I need a little inspiration to resuscitate this blog. Our group is hard at work "addressing the social determinants of health." We are working on curriculum, talks, posters, workshop, etc. But it is usually some sort of patient encounter that prompted me to act...I recently admitted a very young woman with a hand infection due to injection drug use. She was studying to be nurse a one point, had less than ideal childhood and family circumstances, literally homeless but she wanted to quit. She did well on buprenorphine for 2 years, lost her insurance recently (you name it). She wanted to go to a nearby hospital for detox and rehab but we just could not get her in. Luckily she did not have bacteremia or endocarditis and she was also resourceful; she knew various treatment programs in the community. She had friends whom she knew she would quickly relapse if she went to stay with them. She found a friend who was in recovery who was willing to let her stay on his couch for 1-2 weeks until her hand got better. The inability to provide ready access to addiction treatment has always been so infuriating to me. Her story is not unique. As a primary care provider, I see a lot of intersection between pain and addiction. I'm concerned that in our war on drugs and in the efforts to curb the opioid abuse epidemic, we have overlooked pain treatment. Yes, of course, there are "physical" pain and "emotional" pain and all shades in between but they are all pain, pain managed with physical therapy, talking therapy, alternative therapy, anti-depressant/anti-anxiety medications and yes even opioids. There is also pain that comes from the lack of opportunities in our society, pain from inequality, social injustice, social isolation and a culture that thrives on financial success, individualism and personal responsibility. Is there a medication for that? In the next segment, I will summarize legislation that tries to address this issue.
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"