Heroin’s surge raises life-or-death medical ethics issue

Florida surgeons are telling heroin addicts in need of surgery for heart valve problems due to their drug abuse habits that they will no longer offer service for repeated medical conditions. The resurgence of these problems within an individual are a direct result of their self destructive illegal habits, and it is getting waaay too expensive!

The Tampa Tribune

TAMPA — Heroin addicts with recurring heart valve problems caused by their use of dirty needles are forcing surgeons across the state to make difficult ethics decisions on continuing to provide them expensive care.

Cardiac surgeons are seeing a 50 percent increase in ineffective valvular heart disorders attributed to the use of dirty needles, said Scott H. Bronleewe, a cardiac surgeon practicing in Tampa for the past 26 years.

The cost is staggering: more than $500,000 for the procedure and hospital stay for an uninsured addict, many of whom are back on the operating table within a few months, suffering from the same infections.

Surgeons across the state, already stretched thin by the problem, are stepping back, saying they will operate on an addict once, maybe twice, but will draw the line at a third time.

“If they return with reinfected endocarditis due to continued drug abuse, they are on their own,” Bronleewe said.
Though this could open the door to legal action, he said, no medical malpractice suits have been filed yet. Courts have indicated that this stand is legal because it is a form of resource rationing, he said.

By Keith Morelli | Tribune Staff

All I can say is that these surgeons spend much time, effort, and resources to treat these problems,and these junkies just have no shame or concern for their well being. I have to side with the surgeons with this one. However, is it possible this could set a precedent in regards to other lifestyle health issues such as STI's or even obesity?? One step at a time I suppose, but some could very well argue for in either case.

Life and death as a result of personal free will choices and the costs associated with them are very controversial topic. Lets hope we can try and persuade addicts away from drug use somehow, or perhaps make treatment conditional on rehabilitation in some way?

All I can say is that these surgeons spend much time, effort, and resources to treat these problems,and these junkies just have no shame or concern for their well being. I have to side with the surgeons with this one

Excuse me? Who restricted clean needles from addicts? Not addicts.

I was taken back by the title, because I knew heroin doesn't really cause problems for people, even long term use. The father of modern surgery, who was also 1 of the 4 founding doctors of John Hopkins hospital, was a heroin addict. Up until ~70 years old, and he practiced long into old age, taking a substantial dose every day.

This is some of the worst moral indignation possible here. This is also why proponents of a free needle exchanges encourage more programs like this in every city. It saves money over time because people who are addicted aren't forced to use dirty needles. It also cuts down on disease transmission, HIV/Hepatitus/et al, which again, saves a lot of money of time.

Society deemed drugs to be 'bad' and 'immoral' but its not even the drugs that are causing the problem here, it's the policy for the drugs that is causing the damage. The hypocrisy is brutal.

Part of the Hippocratic Oath.

I will remember that I remain a member of society, with special obligations to ALL my fellow human beings, those sound of mind and body as well as the infirm.

So it is the dirty needles that are causing
The problem not the drug

Easy give them clean needles

Better still legalize it and ban needles
They will go back to the old way
Smoke it

a reply to: AmericanRealist

London has the right idea. People are going to do what they want. If you make a safe way for them to do it they will, if not they will do it the other way.

Its funny these ethics are not applied so directly to people on expensive medical care due to legalized cigarettes? I believe that the drug war absolutely needs to end and also police need to be something different then what they are now. What I am eluding to though is much deeper then political philosophy, its more primal a doctor has a job just because he dont want to do it doesn't make it grounds to change ethics, politics are infused with the affordable care act and I understand some doctors actually packed their sh*t and left because of it. If the drug war ended there could be better probability doctors get paid more for research and actual care for addicts of anything, the problem is, is that is a fantasy with big corporations supplying meds and governments shipping in dope and cops needing to keep cracking down on crime.

a reply to: piney

Legalizing Heroin will be a big mistake. Just because there are a handful of successful people that can still function in society from these drug addictions does not nearly even cover the vast majority. The sad truth is many, if not most heroin addicts are only a notch above crack addicts. They will steal from and even harm their own family with no regard because the brain is focused only on that rush and high. Is this what we want to do to entire generations?? Legalizing such a drug means it can be commercialized. And anything that can be commercially sold will be accessed much easier by minor children.

That is not progress in a civilization, and will only lead to further de-evolution of the population. If I had to concede on the matter, I would vote decriminalization in that there will not be penalties for users who are caught with a determined amount for personal use, but still lock away anyone trafficking in the illicit drug. I would rather it remain illegal.

Anyone who has not witnessed first hand the destruction it can cause a family of an addict is only seeing one side of the debate.

In any case, there are only so many surgeons, and these people are told and efforts are made to convince them of the damage, to no avail. One day a relative of someone who is defending the legality of this will not receive the timely care they need because one of the few cardiac surgeons available was too busy dealing with a repeat self destructive addict. What then will the opinion be??

They are still giving them two shots to fix their life, that is a very fair option IMO. 3 strikes and your out. It is really simple, and should be clear logic to anyone who has issues with the cost of medical care and insurance.

a reply to: AmericanRealist

these junkies just have no shame or concern for their well being.

