Dopesick - Beth Macy Page 0,94
was helping local psychologist Cheri Hartman, one of the Hope Initiative coordinators, set up a similar transfer in Roanoke, but they were stymied by bureaucratic, financial, and legal hurdles, including a shortage of MAT providers and not enough opioid-detox and treatment beds.
Both were hopeful about a grant they were applying for to make the handoff smoother. Until then, Kuehl said, hospital social workers were referring revived overdose cases to Hope—among them an increasing number of people who were passing out while driving.
The state was concurrently working, through Carilion and other hospital networks in the state, to free up money to train peer recovery specialists who would facilitate the treatment handoff among overdose patients and others seeking treatment for both opioid-use disorder and mental illness, but the program wouldn’t be operational for many months. “Right now everyone is running around in crisis mode, trying anything they can, but there’s a lot of mismatched interventions, and no sense to it,” one health-system insider told me.
“In the meantime,” Kuehl told me, sighing, “I’m definitely getting a bigger car.”
Four months later, the women were crushed to learn they did not get the grant.
*
Though she was still grieving her son’s fentanyl-overdose death—Bobby had been dead now for fourteen months—Janine Underwood thrust herself into the Hope project with vigor. She wasn’t a believer in harm-reduction strategies or MAT, but she was trying to keep an open mind. When users shot up in the parking lot at the clinic—“getting their last hurrah,” she called it—police declined to take action, knowing it would inhibit users from coming.
Like most of the angels, Janine allowed participants to contact her on her personal cellphone. Texts and calls came by the scores, ranging from grieving mothers who wanted the ear of another mom who’d lost a child to a young heroin user named Matthew who’d heard about the program and just wanted to talk. He was suicidal, he said, and they spoke multiple times over the course of several days.
When Janine learned that Matthew had hanged himself the day before he was scheduled to come in, she fell apart. “Before I knew it, I was becoming a crisis center,” she told me, a month into the program. “I was in over my head.”
The following week, a young woman escorted to the clinic by police staggered indoors, then exhibited signs of overdose in the clinic foyer, necessitating a 911 call and several doses of naloxone to bring her back. And though Janine left follow-up messages with her, she never called or returned.
A conservative Rotarian, Janine realized that barriers to treatment were more formidable than she’d understood, as was the epidemic’s scope. It wasn’t just the money and limited treatment capacity that waylaid people; it was the morphine-hijacked brain, the scrambled neurotransmitters that kept people from thinking clearly or regulating their pain with nonnarcotic substances, or imagining the possibility of feeling happy again.
Janine wished for a way to force users into treatment, a detention order for the heroin-consumed brain. Bills to involuntarily commit users were increasingly being introduced in state legislatures from Kentucky to Massachusetts, but there were civil liberties concerns, and patients-rights groups and many experts believed coerced treatment backfired more often than not.
Twenty-two people walked into the Hope Initiative in the first month, and the angels felt they were making progress with some, the ones who expressed repeated interest in getting help and continued to text and call. Still, exactly zero of them had entered residential treatment, and only a handful had been able to access outpatient MAT. Janine was so mentally exhausted that her colleagues had to call EMS after she passed out from stress-related vertigo at work one Saturday.
Looking back now, the spreadsheet the angels had so carefully created seemed naive, akin to spraying citronella oil on a termite infestation and expecting your home’s crumbling foundation to magically reconstruct itself.
*
The first Hope Initiative success came months into the program and took weeks of life-and-death negotiations—dozens of phone calls, days of hand-holding, and thousands of dollars, eventually, to arrange residential treatment placement for a single patient. Janine had personally spent eight straight hours in the emergency room with the family of “John” (not the person’s real name), a ten-year heroin user who had been a friend and fellow user with her son Bobby. John had tried detoxing at home, but his parents took him to the hospital when he became too sick, partly from needle-stick abscesses on his hands and arms, his temperature soaring to 103.
Janine wiped the young man’s dopesick