A 10-year-old boy in Miami is only the most recent victim of the opioid crisis. A 3-month-old died in July, 2016 and an autopsy revealed fentanyl in the baby's gastric system.
Today is my first visit to an outpatient addiction treatment center. On my way to Baltimore's Concerted Care Group (CCG), my Uber driver warns me, "This is a dangerous neighborhood." It's lunchtime on a cold Friday afternoon in March, and I've taken a vacation day from work to come in from Washington, D.C., where I live.
My driver drops me at the gas station next door to CCG. I walk toward the entrance and am greeted by a friendly, armed guard entering the building. Just past the reception and guard desks that flank the front door is a large waiting room with several empty chairs. It's bright and clean. A bank of windows lines the right wall with people sitting behind glass like bank tellers but with big curtains at each window. I check in and have seat against the back wall. I try not to stare, but I wonder about the curtains.
The opioid crisis has devastated my family, but I'm not here for treatment. I'm volunteering. My sister, Jenny, died last year from cirrhosis of the liver from alcoholism and opioids. She was 44 — a college-educated, middle-class suburban mom. I experienced the entirety of her addiction, struggle and death in six days last July. Our family was close and saw each other often, but we didn't know Jenny had substance use disorder.
Every day since her death I feel an overwhelming sadness and almost debilitating regret that I did nothing to help her. I'm so ashamed of myself.
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I look around the waiting room at patients coming and going, but no one is waiting; everyone who comes in is served immediately. I assume they are low-income Medicaid recipients based on their clothing — and I'm sure my own unconscious bias. A few have battered sweat jackets with hoods up and their heads down, so I can't see their faces. A young woman checking in has the skinniest legs I've ever seen, like two pencils in colorful, leopard-patterned leggings. She wears big hoop earrings and dark lipstick and has friendly banter with the armed guard. I am suddenly self-conscious about my Stella McCartney bag and warm cashmere coat. I feel like a jerk.
My family's story feels different from this, no worse or better, just different. I don't know this world of substance use disorder since I only experienced it for six gruesome days in a hospital watching my sister die while moaning for Dilaudid (a synthetic opioid).
I'm here today to run a workshop about management methods I've learned while working at the United States Digital Service. Using materials from a class I teach at Georgetown, I've planned a 2-hour session with the CEO, Dr. Andrey Ostrovsky, for his 15-person CCG management team.
Andrey greets me with a huge smile and gives me a tour. I learn the curtains are for privacy while patients take their medication at the window. Andrey explains they have plans for a better set-up, but for now it's a fast, effective way to serve more than 800 patients a day. As we walk through the halls, there are graphs taped up on walls plotting data with performance metrics. The place feels more like a Midwest tech start-up than an inner-city health care clinic.
I learn that CCG offers addiction treatment (with no wait times), behavioral health, primary care and other wrap-around programs like GED classes all in one location. This seems like common sense: What's the point of getting off drugs if I don't have a job, place to live or the mental health services I need?
Our workshop is in the CCG building next door. The conference room has glass doors and a large TV monitor I hook up to my computer. The walls are covered with stickies, like a team from Apple or Google has just finished a working session here.
The workshop is great. We work in rapid, iterative cycles, and everyone is engaged as we go through team exercises on agile delivery, design thinking and minimum viable products. They are a talented and dedicated team, and I am grateful they let me be a small part of their work.
We finish the workshop, and as Andrey walks me back to the waiting room, he tells me about his daily neighborhood "walkarounds." Yesterday was a good one, because one of his clients was involved in a "jacket-only" stabbing, so no one was hurt. His optimism is genuine and contagious, and for the first time since I started researching the opioid crisis last year I am not hopeless about our national response, because small groups of thoughtful committed citizens like Andrey and his team are going to fix it.
If we apply an innovative and patient-centered approach like CCG's at a national level to improve treatment and recovery, we can do a lot with the $3.3 billion recently approved in the omnibus for the opioid crisis (which is estimated to be a $504 billion problem by the White House Council of Economic Advisors).
But treatment and recovery is just one swim lane of this crisis. Our national plan needs to provide leadership and resources for all the lanes: health policy, education, prevention, treatment for criminal justice populations, harm reduction, medical school curriculum updates, training for nurses and pharmacists, law enforcement reform, and monitoring and surveillance.
As I'm waiting for my Uber home in the CCG lobby, I notice a sign next to me in different color markers with big artsy letters advertising a program for "Women Who Want to Change Your Life" on Saturdays from 9 a.m. to 10 a.m. I wonder if the skinny-legged girl will be there. The sign is so positive and inviting. I want to go. I want more than anything to go with my sister.
And then I realize my family's story isn't different at all.