Make Hippocrates proud of you!

Charles is a stubborn man in his upper 80s.  He lives alone in a ranch style house and gets around in a wheelchair that is leashed to his bedroom by a very long oxygen tube that often gets tangled as he rolls from room to room.

He's grumpy and never tells people anything about his health.  He's not interested nor ready to get help for a noticeable difficulty with breathing that started a few days ago.  Determined to keep going in his independence, his breathing shallows to the point that he gets dizzy upon any exertion.  Still determined to not call for help, he struggles to stand up to put on his sweater that is on a hook at the top of his basements steps.  It's more effort than his ailing body can absorb.  He passes out, falls down the steps and lays there until his son stops in for a random visit the next morning.

Finding his dad at the bottom of the steps urine-soaked and soiled, the son calls 911.  The ambulance, medics, and police arrive and take him to the hospital for care of his obviously broken wrist and lower leg.  At the hospital, it's also discovered that he has very advanced pneumonia which the doctors immediately recognize as the primary cause of Charles having passed out and fallen.

Casts are placed around the broken bones and antibiotic therapy is immediately provided to clear up the pneumonia.  About a week later, Charles is transferred to a nursing home for therapy and rehab of his broken bones and to monitor is clearing pneumonia.  

**********

Hannah is a delightful and stubborn woman in her 20s.  She lives on the streets, gets around by foot and finds food for the day at local outreach ministries.  She's been on the street for years as she does what she needs to do in her life as a homeless woman with Substance Use Disorder in its addicted phase.

She's settled into a routine of what drug combinations she prefers and has avoided overdose until recently.  For reasons that she can't identify, she's overdosed four times in two weeks and[1] been revived by Narcan each time.  At her third overdose, she was taken to a very local hospital where the nurse told her to get out.  Hannah returned to the street and overdosed for her fourth time four days later.  This time, she fell and caused enough of a bodily injury that she had to be taken to a more advanced local hospital that could handle her injuries.  And that the hospital did. 

They tended to her injuries which were the direct result of falling as she overdosed from her use of street drugs.  While fully aware of her use of drugs, the hospital, according to their policy, did not treat her symptoms of dope sickness that were increasing by the hour and day.  "We don't detox patients on this floor.  Detox is done in a different unit." They explained to me.

With four days of medical care for her injuries and no real care for her dope sickness, to relieve that sickness, Hannah signed out AMA[2], made her way to Kensington, consumed her first bag of medicine and began to…

As you read this, Hannah's story is unfolding on the street in a way that could oh so easily march her right into her fifth and final overdose.

**********

Charles' fall and resulting broken bones were the result of passing out due to insufficient breathing caused by pneumonia.  The hospital treated his injuries and his illness simultaneously.

Hannah's fall and resulting injuries were the result of passing out due to overdose caused by street drug use.  The hospital treated her injuries and would have treated her withdrawal issues only upon transfer to the detox unit.

Charles was transferred to a nursing home where his healing continued under the watchful eye of professionals who have pledged their careers to the Hippocratic Oath.

Hannah transferred herself to the street since it's far faster to do a quick date for the money to buy a bag of drug and relieve her dope sickness than it is to wait a few more days to be transferred to the "proper unit."

In a few weeks, Charles will be heading home, this time with arrangements for a daily visit by a community nurse.

Hannah, well, Hannah might be dead by now.  I don't know.  She may be deceased by an overdose that could have been avoided if the hospital had treated her in her entirety and not symptom by symptom. 

Now that Charles is home, his son visits him on a daily basis and asks him why he's so stubborn.  They laugh about it a bit as Charles agrees to be more honest about his health issues.

My concern for Hannah is that the day will come when her cousin will hold Hannah's youngest child in her arms as that child looks down at Hannah and ask "Why is my Mommy asleep in that pretty box?"

**********

When a patient of Substance Use Disorder is admitted to a hospital for treatment of any injury or illness, that hospital MUST do everything within modern scientific understanding to provide comfort and relief of withdrawal symptoms while they attend to the illness and injury. 

Make Hippocrates proud of you!

---

[1] , because she injects in public, has been seen overdosing and

[2] Against Medical Advice

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.

The "Cure" Is Worse Than The "Problem."

