Kim Sue, MD, PhD
@DrKimSue
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Addiction medicine physician, med anthropologist @YaleMed @YaleADM | previously @harmreduction @MGHMedicine @HarvardMed | Author: Getting Wrecked| donuts| she/her
Joined November 2011
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For doctors, nurses, RTs, x-ray techs and all frontline healthcare workers, listening to trump talk about covid is the biggest gaslighting of all. The denial of our lived experience and trauma and of our patients and their families. We are depleted and traumatized.
#Debates2020
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I keep masks in my car for homeless folks or ppl panhandling. They are very vulnerable to many possible harms including Covid-19. I always think of my pts who panhandle and how hard it is. Ppl have been grateful to get masks. Also I think it helps the hustle to be masked up. 😷
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I won’t give extra clicks to the piece titled “Keep Politics out of the Doctor’s Office” in WSJ. But anyone who’s been a clinician practicing in midst of a mass disabling + deadly Covid pandemic the past 2 years knows how politics IS already in our offices whether you recognize /
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We should be saying Dr. Susan Moore's name like we have been saying George Floyd's name. The deep violent structural racism that brought the premature death of a Black doctor of COVID in her 50s, a system denying pain medication, necessary treatment, compassionate care...horrific
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Day 1 Covid isolation. For me, Omicron is NOT MILD. Myalgias, cough, nausea, diarrhea, terrible headache. Vax x2 + boost, (Oct, had contemplated a fourth shot but did not get, maybe should have)? Our policies need to be better- mandatory indoor 😷! Would not wish this on anyone.
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A medical student commented yesterday that it sounded like my work was that of a social worker. If social workers treat people (who use drugs) with dignity, compassion, respect, autonomy, get people what they need to achieve health, well-being + thrive, then yes, that is my work
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What do you think about this drug public education campaign from Norway that someone sent my way?
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How many times do I have to say that you can’t overdose by touching fentanyl? Addiction medicine/ harm reduction experts spending time trying to whack-a-mole dangerous myths that media and police put out that ultimately could harm people who use drugs
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If you carry naloxone, remember that the ppl who need it most are ppl using drugs. I just gave my naloxone kit away to two ppl in heavy nods in the subway station. They didn't have any and were grateful. They watch out and care for each other & are the FIRST first responders. 🙏
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Thousands peacefully marching over Manhattan bridge from Brooklyn tonight.
#BlackLivesMatter
#NoJusticeNoPeace
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At least 5 people I know including several rad doctor friends have Covid for the first time in >2 years, along with myself. New contagious subvariants + public policy failures to prevent Covid transmission led to this. Repeat infections, long Covid, and deaths are the outcome. 😷
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Elon Musk drops $44 billion on buying Twitter when Congress won’t pass a bill for half of that- $22 billion - for a federal Covid plan. Imagine if we taxed billionaires and had the political will to fund comprehensive public health programs to address a pandemic 🤷🏻♀️
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Today I rode the subway and there was >90% of riders with proper mask coverage. One NYer aggressively ordered another to sit farther away. NYC has been through it with COVID. We feel lucky to have masks now. So many of us got sick and died before we knew how important they were.
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2019: HgA1c 15% -HOMELESS
2018: 8.0% - HOUSED - Better
2015: 13% HOMELESS
Trying to understand what was going on when pt's diabetes was under much better control, I discovered it was housing. Housing is medicine b/c it provides a critical foundation for many interventions.
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Woken up just now by a senior resident that my grandfather was coding in the hospital. I’ve made those middle of the night calls. I told them he wouldn’t want intubation. They didn’t get ROSC. No one had asked us for his code status despite him being 95. Don’t presume full.
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COVID admissions are rising rapidly at Yale New Haven Health System. Highest numbers hospitalized, ICUs, on vents, since April of 2020. Who says omicron isn't affecting us? This is impacting us giving timely effective pt for ALL patients- with heart attacks, bleeds, ODs, cancer
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Reading about the pharmacist who alleged tampered with 500 doses of COVID-19 vaccine just reminded me about this pharmacy student who posted online that he let a woman die of an opioid OD. Just because you're in the health profession doesn't mean you're ethical or compassionate.