Man that sounded low. No compassion at all? These people have to be in an incredibly crappy place to try heroin in the first place.

Addiction is a terrible thing, these people are sick. I think we've all made some bad choices here and there, unfortunately an addict makes the mistake once and it's not so easy to give up.

Lets hope we can try and persuade addicts away from drug use somehow, or perhaps make treatment conditional on rehabilitation in some way?

Completely agree with this. I wonder what the cost/benefit would be if people were adequately treated instead of thrown in jail for a little while and then let free only to repeat the cycle.

a reply to: AmericanRealist

Make it legal through medical resources, not buy a fix at the gas station. If someone isn't an addict they don't get any. If they are, it's better to get them treatment that is suitable to them, as shown across the globe in the places that have done so.

That's a tough one. A large portion of people believe it comes down to the choice of the junky to kick the lifestyle. I at this point disagree. Its not a matter of will power when only a tiny percentage of the population inherently carry the will power to fight the addiction. Few people can comprehend the power of a hard drug to kill in an instant or reprogram the brain beyond recognition. Hard drugs rewire the brain and cause the user to make choices they would never dream of without the addiction. Choices completely outside their nature. Its a hardware change in the brain that physically robs them of the freedom to make rational choices. People that have the inherent willpower to affect change are special, an exception, like a rare immunity. When the typical person doesn't have an immunity then we cannot expect someone can just help themselves.

I have trouble completely blaming the individual for taking that first leap into hard drugs too. If our guardians, mentors, education system made a point of truly depicting the effect of hard drugs there wouldn't be an epidemic because people would be rationally opposed to taking such an incredible risk . And because people are not aware that a single hit can addict you, traumatize your brain permanently or even kill you, these "junkys" have succumbed to peer pressure. Its easy to just see and be angry at the trouble making loser exterior but really I think the issue is more of a cultural one.

a reply to: AmericanRealist

I agree wholeheartedly with all of the replies so far. The biggest thing is free clean needles. I do understand the frustrations of the doctors though, but I'd prefer they just do their jobs, and maybe put the pressure on Florida to do something about their junkies using dirty needles.

a reply to: boncho

lOL EXCUSE ME I LIVE IN A NEIGHBORHOOD IN CINCINNATI where 2 kids 19 an 21 died this week due to overdoses
and this was after years of abuse where i watched these kids around the neighborhood since they were 12 and
i watched them turn into zombies and the ligh sucked right out of them so on and so on ect... ect..
NUMBER ONE KILLER OF TODAYS YOUTH....
www.rt.com...

So when you say its about the needles lol shows you are either a user which i have been one before never shot it up.
Or you just dont know what your talking about ....at all.
A few days ago I said hi to some kid coming bacvk from the local outdoor pop machine an he was all itchy
and rubbinig his nose and he told me he was high as hell on suboxone then after drinking a sip of pop he then puked five or six huge loads of puke all over the ground and stumbled down the road looking like he was falling asleep lol
I then had to go and get a bucket and dump water all over the street seeing as it was right outside my door.

Now I know the dirty needle problem is a problem also but it is a far cry from the only problem with opium abuse.
I mean a dirty needle can cause staff virus exchange although a virus has a hard time living outside the body .
But I lose my damn mind when my daughter or one of the other kids comes to get me because a damn needle washed up in creek ......happens at least one a year at least because people just throw them on the ground no respect for themselves let alone anyone else.

So Im with the dr.s if your gonna just keep on doing this to yourself your family your community then im not gonna waste my time to help you there is a little girl with cancer in the next room that wants my help not just here to get needles or pain medicine .
I think that might be the most uninformed statement about heroin I have ever heard.

God help us all.

a reply to: sweets777

Oh yeah I dont live in the city city either i live in more the country area the suburbs loveland ohio
right nect to indian hill ohio the richest area in ohio where all the bengals live lol so im not in an inner city area .....thank god im or else sure i would see more

originally posted by: Domo1
a reply to: AmericanRealist

Man that sounded low. No compassion at all? These people have to be in an incredibly crappy place to try heroin in the first place.

Addiction is a terrible thing, these people are sick. I think we've all made some bad choices here and there, unfortunately an addict makes the mistake once and it's not so easy to give up.

Yes that was a bit harsh, I will apologize. Let me just say, unfortunately I have met every type of addict known to man, and many of them know full well they dont care to change and admit they will die with a needle in the arm or a glass pipe in their hand. It gets to be depressing.

a reply to: dogstar23

Thing is, people who have hit rock bottom are not even thinking of the cleanliness of the needle. It may be an afterthought when the drug wears off, and many just toss them out into the grass or parking lots. I think that also ties in with what CraftBuilder stated in that those who can actually manage the addiction are a rare breed with a sort of rare immunity.

This article from 2010 explains part of the problem with dirty needles in this state

"Chapter 893 of Florida statutes makes it unlawful to conduct a syringe exchange program," said Susan Smith, press secretary for the Florida Department of Health. "We implement policies set forth by the Legislature."

