“Our lives suck… ” said this 30 year old boyfriend of my patient. I was in the middle of performing an incision and drainage on his girlfriend when he made this statement. The abscess requiring the I&D was a product of repeated heroin injection from using a dirty needle. She would lick her arm “clean” then inject heroin with a previously used or shared needle. Her feet were covered in dirt. Her dentition was poor. She and her boyfriend had been using since they were 15 years old. They were crying. She was crying from the pain and stress of the procedure, him from watching.

We sat and talked for a while about their heroin addiction. They both knew they needed to quit, but every effort they made was deterred by physiologic (withdrawal symptoms) and psychological (hopelessness) barriers coupled with a real lack of resources. I wish I could have told them that the resources are out there and that pain clinics are easy to access, but the exact opposite is true. Methadone clinics are available, but may be difficult to get to. Patients in the area I work in have to travel to neighboring cities for methadone clinics, another real barrier to getting treatment.

“… we live in a tent.” It was raining last night. Keeping the wound clean, ideally a simple task, was a source of stress. No access to clean water, living on a floor of dirt, and relying on a tent roof for protection.

I left wishing them the best and reinforced their desire to quit their addiction.

It probably wasn’t enough.

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