Today, for the first time in the three years that I have been visiting the people on the streets of Kensington, a new and disturbing thought hit me…

While acknowledging and being thankful for pockets of success…

Sadly, the inept[1], unprofessional, cruel, incompetent, non-respectful, etc. etc, etc. responses by people who have pledged themselves to integrity in government or their medical careers to Hippocrates have largely been an utter failure in making better to any real degree this national tragedy within homeless addicted people diagnosed with Substance Use Disorder.

The men and women of SUD themselves, in their attempts to maintain self developed safety guidelines had been doing an amazing job.  For example, 

To the untrained eye, a bunch of people living in tents under a bridge are labeled “addicts” “whores” “moral incompetents” and other uneducated, painful, derogatory references.

Looking more closely, however, you would have discovered a gathering of people bound together by an officially recognized disease of SUD and who are in the addicted phase thereof.   In the absence of respectful, timely medical treatment at the Medicaid level of care, they have no real choice other than to continue to take their "medicine".  

In the absence of being able to find w-2 type employment they must resort to various forms of less dignified ‘service jobs’.  For the men: this might include hauling loose metal to junkyards to redeem for cash or for the ladies: renting their bodies for, well, you know…

They gather in these communities for one overriding reason.  Their needed medicine can kill them.  They know this.  So as to avoid this possibility as much as can be, they gather together to inject.  If one person starts to overdose, someone else will see this happening and provide Narcan.  In so doing they save each other’s lives.  

The number of saves of homeless SUD patients by other homeless SUD patients will shock you.  153… 76… 43… 25…  These are real numbers presented to me by four street residents.  That’s a lot of non-dead relatives and funerals that didn’t happen.

By being in community, they maintain their own grassroots level overdose prevention sites.  Well, we need to put that in past tense.  These coherent communities were deleted by the City of Brotherly Love in their efforts to “clean up” the problem of “addicts” injecting in the open.

The end result has been an increase in the number of orphans as their Moms/Dads or both have overdosed in the solitude of an abandoned house, back alley or other such settings

and

Moms and Dads of these men and women who suffered from SUD who have had to bury their daughters and sons.  

There are many other examples of how these medical patients have been failed by those who were pledged through oaths of office and Hippocrates to serve, protect and do no harm.

Judicial practices plant these medical patients in cells designed for criminals for months on end and with no rehabilitation during this time of “mental rot.”

Subsidized housing offers protection from the street but increases the likelihood of solitary injecting in rentals that are not abandoned but largely slumlord managed.  

When any of these Medicaid reliant SUD patients decide they have had enough, they must climb what I’m calling “Medicaid Mountain” so as to get to their personal path of healing.  Most don’t make it as they navigate narrow ledge trails on the sides of this mountain through bureaucratic procedural obstacles and attitudes of supposed professionals who they encounter along the way.  

So, you may be asking…  What was that disturbing thought that I had earlier today?  

Given that the homeless men and women of SUD had already established their own Overdose Prevention Sites and were saving each other at astounding rates and given the low quality of care that these children of God receive on the narrow cliffs of Medicaid Mountain from the larger community, it’s sadly safe to concur that the current ‘cure’ for the problems associated with SUD in its addicted and homeless phase is much worse than the "problems" themselves.

---

[1] not in keeping with what is right or proper for the circumstances

And She Slept... Two Years Ago Today

Dear "Diane,"

Who would have ever known, other than our LORD, that you would be unwittingly and unknowingly going home to Him a year and almost 7 months after you slept on a sidewalk tucked inside a donated quilt?

You were and are loved by so many people who had the joy of knowing you.  Mom, Dad, Sisters, Step Dad, best Friend and extended Family[1] love and adore you to this day and for the remainder of their lives. 

You gave them two precious living memorials to your life.  May God Almighty be with those memorials and teach them His ways as you would have done as the healthy Christian Mom who you so very much wanted to be.

You wanted healing.  You sought healing.  For as much as you wanted and sought while on this earth, it was not to be found here for reasons that need societal correcting.  You did find healing within the loving eternal presence of your Savior.  

From "Diane's" letter to me 10 days before she went Home.

Day by day, we mourn our loss.  Through our tears that miss your presence, your hug, your naturally raspy voice, we do what we can to celebrate in knowing that you did find healing when you met Face to Face with your Ultimate Healer.

We miss you.  We celebrate you.  We worship our LORD with you on earth as you do in His actual factual Presence in Heaven. 

