“There is no way you could understand.” These words grab my attention as a friend, now sober 20 years, tells me of his addiction. Drug addiction has not been my personal journey, not one that I see reflected back in the mirror every day. But I’ve see it written in eyes and on faces all around me. As an emergency physician and public health advocate, I am familiar with the invasive effect addiction has on the lives and communities it touches. It mocks me, forced simply to watch, time and again— impotent to impact the course of this disease. Addiction cuts close to those I love, its siren song of unfathomable craving, an epidemic of desire.
Memories, now all too personal, weigh like the invisible pack I carry. Like Bunyan’s Christian, seeking to escape the City of Destruction, I hear the outcry of our age, railing against the injustice of our enslavement, lost as we seek to lay this burden down.
The young man I am now meeting is the son of a colleague. No hands are offered as we smile in greeting, sitting down to lunch. His hazel eyes look out from a freckled face; they dance as we eat the fire he calls green chili. Hollered farewells, clinking glassware, and the clatter of dishes accompany our conversation. He tells of his journey: abandoned gutters, shared illusions of intimacies and escapes, attempts at exotic stories in renaming past grimy truths. The young man shares these tales of indulgence, fueled by his drug of choice, black tar heroin, with hesitance. He is testing me. What will my reaction be?
There is not much I have not seen or heard. So I stay, steady eyed, my face impassive, as his stories continue, his words conveying a twisted arrogance. “There is no way you could understand.” The truth, evident only to me, is that I understand far more than he knows. I’ve seen the birth of this monster, addiction, in lies woven into a tapestry of devastated lives. I’ve placed my hands in the monster’s maw—a girl’s chest, her face a memory from my past. I am an intern at an inner city hospital, very young, my unlined face and eyes still full of hope, really but a girl myself. I have just come on shift, dressed in crisp blue scrubs and a white coat, long, starched, pressed, so that I will not be mistaken for a candy striper.
An ambulance screeches into the emergency bay. Urgently flinging open the rear doors, a fresh-faced paramedic gives his report, all the while moving, touching, arranging and rearranging. His words and movements introduce our patient and convey our points of triage.
She is younger than I. Her terror-stricken eyes of blue lock in on mine. I join the head of the bed, taking the outstretched hand she offers, as if to anchor her to this life, ground her, rooted in my intact skin, within the coat, within the scrubs. As we rush to the trauma room, floodlights and trays at the ready, her plea for me to save her fades, lost from her lips to mine.
She had refused to pay with her body at the flophouse. We flay open her chest, connecting the dots of the stab wounds, hands diving to the warmest part of her, squeezing her heart, now still on its own. I am ready, having parted her motionless, warm, still moist lips to place a tube between them, to breathe for her. But her heart, severed from its tethers in the chest releases what it holds in a singular wave. Baptized through immersion in her blood, I stand, immobile in a crimson rain.
A water glass explodes as it hits the tile floor. I look up to see the young man still sitting across the table from me. His stories continue; I sip my coffee. He has far to go. He knows the words to say to himself and to the world, but we both know that his heart is still lost in the itch of desire, in the false pride of shame. Sadly, I watch as he jumps from the table, a saucy smile behind his eyes, swinging a backpack, turning a jaded knowing ear to my words. His life without margins.
I turn to pick up the tab, but hesitate in a moment of contemplation. My ceremony of initiation into this inclusive club of death has long past, but his has just begun. What name will he take from this ritual? How far does he stand from the water’s edge? What lies in the depths of his baptism? I stand but a parishioner this time; his priest has yet to come.
Walking alone out into the cool of the afternoon, the day seems to take a breath in anticipation of evening’s arrival. I have come to realize that it is time for me to don this mantle, to mount a battle cry. Addiction is devastating our culture. It arrives with stealth and leaves a trail of lost work, relationships, and lives in its wake. It no longer affects us as ripples from a stone thrown into a lake, but has become the tide of a tsunami, by which we are all posed to be washed away.
How do we rise from these waters? I believe that we, as healthcare providers, are the bridge to answer the call to end opioid addiction. As we address emergencies and chronicity, prevention and treatment, we are summoned to embrace and promote a compassionate holistic vision of health, while taking care to avoid the unintended consequences of opioid prescription.
Knowing the tools in our toolbox is crucial. There are CDC guidelines written to assist with best prescriptive practices. Full disclosure of the risks when we do prescribe is essential, so that patients and families have the awareness and the means to make informed decisions. As we hone our prescriptive writing, we must offer alternatives for patients who have acute pain, and even more so, for those who use these medications chronically. By assisting patients in finding complementary, healthy options, we help them avoid illicit choices. Biofeedback, acupuncture, exercise therapy, massage, cognitive-behavioral therapy, nerve blocks, and alternative medications are all viable potential treatments. It is imperative that healthcare providers explore and advocate for a variety of therapeutic options. Finally, we, with the assistance of the greater community, must recognize addiction, reduce its stigma, and remove barriers to treatment, while helping patients in finding their path to sobriety.
In this journey, perhaps we are all pilgrims trying to find our way. By acting in solidarity— citizen, policymaker, physician, father, brother, mother, child—we can part these waters. Only together will we reach the promised land, where we may, finally, lay this burden down.
Guidelines for prescribing, addressing chronic pain –
Community Health Partnership Opioid Coalition – https://www.ppchp.org/programs/chp-initiatives/opioid-abuse-prevention/
Colorado Consortium for Prescription Drug Abuse Prevention – http://www.corxconsortium.org/