Detroit residents often live nearby major industrial sites. Both residential homes and the Marathon Petroleum refinery can be seen from a pedestrian bridge over Interstate 75, which separates the two areas.
The surgical mask is a relatively new part of Emma Lockridge’s bedtime routine. Now, with tar sands oil being processed a few blocks away from her home, the mask prevents particulate matter from getting into her lungs and irritating her asthma. Winters are even harder for the longtime asthmatic. “With all this fog, the air cannot rise, and stays on top of us and our homes and our lives,” she says. “I’m suffering right now due to the impact of Marathon Petroleum.”
Lockridge isn’t alone. In Detroit, a combination of poverty and pollution has created a population of poor asthmatics who are driven to unconventional means of obtaining medicine. Whether it’s relying on the leftover medicines of friends and family, constant emergency room visits, or even turning to a small black market, Detroit’s residents are often forced to go to great lengths in order to breathe.
Neighborhoods in southwest Detroit are interspersed with heavy industries, such as Marathon Petroleum’s Detroit Refinery, coal plants, and steel mills, which pump out an incredible amount of pollution next to homes and schools. This area is home to the state’s most polluted zip code, as well as some of the only areas in Michigan that are in non-attainment for sulfur dioxide, meaning the levels of this pollutant make the air unhealthy to breathe. Here, 1 in 6 people have asthma. But with 2 in 5 living in poverty, access to proper care is extremely difficult.
When asthmatics seek medical attention, they often find that their symptoms are treated, but the root causes of those symptoms are ignored. “We have some great doctors and great physicians out there, but we’re not catching everything,” says Elizabeth Milton, an asthma educator in the Detroit area. As part of her work, she regularly counsels children and adults who are on Medicaid to help them understand and manage their asthma.
Milton recalls a seven-year-old patient who lived two blocks from the Marathon refinery. “The doctors were increasing his inhaler constantly, but never thought to ask: What’s going on? Where does he live? That’s critical information, that you are exposed on a daily basis to sulfur dioxide.”
Representatives from Marathon Petroleum could not be reached for comment.
According to Milton, improved treatment of asthmatics will require a shift in mindset as well as a willingness to ask critical questions. “People respond to asthma as if it’s an acute situation, and not a chronic situation,” says Milton. “Emergency room doctors are there to treat acute situations. But if you’re treating that same person for the same problem 6 times, it’s time to make a change in how you treat that patient.”
Physicians often aren’t aware of major barriers to care such as cost, transportation to pharmacies, and ineffective information transfer to patients. “These are very small questions,” says Milton. “It wouldn’t take much time, but it might make a difference.”
Although progress is being made in both patient and physician education, there are still needs that the current medical system doesn’t fulfill. For many, compared to conventional means, sharing medication is cheaper, easier, and may be their only option. “There has been more than one occasion where I’ve called somebody up who I know has an inhaler,” says Ms. A, a lifelong Detroit resident. (Ms. A did not wish to be named.)
According to Lockridge, various environmental factors can cause periods of reduced symptoms, which might result in “a few extra puffs” left in an inhaler or nebulizer before the prescription’s renewal or expiration date. On the other hand, says Milton, during periods of frequent flare-ups, “that inhaler will not last through the month.” During times between refills, Milton says that her clients “do access other venues to get medication. That’s where you see sharing.”
In addition to sharing medication, some have to resort to further measures in order to breathe. “When you’re talking about such a desperate condition, not being able to breathe, it can literally drive a person to do all sorts of things just to get a breath,” says Milton. “I do have several clients who have purchased inhalers from the street.”
By all accounts, Detroit’s inhaler black market remains small and underground, mostly consisting of people making person-to-person sales. Given the daunting barriers to accessing this life-saving medication legally, this black market plays a small but critical role for Detroit’s most vulnerable asthmatics. However, even the black market does not fulfill all the medical needs of residents. “You have people out on the streets selling drugs, and we wish there were people selling inhalers,” says Ms. A.
Most inhalers are prescription medications, so sharing and selling them raises numerous issues. While few people (if any) have faced legal consequences from sharing or selling these medicines, there are legitimate medical concerns with using someone else’s inhaler. Some, such as albuterol, are fast-aeting rescue inhalers, suitable for treating asthma attacks. Others are slow-acting maintenance inhalers, designed to be used once or twice a day.
An uninformed buyer might end up relying on a maintenance inhaler during an asthma attack, with potentially tragic results, or might be using a rescue inhaler daily, which would do little for asthma prevention. Even if buyers know what kind of inhaler they’re getting, the varying strengths and dosages may result in over-treating or under-treating, putting an increased burden on both patients and physicians.
Uncertainty over the amount of medicine black market buyers are getting is another pitfall. “Most asthmatics don’t want to walk around with a few puffs in an expiring inhaler,” says Lockridge.
According to residents, government at all levels has been slow to address the problem, even in areas such as Detroit’s 48217 zip code – the most polluted one in the state. The 48217 zip code got its first MDEQ air monitoring station just last year. “I wonder why the state of Michigan hasn’t done more to protect that community,” says Milton. “They’ve really been a friend of business.” Even though the area is in non-attainment for sulfur dioxide, in 2015, the MDEQ was poised to approve a request by the Marathon refinery to increase sulfur dioxide emissions.
Although activists successfully pressured MDEQ to make Marathon reduce emissions, the episode left a bitter taste in the mouths of many residents, and not many are optimistic that change is coming. As Ms. A puts it bluntly, “I think it’s going to be business as usual.”
For Detroit’s asthmatics, “business as usual” would mean a continuation of a grim status quo – as long as the pollutants keep coming out of the smokestacks, then asthma, inhaler sharing, black markets, and uncertainty will continue to be a major part of their lives.