An Interview with an Emergency Department Physician in Colorado
I received a recent communication from Dr. Karen Randall, an emergency room physician in Pueblo, Colorado that is facing the outbreak of COVID-19, now straining its emergency services. Health care personnel are already short of resources, as Personal Protective Gear (PPE), capacity to test for the disease, and essential medical devices, such as ventilators, are in short supply.
The viral disease, when it strikes the most vulnerable, such as the elderly, the immunocompromised, or those with underlying co-morbidities, can progress rapidly from initial respiratory illness to profoundly impaired lung function, and death.
Adding to their wider public health threat, the town also has a large homeless population, often recent arrivals to Colorado, concentrated in make-shift encampments near town. Medical personnel are especially concerned with the spread of COVID and other infectious diseases in these encampments—many will become ill in a short period of time, resulting in a potential overload for an already-stressed health care system.
Colorado has issued orders to implement necessary closures and social-distancing practices. In particular, an appeal has been made to forestall non-emergency medical procedures in an effort to preserve the functionality of hospitals, physician and nurses, and emergency departments, which are at the front lines of medical care responses.
In order to preserve scarce resources for essential personnel serving the most vulnerable at-risk patients, residents above all should take no actions that could hinder the emergency public health institutions struggling with the outbreak.
Businesses or operations deemed “essential” are provided exemption from the social restrictions meant to stave off a wider epidemic spread. Colorado is, of course, well-known for its commercial marijuana businesses. Remarkably, these very businesses have been deemed “essential” services by the state, and hence are exempt from closure.
Dr. Randall’s account warns of the risk caused by this exemption. Substantial percentages of the entire Colorado community are drug users, with concentrations of heavy marijuana users found in the homeless encampments, many of whom moved to Colorado because of their commercial market for high-potency marijuana and related products, such as concentrates and edibles.
The percentage of dependent daily drug users is growing and has already stressed social services, including emergency hospital resources. By consuming high-potency concentrates, consumed by means of smoking or propane/butane-fed flames, or by practicing dangerous vaping ingestion, this population has been routinely presenting to emergency services with the consequences of their addiction: compromised and damaged lungs; cyclic vomiting, or hyper-emesis, requiring hospitalization; and repeated episodes of psychosis or mental derangement associated with consuming THC, the psychoactive component of marijuana, with intoxicated patients showing up time and again in the emergency department behaving irresponsibly.
With the arrival of the highly contagious COVID virus, the risk presented by drug use is accelerating, increasing the stress on the system of emergency and intensive care, further taxing beleaguered physicians.
Doctor Randall describes her work this way:
We have been hit with COVID. It is just ramping up. Sadly, the decision here was to consider the marijuana businesses 'essential'; the lines to access the dispensaries have been extraordinary. Of course there is no 'distancing'; people are buying products to smoke at a time when lungs are vulnerable. This means that the policy to keep marijuana shops open is counterproductive.
The drug users continue to come to the emergency department—cyclic vomiting, acute intoxications, etc. Not only do they 'clog the ED wheels.' they risk spreading COVID infection by coming to the ED. Seeking emergency care following a marijuana episode, patients present at the Emergency Department and thereby increase their own risk of exposure to the virus, as well as they risk becoming a vector of infection among others.
Personally, I have never been as concerned about going to work as I am now. I have seen intubated patients who had exposure and present clinical findings consistent with COVID. These people are frightened and are very sick. There are times when I feel overwhelmed because there are too many sick patients all at once.
As you know, there are significant PPE shortages. We have not been spared this problem. The fact that the marijuana stores would stay open is difficult to justify. It is medically stupid on many levels. The last thing the U.S. needs is intoxicated drug users turning up with COVID pneumonia, adding to our at-risk senior population.
We are already concerned about a shortage of ventilators and ICU beds. Should we add to this burden by enabling people to continue their intoxication? We see patients exposed to the virus through a known contact who begin to show symptoms, and then show up at the Emergency Department, but not before sharing a last bong with close friends before going to the hospital.
As you can see, hallucinogenic drug use leads to poor decisions. While intoxicated, drug users take unnecessary risks, endanger themselves and others, and then need help.
Emergency departments are packed with people already—we have the elderly, the smokers, the immunocompromised to deal with and we are inviting a subset of the population that should be healthy into this disaster—when, in fact, their lungs are no longer 'young' or 'healthy.'
There is finally the risk of users becoming immunocompromised with chronic excessive drug use. Early indications are that COVID causes injury to pulmonary structures. So, if a person is vaping and already altering the structure of lung tissue, this behavior compromises them even more, providing additional injury, less resistance to infection, and a greater likelihood of long-term consequences from both vaping and COVID.
The Colorado exemption for marijuana businesses represents a public policy mistake. The crazy part is that anyone would consider a hallucinogen a necessary medicine.