I sit across the room from my new, high-risk patient, Ray.* He’s already had years of practice at not dying. He’s out of custody now, released in the last few days. No longer sharing a single needle with 20 or 30 others.

He’s starting on methadone.

A few weeks into dosing, Ray’s getting stable. We sit together and yarn about his new life. Now that he is on opioid substitution, he’s back with his family and looking for a job. He tells me he loves to work hard. He likes to contribute to his family and the community.

Abused as a child, Ray self-medicated, his pain arising from his shame and humiliation.