This link is to a piece by a woman who survived a potentially fatal opioid overdose. More than one, it seems. That’s disturbingly common, especially now in view of the popularity of extra-powerful synthetics such as fentanyl and (worse yet) carfentanil. Just recently, authorities in SoCal arrested a man and woman who were in possession of 46 pounds of the latter. Plus heroin and coke.
“It’s a whole new ball game out there, folks,” complained one big city emergency coordinator.
Something we’ve had to explain many times to friends and families of survivors– the user may wake up with little or no awareness of what’s happened. They slept through it, I guess. As a result, any deterrent value is easily lost. It’s one reason so many go out again and overdose a few weeks or days (or even hours) later.
The overdose may be over, but the addiction that led to it is not.
I don’t have any data as to percentages of repeat OD, but anecdotally, it’s said to be quite common. You hear complaints from police, firefighters, and EMTs who encounter the same victims on multiple occasions. “We gave him Narcan and he got up and walked away,” groused a paramedic. “Did it again two weeks later. It’s discouraging.” We can understand that.
From a counselor at a hospital detox: “we refer 100% of OD victims on to treatment before they’re released. Maybe one in ten follows up, if we’re lucky. Most just go back to doing what they were doing.”
That would be using drugs. When questioned, you get a shrug and a response from them along the lines of:
- “Oh, treatment — that doesn’t work.” There’s plenty of evidence that it does, but of the sort that’s primarily of use in defending programs from budget cuts. It’s not the kind of information that sways many actual drug users. They’re more from the Nicki Minaj school of reasoning: “I heard about one guy from this other guy who went to school with his brother…” This appeals to people who aren’t really interested in giving up drugs, and are looking for reasons to justify that choice.
- “Look, don’t worry about me. I’ll stop when I’m ready.” Really just a way of putting off the inevitable. Often, the elusive ‘readiness’ arrives too late.
I never forgot the startled look on the face of a 25-year-old heroin addict when asked if he had any drugs in his possession. “You’re kidding,” he said. “If I had drugs left, you think I’d be trying to get into detox?”
I wonder if by focusing so much of our energy on preventing fatality, as essential as that is, we may have inadvertently revived the ‘revolving door’ syndrome that plagued drug and alcohol treatment in the 1950’s, 60’s and 70’s. It’s continuation in treatment that seems to be missing.
Ideally, our treatment continuums would be designed so that:
- Each step led logically to the next, per ASAM placement levels.
- The community continually sought to eliminate barriers to ongoing treatment. Whatever those may be, in your community, or in mine. They’re not always the same.
Such systems already exist, of course. I’ve seen them in action. But clearly not yet in the numbers needed to make a serious dent in the problem.
So, there’s our challenge.