We seek rest in knowing that your earthbound battle is over.  We do what we can to know that you rest in the presence of the King of Kings and LORD of LORDS.  We seek to sleep at night knowing that you sleep in the bliss of Heavenly eternity.  

And She Slept 

---

[1] and a judge

**********

Blog Analysis Addendum: And She Slept... Two Years Ago Today

Original Blog Title: And She Slept... Two Years Ago Today

I. The Human Narrative: The Living Memorials

This post is a "Memorial Audit" of the collateral damage caused by systemic failure. You speak directly to Diane, acknowledging the "precious living memorials" (her two daughters) she left behind. The narrative contrasts the "donated quilt" on a cold sidewalk with the "eternal presence" of her Savior. The "visceral grab" here is the mention of her "naturally raspy voice"—a sensory detail that reminds the legislator that Diane was not a "case file," but a mother, a daughter, and a friend whose physical absence leaves a permanent, jagged hole in the lives of those left behind.

II. The "Lynne’s Laws" Article and Section Review

This retrospective identifies the need for Article 12, focusing on "Maternal and Generational Protection."

Article 1, Section 1: The Medical Necessity and Parity Mandate. The letter states Diane "sought healing." Under this mandate, "seeking" would have been met with "providing." Her desire for health would have triggered a legal requirement for the system to match her effort with a medically secure environment.

Article 12, Section 1: The Maternal Recovery and Preservation Act (New).

• The Law: Recognizes the unique societal value of "Mothers in Recovery." It mandates that the state prioritize family-integrated treatment where mothers can receive care without the total severance of their "Maternal Identity."

• The Application: This would have addressed Diane’s "deep desire" to be a healthy mom by providing a pathway that kept her connected to her daughters, providing a powerful biological and emotional incentive to survive the "Interval Gap."

Article 12, Section 2: The Memorial Child Support and Education Fund (New).

• The Law: In cases where a parent dies due to a documented "Failure of the Safety Net" (like Diane's unsafe discharge), the state must provide a trust for the surviving children’s education and therapeutic needs.

• The Application: This acknowledges the "Societal Correcting" mentioned in the blog. If the state failed to provide the "Found Healing" Diane sought, it must now provide for the "Living Memorials" she left behind.

III. The Professional Tension and Consensus

• The Supportive View: Child advocates and trauma specialists argue that the death of a mother in the "Gap" is the single greatest predictor of future addiction in the children. They support Article 12 as a "Cycle-Breaker."

• The Skeptical View: Fiscal conservatives may argue that the state cannot be a "Life Insurer" for every patient who overdoses.

• The Lynne’s Law Resolution: This is a Generational Debt issue. If the system's "reasons that need societal correcting" caused the death, the state is responsible for the "Wrongful Loss of a Mother."

IV. Legislative "Teeth": The "Inability to Find Healing" Standard

• The Objective Standard: If a patient "sought healing" (evidenced by the Judge's intervention and her own letters) and was placed in an environment where drugs were present (the Kirkbride scenario), the state has defaulted on its contract.

• Strict Liability: The law establishes that the System, not the Patient, is responsible for the outcome when the provided environment is clinically compromised.

V. The Prevention Savings

By implementing the Maternal Recovery and Preservation Act, Pennsylvania saves on:

• The Foster Care Pipeline: Every mother saved is two children kept out of the state’s expensive and overburdened foster system.

• The "Two-Year Retrospective" Cost: Reducing the number of memorial services means reducing the long-term societal depression and loss of productivity in the community.

VI. The Corrected Path

Under Lynne’s Laws, the "reasons that need societal correcting" would have been corrected before the Holy Week of 2019. Diane’s "naturally raspy voice" wouldn't be a memory; it would be heard on the phone as she checked in with her sisters. The "donated quilt" would be a family heirloom on her own bed, not a makeshift shroud on a sidewalk. The "Judge" wouldn't be a mourner in a footnote; he would be the official who signed her "Certificate of Completion," celebrating the fact that the "Healthy Christian Mom" she wanted to be had finally come home.

#LynnesLaws

Damaged Determination

Over my shoulder, as I was heading back to my car, I heard a soft-spoken whimper...

"Banana Man?" 

Turning around, I wondered who had just called out in this quiet tear toned soft voice of despair.  I saw a human-shaped form under a black quilt, walked over to it and saw some long hair and enough of an eye to realize this was one of the ladies of the community.  She spread the opening of the quilt just enough for me to see her eyes and her eyes only.

