Reversing opioid overdoses isn't enough
I’ve worked at Preble Street in Portland, Maine, for 26 years and never thought I’d see the day when our social workers are reversing opioid overdoses on a regular basis.
In my first 22 years here, we had no overdoses. Zero. Now every eight days we find someone on a bathroom floor, lips blue, not breathing.
Preble Street is a private non-profit agency founded in 1975, beginning as a social work training site for college students and activists. From the start, we’ve carried forward a set of principles, foremost among them that there is value in all people, that everyone deserves to be treated with dignity and respect, and that our social work can and should be layered throughout with love and compassion.
In 42 years of Preble Street’s existence, we’ve witnessed tectonic shifts in our communities, watched the dismantling of the so-called social contract in this country, and wept for the masses of people trapped in poverty. And today the picture is even more grim: an unchecked, growing, deadly opioid epidemic challenging everyone doing anti-poverty work.
Four years ago, a young man was discovered on the floor of our soup kitchen bathroom with a needle in his arm, the first victim of an opioid overdose at Preble Street. It was the start of a terrible trend that has become rampant. Three years ago, we averaged one overdose every three months. Last year it was one every two weeks. This year, every eight days a Preble Street social worker keys into a bathroom and finds someone on the floor, not breathing. That social worker has become a first responder.
For four decades, we trained social workers in building relationships, in helping people find housing and jobs, and reunite with families. To be effective advocates.
Now the very first thing we train social workers to do is reverse an opioid overdose. Every staffer carries Narcan and is trained to use it. This year to date, we’ve reversed overdoses and saved the lives of 40 people.
As tragic as it is to think about someone alone and desperate, dying in a soup kitchen bathroom, what is even more horrific is that each and every person who has overdosed in our buildings and programs has asked for help before that overdose. They’ve asked for help in getting into detox. They’ve wanted to go to a recovery program. They’ve stated out loud their hopes of getting sober.
And this is every social worker’s dream. You’re talking with someone suffering from substance use disorder, over coffee at the soup kitchen, and they ask for help getting sober. They have a moment of clarity, and it is that moment — that precious moment — when a social worker wants to jump on it: “Great! Let’s make some calls. Let’s make a plan. Let me walk you to the detox center.”
The moment when someone is seeking sobriety is the perfect moment to help them really change their lives. But tragically, too often this can’t happen. Detox programs in southern Maine turn away about 100 people each month. The services just aren’t there. Treatment programs barely exist, and those that do are mostly for people with insurance. For people who have Medicaid, which — make no mistake about it — is the “magic key” to most recovery programs.
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And Maine was one of the states that did not expand Medicaid. So over and over again people are denied treatment — denied hope — because they do not have insurance.
Due to our advocacy work on hunger and homelessness, MAZON, a partner advocacy organization, invited me to testify on behalf of Preble Street recently in Washington. We addressed the moral impacts of budget cuts to human needs programs in the wake of the tax plan likely to pass this week. Medicaid and services for people with disabilities will be more difficult to access. And the escalating opioid epidemic will rise to new heights.
In a recent team debriefing, after we successfully reversed yet another overdose, one staff member commented on how beautiful it was to hear the chorus of calm, gentle voices of social workers calling to the person on the ground, urging him back to life.
“Breathe. Live. Breathe. Come back to us. Breathe. Live.”
Our work has taught us if there is any hope of survival, this person needs to hear we are with them, loving and cheering them on to life. And if survival is not possible, the last voices they hear should be from people who respect and love them.
That is good social work. That is love and compassion.
Mark R. Swann is the executive director of Preble Street, a non-profit social service agency in Portland, Maine.