When we speak of the addiction crisis, the conversation often focuses on willpower, drugs, or detox beds. But for magnificent human beings battling substance use disorder (SUD) on the streets, the greatest hurdle is not the drug itself. It is the agonizing choice between the known suffering of addiction and the terrifying, often compounding, pain of seeking professional help.
The reality is tragically simple: many individuals intellectually know they want a better life, but the detox process is so brutally painful, and the care they receive so often devoid of dignity, that choosing to remain on the street feels like the only rational act of self-preservation.
1. The Agony of the Rational Choice
Imagine a young woman, deep in the cycle of addiction, who gathers every ounce of courage to seek medical help. After hours of waiting—six, seven, eight hours—the agony of acute withdrawal, or "dope sickness," begins to set in. She realizes the medical facility is failing to manage her symptoms or even see her in a timely manner.
In that moment of exquisite, unbearable physical pain, she faces a choice:
* Endure the unmanaged agony while being treated with contempt by medical staff, potentially for days, only to risk a traumatizing relapse within the facility.
* Leave and find temporary relief to survive, even if it means resorting to desperate measures, like prostitution, to pay for the substance she despises.
When the system cannot provide simple stabilization—like an anxiolytic to calm a terrified body and mind—it actively forces the vulnerable back to the streets. The choice is made not by a failure of will, but by a basic survival mechanism triggered by systemic neglect.
2. The Medical Nightmare: Unknown Withdrawal
This crisis is further complicated by the evolving nature of illicit drugs. Standard Medication-Assisted Treatment (MAT), such as buprenorphine for opioids, is often insufficient because the drugs consumed are increasingly unknown, complex, and synthetic. These polysubstance addictions create chaotic, unpredictable withdrawal syndromes that are profoundly frightening and often unaddressed by standard protocols.
For medical staff, this presents a diagnostic challenge; for the patient, it’s a living hell. The fear of this agonizing, unknown detox is entirely valid, and it is exponentially worse when combined with the certainty of dehumanization in the care setting.
3. The Systemic Betrayal: Dignity vs. Dollars
The final, and most heartbreaking, barrier is the quality of care available to those who rely on Medicaid.
As chronicled in painful detail by the journey of one former patient, the care at many Medicaid-level facilities tragically and repeatedly failed to provide the kindness, respect, and safety owed to every human being. The result is a toxic environment that actively reinforces the patient’s worst fears and feelings of worthlessness:
* The Financial Paradox: Private facilities with ample beds often charge $1,000–$2,000 per day, while Medicaid reimbursement is barely $200. This disparity creates a "Medicaid Mountain," where dignity is a product reserved for the privately insured. As past documentation has shown, individuals on the streets of some communities can earn more money from survival activities to fund their addiction in 24 hours than the system pays to save their life with dignity. This economic reality screams the message: your life is not worth the cost of compassionate care.
* The Dehumanization: Staff in these underfunded environments often lack trauma-informed training and resort to using derogatory labels, such as "junkie" or "whore." This verbal and emotional abuse transforms the healing space into a place of moral injury, where the very people sworn to "do no harm" become the primary source of emotional violence, eroding self-worth at the precise moment it is most needed for recovery.
4. When Systemic Failure Becomes Fatal
The consequences of this systemic cruelty are not theoretical; they are fatal. The record of one patient's attempts to seek care serves as a devastating catalogue of how the system kills hope and, ultimately, life:
* Medical Malpractice: This patient suffered precipitated withdrawal after being given necessary medication "far too early," a clear deviation from standard clinical practice that plunged her into agony, shattered her trust, and led to a desperate, immediate relapse.
* Unsafe Environments: She was subjected to physical assault and sexual exposure within a co-ed facility, where staff failed to protect her and later mocked her trauma.
* Negligent Discharge: In her final attempt at sobriety, after expressing commitment to care, she was administratively discharged to the curb in a state of crisis because she was deemed a "liability." She died shortly after being abandoned.
Every failure—from the denial of food for hours to the shaming language to the negligent removal—was an act of systemic betrayal that undermined her magnificent potential.
A Call for Dignity and Justice
This is not a cry for more facilities; it is a demand for a revolution in care.
These are magnificent human beings who deserve the highest dignity, honor, respect, and love. Our systems must reflect that truth.
We must advocate for:
* Timely, Symptomatic Care: Implementing rapid triage and evidence-based protocols in all emergency settings, ensuring immediate medication for acute withdrawal (Ativan, MAT, etc.) to stabilize the patient and preserve their window of opportunity.
* Increased Medicaid Reimbursement: Closing the financial gap is the only way to incentivize quality facilities to provide compassionate, safe, and effective care to every patient, regardless of their income.
* Mandatory Dignity Protocols: Instituting zero-tolerance policies for stigmatizing language and negligent discharges. Trauma-informed care must become the mandatory, baseline standard across all treatment facilities, recognizing that compassion is not an emotional luxury, but a medical necessity.
We must ensure that when a person gathers the monumental courage to seek help, they are met not with institutional abuse, but with the magnificent care their inherent worth demands.