"'Rose' is that you?" 

She spread the opening of that old black quilt a bit more and there she was.  With tears running down her cheeks just as they had upon our first conversation, she shared with me her agony of despising her current life situation, wanting life to be better and asking me to take her to detox NOW.

As she began to cry harder than perhaps I’ve ever seen her do so, she leaned into me for a hug.  It had been about 6 weeks since we’d seen each other.  During that time, we had one brief Facebook chat.  

As she began to sink into my chest, I showed her that I was still wearing the bracelet that she had slipped onto my wrist when she asked me to love her as a daughter.  She cried harder. We held each other, there on that sidewalk as would any father and daughter[1] upon rediscovering each other in a daughter's agony.  Tears flowed from both of us.

After a few phone calls to develop a plan, we went to Gaudenzia for Detox.  It was determined that there might be something medical going on in addition to the obvious SUD[2] related issues.  We went to the hospital that they recommended for evaluation in the ER.  It was midnight before Rose was being taken to her room for admission to receive antibiotics for an infection, the specifics of which were still to be determined.

From our arrival at Gaudenzia to the moment of being lifted to her admission bed, Rose endured with grace and determination to see it through, her personal version of increasing dope sickness as the hours ticked by.  Shivers and nausea were followed by sweats and vomiting.  Determination to see her mission through to health and healing grew within her as did the pile of soiled linen in the corner hamper.  

For the next 36 hours, four of which I sat with her on Monday, she twitched and turned in the increasing discomfort of being treated for her infection and barely at all for her detox.

36 hours after being admitted, 40 hours after determining to be done with addiction, Rose signed out AMA[3] in obvious physical and spiritual agony, yelling at heroin - telling it to stay away from her and craving it at the same time.  

Rose is back on the street fully absorbed in addiction and free of her infection.  

Rose is a patient of SUD.  Her SUD was all but ignored and her infection, a condition brought on by her SUD and its associated state of homelessness was treated.  By treating the infection and not the SUD, the doctors and nurses of the hospital who are representatives of the Hippocratic Oath did one thing.  They helped Rose regain the strength that was being absorbed by infection and in so doing made her stronger for her to continue her life in addiction and homelessness.

SUD and the infection are both disease processes that should have been treated in totality and simultaneously.  By treating a secondary symptom of SUD - the infection - the Doctors within this hospital did not promptly address the main cause of the infection - SUD itself.

Damaged Determination

---

[1] Reminder: This is an honorary relationship.

[2] Substance Use Disorder

[3] Against Medical Advice

A Cast Now or Surgery Later

A couple of years ago, "Cecile" came up to me in Emerald City and shared with me how he had pulled someone out of the path of an out of control motorcycle.  The person was fine but he now had a broken arm. 

People on the streets do everything possible to avoid going to the E.R.[1]  Cecile had put a splint of his own making on his arm.  His arm was completely useless for a couple weeks as he tried to bring healing to it without professional care.  In time, his arm "healed" but had a noticeable bend in it.  He was told by a doctor who visited Emerald City that the day would come when surgery would be needed to correct the improperly healed break that could have been dealt with early on if proper care had just been provided when it was needed.

Melanie and Natalie are sitting in jail cells at RCF[2] as I write this blog.  Both ladies have been there for three to four months.  They have both detoxed from their "medicine" and have been in a holding pattern, living in a cell that can better be described as an oversized toilet stall with cots.  They have received no counseling nor therapy for their Substance Use Disorder issues. 

Their "broken arm" has been the addiction/homeless phase of their Substance Use Disorder.  Their time in a homemade splint has been these past months as they have sat waiting for the legal system to find them a medical bed in a facility to provide the care - the cast - that they should have had months ago.

As they sit and wait, they think.  They climb inside their own heads, talk to others who are in this similar holding pattern and develop their own -  largely unguided - understanding of what happened to get them where they are today and how they might correct their path.  In the absence of the placement of a proper cast at the time of injury, their soul may heal but with a bend that will require "surgery" since healing was not provided at the time of the injury.

Would it not be better for these ladies, - who represent thousands of other men and women in this same situation - if we as a society had the mechanisms firmly in place to provide the cast when it's needed and not wait to provide the surgery long after the injury? 

