By Abigail Block, Washington & Lee University (2017)
When I attempt to explain my summer experience to friends and family, it comes out sounding like I selected a few Cleveland agencies out of a hat and put together a jumbled schedule of unconnected experiences. My internship consisted of half days travelling between a family health center, an HIV clinic, a clinical pharmacy, a syringe exchange van, addiction therapy groups, the Cuyahoga County Justice Center, and a detox unit—in that order. Mondays, I discussed the rising rates of diabetes and the toll it has taken on the population’s health, while Thursdays were spent addressing Cleveland’s heroin epidemic. This breadth of experience allowed me to observe, in most basic terms, the ways in which America’s healthcare system is broken. It pits freedom, progress and health against each other, creating conflicts for patients and healthcare professionals alike. The systematic flaws affect members of all socioeconomic classes, but for many, these shortcomings are bearable. The majority of people in this country can compensate with additional time, energy and resources. Yet the poor lack these resources and are forced to endure the consequences of this broken system. Their poverty damages their health and their poor health pushes them further into poverty, creating a cycle that amplifies their struggle. As an addiction services intern, I witnessed this most prominently in the health of people with chemical dependency.
Abby Block “has become passionate about interdisciplinary healthcare and its influence on the poor.”
Friday mornings, after making the patient rounds with an addiction psychiatrist in the detox unit, I would sit at the table in the common room, waiting for patients to gather for art and music therapy groups. I sat there, feeling like an intruder as I observed people in their most vulnerable state. Usually, one or two curious patients would strike up a polite conversation and put me at ease. One woman sat down across from me, clearly frustrated and looking for someone to hear out her concerns. She had traveled 200 miles to the Cleveland Clinic to start a reputable pain management program, as she had been prescribed opioids for over ten years which were no longer serving her needs. Upon her arrival, she was immediately transferred to the Alcohol and Drug Recovery detox unit, hearing for the first time that her prescribed dose was dangerously high. She had unknowingly developed a severe chemical dependency. While this case is rare, it only differs slightly from the most common stories of dependency: when the patient’s drug tolerance grows as physical pain persists, causing patients to take a stronger-than-prescribed dose.
One of the issues at work here is that there is little data to support the long term use of prescription opioids for pain. As time passes, the risks of the drugs increase substantially while the benefits are either diminished or stagnant.
Our healthcare system’s pharmaceutical dependency is being transferred onto its patients. Opioid prescriptions have been on the rise since the 1990s, especially for the vulnerable adolescent population, for whom prescribed opioids have almost doubled over a thirteen year period (American Society of Addiction Medicine). The boost in medically viable opiate use and abuse has led to a heroin epidemic which has very much been the case in Cleveland. Heroin is much cheaper and in some ways easier to obtain than prescribed opioids, causing around 75% of opiate addicts to move on to heroin abuse (American Society of Addiction Medicine). Here, the American mentality of instant gratification is abused as pharmaceuticals become a quick fix without paying mind to the long term consequences of addiction. Once again, the poor are at the highest risk. Doctors accepting Medicaid are hard to find, and the ones that do, have far too many patients to see. These doctors are forced to rely heavily on the “quick fix,” as their time to investigate health issues like pain is lacking. Our system continues to marginalize those in poverty in ways that seem to cause health issues such as chemical dependency.
Abby’s internship with the Cleveland Clinic included exposure to family health center, an HIV clinic, a clinical pharmacy, a syringe exchange van, addiction therapy groups, a detox unit, and more.
The bulk of my summer was spent with patients who had fallen victim to this trend. Their addiction had jeopardized their health, and they came to seek support. However, it is not easy for most to admit that a system built to help society has taken its toll and led to addiction. Thus chemically dependent individuals face stigma and judgment. Often times, our first societal response to people suffering addiction is the criminal justice system. The heavily weighted criminalization of drug use in our country seems to contradict the medical community’s recognition of addiction as a disease, so the law responds before the healthcare system can. Rather than offering rehabilitation, drug offenders exit the prison system with less opportunity than they previously had. Job prospects are harder to come by and familial support may be diminished. Without any treatment or focus on coping skills, heroin is readily available to fill the gaps upon release from prison. The treatment available to the chemically dependent remains expensive and narrowly targeted. Without sufficient health insurance, the poor are excluded from many of the existing programs that offer buprenorphine therapy and counseling.
These frustrating complications call for an open dialogue about addiction from those in recovery and those at risk. Eliminating the stigma surrounding chemical dependency would allow more people to get behind accessible addiction treatment. Chico Lewis, who runs the Syringe Exchange Program out of the Free Clinic is an encouraging example. A recovered addict himself, Chico understands and relates to the patrons of his van. He knows most of his clients by name and they feel comfortable to share the trials of their day with him. Without judging or preaching, he subtly reminds them, as he would a friend, that he can easily connect them with a treatment center when they are ready. Sustaining a welcoming environment where accessible treatment is a constant like Chico has, would help communities reach those marginalized by criminal justice and healthcare systems. By diversifying the group of people involved in addiction services to include numerous professional perspectives, we could widen the community interest and provide in depth care for the chemically dependent.
The flexibility of my internship allowed me to pursue my interests by seeking out pharmacists who understand my objectives and can discuss the frustrations they face. Although they were not directly involved with addiction services, the barriers of healthcare that clinical pharmacy attempts to eradicate would be invaluable in dealing with chemical dependency and other services for those in poverty. As a clinical pharmacist, I could dedicate time and attention to at-risk patients who may need assistance with health literacy or focused attention to family history. Clinical pharmacy and its growing influence on the population’s health has become an important discovery for me as I have become passionate about interdisciplinary healthcare and its influence on the poor.
Works Cited “Opioid Addiction Disease 2015 Facts & Figures.” American Society of Addiction Medicine: The Voice of Addiction Medicine (2015): n. pag. American Society of Addiction Medicine, 2015. Web. 24 Aug. 2015.