On a cold December night in 2023, the staff at Providence Milwaukie Hospital in Milwaukie, Ore., called local police. They wanted help getting one of their patients, a 26-year-old man named Jean Descamps, out of the emergency room.
"He's been evaluated medically. There's no medical problems for him," a member of the hospital team, who NPR has not been able to identify, told police. The moment was captured on an officer's body camera.
Records show the hospital's medical staff believed Descamps — emaciated, covered in feces, and often unresponsive — was experiencing symptoms of chronic street drug use, a leading cause of death for young Americans.
After Descamps arrived in an ambulance earlier that day, hospital staff cleaned him up and administered naloxone, a medication that reverses opioid overdoses. But now they wanted him gone. "He's not thriving chronically, but there's no medical reason for him to be here anymore," one hospital staffer can be heard saying.
Video released by the Milwaukie Police Department shows Descamps sprawled in a hospital bed, his body limp, moaning and drooling, while medical staff stood nearby. After determining Descamps was too unwell to spend the night in jail, police officers challenged the hospital's decision to discharge him.
"He can't be on his own," one officer said. "Why is he being released? We have no place to take him."
"A bus station is fine," a hospital worker replied. Another member of the hospital staff told police Descamps was faking the severity of his illness: "It's not really a medical problem, it's malingering."
Officers eventually complied, rolling Descamps' limp body in a wheelchair into the dark parking lot, where they covered him with a blanket against the winter cold. Police who gathered around Descamps can be heard voicing fear for his safety.
"Do you feel at all comfortable with anything that's going on right now?" one police officer asked. Another officer answered, "No."
Their fears proved justified. A short time after being discharged, Descamps would be dead of an overdose from street drugs already in his system. A spokesman for Providence Milwaukie Hospital declined NPR's repeated requests for an interview about Descamps' case and didn't respond to detailed questions about his treatment.
In a statement issued to the media after Descamps' death, the hospital expressed regret and acknowledged the care he received was inadequate. "In this case, we fell short of our goal of providing safe, reliable, compassionate care to our patient," it said.
But in interviews with more than a dozen doctors, scientists, federal officials and addiction activists, along with a review of research and government data, NPR found that what happened that night in Oregon is part of a troubling national pattern.
People with serious alcohol or drug addiction in the U.S. regularly go to doctor's offices, clinics and hospitals, only to leave after receiving insufficient or no treatment, often with devastating consequences.
"I think we should be outraged every single time someone dies from any condition that has treatment available that someone isn't getting," said Dr. Judy Chertok, who treats addiction patients and teaches medicine at the University of Pennsylvania. "We would not allow, as a society, people with heart attacks to come to a hospital and not get appropriate treatment. This is as serious as that."
Most addiction patients get little or no treatment
Chertok is among the growing number of critics who say efforts to bring addiction treatment into the mainstream of American medicine have fallen short.
Addiction is widespread in the U.S., affecting more than 40 million people, according to the latest federal data released last month. While drug overdose deaths have dropped in recent years, alcohol- and drug-related disorders still kill more than 250,000 people every year. Meanwhile, research shows alcohol-related deaths have doubled over the last 20 years, while nonfatal overdoses from fentanyl are rising.
Despite that toll, the federal data released last month shows that in 2025 more than 80% of people who need help get no medical treatment of any kind for their addiction.
"Much of what I do is scream back at that," Chertok told NPR. "Many who ultimately die from their [addiction-related] illness have had significant contacts with healthcare and social services agencies in the few months leading up to their deaths."
In the case of Jean Descamps on that winter night in Oregon, death came much faster, after Milwaukie police decided to transport him to an emergency behavioral health center in nearby Portland.
On the body camera recording, officers can be heard growing increasingly alarmed by his condition as he sat in the back of a police cruiser. "Hey Jean, hey Jean!" one officer shouted, after searching for signs Descamps was breathing. "Boy, I don't know. Look at his eyes, I don't know."
Efforts to revive Descamps failed. An investigation by a local prosecutor in Oregon found hospital staff failed to give him a toxicology test to evaluate drugs in his body before discharging him.
While this kind of catastrophic outcome is rarely caught on camera, federal data suggests similar moments may be common. One study by the Centers for Disease Control and Prevention found more than two-thirds of Americans who died from fatal overdoses in 2024 had "at least one potential opportunity for intervention" but didn't receive help.
"When it comes to substance use disorder, we have not decided as a country this is an illness we actually can treat," said Beth Meyerson, an expert on addiction care at the University of Arizona's College of Nursing.
Addiction treatments are safe, effective — and rarely offered
According to Meyerson, the problem isn't just in hospital emergency rooms. It's still the norm for doctors and nurses across U.S. healthcare settings to avoid treating patients with alcohol- and drug-related disorders.
"If I'm at my own general practitioner and it's suddenly clear I'm addicted to an opioid, my doctor will likely send me somewhere else," Meyerson said. "Versus [saying], I can treat that here, just like I can treat your diabetes or any other chronic disease you might have."
This happens despite the fact that safe and affordable medications for treating the deadliest forms of addiction have been available to U.S. clinicians for decades. "We have good tools. Methadone and buprenorphine are gold standards," Meyerson said. "Access to treatment would reduce opioid overdose by 60%. In some studies, I saw 80%."