---

[1] Mostly because they have come to know that most E.R.s treat them as something less than human.

[2] Riverside Correctional Facility

Comparative Studies in Addiction

Reliant on Medicaid to fund her healing, Melanie sits in a jail cell for 3, 4, or 5 months with all of the constraints of an imprisoned person while awaiting handcuffed transfer to a medical facility that is charged with the privilege of serving her in her healing from Substance Use Disorder.

Reliant on Private Insurance to fund his healing, Ralph sits in a plush luxury vehicle for his transfer to a medical facility that is charged with the privilege of serving him in his healing from Substance Use Disorder.

*****

An Imperfect Analogy:

If the use of insulin was considered wrong would medical patients who have been diagnosed with diabetes be living in tents under bridges or out in the open on city sidewalks?

Would they be unemployed, 'panhandle' and 'date' to raise funds to go to their street corner insulin dealer to buy their insulin to avoid 'insulin sickness?'

Would they be derogatorily described as "Diabetics?"

If the use of heroin was considered acceptable would medical patients who have been diagnosed with Substance Use Disorder be immediately treated upon request in emergency rooms, clinics or hospitals?

Would they survive and be employed to raise funds for their family instead of going to their street corner heroin dealer to buy their heroin to avoid 'dope sickness?'

Would they be derogatorily described as "Addicts?"

Patients who have been diagnosed with Diabetes and patients who have been diagnosed with Substance Use Disorder are all medical patients who have been diagnosed with a medical condition that results in its respective sickness if a 'medicine' is not provided to avoid that sickness.

One diagnosis is socially accepted.  The other is not.

You can't do this for me and yet the opposite of addiction is connection.

Earlier this week, I saw the following statement posted on Facebook on one of the outreach group sites that I follow.  I copied it into my word processor and then it happened…  My computer burped… I lost the original post and, in the absence of my morning coffee, could not recall where I had been reading it.

I wanted to know more about this disturbing statement that was making me wonder if I should stop doing what I do in Kensington.  I Googled the first sentence of it and found the statement in its entirety in this post from 2005.

I suddenly started wondering if I was reading something that is very accurate to today's current situation in Substance Use Disorder and addiction or was this something more along the lines of coming from an excellent but outdated textbook from two decades ago?  Here's the statement[1]:

"If you love me let me fall all by myself. Don't try to spread a net out to catch me, don't throw a pillow under my ass to cushion the pain so I don't have to feel it, don't stand in the place I am going to land so that you can break the fall (allowing yourself to get hurt instead of me) ... Let me fall as far down as my addiction is going to take me, let me walk the valley alone all by myself, let me reach the bottom of the pit ... trust that there is a bottom there somewhere even if you can't see it.

The sooner you stop saving me from myself, stop rescuing me, trying to fix my brokenness, trying to understand me to a fault, enabling me ... The sooner you allow me to feel the loss and consequences, the burden of my addiction on my shoulders and not yours ... the sooner I will arrive ... and on time ... just right where I need to be ... me, alone, all by myself in the rubble of the lifestyle I lead ... resist the urge to pull me out because that will only put me back at square one ...

If I am allowed to stay at the bottom and live there for a while ... I am free to get sick of it on my own, free to begin to want out, free to look for a way out, and free to plan how I will climb back up to the top. In the beginning, as I start to climb out .. I just might slide back down, but don't worry I might have to hit bottom a couple more times before I make it out safe and sound ...

Don't you see ?? Don't you know ?? You can't do this for me ...

I have to do it for myself, but if you are always breaking the fall how am I ever supposed to feel the pain that is part of the driving force to want to get well. It is my burden to carry, not yours ... I know you love me and that you mean well and a lot of what you do is because you don't know what to do and you act from your heart not from knowledge of what is best for me ... but if you truly love me let me go my own way, make my own choices be they bad or good ... don't clip my wings before I can learn to fly ... Nudge me out of your safety net ... trust the process and pray for me ... that one day I will not only fly but maybe even soar."

If this statement is accurate to today's situation and we take it at face value, anyone who does anything for/with people on the streets and in the addiction phase of their officially recognized Substance Use Disorder, might as well go home and find something else to do with our time.

But wait! 