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Had a pt run out of medication early recently.
Why?
He was sleeping outside, and it was cold, and he took extra.
I’m supposed to shake my finger and say you must “take as prescribed!"
Instead I said: What’s going on with your housing application?
#HousingISmedicine
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My parents got me a mug recognizing that caffeine is a psychoactive stimulant substance (antagonist of adenosine receptors) that I consume daily, enjoy, and that significantly improves cognition + mood. Ppl should have safe supply of stimulants - not just socially acceptable ones
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I went to a doctor’s appt with a friend as an accompagnateur/ally/witness and ... WOW 😱 I apologize that we doctors treat you all patients with such disregard. A little thread 1/x:
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When hospital systems begin to roll out the vaccine, I hope the maintenance staff, front desk, security, techs all are able to get it ASAP. So many in NYC hospitals died in frontline essential work. Often Black and Brown, with other structural vulnerability - pls prioritize them
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Clinicians, especially in addiction medicine, should not be using the term "addicts" in any of our writing, papers, notes, public talks, statements. Our pts can use what terms they want and accord with their identity. Part of ending stigma is understanding the power of language.
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Remember that me wearing a mask is protecting you. Since I just had Covid, despite being cleared to leave isolation, I want to ensure I don’t spread it to anyone. It’s an essential part of community care. Don’t tell me I don’t need to wear it, I want to wear it. 😷
#MaskUp
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Imagine how much better we could all be if we had a 20 -30 year running show like Law and Order/SVU but instead it was exalting and lifting up the work of public defenders and restorative justice groups 🧐⚖️🤝
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Instead of making a resolution to lose weight (🥱), why not make a vow to prioritize mental health and deepen friendships, end the War on Drugs, call out structural and everyday racism/sexism in your institutions, use less plastic, or work on a local political campaign? 🤷🏻♀️
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I wore my “the only thing naloxone enables is breathing” shirt from NVHRC to the hospital today. Be safe out there tonight! Watch out for each other, carry naloxone, go slow, stagger use of multiple substances. I’m working this weekend but don’t want to see you in the hospital 🙏
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When a patient comes into the office and starts off by saying, "You're not going to like this" or "You're going to be mad at me," or "I've been bad," my response is: "Hold up! I’m so glad you’re here. 👋 You made it! We can talk and work on anything." 🤝
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Well in news not related to pandemic, uprising or complete election chaos 🗑🔥& other 2020 highlights, I can say that I’m headed to
@YaleADM
to be addiction faculty! Looking forward to harm reduction research, teaching, activism + improving the care of people who use drugs.
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No one should be jail and prison for simple possession of any substance, marijuana and more—cocaine, heroin/fent. We need a health and public health approach not a carceral one.
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Eric Adams reviving plain clothed police units in NYC is not good. Will undoubtedly cause harm, violate human rights. Stories of cops posing as ppl asking for drugs outside methadone clinics. Discourages and scares ppl from getting life saving meds, snares ppl in carceral systems
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It or not. In my field of addiction medicine, politics is why some tragically die so young, why some get preventable infections like HIV or HCV or not. Political decisions about harm reduction or treatment funding DO show up in my office, as preventable abscesses, as ODs…
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Thinking of how many people I know that have COVID right now. Same probably in your circles. Think of these COVID infections as political failures, w/ systematic de-investment in public health, social services and prevention policies. Mass COVID infections are not inevitable.
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Overdose death rates have been climbing for Black Americans long before + continuing into the pandemic. Access to medical care, avoiding carceral entanglement and criminalization, housing, evidence-based treatment and harm reduction are and have been urgent healthy equity issues
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I've been so busy I didn't realize the Medicaid Re-entry Act was included in the Build Back Better legislation. This allows Medicaid to cover health services during the last 30 days of incarceration + create linkages to community-based care. This is super important!
