Just Say Go!

In 1999 I was working at a methadone clinic in West Philadelphia, just down from the train tracks.  My job was to hand out methadone to patients.  Most patients had to present twice a day to stand in line and receive a cup of liquid orange flavored methadone that I passed to them through a small trap door from my position behind shatter proof and reinforced glass.  The patients had to toss the methadone back like a shot and then open their mouth and raise their tongue up to show me that they weren’t pocketing any of it to sell. 

Periodically everyone would have to provide a supervised urine sample on demand.  If your urine sample dipped positive for any substance you were kicked out of the program.  If you didn’t attend group and individual therapy, you were kicked out the program.  If you missed too many of your doses you were kicked out of the program.  This was the old school, Nancy Reagan, “ just say no” era of treatment for opioid use disorder- full of moral judgement, arbitrary rules, and so much stigma.  The most absurd rule was that in order to start methadone you needed to provide a urine that was free of any substances…the irony here is that if you can provide a urine free of substance, you are already ahead of the curve.  Those with substances in their body fluids are those most in need of treatment!  In 1999, there was no questioning the standard of care for opioid use: one size fits all or nothing, my way or the highway, zero tolerance.  That didn’t prove to work out so well.

Fast forward twenty years, in a country that is ravaged by overdose deaths.  Where one in every seven persons has been personally impacted by opioid use disorder.  And where we have left Nancy Reagan and her “just say no” mentality behind and are embracing a harm reduction approach to opioid use disorder.  Where we understand that OUD is not a moral failing but a physiological illness like other physiological illnesses that require medical standards of care.

In my job now I get to educate medical professionals about the importance of providing the gold standard of care for opioid use disorder in the emergency department.  I get to produce toolkits and cheat sheets and badge buddies to support naloxone prescriptions and buprenorphine induction. I am entrusted to demonstrate to clinicians that even one dose of buorenorpune in the ED can give a person hope.

  I am privileged enough to educate about external, systemic, and intrinsic bias and prompt clinicians to think about their own barriers to providing stigma-free treatment.  I have the power of data to drive critical conversations about how to improve the care we provide, and I get to see the tangible outcomes of my work on our clinicians learning curve and their dedication as I watch our compliance rates for OUD measures multiply.  And best of all, I get to translate that data into the number of lives impacted and that number of lives saved by the work that I help support.

Someone once said that statistics are patients with the tears washed off.  As we commit our time and our talents to PRSL and we tally up the numbers of naloxone handed out, the condoms distributed, and the swabs completed we should never forget that each naloxone kit, each condom, each swab is a life that we’ve touched. One more life given one more chance because we’re part of a bigger movement.  The world is better because of us.  Just say Go!