There is something for us to do even if the statement above is 100% accurate:

Develop and Maintain Connection for that time when our loved ones on the streets are "ready"!  I encourage you to watch the following video which addresses the importance of connecting with Substance Use Disorder patients who are in the addiction phase of their disease:[2]

Here's the takeaway statement from this video:

And what I've tried to do now, and I can't tell you I do it consistently and I can't tell you it's easy, is to say to the addicts in my life that I want to deepen the connection with them, to say to them, I love you whether you're using or you're not. I love you, whatever state you're in, and if you need me, I'll come and sit with you because I love you and I don't want you to be alone or to feel alone. 

And I think the core of that message -- you're not alone, we love you -- has to be at every level of how we respond to addicts, socially, politically and individually. For 100 years now, we've been singing war songs about addicts. I think all along we should have been singing love songs to them, because the opposite of addiction is not sobriety. The opposite of addiction is connection. 

So what do we do in our connection with our loved ones when they are "ready"? 

The answer is actually easy and yet our society can't seem to do it:  Connection may lead them to seek treatment.  Medical facilities must treat them and treat them without delay as a medical patient of their Substance Use Disorder!  Connect with and treat them in an environment of dignity and respect.

Patients of Substance Use Disorder who are reliant on Medicaid for financial coverage of their disease's expenses[3] face the requirement of climbing  "Medicaid Mountain."  Many of our nation's daughters and sons fall from and die as they hike in their weakened condition along the high and narrow cliff trails (that do not have guard rails of dignity and respect) that lead to the health care that they need and now want.

To better understand the differences in health care provision for people with private insurance and Medicaid, I invite you to read this linked  blog.

---

[1] I've broken it down into separate paragraphs for easier reading.

[2] Clickhere for the video that includes a transcript.

[3] This is almost every homeless person.

Sitting in a Cell with SUD

Once again in my time of blogging, I find myself eating lunch at the Applebee’s on Aramingo Avenue following a wonderful visit at RCF with “Melanie,” my Delaware County neighbor.  As a patient of SUD, she sits in her jail cell minute after hour after day after week after month awaiting word that the legal system has found a bed for her within the medical system for her to go to that will meet her rehab needs.

She’s been sitting there waiting in a jail cell designed for criminals longer than your standard 30 days of typical private insurance rehab.  It’s a time for her to contemplate her navel or come to the conclusion that the system just does not care.  Rather than receive the emotional and spiritual healing that could be had within rehab,  this extended stay in jail only adds to the emotional trauma that she has experienced thus far in life. To the system, she’s just one more ‘case.’ 

To those of us who know and love “Melanie” for who she is with her fun, lighthearted and playful spirit, we mourn her prolonged and unnecessary suffering in a cell – an oversized toilet stall shared by previous strangers who now sleep in neighboring cots and share an exposed toilet.

Let us remember now and never forget, “Melanie” and the hundreds/thousands of other sons and daughters who are sitting in cells with SUD when they should be in rehab getting therapy. 

I don't know, go or care! Carry Narcan!!!

I don't know any addicted people.  I don't need to carry Narcan.

I don't go to any places where I might see an overdosing person.

I don't care if an overdosing person dies.  They chose to be an addict.

I don't know any addicted people.  I don't need to carry Narcan.

Substance Use Disorder patients are everywhere: in your neighborhoods, churches, shops, and highways.  You don't need to know a Substance Use Disorder patient to save their life if overdose tries to claim them.

Carry Narcan! 

I don't go to any places where I might see an overdosing person.

Substance use knows no boundaries nor borders.  Whether you live in a gated community or a housing project, heroin is hovering nearby.  If you're a high society individual who only goes to high society places, heroin is there and hiding in more pockets and purses than you can possibly imagine. 

When that day comes that you excuse yourself to use the restroom in your high society restaurant and you find a person lying on the floor or gasping for breath from inside a closed stall, you'll wish you carried some Narcan. 

1, 116 people died of an overdose in 2018 within the Philadelphia city limits.  Over 68,000 people died nationwide in 2018.  Many more than that were saved by Narcan, a stunning miracle drug that is reducing the number of parents who bury their children and reducing the number of children who have lost both parents from entering the foster care system.

Carry Narcan! 

                                                                                                                                                     

I don't care if an overdosing person dies.  They chose to be an addict.

It's shocking to me that some people feel this way. 

The topic of "choosing to be an addict" is an incredible error in understanding the issue. 

