I am a practicing hospitalist physician in Dayton, Ohio. Dayton has emerged in the last year as the city with the highest per capita death rate from opioid overdoses. When we measure the number of deaths here we talk about how many there are per day, not per week or month. We have been inundated with heroin and other products laced with fentanyl or carfentanil. Every other drug, including marijuana, is laced with an opiate in this city. Dealers stand on street corners and throw baggies of heroin into passing cars who have the windows open — free of charge — to get new customers hooked. A routine dose of Narcan to revive someone here is not the standard 0.4 mg dose, but a minimum dose of 10 mg. Many people die and cannot be revived despite maximum Narcan doses.
Our hospitals are overrun with opioid dependent patients. They take up a staggering amount of the healthcare community’s resources. When you are an IV drug user, there are many acute and chronic medical illnesses that come with it:
- hepatitis C
- bacteremia
- endocarditis
- abscesses of the skin and bone
- osteomyelitis
- pyomyositis
- rhabdomyolysis
And that’s if you are lucky enough to survive an overdose. Many of these conditions take months to treat and will cost hundreds of thousands of dollars.
In hospitals and clinics in Dayton, the medical community is being tested. We do not have enough resources to help patients get clean. And even if we did, the number of patients who achieve remission then relapse over and over and over is staggering. Instead, we spend our days putting out fires. Reviving opiate users and patching them up so they can leave against medical advice only to return day after day in an endless cycle.
What you will see throughout the city is a community exhausted by opiate abuse. Our job is to take care of all patients, but you can clearly see over time a degradation of empathy and willingness to keep endlessly helping drug abusers. When day after day you are constantly verbally abused and threatened, sometimes physically as well, it is very hard to maintain any kind of positive outlook and caring bedside demeanor. It wears on us to be abused and mistreated by our patients and to even fear for our safety in caring for them.
Because the truth is that most of these patients we take care of are going to die of an overdose or a complication of their drug abuse. Right now things look bleak and a solution seems unreachable.
All I can do right now is keep trying to fulfill my duty to “do no harm” and treat each patient to the best of my abilities, but I’m not going to pretend that doesn’t get harder and harder each day.
Jenny Hartsock is a hospitalist.
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