A Heated Discussion: Medical Student Shares Perspective on the Rural Opioid Epidemic

I started college in 2018, just after the Oroville Dam in Northern California collapsed and flooded much of the city of Oroville. The reservoir holds much of the water responsible for irrigating the San Joaquin Valley of CA, my childhood home and where a good portion of the country’s produce and livestock is cultivated. Just as the community began to recover from the flood, another disaster struck: the 2018 Camp Fire. 

This fire completely destroyed the neighboring town of Paradise, leaving 30,000 residents without homes, with post-traumatic stress disorder, and after the media frenzy surrounding the disaster had slowed, without any real state support. As a result of this displacement, the residents flooded into the nearby town of Chico, where I was attending California State University Chico and just starting to become interested in medicine. 

My first introduction to the field was triaging the hundreds of patients who faced burn wounds more traumatic than any I’ve seen since, even following my time working in an Emergency Department, and listening to the cries of help and anguish from each person I encountered. I was 18, and not equipped to help these folks. But I tried my best. 

As time went on, many of the refugees from the Camp Fire made their home in Chico. Some found apartments and bought homes, but many were priced out as rent skyrocketed and Chico’s population grew 30% overnight. 

Consequently, the city now faced a large population that was unhoused, facing medical need, and would become increasingly reliant on social support to get them back on their feet. City officials had an insurmountable task in front of them, and understandably were overwhelmed. That didn’t excuse what happened next.

As the unhoused faced cold northern California winters, warming centers were made available to some under one condition: you had to prove you were sober. As a result of this policy, people were left cold, hungry, and feeling unwanted on the streets. 

Crime rates rose. People fought. Drug use skyrocketed. And our little clinic became a safe space. We provided food to those we could, our director Nancy advocating in the state senate for additional funding and spending her nights writing grants instead of with her grandchildren. 

Dr. Logan, our primary provider, began staying later than normal. When I first started at the clinic, we were typically open from noon to 4, sometimes 5 o’clock. Now we regularly stayed late into the night, charting, organizing, triaging, and talking to patients as they waited. 

I was green, and frankly, afraid. I knew I couldn’t provide any care to these patients, and that the mental health care they sought was hard to come by prior to the Camp Fire. But I could listen to what they had to say. Waiting lists for mental health services were YEARS long. Post-Traumatic Stress was present in nearly everyone we saw. Without counseling, and oftentimes without any hope for support, many turned to illicit substances for comfort, and through these substances, they reunited with families they’d lost, their brief euphorias giving them relief of the horrors that everyday life brought.

In the summertime, when temperatures soared to well over 100 degrees, cooling centers were opened, but held the same restrictions: “must be clean and sober for 30 days prior to entry. No drugs, no needles, no dogs.” The unhoused were evicted from everywhere they set up camp, and bulldozers were brought into the areas of Bidwell park, once a sanctuary that held coniferous and deciduous foliage collected from around the globe, and used to destroy encampments that the Camp Fire refugees called home. 

People died on the streets from heatstroke, and in the emergency room of Oroville Hospital and in the waiting rooms of the Shalom Free Clinic, I met people with trench foot, blown out veins, and eyes that showed an emptiness, a hopelessness, that brings me to tears when I think of them. 

Substance use disorder is not often a choice. The social determinants of health do not only dictate conditions like obesity, or cancer, or even hearing differences. They can also push people into seeking shelter from storms caused by negligence. In Paradise’s case, it was caused by a lack of empathy for the life of your neighbor, your friend, and even your loved ones. 

Without getting too much into the weeds, the mechanisms of addiction vary just as much as eye color or a disposition towards a receding hairline. Compare any two people, and their cytochrome p450 genes may differ tremendously, one allowing casual substance use, and the other causing exponentially greater tendency towards addiction. 

Compound that variance with the feeling that your state has left you on the streets to starve in triple digit heat or single digit winters, and you begin to lose empathy for the argument that these addictions are spurred by choice. 

If there’s ever any uncertainty about who’s affected by the decision to allow suffering, I encourage those who question these mechanisms to witness them firsthand. Encourage friends and family members to step outside their comfort zones. 

And then to do it again. 

And again. 

Do it for years, and people will begin to understand. It’s our job as healthcare providers to support not only our patients, but our communities by sharing the perspectives afforded to us by this career.  Life has a way of pushing us towards destinations we never thought we’d call home.