Several years ago I and a group of coworkers conducted a
comprehensive analysis of the client caseload I had been working with. Our
purpose was to identify specific groups of drug users, the treatment modality
they were referred to and completed, and their outcome in our program. We were
looking for data regarding methamphetamine involved clients and how well they
were doing with completion of program goals. One of the pieces of data that
came from our study/ reflection was most troubling. Anyone who was coming from
prison with an Opiate Dependence diagnosis and assigned to my case load was
dead. They had died from Heroin overdoses, found in houses, ditches, and
automobiles, usually with a needle still stuck in their arm. If they were “lucky”
they reoffended and were back in prison. Every outcome regarding success was
0%. I fought back tears. I was not doing my job properly. I didn’t know how to
do my job properly. I considered 0% unacceptable. I spoke to community based treatment
providers who noted similar success rates, 0%. I began to work on a strategy to
address this. To change the course of my work, to change my outcomes, and
hopefully change lives. I began seeking education regarding street grade
Heroin. I decided I was going to start discussing Heroin Dependence specific symptoms.
At the same time Opioid Antagonist medications were being introduced, Medically
Assisted Treatment. We knew Methadone was the “gold standard” for treating
Opioid addiction that it was possible to save lives, was not available in
southern Illinois, and came with much controversy. Suboxone would become available but the way
licenses were monitored many doctors had waiting lists that were years long and
people continued to DIE. I started spending what I would consider “intimate”
time with Heroin users, going into dope houses, taking people over and over to
detox programs (some people I took 5 times, and talking about the power of
Opioid addiction with anyone who would listen. I started attending trainings
regarding MAT (medically assisted treatment). I learned firsthand from
consumers of heroin that the “rules” no longer applied, common sense no longer existed.
I was interviewing an active IV heroin user for a presentation and when I inquired
about the purity levels in Southern Illinois, He responded “Brad, this Heroin
is so good it’s killing people”. I knew than that all the rules were different
and everything I knew about working with substance abusers was in need of
modification.
I am still learning, still working one on one with heroin
users, still trying to understand why people addicted to heroin are considered
expendable by society, still being an advocate when I can to change the rules,
still improving my outcomes (it has many years since I had a client die as a
result of heroin use), and I am still looking for ways to help others to live.
B
