Plateau

Plateau -(noun) “ a usually extensive land area having a relatively level surface raised sharply above adjacent land on at least one side.

Plateau-(verb)- to reach a level, period, or condition of stability or maximum attainment,

Merriam-Webster

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The United States Health Secretary announced recently that the opioid overdoses deaths appear to be plateauing across the country.  While some states have seen a decrease and others an increase, the overall numbers appear to have slowed after a parabolic rise.

Opioid Deaths May Be Starting To Plateau, HHS Chief Says

The credit can go to harm reduction programs, public health and safety efforts and community organizations who have worked hard toward solutions.

Good news certainly, but not cause to disarm.  The death numbers, even if they plateau, are staggering.  70,000 deaths in 2017. Many young people, who would otherwise have many years of life, family and contributions to society left, had they not been ensnared in this terrible epidemic, are vanished.

Ensnare is another word for the day.

Here are the synonyms (also from Merriam-Webster) – catch up, enmesh (also immesh), ensnarl, entangle, entrap, mesh, net, snare, tangle,trap

I recently attended an opioid overdose conference where one of the speakers, addressing her daughter’s death, called her child’s journey into opioids “an innocent entry” and an “impossible exit.”

Powerful and true words.  

We don’t know what the future holds.  Will a new deadlier opioid emerge or a new combination of drugs?  I don’t know.

***

Things in Hartford were very quiet early this October.  I am involved in a process tracking opioid overdoses in our service area and we witnessed a lull in the first half of the month.  Overdoses were down 50%. Driving down Park Street, the ever present users on the nod seemed to have disappeared as if taken by spaceship.  What was going on? I inquired of neighboring services, asked at the hospitals and talked to users on the street. They all reported the same things.  Overdoses are way down.

Was it a turning point or a lull?

Then things started picking up again.  The nodders were back. New brands hit the streets, as well as some oldies.  Red Star. Power Hour. Pray for Death. Fuck You. Power Ball. One Way. Calls for overdoses went out.  Naloxone vials came off the shelves.  Users had their respirations restored with some denying they had used, some vowing to never do it again, and others choosing not to say anything in scenes that can only be called commonplace.

I did ODs three days in a row.

An old man sitting on the porch, unconscious.  In another world, I would be thinking stroke, diabetes or ETOH.  His wife, who called, sits at the table and shakes her head. “Heroin,” she says.  “He’s at it again.”

We nudge him and barely get  a response to pain. His pupils are pinpoint.  His SAT is in the 80’s. He has COPD.  His ETCO2 is in the 70’s.  We give him just enough Naloxone to, with O2, get his SAT into the low 90s, his ETCO2 in the high 40s and get him to at least mumble some answers.  Instead of an empty vodka bottle, by his chair we find a torn glassine envelope. A $4 bag of heroin is cheaper than a pint of vodka on the avenue, and the effect is more pleasing.  I don’t know the relationship between the man and his wife, but I suspect it is not what it once was in their younger days and heroin offers the old man a form of escape.  Today he just caught a bag with a hotspot.  At the hospital he is alert enough to admit he sniffs a little heroin now and then.  

A young man collapses on the sidewalk and gets from bystanders both IM naloxone in his thigh and an ice filled Slurpee in his pants.  He comes around with some bagging and another 0.4 mg IV from us before he is resurrected.  The crowd of thirty or so  all praise each other and EMS for another life saved, while the young man hangs his head in shame as a woman lectures him that this had better be the last time.

The third patient has no human audience for his overdose.  No disproving wife to call 911. No bystander to fill his pants with ice.  He dies alone witnessed only by the skulls on the torn glassine envelopes by his bedside.

***

48 Hartford residents died in the first six months of 2018. 68 people died within the city limits.

Whether is it stacking bodies to the sky or just laying them on an already high ground, it is too many.

Years ago, a United States Senator, William Proxmire, used to have a saying about federal spending.  “A million dollars here and a million dollars there, and pretty soon you are talking about real money.”

To paraphrase for the opioid epidemic:  A thousand bodies here and a thousand bodies there, and pretty soon you are talking about a massacre.

 

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