I first saw her in my clinic seeking care for HIV but when we first met like most patients with her medical condition she was not an ideal patient. The decision to start her on ART Antiretroviral therapy in those days when the only single tablet regimen was Atripla (Tenofovir/Emtrictabine/Efavirenz) was not an easy one but if there is one thing that I have learnt from taking care of the patients that most physicians may consider as non ideal is to always give people the benefit of the doubt and let them prove themselves. There is nothing better than the will to live to make people achieve feats that may seem impossible in other circumstances. The reason I was concerned about my patient’s ability to do well on therapy was not because of anything that I knew about her but the fact that she was a heroin addict.
Anyway when our clinical team started her on medications for HIV with good supportive case management and medication adherence counseling she did very well. She struggled with her drug addiction but her HIV virus was controlled with ART therapy for many years until her hepatitis C which I had not addressed on account of the high failure rates on interferon therapy in patients like her pushed her into liver failure.
This is when her good clinic follow up and medications adherence paid off. I still remember getting a call one afternoon from a transplant surgeon asking about her ability to follow up in clinic after liver transplant. Well, I did not need to convince him all I had to do was to recall how long I have been treating her medically and how well she had done on treatment. To think this was a lady that I was worried to start on Truvada, Reyataz and Norvir for HIV. Yes she got the transplant and 3 years after the surgery when I last saw her she was doing well.
So; she did win the war on drugs; her own private war on drugs which she fought every day; 24 hours a day, 7 days a week. She won that war. This little lady from Baltimore City that I was second guessing won a war that the United States of America has fought ferociously for almost 5 decades and lost terribly.
Last Friday the city of Seattle, Washington passed a motion to vacate all convictions and drop all charges for marijuana possession in the city. This follows the legalization of recreational marijuana use in Washington State in 2012. From the 1970s onwards the United States of America has spent close to $1 trillion on the war on drugs. According to one drug policy think tank in 2015 alone we spent $36 billion tax dollars on this war, majority of this money going into law enforcement.
In 1980 the US had 50,000 people behind bars for drug law violations today we have half a million. This same war on drugs which my patient won with some support by us aided by Ryan White Funding dollars at the federal level has created major barriers to harm reduction strategies that have been shown to assist drug users like her turn their lives around. Unfortunately it is the same tax payers dollars that assisted patients like Julie to achieve control of their lives and battle major healthcare barriers that is used to create barriers that keeps others enslaved by drugs.
My twitter post with this question “who won the war on drugs” elicited some interesting responses see a screenshot from my twitter page.
What I hope we learnt as a nation after 50 decades of the war on drugs is that it really does not pay to attack the victims of a problem in our fight against these problems. That simple lesson would assist us in making decisions on all our wars, be it Syria, ISIS, or the Muslim Brotherhood.
I would say it again, if we want to win the war on drugs we need to support patients like Julie in their own private wars. That is a war we can win and victory in that war though not always easy is very tangible when you achieve it.
By Leonard Sowah a physician in Baltimore, Maryland
Image Credit: Insight Crime – Coca field picture in Columbia
Patient with health care worker – Free images http://www.freeimages.com