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My grandfather lived independently until 95 in his own house of 50 yr until Friday when he was found down in the bathroom after not picking up the papers. I told them not to cath him, suspicion was he had ACS. He had what so many would want, a good and long life on his own terms.
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Hospital folks: pls start ppl on methadone or buprenorphine to treat OUD amidst the country’s worst OD death crisis + do not take those who are on them off potentially destabilizing them. Signed, addiction clinicians trying to get evidence-based meds so ppl can live + thrive
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Consumption of substances is on a spectrum, from abstinence to non-harmful social use to persistent or chaotic use. Mandating treatment doesn’t make sense, is a violation of autonomy & human rights, often harmful. Ask some experts - we will help
@JoeBiden
“Anybody who gets convicted of a drug crime, not one that is in terms of massive selling but consumption, they shouldn't go to prison. They should go to mandatory rehabilitation,” Joe Biden says
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Seeing all the cases shoot up around the country is bringing back our collective NYC healthcare worker trauma from March/April. It is infuriating b/c these cases are preventable. Behind “ICU/hospital beds” are teams of ppl bearing COVID risk & immense emotional & physical labor.
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Breaking up encampments has significant public health harms. They throw out ppl's medications, wheelchairs/supplies, belongings, destabilize ppl from their friends and resources, has MH consequences, possibly increase risk of OD deaths/hospitalizations
The news just announced that Eric Adams now wants to destroy all 150 homeless encampments in NYC by Friday, with no plans to house the people currently living in them, if you want to talk about violence.
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Since 2010, I've been conducting ethnographic research & writing a book on how incarceration harms women with opioid addiction. And I also became a doctor to improve our care. It’s finally here! Use this 30% discount - source code 17M6662 at checkout
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In Texas giving a harm reduction talk. Someone asked me if the goal of the methadone clinic where I work is to get someone drug-free and I said the goal of my methadone clinic is to keep people alive and well and the room burst into applause 👏
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Stopped by TSA for carrying on 400 doses of naloxone in my suitcase. TSA worker says: “I’m also an addiction counselor. Fentanyl all over Chicago where I’m from. Keep up the good work, doc.” You too!
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A middle-aged incarcerated patient sheepishly apologized to me today: "We black guys just don't like going to the doctor." I apologized to him for our system of institutional racism, for not making it easy, welcoming, affordable or equitable. We have so much work to do.
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OK let’s just say this is my first encounter with a real life harm reduction billboard and I flipped out with happiness. All cities and states should have such affirming anti-stigma campaigns 😍 Dr Nyaku spreading the word in New Jersey
@Rutgers_ADM
@NJHarmReduction
@VitalStrat
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If you’re drinking +/- using drugs, pls watch out for each other tonight. Carry naloxone, even for stimulants just in case, alternate water with drinks, avoid mixing and stagger use, go slow with a new supply, make sure to eat. Thanks 🙏- yr fav harm reduction doctor 😍
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I come back to twitter and see this trash opinion piece in
@WSJ
trending. As a woman with both an MD and a PhD, I've got to say that the PhD was 100x harder. She deserves the title "Dr." The denigration of women in higher education in this country needs to stop.
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As I work more in harm reduction and addiction medicine, I really only have increasing amounts of rage against the Prohibitionist + racist structures we live and work within, carceral systems of surveillance + social control, and pervasive stigma + violence towards PWUD
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Glad there’s a generation of social medicine folks - especially students!!—doing the work, leading the way with both excellent evidence based care and upstream policies. Working on legislation, giving testimony, advocating always for better conditions and care for our pts. 🙏
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Thanks to all the ppl who studied anthropology, history, or the humanities generally who decided to go into medicine. Every time I’m on rounds, I find that anthropological and social medicine orientations are equally if not more important than any tests or treatments we decide on
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Teaching myself about toothaches (pulpitis? periapical abscess??!). I went to
@harvardmed
and primary care residency and never once was taught to examine a mouth. A common jail complaint and common issue for people who use drugs. Oral health= important health equity issue!! 🤦♀️
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I don’t know how we can fix this BUT I tell my friends, patients, people who use drugs, it’s good to have someone else go with you to appts - a friend or anyone really- to be present, help advocate, take notes, witness. Quality healthcare is your right!
