We’re dispatched to an overdose on Ashley Street. I am in the fly car and a BLS crew is in the ambulance. We’re driving around looking for the victim. I don’t see anyone on two passes, but then I hear the BLS unit radio they’ve found him. I swing around to where they are now parked at the curb with their lights still going. An EMT is already wheeling the stretcher down a short alley where his partner is kneeling by the dumpster. As I approach, I see he has the ambu bag out and is providing ventilations to a man who is dusky with agonal respirations. The man’s hair is long and unmatted, his blue jeans are muddy and his books are wrapped with duct tape.
“Good job,” I say to the young EMT. “Eagle eye.”
“Thought I’d check behind the dumpster,” he says.
“You found him.” I marvel at his simple logic.
In EMS many times when we meet persons with opioid use disorder (the correct language to describe what we used to call junkies — a stigmatized term that originated with “junk men” people who went through garbage –the connotation indicating human trash), we find them at rock bottom. I have done many overdoses like this one of homeless people who were in fact down alleys and behind dumpsters. From TV news coverage that often includes clips of homeless people overdosed near dumpsters, many would assume that all drug users seek trash cans out to hide behind while they stick “dirty” needles in their scab and abscessed filled wasted arms. The young EMT did and it helped us find this lost soul.
Rock bottom means there is no lower that someone can go. If you were digging a well, you might go through many yards of dirt until you hit solid rock, and can dig no further. It is a common belief that someone needs to hit rock bottom before they are really ready for help.
How does someone get to rock bottom? The stories my patients tell me are often similar. They begin with risk factors that led them to their opioid use disorders. They were injured physically or they were damaged mentally by abuse. They may have true mental health issues, often undiagnosed. They had access to drugs either through a doctor’s prescription or through a friend or the black market. Once they were addicted, they hid their use because of fear and stigma. Their relationships with family and community were strained or completely destroyed. They appeared in court or were hospitalized for overdose. They lost their jobs, and were evicted or kicked out of their places of living. If they had kids, a spouse, relatives, or social services took them away from them. Poor employment histories, supplemented by new criminal records for small crimes from petty theft to trespassing, restricted their ability to find work. Home became the street, and drugs continued as a way of coping with what lives had become. They use to forget, they use to not be sick anymore. They overdose behind the dumpster where I give them naloxone and put them in the ambulance.
We revive this man and he tells me his story, all too familiar. He used to own his own construction company. Now he lives under the highway and hasn’t seen his kids in two years.
I think of my early remarks to the users I revived before I thought to ask them their stories, when I just saw them as people who needed to get a grip. Get your life together, just say no or you are going to end up dead or in jail. Look at yourself. I held up to them not a picture of who they could be again, but who society saw them as — junkies, human trash.
It is hard to make something of yourself in this world, much less when your current position is the rock bottom and when the whole world is looking down on you.
We need to create communities that catch people before they fall to rock bottom, before they lose everything that matters to them, communities that recognize the humanity of those who are lost.
Treat addiction as the disease it is. Don’t criminalize it. Don’t stigmatize it. Offer a helping hand. Love thy neighbor. Don’t let them hit rock bottom.