ENTRY: Patients inflate use history to ensure treatment

Being in recovery myself, I tend to notice certain behaviors of the folks seeking recovery themselves as they proceed through the intake process at work.  In case you weren’t already aware, I work as a peer recovery coach at a treatment center specializing in MAT therapy (we offer both methadone and Suboxone) and mental health diagnosis.  I have learned so much more about myself while doing this work, and not just as a former junkie, either.  I’m talking as a person, through-and-through.  In my time as a peer coach, talking to fellow like-minded individuals, trying to help them get back on their feet and such, I’ve learned more about my own natural strengths and deficiencies.  This role has granted me the gusto to improve upon my areas of weakness (such as developing a firmer sense of self-possession).  However, I’ve also picked up the nugget of wisdom that says that self-love is the most crucial skill en route to living the most fulfilled life.

e-cigarette-conseils-vape-heureuse.jpgI wanted to share a tidbit with all of you from yesterday.  We had a brand new patient in the midst of his admissions process, which always takes a bit longer.  Well, unsurprisingly, the nurse went over his use history with him.  Of course, this is very typical, particularly with MAT, since the doctor needs to know how much a person uses/used in order to approximate tolerance levels.  It just so happened that I was in the room at the time, as I had to speak with our nurse care manager.  Typically, I’m not present for methadone admissions.  I’ve been to loads of admissions, though.  Once the RN got to the use question, this patient admitted to using an insanely high amount, weight-wise, on an average, daily basis.  It was actually shocking…but only for a few seconds, as I realized that it was just as likely that he could have been fibbing about how much he was using.

Why did I think this way?  Well honestly, new patients seem to do it all the time here, and we’re basically 1000% sure that it’s because each person believes that if the doctor hears that earth-shattering figure, he or she will be the first and only person in history to theoretically “beat the system,” and get started taking methadone at a much higher dose than the legal maximum amount of 30 mg.  Unfortunately, it doesn’t ever work that way because, as I just mentioned, we’re talking about the law here.  It’s sad, too, because with the influx of fentanyl hitting the streets really nationwide these days, that maximum amount has not changed federally, and there are no plans for it to as of yet.  If the patient is still “in withdrawal” at the initial dose, he/she will most likely be put up 5 mg max the next day, and then every 3-5 days pending evaluation.

1__mJSH7-q0wjdvq8G-Qv_DQTragically, however, there is another reason that patients with substance use disorder will lie about their use history when completing an intake for admission into a treatment modality, whether it be a methadone clinic, a short-term detox facility, an intensive outpatient program, or anywhere else.  Believe it or not, it is a very unfortunate fact that potentially new patients will exaggerate to the admissions nurse in order to ensure themselves a slot in the program.  I know this because I’ve actually been guilty of it myself, and I remember several years ago when I was still out using, I crossed paths with tons of folks that happened to mention to me that in order to be admitted into a detox facility, they needed to tell the nurses that they were irreparable alcoholics, guilty of drinking all throughout the day and night.  I can actually recall one man telling me that he had to shake and twitch through the evaluation appointment so that he would come off as more believable.

When it came time for me to detox this last time (over five years ago now!), I just knew that I didn’t have the devices to get through it on my own.  So, I elected to voluntarily admit myself to a short-term detox facility, and yes, I told them I was an alcoholic (in addition to being dreadfully addicted to opioids, of course).  Thankfully, I was granted a bed.  I did fess up to a nurse just prior to being discharged, though, and she told me that what I’d heard on the streets was basically true.  Since there’d been a shortage of funds and resources, the intake specialists at the hospital were being very strict when triaging these people who were, in essence, probably very ill.  I’ve gathered, by asking around and doing some research online, this policy still appears to be in place.  Here in the southern part of Maine, a state that’s seen one of the most terrifying spikes in opioid misuse, we still seem to be deprived of the adequate provisions, so patients who are simply “dope-sick” will either be held off from what the state has to offer (basically just a treatment protocol in hallways at the hospital), or placed on an excruciatingly long wait-list.  In order to guarantee yourself a bed somewhere, then you, in essence, must also have a potentially fatal co-morbidity, like severe epilepsy, for example.

detox-patient-hospital-600wIn reality, I would argue that “drying out” is the most essential part of the initial recovery process.  Years ago, whenever I relapsed in the wake of a half-hearted sobriety attempt, it was always because I wasn’t feeling well.  Moreover, since I had no way of treating the extremely unpleasant symptoms, my only way out was to go get high again.  And so I did — time and time again — without fail.  It is much easier to sort out your options for moving forward with a clear and unimpaired mind.  I would not have been able to maintain my own sobriety this previous time if I didn’t attend the detox facility first.  Notwithstanding, how can you attend detox if there’s no detox place to attend?!?  This has become an incredibly severe problem within the state of Maine and all about the country.  There is a private detox facility that just opened up in Portland, and I can tell from the photos I’ve seen that it looks to be a top-notch establishment.  Be that as it may, they don’t accept Medicaid, and you have to pay up-front.  They’re not cheap, either.  If there was ever a time to request federal aid, then this would be it.

NHS-1096233It just goes to show: this is another painfully true example of utter irrationality within the addiction care industry.  It does not make any sense for an opioid-dependent patient seeking medical marijuana to lie and feign having another, more pitiable ailment at the doctor’s direction.  And in this case, it is unjust that patients looking to detox off opioids actually believe it is required to provide an exaggerated drug history in order to be admitted to the facility.

When will there be SOME accountability?  I think that we recovery coaches, counselors, case workers, and advocates should start attending city council or town hall meetings.  And I mean this about everywhere in the nation, not just Maine or New England, as I’m hearing that this problem is not confined to just the ol’ 207.  Frankly, I think this is a critical moment in our nation, and our voices must be heard when it comes to OUR tax dollars.  WHERE is all the loot going?!  Furthermore, instead of protesting or yelling out our frustrations, I think that it is way more effective to sit down and have a civil, intellectual conversation about this issue.  I’ve totally gotten sick of hearing about these nationwide protests that almost always end up with people in ambulances.

While writing out this entry, I’ve experienced quite the epiphany.  The initial detoxification phase (typically 2-5 days for most individuals, depending on what was being abused), is by far one of the most crucial aspects of recovery.  If state, local, and even federal governments are supposedly so concerned about this “opioid crisis,” then one would think that they’d be appropriating MORE funding to adequate public detox facilities, where ALL types of insurance are accepted, and beds are aplenty.

Again — one would think.

Let me know what you think.  Send me a message (click here).  I wanna hear your ideas.