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This is a solidarity tweet to the ppl with 4+ co-morbidities rising up. Most of my patients have 4+ health issues and vulnerabilities and are so often discounted and exposed to harm and left to fend for themselves by bad govt policies, racism, ableism, and stigma.
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Naloxone OTC! A moment to celebrate!! 🎉 a life saving drug that can reverse potentially fatal overdoses… which is why we say that opioid OD deaths are preventable (and policy failures). Let’s ensure naloxone is affordable and accessible for people who use drugs + loved ones 💕
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I didn't know that I would go into addiction medicine. But it's a cool job because you get to be a doctor + talk about drugs all day. And a harm reduction approach means you don't push people to do any one thing, just offer ways to be safer + informed, stay alive + thrive💖
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More importantly, I was there to advocate for a new med for relief. She said “He told me before there was nothing else, but today with you here he says there are 10 or more we can try.” 😡 Ppl shouldn’t need to have doctor friends go with them to get what they need!
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I am still in shock over Paul Farmer's death. For now, all I can say is that his work directly inspired and led me to train at Harvard as a physician AND an anthropologist. I see my work as illuminating, acting on structural violence. There are so many of us carrying it forward💔
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Reading about the mass displacement in Ukraine, including 15,000 ppl sheltering in the Kyiv subway, and thinking of how hard it must be for ppl w/ chronic diseases, mental health conditions, substance use disorders, disabilities, to access what they need to survive 💊💉🍲
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Over the counter naloxone has been something long needed (non-Rx). It is super safe and life-saving. We must increase access to naloxone. It also has to get into the hands of people who use drugs most likely to use it.
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Ordered my 4 rapid tests and going to give them to my patients. Including formerly incarcerated ppl, older pts who don't know how to use phones/computers well or don't have them, ppl who don't have reliable internet, ppl experiencing housing insecurity or just life chaos.
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We should not just be focusing only on hospitalizations and deaths. This pandemic is about mass disabling illness, pain, quality of life and ongoing suffering — often layered on top of existing structural vulnerabilities.
A word of warning. I’ve had Long Covid for 12mths and counting. In this time, I’ve been diagnosed with neurological sleep apnoea, encephalitis, sensorineural hearing loss, tinnitus dysautomnia and POTs, and myopericarditis. I was never hospitalised. My case is mild.
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ACTION ALERT🚨: do you work for a fire/police dept, health dept or system that has a significant quantity of expiring or expired naloxone (Narcan preferred, IM ok too)?? We need it! Please do not throw away + get it to me at NHRC (DM me). Pls share widely 🙏😃
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My feed is full of hospitals and their employees around the country taking the knee in solidarity. But so many of our institutions have been built on slavery, excluded women or black doctors and patients, propped up racist or misogynistic Department heads. Where are the plans?
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Ugh no… A shooting in a hospital in Tulsa, Oklahoma. The gun violence in this country is so horrific, causing unending psychological terror, distress and death.
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Tips for new interns taking care of anyone (people who use drugs):
1. Don't use the word abuse in your notes or consults. Use DSM-5 + person first language.
2. Be compassionate, curious, + respectful of ppl's expertise over their bodies.
3. Treat withdrawal! It is life-saving!
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A short Christmas wish list: 1) people aren’t sent to jail or prison for drug use 2) OTC naloxone 3) overdose prevention sites - legal, funded, ready to use 4) reparations to communities of color ravaged by war on drugs policies. What else am I missing? Too much to ask?
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Michael K. William’s death and so many thousands of deaths in the US could have been prevented with a safe supply, drug checking capabilities, a safe place to use and receive opioid overdose reversal and support. Harm reduction saves lives.
BREAKING: Actor Michael K. Williams death was accidental and came after ingesting fentanyl laced heroin and cocaine, the city’s chief medical examiner announced this afternoon.
