This past Sunday, Zendaya gave a masterful performance on the hit HBO show Euphoria. While fictional, it gave viewers an honest look at the devastating realities of the opiate epidemic. Particularly impactful was the ability for all to see what our patients and their families are confronted with daily.
To summarize, Rue, an adolescent girl with a severe opioid use disorder, is intervened upon by family and friends. Her ambivalence is palpable. We see her vacillate multiple times between tearful pleas, desperate to get help, and then, without warning tearing up her mother’s room, looking for the drugs that were confiscated. It is confusing and inexplicable unless you have experienced or witnessed this common experience among opioid users in withdrawal.
The powerlessness of the user and helplessness of loved ones displayed is heart-wrenching – and happening all over the country, just under most people’s noses. These experiences are not shared by those facing them because most of the public does not have the stomach for it nor has answers for what to do. Therefore, people keep it a secret. Shame and hopelessness drive it into the dark corners of society. These secrets are found in all walks of life: wealthy neighborhoods, middle-class families, and homeless shelters. Gallus’ Executive Clinical Director, Steve Carleton, explains, “My experience is that most people don’t want to hear these stories at a dinner party, but it is critical to understand the reasons behind Rue’s destructive and incomprehensible behavior.”
After causing tremendous property damage and emotionally abusing and gaslighting the people she loves most, Rue agrees to go to what she believes is the emergency room. In the car with her mother and sister, Rue learns she is being taken to a drug residential treatment program, not an emergency room, where she believes they will give her narcotics. Sheer panic sets in for Rue, and she jumps out of a moving car and dances around traffic, nearly hit by numerous cars. This is not far off and fictional. There are many unbelievable stories of the lengths people will go to avoid withdrawals and programs that undertreat symptoms.
At Gallus Medical Detox, we turn the status quo upside down. People do not need to suffer in detox needlessly. Nearly every hospital or residential center waits until a client is sick before medicating. There are toxic beliefs that suffering will somehow motivate a person to change; there is zero evidence and no rational explanation for this attitude. The Gallus proactive approach to withdrawal management has created an environment where people no longer need to be afraid to withdraw. If someone is cared for compassionately and doesn’t feel terrible, there is a higher chance they will trust providers and engage in a conversation about seeking further help.
Before providing intervention, most detox services wait until people score an eight or higher on the COWS (Clinical Opioid Withdrawal Scale). On the COWS, one correlates to minor withdrawal symptoms. An eight is associated with mild to moderate withdrawal symptoms. If a patient scores a 14-15 on COWS, they are visibly ill; they would have goosebumps, be sweating, and most likely be experiencing diarrhea or vomiting. Shannon Weir, our Director of Clinical Education, scored Rue’s character based on her visible withdrawal symptoms. She scored her an 18-20 because of her excessive sweating, vomiting, yawning, restlessness, and overall discomfort.
At Gallus, we don’t wait. When people arrive, we immediately start treatment using our Accelerated Micro Induction Protocol. Most patients rarely score more than an eight or a nine throughout their entire detox, and commonly a score of 3 or 4 is the highest because that is the threshold for our medical staff to provide needed medical support.
Rue’s fear of detox leads her to hide in trash cans from the police, take life-threatening risks, and cause irreparable damage to relationships. Within hours, she puts herself in a position where she injects morphine with a dealer that has threatened to sell her to human traffickers if she does not pay. It’s crucial to understand: This is not uncommon and happens daily in our communities. It is painful and uncomfortable to watch, but this is the reality. Often asked by family and friends, “How do people get to that point?” The answer is terrifying: It honestly doesn’t take much. It can happen pretty quickly, and finding the right help feels impossible to most.