As people become more aware of the heroin epidemic going on in this country, we see an outpouring of support to pay for more rehabilitation. Unfortunately, that’s like trying to save the people on the Titanic after they’re already in the water.
Heroin addicts end up in hospitals every single day at every single hospital across the country. Yet we miss the opportunity to help them by treating their symptoms and ignoring or misdiagnosing their addiction.
Abdominal pain gets treated with intravenous drugs.
Nausea/vomiting/dehydration gets treated with IV drugs.
Intractable back pain … IV drugs again.
Abscess on the arm from using IV drugs … treat, ironically, with IV drugs.
This is what happens every day. Within a day or two the patient feels better and goes home — to IV drugs.
How can we do better? Where can we intervene? How can we get them help before the ship has sunk?
Both the problem and the solution lie within the healthcare system. We created this epidemic by prescribing too many pills with too little understanding of the potential problems. We perpetuate this problem by treating symptoms but not the disease. And the treatment itself perpetuates the illness.
Giving IV drugs to drug addicts is like giving donuts to diabetics.
The reason doctors prescribe drugs to drug addicts is because it's what the patient demands and it's the only tool doctors know of to control pain. But there are other options.
I’ve been treating such patients for many years by starting them with sublingual buprenorphine and additional non-opiate medications. Most of the time, they are not happy at first. Some leave the hospital, some stay.
Those who stay are much better off, and eventually feel better.
Those who leave, find it difficult to stay on buprenorphine, which is used both for pain and as medication assisted treatment ("detox").
Most of these patients never wanted to detox, never had the resources or desire to go to rehab, never wanted anything from their trip to the hospital except to stop the pain and/or score drugs. But with guidance, they can be shown that there is a better way.
We must teach doctors to intervene sooner. It's rare for patients to get this type treatment in the hospital because we are not supposed to "detox" in a medical hospital. That is supposed to happen in rehabilitation facilities and psychiatric hospitals.
Hospital based doctors have not been trained for detox. I'd like to see that change.
We can save lives every day, but we have to do it one at a time.
Posts by Melanie Rosenblatt, M.D.
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