Outreach programs provide care in opioid addiction crisis
I have a patient, let’s call him Joe, who is having a rough time. Joe used to work in construction, long before I met him, before he hurt his back 25 years ago. After many failed attempts at other things, he had back surgery. Following the standard of care at the time, he was prescribed opioids by his doctor. When I started taking care of Joe, he had lost nearly all his hope for himself and for his future.
He was initially stable on his high doses of opioids, but couldn’t go back to work, so he lost his job. He couldn’t pay his rising rent, or his medical expenses, so he filed for bankruptcy. He couldn’t see his kid, who had gone to stay with his ex-wife full time, now that he didn’t have his own place. He started staying with friends, on couches and guest beds, but that strained those relationships. Because of all of this, he suffered from anxiety and depression. He began sleeping in his car, which made his back pain worse.
Then opioid deaths became one of the leading causes of death in the U.S. His doctors started to wean him from his medications, without much to replace it. Desperate, he turned to friends and acquaintances to buy pills from them, before that began to dry up too. Finally, about five years ago he turned to the cheapest, most available option, heroin.
Joe grew up in Santa Cruz and will proudly tell you that his great-grandfather first moved here almost 100 years ago. Now he is suffering from homelessness and addiction. These are not isolated problems. They didn’t “just happen.” They were the result of failures in the medical and economic systems in which we all participate.
When I met Joe he was suspicious of me at first, wary of people he didn’t know, with a history of mistreatment by his neighbors. I offered him a bottle of water, sanitary supplies, a mask to protect himself and others from COVID-19. He graciously and politely accepted and was much more willing to talk to me.
He worried about having to move all his belongings again before the city police came to try to drive everyone out of the area. “Where else can we go?” he asked me, “If we had somewhere to be, we would be there already.”
Joe regularly interacts with the local syringe exchange programs through street outreach. He would go to one of the two county syringe services program sites but can’t get there since his car got towed and he doesn’t have money to get it back or take the bus. If he doesn’t get clean syringes, he is afraid he’ll end up back in the hospital, where he was admitted a few months ago for an infected injection site, causing sepsis. He also graciously accepts my offer of a specialized plastic sharps disposal container when I offer it to him.
Programs like the Harm Reduction Coalition provide vital services that perfectly complement, not undermine, the county’s efforts at taking care of our neighbors like Joe. He is empowered to better care for himself, despite the terrible situation he has ended up in. Outreach builds relationships and removes barriers for residents to access lifesaving preventive care. Preventive care decreases disease burden for our entire community and makes economic sense.
Outreach programs keep areas where people live both cleaner and safer, by distributing clean supplies to help prevent diseases, such as hepatitis and STI’s and coronavirus. Studies also show that outreach programs keep places cleaner than those without these programs.
What Joe really needs is more affordable housing, better and affordable access to medical care and wrap-around services, and addiction services, all of which we should also work on. But the bridge to those resources starts with outreach and starts with compassion.