Imagine the following scenario:
Heroin usage has you locked into your current lifestyle not so much for the 'high' that you once really enjoyed and virtually never comes to visit anymore but rather for the avoidance of dope sickness. You know that you must keep injecting heroin or face the consequences.
To keep consuming, you've got to keep earning money. As a woman, your only available option that can produce the needed funds in a relatively short period of time is to provide sexual services to men who pick you up. Prior to the first time this guy picks you up, you did not have any knowledge of his existence on this earth. He's a total stranger to you.
Before there is any discussion of what he's hoping for from you, you check to be sure he's not an undercover police officer. Undercover police are not permitted to do or allow certain interactions in the course of their work. You've learned that the best way to be sure he's not a cop is to ask him if you can kiss him - well let's just say - on a part of his anatomy that should never receive a first kiss from any woman.
Once you're fairly sure that he's not a cop, and following a tiny bit of negotiation on your price for the requested services, you are driven to a secluded street where you provide those services in the front or back seat of his car. You might be taken to a local hotel or not so local hotel for an extended version of the same.
If all goes 'well' he will take you back and release you where he found you and you're free to go buy your drugs, inject your drugs, avoid your impending dope sickness and then start the process all over again. There's no schedule for this. It can be 24/7/365.
If all goes 'well'…
What could go wrong?
I'm trying to avoid the graphic descriptions that I've heard as I describe the following:
I've spoken to women who have agreed to a 'lesser' level of sexual service only to have far more forced on them. Even in the context of 'willingly' providing a sexual service, this non-agreed to and uninvited additional activity is considered rape. Rape in this context goes unreported for obvious reasons.
I've spoken to women who have learned how to escape from a moving car by pulling the door handle, shoving the door open and then rolling out so as to avoid the knife that's just been pulled on them.
Now imagine this: You finished providing full sexual services in the back seat of a car to this guy who a very short time ago you did not even know existed. You had been paid in advance to fulfill his desires. Just before getting out of his car, he pulls a gun on you and demands that you give him his money back or he will kill you. You comply and he releases you. You run in fear with tears streaming down your face to a couple of other women you see who are looking for their own dates. After some time to regroup your thoughts and clean up any hint that you've been crying, you're realizing that dope sickness delays for no one. You go back to your preferred street corner and start the process all over again… Assault with a deadly weapon in this context goes unreported for obvious reasons.
The quickest path to healing for a Medicaid-reliant patient with Substance Use Disorder does not involve going to a clinic or crisis center. The quickest path to healing from dope sickness involves one thing: the injection of heroin. To inject, you must buy. To buy, you must 'do a date.' To do a date, you must face the possibility of rape, knives and guns.
The Medicaid system of health care provision to its patients with Substance Use Disorder MUST review every aspect of how it does what it does. It MUST identify EVERY part of its process that creates a longer path to permanent healing than that path of 'doing a date' at the risk of rape, knives and guns that leads to temporary healing.
For further reading on this subject, I invite you to read this recent blog: "What keeps you from going to detox?"
 I'm sticking with the word 'heroin' while recognizing that the contents of those tiny blue packets is rarely just heroin.
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