A Massachusetts firefighter this week went on a Facebook rant about heroin addicts.
His viewpoint, while certainly not representative of EMS, is not an isolated one. I have heard these sentiments expressed ever since I started in EMS. I have heard them from police, fire and EMS. Not from a majority by any means, but by enough responders to notice, enough for the comments to be commonplace. I am not going to blame the people who say these things, which I disagree with. The fact that the viewpoint is not a lonely one points out what a terrible job we have done in educating ourselves about addiction.
While I have always viewed drug abusers as fellow humans deserving of kindness and mercy, it is not until recently that I have come to understand that addiction is not a choice, but a terrible disease.
It is a shame that it has taken the heroin plague to get into the white upper and middle class community for the larger nation to start to take notice of addiction, and start to treat addicts less like inner city scum and more like fellow sons and daughters, brothers and sisters, fathers and mothers.
I have started asking the addicts who I treat every day — either as a direct overdose or as a patient being ferried back and forth between hospital and treatment facility, how they got started down their road. While a few started on prescription pills recreationally, most had an injury or medical event for which they were prescribed long-term opiates. The patients were told by their doctors that the drug would help them, not harm them. The drugs were given in the spirit of the pain revolution that declared pain was bad for patients, pain was the fifth vital signs and that pain is what the patient says it is. (It should be noted that much of this revolution was funded by drug companies and pain societies that were fronts for the drug industry.)
The drug companies told the doctors the pills were not addictive. They also hired countless medical decision makers, paying them lavish speakers fees and sending them on conference vacations to sunny climes. Purdue Pharma, the makers of Oxycontin, were forced to pay $600 million for misleading the public about the drug’s addiction risk, while they continue to make $2 billion a year in sales of the drug. (The state of Kentucky has filed suit against them for $1 billion). And while many people were able to handle the pills and not become addicted, others were not. And while some may argue addiction is a character flaw, science has proved otherwise.
“Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her. Although the initial decision to take drugs is voluntary for most people, the brain changes that occur over time challenge an addicted person’s self-control and hamper his or her ability to resist intense impulses to take drugs.”
-National Institute on Drug Abuse
Read about addiction at this link:
Today more people die from opiate overdoses than are killed in motor vehicle crashes. And addicts unable to feed their drug sickness with prescription opiates, either legally prescribed or stolen or bought on the street, are turning to the cheaper and more potent heroin in unprecedented numbers. (In Hartford a 30 mg Oxycodone is $30, a bag of heroin is $5.). And the body count continues to rise.
16 years ago, 4000 people died nationwide from prescription drug overdoses. Last year the number was 16,000.
Here are the stats from Connecticut on heroin deaths in the last three years.
I was talking about opiates and pain with one of my partners the other day, and he told me this story. On an EMS call he picks up a patient of his age, early twenties, who is a heroin user. He recognizes her from his high school class. She was The Girl. Cheerleader. Most Popular. Stunningly Beautiful. Prom Queen. What happened to her? She suffered an athletic injury in college, and was prescribed a month long course of Percocets post surgery. The more she took to ease the pain, the greater the pain became, the more she needed to ease it.
How her life might have been different, if when her teammates had thrown her up in the air, she had come down cleanly. Up in the air, her life was suspended. What did the future hold in store? A handsome husband, a house with a white picket fence, darling children and a successful career? Or a devastating injury, an addiction to pain pills, thefts to support her habit, not graduating, losing friends and family, and a hole in her arm where the last of her dreams go?
I’ve been taking care of patients for a quarter of a century. I have looked into people’s eyes and seen, with bad fortune, myself and those I love. Any of us can end up on the other side of the sirens. A slip on stairs, an unseen metastasizing cancer, a sudden clot in the heart or brain, or being in the path of the wrong driver on a dark road.
We are products of our genes, our environments, our choices, and random fortune.
We can’t change our genes and fortune is fickle. But we can try to change our environment, we can teach about addiction, we can try to show ourselves and our next generation that life can humble all. And we can make the choice to be kind.
Nothing written here should be construed to mean paramedics should not aggressively treat people with acute pain or cancer pain with short term opiates such as fentanyl or morphine.
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