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Wouldn’t this be an interesting class? “How To Be Nice to People Who Use Drugs and Ppl in Pain” where half the class are healthcare workers like doctors or nurses, and the other half is everyone else with ample experiences of distrust and mistreatment at the hands of the former
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Is it just me or is it fucked to see a patient who tells you that they are glad to be incarcerated because they could not access Medicaid (and therefore healthcare services) for an important and painful condition?
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So relieved that this jury saw through a “he was using drugs, died of an overdose” stigmatizing malarky defense when we all saw what happened to George Floyd. Here’s to a new day of not blaming drugs or people who use them for the violences and harm inflicted on them by society.
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There are so many coded spoken and unspoken ways that lead to trust & communication breakdown ➡️ substandard care. Pts feel locked in & are structurally vulnerable, dependent on a doctor’s mood or willingness to listen, compromise, try something new, within a HUGE power gradient.
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An Overdose Prevention Center can consist of a table, light, sterile supplies, chair, sharps container and ppl watching over equipped with oxygen and naloxone. Why wouldn’t you want this in your community? People are dying alone at home, in public bathrooms, alleys.
#IOAD2021
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So
@FelicityHuffman
pays $250,000 bail to avoid one day in jail and Kalief Browder, who could not pay $3,000, spent three years incarcerated and committed suicide as a result of his trauma? Nothing so obviously fucked as the bail system for harming poor people of color.
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I make the comparison of an opioid OD to a STEMI (heart attack), similar 1 yr mortality. After a scary almost fatal event, you get started on medication to prevent another one. Methadone and buprenorphine are life-saving. No one asks if or tells you to taper off your statin or BB
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As I practice medicine more, I realize that it is so much more than prescribing meds, which are necessary but not sufficient to practicing "good" medicine. I strive to walk with and collaborate with patients on a path of health, healing and liberation🤝
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I haven’t seen other doctors’ “bedside manner” in a while, and I used to think it was a “soft” skill taught in medical school, but it’s actually the critical foundation of respect and communication, that if absent, could have serious consequences. 2/
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Good on Joe Biden for acknowledging his son's substance use and not adding to it with stigmatizing language. The difference b/w Hunter Biden's substance use issue and other ppls is that he never had to go to prison like Black and Brown folx do b/c of his privilege & social status
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So, SARS-CoV-2 RNA genome IS DETECTED. Yesterday developed a slight cough, rapid tests negative in AM, and again in PM. Did a PCR this afternoon, came back positive an hour ago. Now fatigued, febrile, headache, nausea, and cough. Cancelling meetings, isolating and sleeping!!!
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A 42 year old father of two died on Rikers, possibly of Covid. He was there for “a parole violation… stemming from marijuana use and failure to make an office report.” 😡 This is the how the War on Drugs kills BIPOC. Decarcerate ppl now!!
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All important and necessary items for public bathrooms
Well, this is all available in an Oakland beer garden restroom. Sign of the times.
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Laws around methadone have to change. Methadone is a medication and it should be picked up at a pharmacy like other medications. We don’t have to be so punitive towards this life saving med. This is a part of the war on drugs, which is a war on people, on BIPOC -
@CollinsHiawatha
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Not sure who needs to hear this: methadone and buprenorphine are both highly effective medications for opioid use disorder. For many ppl, they are NOT interchangeable. And for some ppl neither of them seem to work + we need other options ie hydromorphone or diacetylmorphine ASAP
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Harm reduction IS healthcare! Getting ppl what they need and advocating for compassionate and evidence-based care! Safer use equipment, MOUD, programs, housing, connections 🤝
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How often do you take a history with a patient and just feel awestruck by what they are able to do/have done to take care of themselves and others despite a myriad of health and social challenges, being born behind eight ball 🎱 or having tragically bad luck? Pts are amazing. 😍
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Is there some kind of mutual aid mental health listening session solidarity group for healthcare workers treating COVID? I am very worried about ppl in our profession. Thinking of Dr. Breen who died of suicide and others. Facing traumatic # of pts, so tired, so much suffering.
