stuck and that would be a tragedy.

I hope you take all the love you have for me, and put it into the rest of our family.  Every time you want to hug me, grab one of them.  Then it will be like I’m part of the hug.  Give them a great big squeeze and I promise, I’ll feel it, all the way up in heaven.

May you find peace in knowing I’m free, in a way, I never before was.  Up here, there is no addiction. There is only love, the kind of love that is greater than any of us will ever know, below.

You might tell yourself that I am gone. But you’re wrong. I’m right here.  I’m the wind on your face, and the stars in the sky.  I’m the raindrops, falling, outside your window.  I’m the song of a bird and the dawn of each new morning. I’m the rustle of a leaf. I’m the clouds and the sun, and the waves in the ocean.

We will never be truly be parted from one another.  For love breathes life, even, in death.

I am the flesh of your flesh.  Standstill – and you will feel me.

Love, Your Child This Day and Always...

 

Adapted from a writing by Lorelie Rozzano

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[1] and adapted by me only to take out the male gender-specific pronouns and references and therefore make it apply to everyone. 

[2] https://www.google.com/maps/@39.9914644,-75.1227573,3a,75y,21.74h,81.5t/data=!3m7!1e1!3m5!1s4cxyGqRkxiVbE-MZDRkbKQ!2e0!6s%2F%2Fgeo1.ggpht.com%2Fcbk%3Fpanoid%3D4cxyGqRkxiVbE-MZDRkbKQ%26output%3Dthumbnail%26cb_client%3Dmaps_sv.tactile.gps%26thumb%3D2%26w%3D203%26h%3D100%26yaw%3D260.5186%26pitch%3D0%26thumbfov%3D100!7i16384!8i8192?hl=en&authuser=0

[3] For those who don't know, I've been handing out bananas as I do what I do in Kensington.  Soft fruit was requested by these wonderful people four years ago when I started doing this.  I kept bringing bananas with every visit.  One day, a man on the street called out "Here comes "Banana Man!"  The name stuck…  J

[4] https://www.google.com/maps/@39.9926312,-75.1193125,3a,18.8y,25.25h,87.42t/data=!3m6!1e1!3m4!1sknG0gnvvhWvv5kjiYRGN8w!2e0!7i16384!8i8192

24 Hours

Nearly every day as a driver with Recovery Centers of America (RCA), I have the privilege of bringing in for detox and rehab a person who has decided enough is enough.  They want to be done with their substance use.  They want to heal and to reclaim life as they once knew it.

More often than not, this person will have consumed their substance just prior to getting in my company car so as to be comfortable for the trip.  Withdraw is nothing to smile at and they don't want to be going through it on the ride to RCA.

On rare occasion, I have brought in a person who had decided 24 hours earlier that they would no longer consume their substance.  For this discussion, I'm going to focus on patients with Substance Use Disorder who use heroin.  "Dope sickness" is the term for what patients experience when withdrawing from heroin use.  Here's some of what they go through…

The Symptoms of Withdrawal

Symptoms of dope sickness – and their intensity – can vary by person, the drug of choice, and the amount of drugs used on a regular basis. However, common signs of dope sickness include: 

Nausea, vomiting, diarrhea and/or constipation

Loss of appetite/huge return of appetite

Hot and cold flashes

Muscle aches and spasms

The sensation of bugs crawling on or under the skin

Hyper-awareness

Dry mouth

Headaches

Insomnia

Sweating

These physical effects are often accompanied by mental and emotional symptoms. Those who are dope sick may also experience: 

Agitation

Anxiety

Paranoia

Frustration

Depression

Despondency 

When a person I've just picked up tells me that they are dope sick, I call ahead and inform my coworkers in admissions that we will be arriving at a particular time and to please have nursing personnel at the door so as to alleviate our new patients' suffering as quickly and as much as possible upon arrival.  As with any illness or injury, total alleviation of suffering is not possible but much can be done to alleviate the worst of the pain and discomfort. 

These nurses are fulfilling their role as they declared to do when they took their Hippocratic Oath at the beginning of their careers.  Here's a modern version of that oath: (Red wording is most relevant to this discussion.)

Hippocratic Oath: Modern Version 

I swear to fulfill, to the best of my ability and judgment, this covenant: 

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. 

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. 

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. 

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. 

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. 

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems if I am to care adequately for the sick. 

I will prevent disease whenever I can, for prevention is preferable to cure. 

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. 

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. 

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

********** 

Such is not the case for patients with 

Substance Use Disorder 

who live on the streets of Kensington.  

Nearly all of these people are reliant on Medicaid and the Medicaid based system of health care provision for their alleviation of pain and suffering and reclaiming life. 

It occasionally happens to the people on the streets that they don't have the money to buy their "medicine" and end up going 24 hours very unintentionally without it.  Sources of income vary and all have periods when they are not as lucrative.  Examples include: 

• Standing on a street corner with a cardboard sign…
• Hauling metal to the local junk yard for cash
• Trash picking and selling the items on the street
• Shoplifting and selling the items on the street
• Relying on your regulars with whom to do a "date"
• Standing on a street corner in hopes that some guy will want to do a "date" with you.
• Asking for money from family and non-street bound friends 

These people will not be picked up in a company car and brought to an awaiting nurse for their nearly immediate alleviation of pain and suffering. 

Here is a firsthand account of an all too familiar scenario at the intersection of Substance Use Disorder and Medicaid: 

I have personally been to several crisis centers in Philadelphia. A few months ago, I went to one and sat for about 13 hours in a waiting room so very sick shaking and sweating and vomiting everywhere and all for them to come out and tell me that there were no beds and said to come back the next day to try again. 

Mind you I was very very sick and when they told me that, I asked them what should I do as I was laying on their bathroom floor vomiting everywhere and it looked like someone had sprayed a hose on me because I was dripping wet. My clothes were soaked and I was flopping on the floor like a fish out of water. 

The doctor said to me "I don't know what to do." She said she cannot give me anything because I am not admitted and there are no beds. So they asked me where would I like to go to because they will call a cab for me. As I was waiting for the cab, security and a nurse came outside to me and asked me what I was doing and I said "You told me you are calling a cab." The nurse said, "We did not call one and you have to get off of the property!" 

Mind you I had no money and I was so sick so I ended up walking to the EL. The SEPTA personnel told me I cannot go through without money and I told them that I just came from the hospital. I showed them paperwork and they still said "No" so I ended up jumping the train and the SEPTA personnel hit the alarm! 

So thank God the train came before any cops got there so I was fine. As I was on the train I dropped to the floor and had a seizure. When I woke up people were standing around me and they were waiting for the ambulance but I jumped up and said no and got back on the next train and got off at Somerset station and had to find a way to get well... 

My experience that day with the crisis center made me so sick to my stomach thinking that I really wanted to get clean and I really wanted help and nobody helped. 

 **********

RCA and similar private insurance facilities are modeling for all of us what health care providers to patients of Substance Use Disorder should be doing.  Patients in these places are treated with dignity and respect.  They are warmly greeted at the door upon arrival.  The process of healing begins right away. 

The person who decided 24 hours prior to getting into my company car that they would never use again and the street bound person who is unintentionally in that same 24 hour period unable to buy their "medicine" are equally human.  Neither is better than the other.  All or worthy of dignity and respect.  

24 Hours