Therefore, it must be said that this 'opioid crisis' is fueled in part by a crisis of health care provision as provided by processes within the Medicaid system of health care. If this were not so, there would be a higher representative sample of Substance Use Disorder patients on these streets who are not getting detox/rehab and who do have private insurance.
Here is one among many actual accounts of a Substance Use Disorder patient trying to get help within the Medicaid system:
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 so 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.
It does not need to be this way.
The world of private insurance coverage provides the example of how this system can be and should be for the people on the streets. With private insurance, a person can decide that they have hit that point of being ready for detox. They call an 800 number and have their insurance cleared. They make arrangements for any co-pay that there may be and schedule their transportation courtesy of the detox/rehab facility. It is possible to be in that place before dope sickness or other symptoms of withdrawal begin to take hold.
I would urge the powers that be within our city at all levels and aspects of outreach to look at how the Medicaid system can be brought more in line with its private insurance counterpart. Doing so will save lives and greatly reduce the 'opioid crisis' as we know it.
For further reading, I invite you to my blog series that looks at this issue in more depth.
Thank you for reading.