Seen, and Missed: Trafficking Victims in the Exam Room

Written by Maribel Rivera & Gabe Landau

Most trafficking victims pass through our exam rooms while they are still being trafficked. Here’s why we keep missing them, and what would help us see.

Earlier in this series, we traced how addiction becomes both the doorway into trafficking and the lock that keeps people inside it. Now the harder question: if these victims are so hidden, why do the numbers say they are right in front of us?

Because they are. We just aren’t recognizing them.

Recall where we started: depending on the study, between 68% and 88% of victims access healthcare while being trafficked, and the emergency department is the single most common point of contact. They come in with infections, injuries, overdoses, pregnancies, the wreckage of untreated conditions. They are sometimes only an arm’s length from a professional with the power to change everything.

The visit that almost mattered

Picture a Tuesday-night emergency department. A young woman comes in with a worsening skin infection on her arm. She is quiet, a little evasive about how long it’s been there. A man who says he’s her boyfriend hovers close and answers most of the questions for her. The triage nurse notes she seems tired, maybe high. The abscess gets drained and dressed, a prescription gets written, and within the hour, she is discharged, back to the same car, the same man, the same life.

Nobody in that department was careless. Everybody did their job. The infection was the problem they were trained to see, so the infection is what they treated. The reason she flinched when the nurse asked who she lived with was never on the chart.

The story above is a composite, drawn from patterns documented across many real cases. It does not depict any specific individual.

Why we keep missing it

Addiction is part of what hides the situation, and not by accident. A patient who presents with substance use gets read as a patient with a substance use problem, full stop. The symptom gets treated; the cause walks back out the door. Worse, stigma quietly does the trafficker’s work: a person who uses drugs is too often seen as less credible, less reliable, less worth a second question, which means the people most likely to be trafficked are also the people least likely to be believed.

And the clinicians on the front line have rarely been given the tools to see through any of it. In one widely cited survey, only 4.8% of emergency clinicians felt confident they could recognize a trafficked patient, a different measure from the identification rate we opened with, and no more reassuring. Most reported never having received any training on trafficking at all. By some estimates, as many as 90% of trafficked patients go unrecognized in the emergency department. That is the gap. That exam room is where intervention quietly dies, not because providers don’t care, but because no one ever taught them what they were looking at.

What would actually help

If we keep treating addiction and trafficking as separate problems (separate trainings, separate screenings, separate funding), we will keep falling short, and people will keep paying for it with their lives.

The way forward is integration. It looks like care that treats trauma and substance use together instead of forcing survivors to untangle them alone. It looks like trafficking-recognition training for the people most likely to encounter victims: emergency staff, recovery counselors, detox and behavioral-health teams. The encouraging part is that this works: studies show that even a brief training intervention can dramatically raise clinicians’ confidence in spotting and helping trafficked patients. And it looks like genuine collaboration across medical, legal, and community systems, so that at-risk people are caught early in their vulnerability instead of late in their exploitation.

This is not only a criminal-justice issue. It is a public-health one. But seeing a victim is only the first hurdle. In the final piece, we turn to the part almost no one talks about, what happens when trafficking is the thing that creates the addiction.