I walked into the room and saw a frail young woman, in her late 20s, angled in her hospital bed, resting peacefully in no acute distress. A vibrant rose tattoo adorned her left ankle and blonde hair covered her eyes. Although I closed the door as softly as I could, she abruptly awoke. Mildly unaware of her surroundings I watched her as she cautiously glanced at me, observing my white coat, recognizing she was safe despite her unknown future. “Hi, I’m Dr. Campbell, but please call me Jason. I’ll be one of the doctors caring for you.” She silently nodded in acknowledgement her attention glued elsewhere as I further approached her. I don’t know if this is what I visualized in my head when I thought of an intravenous drug user. Most, if not all of my previous thoughts revolved around a two-dimensional image of danger, dishevelment and unpredictability.
The truth is never that simple.
In actuality, she may not make it to her 30th birthday a fact worsened by her limited awareness of this fatal reality. Her chance of survival—lessened by an abnormal growth on one of the valves in her heart—is extremely low without a surgical operation. Every few days—once I had finished seeing and caring for my other patients—I’d return to her room to learn more about her story while we played the board game monopoly. It was human.
How had she arrived at this point? Did we, the physicians, do this?
“Four months—I was clean. It was the hardest thing I’ve ever done, Jason. I got a kidney stone, was prescribed opioid medications and relapsed. They don’t know what I went through to stay clean. All they see is a junkie lying in this bed. That’s all I am to them.” Later in the evening, haunted by her words, I opened my computer in hopes of obtaining an answer to my previous question. I opened the National Institute on Drug Abuse website. I read aloud, “21 to 29% of patients prescribed opioids for chronic pain misuse them, between 8 to 12 % develop an opioid-use disorder, approximately 4-6% who misuse prescription opioids transition to heroin and 80% of people who use heroin first misused prescription opioids.”
Statistics afford us the ability to comprehend the overarching picture but in the same manner can detach one from the realization that each percentage represents an individual person with their own story. One day after I finished performing a routine physical examination—which included listening to her heart to evaluate if her murmur had become louder (an indication the valve was in worse condition)—she disclosed to me an unspeakable past beginning at the tender age of ten. She was kidnapped, abandoned, and left on the streets to fend for herself with little food, the clothes on her back and the shelter of downtown businesses. By the time her grandparents had found her she had already endured so much pain for which there was no delete key.
“What would you do if you could have all of your pain go away?” she asked.
I returned a grin, timid in nature, ignorant unable to contrive a purposeful and succinct answer. She continued on, “I had so much pain. No way to control it. I was abused, taken advantage of with no one to help.”
I return to the initial question, how does one end up an opioid addict? The true summation of this story is that I struggle with the fact that I had, like other medical providers, certain prejudices and assumptions regarding the opioid crisis and the individuals plagued by this calamity. Science can teach us the processes associated with disease (pathophysiology) of addiction, the study of mechanism, action and side effects of drugs (pharmacology) about the medications to prescribe a patient for safe opioid withdrawal but it’s only through our patients that we can begin to understand the complexity and hardships many in the opioid epidemic face daily.
“When you first met me, you thought I was going to die, didn’t you?” she remarked, a smile dawning on her face. I returned the smile.
“I’ll see you tomorrow for our monopoly game.”