If you really don't care if that human being dies, even after you see them turning blue in your favorite restaurant's bathroom stall, I guarantee you that in the days to follow, you'll wake up at night wishing you'd carried Narcan: that simple to administer miracle drug that would have prevented you from carrying the emotional baggage of knowing that your ignorance contributed to the preventable ending of a life and that you could have been some person's and family's lifesaver hero.

Carry Narcan! 

The Grassroots Hospital: A Call for Overdose Prevention Sites

The Grassroots Hospital: 

A Call for Overdose Prevention Sites

Click here for an audio version of this document. It runs 3:41.

The Current Crisis

Until the time when we as a nation have evolved to accepting Substance Use Disorder patients as patients and not as outcasts, we must open Safe Injection Sites and Overdose Prevention Sites NOW.

As I sit here in my suburban apartment, I am acutely aware that many of my Philadelphia friends are gathering at the Federal Courthouse. They are making their voices heard on the issue of Overdose Prevention Sites. My work schedule today prevents me from being there in person, so I wanted to share these thoughts from home.

The Hidden History of Community Care

Grassroots versions of Safe Injection Sites have existed for years—and likely decades. One could argue they have existed throughout the two and a half centuries of our nation's history.

Years ago, our nation's sons and daughters gathered in "The Tracks" to inject their "medicine." It wasn't a perfect system, but it was a community. About three years ago, when the city of Philadelphia closed The Tracks, those residents were displaced. Many of these daughters and sons created new communities under four Conrail overpasses along Lehigh Avenue. The largest of these was known as "Emerald City."

The Miracle of Emerald City

Emerald City and the distribution of Narcan gained attention at roughly the same time. During its height, between 80 to 100 people lived under one of those four bridges. Narcan was distributed as widely as possible among the residents.

The result was an incredible lack of deaths by overdose.

This does not mean there weren't overdoses; it means that nearly every person on death’s door was witnessed by someone else. Narcan was administered by fellow residents, often accompanied by resuscitative efforts and CPR. I witnessed five such events during my visits to Emerald City. Of those five nearly dead people, ALL were saved by members of that community: homeless patients in the grip of full addiction.

Street Level Community: The Actual First Responders

How did these saves happen? The answer is simple and controversial: Street Level Community.

By allowing our nation’s homeless Substance Use Disorder patients to gather in community—under bridges or along sidewalks—lives are saved. They come to know each other. They look out for each other. They become each other’s actual first responders in a life-or-death crisis.

These communities give a human being the opportunity to eventually choose recovery. They prevent parents from the agony of burying a child. They reduce the number of orphans left behind and traumatized for life.

A Failure of Compassion

These are human beings. No one should be forced to live under a bridge or on a public sidewalk because they have an officially recognized disease that society refuses to understand.

While it would make far more sense to treat Substance Use Disorder as a medical condition rather than a societal disgrace, our culture isn't there yet. We aren't opening our hospital doors to these intelligent people—most of whom rely on Medicaid—to give them the treatment they deserve.

The Next Best Option

Public injection, the physical toll of the disease, and the loss of dignity on our streets are not pleasant for anyone to observe. Therefore, the next best option is to create officially sanctioned Overdose Prevention Sites. In these sites, residents can inject the "medicine" their bodies demand while being supervised by professionals who can keep them safe. These professionals can then guide patients into services that have the potential to reunite them with their families and lead them down a path of healing.

The Ultimate Answer

Are Overdose Prevention Sites the ultimate answer to this horrific issue?

No. The ultimate answer is to create a culture that plows down the barriers preventing patients from getting care in an environment that recognizes their humanity.

But until we reach that evolution, we must open these sites now. Until they are open, we must recognize that street communities are the actual reality of grassroots Safe Injection Sites. They are, in essence, hospital wards where the patients are also the medical overseers.

The Last Stop's Sidewalk as a Hospital Ward

The Intersection of Kensington and Somerset as a Hospital Ward

 

Streets Outside Prevention Point as a Hospital Ward

Street In Front of the Kensington StoreFront as a Hospital Ward

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[1] It was called this because it was at the corner of Lehigh Avenue and Emerald Street.

[2] The total number of people under all four bridges was thought to be in the range of 300.

[3] Three of those five were saved by the same woman whose latest save count is pushing one hundred and fifty as of last week.

[4] Neither of which provides bathroom facilities.