Staff writer Margaret Talbot (The New Yorker, issue (“The Addicts Next Door” – June 5 & 12, 2017) offered the nation a flood of stories about the county of Berkeley, West Virginia and the war its residents are waging against a formidable mortality rate due to heroin overdose. Working as I am in the arena of clinical intervention specifically with heroin, I was simultaneously overwhelmed and enthused to digest story after story of risk, loss and redemption.
Three distinct levels of focus that the heroin epidemic requires include families, communities and the healthcare industry. A parallel process of dysfunction exists among the three general domains of focus levels. The immediate family is always, often to a great extent, conflicted about how to respond to the heroin problem in the living room.
For starters, in no unspecific terms, the grandparents, parents, spouses, siblings, employers and friends of disordered heroin users (or addicts) are naïve, stunned and disempowered for the most part in every city or county in America when it comes to heroin. Scandalized by the shortage of available treatment services, they understandably train their focus on the healthcare system. Or outraged by blatantly erroneous prescriptive behaviors by medical practitioners. their focus naturally turns to provider guidelines and reforms. The last and most counterintuitive place family focus tends to go is to the family and its practices and values.
Two weeks ago, my 55-year old wife who is an intelligent, informed healthcare consumer (and spouse of an addictions specialist) had three wisdom teeth extracted. Our new dentist included a prescription for thirty (30) oxycodone tablets to deal with post-surgical pain with the discharge recommendations. No discussion of the dosage, potential medication side effects or the actual prescription itself. She shredded the “script” and used Ibuprofen per its label, adequately to regain dental normalcy. I have made my point. Families need to act responsibly in the realm of personal accountability and investment in their health. AND their loved ones’ health.
It is certainly important for taxpayers, citizens, health professionals and all other allied professionals (e.g., law enforcement and the courts) in the city and county to be engaged in the resolution of the epidemic. It is ANOTHER key in the puzzle. Better police or sheriff’s departments have narcotics operations that recognize the duality of illicit drug use in both mental health and social accountability perspectives. Neither of these perspectives trumps the other. They all matter, at different levels and stages of the family’s, community’s or industry’s development into a more effective and ethical functioning entity.
Sentencing guidelines restrict the options of magistrates and judges to respond proactively to individual cases involving heroin. Jails and prisons offer limited beds for what sometimes turns out to be a helpful detoxification measure: detention. Creative stakeholders in these community scenarios work against stigmatization, expect accountability, and spend more time and energy working towards solutions than listing obstacles. The ‘community family’ is also, often to a great extent, conflicted about how to respond to the heroin problem in the policy and procedure room.
In my fairly well-informed knowledge of healthcare, both as a licensed clinician and a participant over numerous years in the for-profit AND Medicare-Medicaid arena as a practitioner, the upper margin purveyors of for-profit managed care are far from bankruptcy or ruin by fascist governance. By the same token, the dismantling of the not-for-profit resource via the next potential Health Care Act (“American” vs “Affordable”) spells similar disaster at the macro level. The affordable version gave incredible access advantages to much under-served citizens with a much over-worked provider base. We (myself included) are often fatigued and demoralized by the excess of need and limits of supply. The ‘industry family’ is also, mostly to a great extent, conflicted about how to respond to the heroin problem in the program design, pricing and delivery world.
My uneasiness about Margaret’s piece (“The Addicts Next Door”) on heroin is assuaged in this writing, and, confidence that my own war is being waged for the most part where a model is being formed – family by family. The miracle of families’ reconfigurations through humility and hard work serves both purposes. To respond to heroin decisively and productively, and to model the solutions for the community and the healthcare industry at large.
David Petersen is a clinical consultant and interventionist by his definition, “fully engaged in the war against heroin.”