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Well, today is my last day as medical director at
@HarmReduction
! So grateful for all the dedicated ppl I’ve gotten to know and love. Will continue doing this work advancing harm reduction and health justice for people who use drugs
@YaleADM
💉 ❤️
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100,000 overdose deaths in a 12 month period. And yet often erased are the stories of hundreds of thousands of ppl that survive overdoses. It can be traumatic, even cause devastating brain injury that changes the course of their lives. These stories matter.
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Someone sent me a picture from “a regular pharmacy” in Australia. It has “methadone, naloxone, needle exchange.” Right next to diabetes products and passport photos. Where health of people who use drugs is just regular and is part of widespread healthcare infrastructure.
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As an AAPI person and a doctor caring for ppl who use drugs and many who do sex work, thinking today about all BIPOC who are placed at structural harms by working condition, immigration status, skin color, language, ppl assaulted & harassed, killed by police, ppl trying to live.
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Chew on this: Harm reduction got $30 million and everyone was scrambling to get support. Meanwhile, “The FY 2023 budget requests an increase of $335.5 million for Drug Enforcement Administration investigations, diversion control, and other counterdrug efforts.” 😩
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As an addiction physician, I'm really worried about many ppl who are newly unemployed who have lost income for heroin/fentanyl/opioids facing withdrawal who are practicing physical distancing or as supply changes. Ppl in restaurant industry, gigs, even before just scraping by.
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This morning NYPD cops held my train searching for a homeless man to “help” him. Why not hire 500 social workers/nurses instead of cops? If
@NYGovCuomo
@NYCMayor
cared about structural roots of “quality of life issues” they would fund Housing First and harm reduction programs
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Returning from seeing patients in NYC jail. COVID, as predicted, has unleashed a spate of fear, anxiety and harms feeding on carceral structural violence. “Safety” is difficult for patients and staff alike, social distancing impossible. “This is the fish market,” someone said.
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The stigma against substance use within the healthcare field is so vile. I am so sorry people get treated this way. Beautiful healthy babies are born to parents on methadone and or buprenorphine. And their mamas can stay alive and healthy on the gold standard treatment for OUD.
In the NICU the nurses kept referring to their patients as “drug babies”. The head Doc asked my daughter- what drugs she was on. And said “we will find out anyway”.
Methadone babies rock❤️
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Imagine 450K put into harm reduction for meth in South Dakota. Some ideas:
- Syringe exchange and education for safer injection techniques
- Safer smoking kits
- Jobs
- Medicaid expansion
- Condoms
- Safe spaces for people to use
- Not incarcerating ppl who use drugs
🤷🏻♀️
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Spent way too much time buying items on the
#MedGradWishList
of several first generation Latinx/Black doctors going into internal medicine, pediatrics, psychiatry and family medicine. If you haven't shared a wishlist yet, please do so here, I can share. 😍
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Thinking today about how we don’t have a vaccine for HIV >thirty years later. That “heroin users, hemophiliacs, Haitians and homosexuals” were earliest afflicted. Celebrating COVID-19 scientific achievement from virus to vaccine in <1 yr. + reflecting on structural inequity...
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Why we need methadone reform ASAP. Pandemic + blizzard + hospitals full = we need to do everything possible to get lifesaving medication to ppl where they are and keep ppl safe. Methadone for OUD via a primary care/pharmacy model is a must for legislation.
Methadone line @ 7am NYC during Nor’easter. Restrictions are 💯 stigma. My doc wants me to improve diet/exercise/salt intake to lower BP. Sometimes I get a 20 pc and 1/4 lb from McD. Still get to take lisinopril even tho I can’t make lifestyle changes. Gets delivered by USPS.
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Raise your hand 🙋🏻♀️ if you’re sick of being a doctor/nurse/healthcare provider in a country where healthcare is contingent upon linkage to formal labor market. I don’t want to live or work in this societal arrangement. Healthcare is a human right. We need Medicare For All.
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