In 2022, Congress lowered regulatory barriers, making it far easier for nonspecialist clinicians to prescribe buprenorphine, a medication that reduces opioid cravings. But most doctors still don't. It's even rarer for doctors to offer naltrexone, a medication that helps patients by reducing the desire for alcohol.
Many doctors carry a strong bias against addiction patients
The obvious question is why? If addiction is common and deadly but treatments are available, why don't more clinicians help these patients?
There's consensus that this is, in part, a legacy of America's drug war. Addictions are now considered treatable disorders, but for decades substance use was seen by many as a criminal or moral issue, with access to treatment often heavily regulated. Some forms of addiction still involve illegal drugs.
Research suggests this history led to fear and hostility in the general public and among medical professionals toward people with addiction. Chertok said despite efforts to change attitudes, many of her fellow doctors still view people experiencing these disorders with suspicion.
"I have observed or heard people talk about someone with addiction in the healthcare setting in a way that is not tolerated for any other group," Chertok said. "It's so jarring that that is accepted by so many."
It may seem inconceivable, 30 years after the first wave of the opioid crisis made addiction a life-or-death issue for many families across the U.S., that the vast majority of clinicians still actively opt out of treating vulnerable patients because of personal bias.
But studies show stigma among healthcare workers remains deep-rooted. One study published in the Annals of Internal Medicine in 2020 found only 1 in 5 American physicians "have interest in treating a patient with opioid use disorder."
A report issued earlier this year by the American Medical Association, the nation's leading physician trade group, identified stigma among health workers as a significant hurdle for patients needing treatment. Bias is so widespread that many doctors believe their patients will abuse addiction medications to get high, even though, for instance, studies show misuse of buprenorphine is rare.
"Forty-three percent of healthcare professionals believe medications for opioid use disorder substitute one drug for another," said Robert DeForde, with a group called Shatterproof that conducted a survey of clinician attitudes in 2024.
DeForde's organization works to convince doctors and nurses to treat people with addiction, conducting online training and in-person seminars. That work left DeForde convinced that bias in the medical community against this group of patients remains intense.
"They don't want these people around them. They don't think that the drugs that we have that are FDA-approved medications are really going to actually help the patient. That is what I would say is a fatal flaw in our system," he said.
Will the next generation of doctors do better? Maybe not
While the AMA acknowledges that stigma affects clinician behavior and prescribing, the organization has long urged patience with the pace of reform and resisted efforts to mandate more rapid change.
"I think it's going in the right direction," said Dr. Bobby Mukkamala, who served as AMA president until June 2026 and currently leads the organization's substance use task force. "Could it be going faster? Should it be going faster? Absolutely."
In an interview with NPR, Mukkamala said he believes primary care doctors contributed to the decline in drug overdose deaths since 2023. But he also said many physicians are wary of treating addiction because they lack proper training and already feel overwhelmed by other duties.
"We know that we need to do this new thing that we are just gaining comfort with. But facing the headwinds of all the other things that we face as physicians, I think that's a pretty understandable hurdle that we have to get over," he said.
According to Mukkamala, those professional challenges heighten the personal unease some clinicians feel treating addiction patients. "There's the emotional response from within that basically makes us say, 'Yeah, but you know, it's not something I'm comfortable with.' That's the stigma."
Most experts interviewed for this story agree that some progress has been made. But not a single doctor, researcher, activist or federal official described the current level of addiction care as acceptable.
"What models can be developed to actually change the culture?" said Dr. Nora Volkow, who heads the U.S. government's National Institute on Drug Addiction. "How do you embed the education and the training and the support systems in healthcare that will make clinicians feel more comfortable treating patients with substance use disorder?"
But despite the urgency of America's addiction crisis — President Trump declared the opioid crisis a national public health emergency nearly a decade ago — most medical and nursing schools in the U.S. still don't teach students how to care for patients with substance use disorders as a core part of their medical practice.
Meyerson at the University of Arizona College of Nursing thinks that has to change. "We will have to have very clear laws, policies, and frankly training practices and curriculum in medical school and nursing schools to really combat this," she said.
"That guy does not need to be dead right now"
For now, experts say the results of poor addiction care are widespread, with few legal or professional consequences, even when patients with substance use disorders die. After Jean Descamps' fatal overdose in December 2023, Providence Milwaukie Hospital promised to make immediate changes, including more careful evaluation of patients before discharge.
But a follow-up investigation by the Oregon Health Authority, made public in February 2024, found the facility was still discharging vulnerable patients, including those with severe addiction, without proper safeguards. The OHA warned of the "possibility that a similar event could occur."
There's no record that the hospital or its staff faced any kind of disciplinary action or sanction. Oregon officials say the facility is no longer under scrutiny. In a statement sent to NPR, Providence officials said they have enhanced staffing and "strengthened" procedures for caring for vulnerable patients.
The statement also said hospitals shouldn't be held responsible for what happens to patients after they leave. "We do not have the capabilities nor the resources to manage the community needs once patients are discharged from our facilities," it said.
Not everyone sees it that way. On the body camera recording, police officers who tried to save Descamps' life can be heard voicing sorrow and anger at his lack of treatment. "That guy does not need to be dead right now," one officer said. "Their mindset there [at the hospital] is 'Oh, it's just another tweaker.'"
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