My primary goal of this post was to connect readers to a nice collection of Denver Post articles published this past week discussing heroin addiction and street life. These articles follow a young woman over many months in Denver as she struggles with poverty, homelessness, and heroin addiction. The articles in question are the following:
These articles are comprehensive and fully illustrate the inherent suffering experienced in the addiction cycle. They discuss some of the components of ‘harm reduction’ which is one of the most effective modes of substance abuse treatment. Harm reduction involves treatment to alleviate the suffering and ‘harm’ of drug addiction, not necessarily decrease the consumption of the drug itself. Examples of this form of treatment include needle exchanges to prevent infectious disease transmission and methadone or Suboxone replacement therapy to alleviate the cycle of using, withdrawing, pawning/stealing, and eventually, incarceration.
One limitation of these articles is that they do not discuss the need for structure and accountability effectively. They refer to methadone programs in a somewhat poor light, discounting the importance of regular clinical point-of-contact and resources. At the Denver Health substance abuse clinic, with director Carol Traut quoted in the articles, multiple services are provided for patients including group and individual therapy, housing connections, and primary care medicine. This structured service is necessary for patients to replace not only the actual drug, but all of the choices, patterns, and relationships present within the addiction cycle.
Another limitation to this discussion is one involving money. Reports from my past patients have told me that often someone can make $100-200 a day through panhandling. The current cost of black-tar heroin in the Denver metro area is around $80 for a gram (often dealers give a $10 discount if purchasing a whole gram at a time!). A typical month’s use then adds up to around $2000. The cost of enrollment in the Denver Health methadone program is slightly over $200 a month and the cost of Suboxone (as mentioned in the articles) is between $240 and $400 monthly (in addition to the addiction psychiatrist appointment fee). When patients are falling back on the claim that “it’s too expensive to get clean,” there is often a deeper, unconscious desire to maintain the addiction cycle amidst the continued consequences and struggle.