The Emergency Room at Central Vermont Medical Center in Berlin sees around 30,000 patients a year. Of these, 70% are physical medical emergencies like broken bones, and 30% are mental health related. The majority of this 30% involves drugs and alcohol; in these cases the distinction between drugs and alcohol is often unclear.
Dr. Depman, an emergency medicine physician at CVMC in Berlin, sees both the direct and indirect effects of opiates in his job: “We could get a car accident while they were drinking and driving, or someone coming in with a skin infection related to using needles to inject heroin.”
Dr. Depman expressed particular concern about skin infections. Intravenous drug users can get rashes from injecting drugs that can then spread and become fatal.
These infections can be from dirty needles, the open skin, and more, and can be “all over their arms and legs from using every little vein they can to inject drugs over time,” he says, “and those infections can get into the bloodstream and infect the valves of the heart.”
The rashes become very severe once they are an internal infection. “The treatment might involve being admitted to the hospital and being put on antibiotics,” he explains, “but they don’t want to be in the hospital because they can’t use [drugs] in the hospital.”
Dr. Depman sees these cases as a “typical, frustrating example of somebody whose addiction has so taken hold of their life that they can’t even respond to somebody who’s trying to help them.”
Recovery at CVMC
Many patients reach a point where they know they need help. To begin their recovery, CVMC often prescribes suboxone.
Dr. Depman details the effects of suboxone: “it is something you take by mouth everyday to reduce the cravings, and that reduces the harmful effects of using drugs from the streets.”
Suboxone is only the first step. Counselling and therapy are critical steps that must be taken next. “The goal has to be to get off suboxone and return to a life without addiction and medication. And that’s the hard part.”
With opiates from the street, “you don’t know what the concentration is or what it’s mixed with,” Dr. Depman emphasizes. Suboxone and therapy “keep you from using needles and inhaling stuff that can be harmful,” until they can return to a normal, addiction-free life.
Why is There an Opiate Crisis?
Dr. Depman notes that the opiate crisis is about more than drugs. “The question we need to ask in Vermont is why are so many people opting for harmful behaviors when there are so many healthy, positive behaviors in our culture and our state to pursue?” He has some theories about this.
Dr. Depman says that stimulants and sedatives have always interested humans. “It’s a universal human instinct.” He adds that coffee and tea drinking are more common stimulants that are a much healthier way of approaching that desire. Questioning this impulse can assist in leading an opiate-free life.
“What is it about my brain or my body that makes me need these things?”