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

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

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.

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...