LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Wednesday, September 22, 2010

New skills

I untwist the paperclip, bending it carefully around the shiny silver bottle cap, making a handle. With a plastic spoon, I scoop a small amount of the white powder from the Ziploc bag, pouring it into the bottle cap, careful not to spill any.

It looks so harmless.

Next, I tear the tip off of a squeeze tube of sterile water. Squeezing at the middle I fill the bottle cap half full of water, add a wee tightly spun cotton ball, and I’m ready to go.

Holding the “works” in my right hand, I flip a Bic, and begin cooking, holding the tip of flame under the bottom of the cap. Its silver surface turns sooty. In half a minute, bubbles appear. The handle is getting hot in my fingers. The solution starts to boil. I’m supposed to cook it at least 45 seconds.

I always thought that if I did something like this, it would be under a dark bridge somewhere on a foggy night, not a brightly lit conference room on a work day.

Life is full of surprises.

The power dissolved, it’s time. I uncap an insulin syringe, harpoon the mini cotton ball with the tip of the needle, and draw up the warm fluid. The cotton ball is a low tech filter, keeping any un-dissolved crystals out of the syringe.

It’s full.

I roll the syringe between my fingers, feeling it’s warmth. The cold, sterile plastic has become a living thing. I marvel at the feel. How many cold syringes and room temperature syringes have I held in my hands in my life? Too many to count. But this one . . . wow. It’s special. Alluring. Magical. Wonderful.

Even the ritual is addictive.

I tap out the bubbles to the top of the syringe with an expert thump of my finger and gently advance the plunger to get them out without wasting too much of the clear fluid.

I swab the inside of my elbow with an alcohol pad, starting above the vein and swirling outwards. Quickly, I grip the end of the tourniquet in my teeth, wrapping the other end around my bicep, around, under, over. The baby-blue tourniquet is tight around my arm. The vein bulges. It’s ready. It’s time.

I hold the syringe in my left hand, bevel of the needle upwards, 45 degree angle to my arm, and then I slowly lower the needle. It gently kisses my skin above the swollen vein . . .

“Good!” shouts the instructor, “now if this was real, you’d slide the needle into the vein, pull back on the plunger until you see a flash of blood, release the tourniquet (I pull back on the tourniquet by pulling my head up and to the side—the tourniquet snaps off), and shoot up.”

Yep. The State of New Mexico is teaching me how to shoot heroin.

Say what?!

OK, remember how I told you the world is not black and white? But rather, it is a million shades of gray? Well, my world just got grayer.

My clinic is in the process of becoming a certified needle exchange center for intravenous drug abusers. Now hear me out before you freak out. I’ll be first to admit that this is a controversial subject, and it took my boss a full year to convince our community board to go along with it.

So what is needle exchange? Well, it’s what it sounds like. We give junkies brand new clean, sterile needles in exchange for used ones.

Why on earth would we do that?

Because junkies share needles. And sharing needles shares blood. And you should never, ever, ever share blood with anybody. Ever. All kinds of bad shit lives in blood. Hepatitis lives in blood. All three kinds. HIV lives in blood. Need I go on?

And like you can’t judge a book by its cover, you can’t judge a persons’ blood by their looks. There are skuzzy folks with clean blood and sweet little old ladies with AIDS.

Our state has done needle exchange since 1997. Of course we’re not idiots. We call it “Harm Reduction,” instead of “needle exchange.”

Last year we gave out 2.9 million BD insulin syringes to IV drug users. Yeah, that blew my mind too. We also give out pocket sharps holders. We used to give out tourniquets, cookers, cotton balls—everything a proper junkie needs. It’s almost as much paraphernalia as it takes to be diabetic. But State budget cuts have us reduced to the bare-bones basics right now.

So why was I being trained how to properly shoot up heroin? So I can teach others, of course. OK, here’s the thing. There is a right way and a wrong way to shoot heroin into your veins. Do it wrong and you trash your body more than just the heroin alone will do. You blow out your veins. You get ulcers. You cost the tax payers extra money at the ER.

One of my nurses was outraged. She felt we were encouraging drug use. A lot of people feel that way. But you know what? If people choose to use heroin, they are going to do it. With access to help or not.

Now, I used the word “junkie” for dramatic effect in this post. I don’t really feel that way about drug users. They’re just people. And people get addicted to all kinds of things that are bad for them. Tobacco, too much alcohol, excess food, sex with strangers. But they—we—are all still just people. I don’t care what color your skin is. I don’t care what your sex or age is. I don’t care how much or little school you’ve had. If you are a member of the human race, you deserve something as basic as health care.

So needle exchange actually is harm reduction. If we accept you as you are, and treat you to minimize the harm you are doing to yourself, we help us as much as we help you. We lower our society’s health care costs by keeping you as healthy as possible. We reduce the spread of pathogens that may someday spread to us if we ignore you. Or to our children. The availability of clean needles reduces the risk our children will play with dirty ones they find in our parks, our alleys, and our vacant lots.