The law makes it a third-degree felony "to deliver, possess with intent to deliver, or manufacture with intent to deliver drug paraphernalia, knowing, or under circumstances where one reasonably should know" that it would be used to inject, ingest or inhale an illegal substance.

"You'd have to have that willingness," said Allan Clear, executive director of Harm Reduction Coalition in New York City. "One of the problems with Florida is it's not had that willingness. It's politically conservative."

However

The Florida Department of Health is studying whether to recommend a change in the law. That would need to be in collaboration with the state's drug director, who takes the major role in drug policy, said Tom Liberti, chief of the department's Bureau of HIV/AIDS.

Bob Rihn, executive director of Tri-County Human Services in Lakeland, said he would support having an exemption for syringe-exchange programs if appropriate guidelines were in place.

I dont know how much progress is being made, but I found this on Lifeinvader, and have no idea what it says because I dont have a life invader account. Anyone want to help me disseminate any useful info from there onto this thread would be appreciated.

a reply to: sweets777

So your answer is for them to "figure it out"? You don't see any benefit at all in getting these people treatment, while at the same time covering their fix?

Every one I know that's addicted to smack is a direct result of pharmaceutical opiates. The real issue here goes much deeper than some dirty needles.

Besides, they hand out clean ones.

a reply to: Flesh699

yes they did mention this as well. Trust me I lived literally in the heart of the pill mill epidemic. I personally saw the lines reaching for blocks.

The rising use of heroin by addicts left high and dry by the shuttering of opiate pill mills a few years ago is the main reason behind the increase, surgeons say.

Bronleewe, also president of the Florida Society of Thoracic & Cardiovascular Surgeons, said his group of five surgeons in Tampa has noticed a sizable bump in the need for the procedure over the past two years, since the state shut down all the pill mills, which were an easy way for addicts to obtain opiates.

Those were some really bad times man. A couple of my friends are only now recovering from the decisions they made i those days. They were like zombies a lot of times man. Scary stuff.

Just wait till the same standards apply to football players with their concussions , or parents that have disabled children...i mean how dare those two parents with defects have a child with defects and the money invoved in trying to fix them. Just keep going down the rabbit hole of control and no empathy and we're home.

originally posted by: sweets777
a reply to: boncho


So when you say its about the needles lol shows you are either a user which i have been one before never shot it up.
Or you just dont know what your talking about ....at all.

It is about dirty needles, at least this thread is. Dirty needles directly cause the heart infection. The doctors in the article do not want to do repeated surgeries on the same person for the same reason.

Therefore, it leads to Florida's laws against needle exchanges or providing clean needles. Changing laws alike this would go a long way in reducing those infections and others and reduce the amount of needles found on the ground, because they would have somewhere to drop them off.

originally posted by: AmericanRealist

originally posted by: Domo1
a reply to: AmericanRealist

Man that sounded low. No compassion at all? These people have to be in an incredibly crappy place to try heroin in the first place.

Addiction is a terrible thing, these people are sick. I think we've all made some bad choices here and there, unfortunately an addict makes the mistake once and it's not so easy to give up.

Yes that was a bit harsh, I will apologize. Let me just say, unfortunately I have met every type of addict known to man, and many of them know full well they dont care to change and admit they will die with a needle in the arm or a glass pipe in their hand. It gets to be depressing.

a reply to: dogstar23

Thing is, people who have hit rock bottom are not even thinking of the cleanliness of the needle. It may be an afterthought when the drug wears off, and many just toss them out into the grass or parking lots. I think that also ties in with what CraftBuilder stated in that those who can actually manage the addiction are a rare breed with a sort of rare immunity.

This article from 2010 explains part of the problem with dirty needles in this state

"Chapter 893 of Florida statutes makes it unlawful to conduct a syringe exchange program," said Susan Smith, press secretary for the Florida Department of Health. "We implement policies set forth by the Legislature."

The law makes it a third-degree felony "to deliver, possess with intent to deliver, or manufacture with intent to deliver drug paraphernalia, knowing, or under circumstances where one reasonably should know" that it would be used to inject, ingest or inhale an illegal substance.

"You'd have to have that willingness," said Allan Clear, executive director of Harm Reduction Coalition in New York City. "One of the problems with Florida is it's not had that willingness. It's politically conservative."

However

The Florida Department of Health is studying whether to recommend a change in the law. That would need to be in collaboration with the state's drug director, who takes the major role in drug policy, said Tom Liberti, chief of the department's Bureau of HIV/AIDS.

Bob Rihn, executive director of Tri-County Human Services in Lakeland, said he would support having an exemption for syringe-exchange programs if appropriate guidelines were in place.

I dont know how much progress is being made, but I found this on Lifeinvader, and have no idea what it says because I dont have a life invader account. Anyone want to help me disseminate any useful info from there onto this thread would be appreciated.

I did find your OP harsh. It's better that you found the problem in Florida's laws.

Patient's can't be turned away. It is against federal law. The doctors in the article know what their job is. Turning people down for surgery to treat a heart infection is not in the job description.