The Empty Chair
Thoughts on a Fatal OD (RIP CW)
The other day, during a meditation group we had at our center, our center manager related that a newer member of our community, a woman probably in her early 50's, had suffered a fatal OD on the streets of New Haven. I had recalled “C” to mind as I had helped her with the online part of our onboarding process for volunteers. C had been recently homeless after finally getting out of active addiction to Crack Cocaine. Well put together, she had been using shelters or staying out on the street when there was no space, and as a single woman sleeping solo outside, it was often a scary and traumatizing experience for her. C would come into to our recovery meetings with the weight of the world on her shoulders and in her eyes. The sadness just radiated from her, a certain hauntedness.
Sitting in our Great Room talking to a fellow volunteer, I looked over to where C almost always sat, a side chair near the front of the room where she could see the door. Sunlight poured in through our tinted windows and cars honked out on the street. I recalled other people we had lost to drugs-Reggie and now C, in the span of 2 months. I wondered about other people who were “back out” on the streets-Jim, Annie, TT, Juan.. What happens to them? Are they still around? The voice of my mentor floated into my head- “Focus on the potential, not the pathology”. People will do what they do when it comes to substances. Many will relapse, and that's not at all abnormal. Others will OD and be brought back via Naloxone, others may not make it. I assume that C was alone without someone carrying Naloxone on them, a small thing that could have saved her from an OD if she had taken Opiates (though you cannot reverse Xylazine with Narcan). While fatalities have dropped in CT by over 45%, here in New Haven we've seen that First Responders still deal with overdose emergencies quite regularly, though thanks to the distribution of Narcan being widespread, people are being brought back from what would otherwise be a fatal Fentanyl overdose. It's a bit give and take-For everyone I coach who manages to get sober or go to detox to kick the habit, there will always be the people who don't come in, who stay out, who are hiding out in abandoned houses or behind a dumpster off of Grand Ave. There will be the people on the New Haven Green who “nod off” but never wake up. Some make it, some don't.
Unless you've actually known someone who fatally OD'd, you tend to think of Overdose as a symptom, not a story. Someone uses drugs, they have a bad reaction, they die-Isn't that why we have Drug Prevention programs in schools? Isn't it a foregone conclusion that someone addicted to drugs will eventually die from it if they don't put the drugs down? Not exactly. It's easy to know the “What” of a fatal outcome from drug use, it's less easier to know the “Why”, which may be Trauma, Family History of Addiction, Self-Medicating for Mental Health issues, Childhood exposure to substances in the home, Ineffective pain management, or a host of other issues. This is where a Coach or a Clinician who asks the right questions of someone in crisis can make a difference. If you go to your local ED, unless one of our ED Dept Recovery Coaches is there, you may find you get treated more like a patient with symptoms then a person with underlying needs-Treat the symptom, discharge the patient. But..what if we see an OD as a story? What if this story, this narrative about how they got to the place where they overdosed, is what really heals? How much shame and secrecy is tied to the act of heating up that spoon, or loading that stem, or negotiating the cost of a pocketful of Benzos? If we can understand what's driving use, then we have a better chance.
I had inferences of what was going on with C's life, but like many women with trauma, she didn't really bring a lot of it out. I can't say I blame her. Women of color who disclose trauma are often under treated, dismissed as attention seeking, or seen as tougher then they are due to the idea of the “Strong Black Woman” who handles it all herself and so doesn't need as much. The NIH and others pointed out that this persona was often adopted as a defense mechanism against threats to Black family systems via racism, unfair labor practices, and stereotyping of the “Welfare Queen” who “uses” the system in a predatory manner to enrich herself and her family. We praise people who keep it together under pressure, we shame the chronic relapser who “can't get right”. Perhaps when we see an empty chair in our meetings, we should ask ourselves simply “What does it really mean?” and grieve what we couldn't provide.