Users can enroll in our program anonymously. They are literally just a number. They also get a “get out of jail free” card. Any one enrolled with the state’s Harm Reduction program can’t be arrested for carrying their gear. We also give out Narcan, a nasal mist that brings an overdose back from the other side. It’s the opiate addicts’ version of Glucagon.

The State’s program has also had an unexpected consequence. Every site that has been established sees a drop in drug use within 18 months.


Because junkies become people. They develop relationships and trust with the staff at the clinics. While we give needles we have the chance to bandage scraped knees, treat illnesses, and begin to mend broken hearts and minds. We have a chance, one little step at a time to bring those on our fringes back into the fold. And when they are ready, and not a second before, we will be there to help them beat their addictions.


Blogger Scott S said...

Interesting when you say "the world is not black and white? But rather, it is a million shades of gray?" Laura Schlessinger has a quote that might be relevant on that point: "When you're the victim of the behavior, it's black and white; when you're the perpetrator, there are a million shades of gray." I suppose the same could be said about heroin usage. The issue that needs to be dealt with is how to minimize risk to the extent possible, right?!

8:58 AM  
Blogger Jonah said...

Kol hakavod lachem.

After I was diagnosed with diabetes, I felt like the stigma of needle use was a little bit too shared. I went to volunteer at a needle exchange program in Chicago, although actually I never completed the training. I did get to see the mobiles and the syringes and all that. They get 28 G ones.
They give out syringes (mostly small ones, but also some intramuscular ones for street hormone users), condoms (which is actually what most people wanted), hepatitis vaccines, sharps containers, something that was supposed to treat overdose (I don't think it was a mist) as well as a little basic training for using it. They give people little cards that say they're in a study and allowed to carry syringes, They also accept back full sharps containers.

I read a book a few months ago by a doctor who worked in a high crime area of New York and he said one of his HIV positive patients was opening the hospital sharps containers, taking out syringes and needles, and selling them / trading for drugs. That is exactly why we need needle exchanges.

4:58 PM  
Blogger Jonah said...

P.S. Once a week they also had a free barbeque by the needle exchange.

4:59 PM  
Anonymous Bernard Farrell said...

Wil, I think there are a million ways in which people get hooked on heroin and other drugs. But there's one principal way in which they get off - with lots of help and encouragement. I know I'm being simplistic.

I hope this program really helps people kick their additions.

7:11 AM  
Anonymous Anonymous said...

fantastic post, I enjoyed all the thought provocation, thanks!

9:43 AM  
Blogger Sweet Virago said...

A-MAZING! Simply amazing. What a terrific blog. I began reading because I am a diabetic, about go go on the pump after begging for 8 years. I, too, have little to no awareness of being too low OR too high! But when I started to read the blog, and realized what you were describing, I HAD to keep reading.

In the early 1970's, in high school, I became addicted to meth - I never snorted it, or took it as a pill or put it in tea to drink. From day one, I shot it up. My driver's ed teacher taught me. I was 16 and hooked for life.

I have not touched the stuff for over 35 years but every once in a blue moon I'll wake up, gasping in body pleasure, because I dreamed I had just shot up. I'm sure there are reams of academic papers on memory and pleasure, but living it is entirely different.

I am so happy to read that there IS a program like the NM needle exchange, and that you do more than just swap out dirty needles. I was not so lucky and am quite sure the Hep C I have now came from back then. I had Hep A and B, too, but never knew it and am now immune. This was in the days before HIV so I lucked out completely on that issue!

However, there were no caring people around back then that understood much about addictions, or the people who became addicted to anything. Most of the drug programs were shams, and to any intelligent person, addict or not, steering clear of them made more sense than getting involved in what I still perceive as a substitute addiction.

I have definite ideas on how and why I began, and why I stopped, without outside help, but to read that there are people 'out there' NOW who understand that addicts are just people, too, and could use instructions, I started to cry. If only ... Then maybe Jack, Steve, Ross, Lydia and others would still be alive.

Every day now I have to inject insulin into my tummy and have, on occassion, laughed at how easy it is to simply go buy syringes - if you know the lingo of "units, Novolog, test strips, glucometer, etc." Back then, no one needed a prescription for syringes but we were all too embarrassed to go in and buy them, plus pharmacies gave us a ration of hell when we tried. Thanks to one kid's dad, who was a vet, I learned how to clean my syringes with bleach and water but that wasn't always available, and huge risks were taken.

There still is so much ignorance, so much judgemental BS and so little compassion regarding "needle freaks." I'm glad to see your program working.
You NEVER know what will make a person quit using - perhaps it has been one of your staffers, or yourself, that has given someone the deeper desire to quit vs. continuing to use; and probably for reasons they barely understand and that you may NEVER know.

Thank you for what you do. I'm relocating back to the city where I first started using soooo many years ago, perhaps now that I'm retired/disabled I can see if there is a similar program there, and volunteer. I'm not afraid of using again, and believe that my personal experience could be a big help. Even if I never know it, maybe, like you, I can help someone stop. It's worth a shot!

8:52 AM  
Blogger Sweet Virago said...

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8:56 AM  
Blogger Sweet Virago said...

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8:57 AM  
Blogger Sweet Virago said...

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8:57 AM  

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