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Clinical Case. The bad dealer 16th October We present a case to you that goes beyond our capabilities. It is an example of how a person can be enslaved because of their drug addiction. A 32–year-old woman is physically abused on a systematic and daily basis. She has clear signs of abuse, bruises and wounds. She doesn’t go the police. We interpret that the attacks are by her dealer but she prefers to accept the blows if she can get heroin and cocaine. We have offered the simplest and most conventional approaches: find a sheltered spot, changing city, methadone maintenance, but we come against a brick wall with the reply that she needs a high intravenous dose. She does not accept our proposals. We are concerned because this abuse will end in her death, but any alternative needs to ensure intravenous consumption. We think of treatment as compassionate use, understood as use of a medicinal product not yet authorized such as intravenous heroin, avoiding our responsibilities by finding a "good dealer" to provide her with the drug free of aggression. It is a very complicated situation, but we cannot think of another alternative. We sincerely believe that this is a life-threatening situation and we would hate our forecast of death to be confirmed. November 1st After your efforts, we could contact her and accompanied her to the emergency department of psychiatry. On the way to the room, however, she preferred to postpone it until the next day and a hospital bed was reserved for a week. According to our information she has not used this possibility. However, we have learnt that coinciding with these events she has left the flat where she received the drugs and abuse. We are confident that after this first intervention she has been able to avoid abuse and, later, better prepared, will be able to make positive changes for her health. December 1st A few days ago we learnt that the woman has been found dead in the street. We do not have any further information. On the one hand we have the feeling that there was a broad-based mobilization. On the other hand, possible benefits must be extended in order to improve our coverage and care for selected cases and we must think about raising different legally structured treatments.
LowThresholdJournal 2015; Vol 3: 22
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