Dear Policymakers: Get Addicts To Help You Protect Public Health.
Read my piece at The Fix today about David Kwiatkowski, the hepatitis C–infected hospital tech indicted last month for stealing drugs from operating rooms. He is suspected of stealing syringes of fentanyl, injecting himself, then refilling the vials with saline and sticking them back on the drug-carts—in ORs in 18 hospitals across the country. OR staff then unknowingly used dirty needles on healthy patients. So people in this guy’s wake are testing positive for hepatitis C.
The indictment and the subsequent news stories were only about the drug-thefts—how sneaky he was, how messed up he was, how the staffing agencies kept hiring him out even though he was fired from several hospitals and found passed out in at least one hospital bathroom under the influence of fentanyl. Empty syringes were found in his lockers and clothes.
What interested me was the intersection of addiction and public health. Here was a guy who was in the depths of addiction, using the same drug I’d used. He used on the job, as I did. But I used alone in one room of my house. And this guy knowingly put the health of hundreds, if not thousands, of other people in danger.
How could that happen? What were the gaps in the system? How could they be fixed?
My medical sources for this story were amazing.
David Smith, M.D., founded the legendary Haight-Ashbury Free Clinic in San Francisco. He’s worked with street-junkies for years and is now starting to work with white-collar dopefiends like me and Kwiatkowski. It’s always interesting interviewing these guys because they sometimes know so much about drugs. I can sometimes tell which ones of them are also addicts, and it was my sense that Smith is a recovering addict, and I was right. (He’s open about it.)
Smith knew a lot about drugs.
“Fentanyl is a very addicting drug,” Smith said. Healthcare workers, he said, are at greater risk than others of abusing fentanyl because it’s a common drug in surgical procedures. Healthcare workers steal it from ORs. Smith told me about a patient of his who ate a patch and had a heart attack.
He told me about a truck driver who was prescribed fentanyl for chronic pain, who put on too many patches and passed out behind the wheel of his truck, fortunately before he started the engine. The department of transportation tested him for drugs and he passed—because fentanyl, a synthetic opioid, is not on the standard five-panel drug test.
“But he had fentanyl patches on his body,” Smith said, “so he was mandated into drug treatment.” We need to test for prescription drugs, he said.
Society is focused on illicit drugs, but the biggest growing problem is prescription drugs, and they fall through the cracks.
He told me about another patient, a registered nurse, who ate a fentanyl patch and died. Addiction among nurses has not been studied as much as addiction among doctors. Smith’s wife founded the first nurses’ addiction-treatment program in California. These professional programs have fantastic success rates. If only all addicts could get the kind of healthcare that doctors (and politicians) get.
I’m working on a story now about addicted nurses and doctors. If you’re a nurse or a doctor addicted to opioids, and you’d like to speak (either under your name or anonymously) about your experience, please email me at email@example.com.
My second source, Richard Garfein, an epidemiologist at UCSD (and a really smart guy on whom I might have one of my little geek-crushes), used to be a CDC worker who would visit hospitals to figure out how patients got infected with hep C. It was when I was talking with him about how to change public-health policy that I had a brainwave:
What if hospital administrators and public-health officials got recovering addicts to tell them what the gaps were in the system?
“If you’re trying to protect your house from theft,” I mused to Garfein, “who better to hire than a thief?” I had already told Garfein I was an addict, so he knew he had one on the phone. One who could talk policy.
“Huh—you want to stop internet hackers, you hire a hacker,” he murmured. “I think that’s a really excellent recommendation. If you are doing a study that involves prison inmates, you have to have an inmate on your committee. There’s a lot to be gained by talking with people who have been on the other side.”
He emailed me this morning:
I fully agree with your message that users should be included among the stakeholders working on the solution to this program.
Hire me! I want to say. Hire me!
Do I need an MPH for this? Makes me want to go get one.