How'd That Get There?

In my previous life as a public health official, one of my tasks was to make people aware of the hazards of secondhand smoke. Now that I’m back on the front lines, I feel the need to make the world aware of the latest secondhand scourge. Of course, I’m referring to secondhand crack.

I am certain this is a public health concern because I now have a case series of six patients within the last three weeks who have all tested positive for cocaine in their systems and have no idea how it got there. In one case, it’s thought that it was inadvertently inhaled at a party despite the patient’s best effort to stay out of the room where “that s..t was going down.” A second patient thinks that someone may have intentionally put “crack in my weed.” (The fact that the drug screen showed no evidence of cannabis but positive traces of cocaine seems beside the point.) The third is certain it must have seeped in through his skin while he held the crack for someone else who was actually smoking it. A fourth patient cannot have actually been doing crack because, as noted by her supportive spouse, “Between raising the kids and stripping, she’s too busy to do that.” The patients in cases five and six have never seen crack, do not know what crack is, and only associate crack with overweight plumbers and other home repair professionals. However, we know that in some way they must have been exposed to secondhand crack. It must surely be so, because we know that all patients who come into the ED are inherently honest with their health care provider, especially where the use of illicit substances is concerned.

You may have heard that there is an ongoing discussion regarding the need to report those patients found with drugs of abuse in their systems to law enforcement, and that results of clinically indicated drug tests should be used as a way to ration or limit health care benefits. I used to be in favor of such a plan, but clearly the innocence of these patients demonstrates the fallibility of that approach. We might inadvertently report the innocent for just being in an environment where other, less socially responsible individuals are smoking crack while the patient themselves might have just come over for a “Little House on the Prairie” marathon. And that would be a miscarriage of justice.