. . .that’s the message from Dr Bertha Madras, deputy director of the White House Office on National Drug Control Policy, to heroin and morphine users whose lives might be saved in the overdose situation by public distribution of “overdose rescue kits” comprised of a $9.50 nasal spray containing Narcan.
Narcan is the brand name for naloxone, an antagonist (blocker) of these drugs at μ opioid receptors. When an overdose of opioid drugs binds to these receptors in the respiratory control center of a primitive part of our brain, one stops breathing, a situation that pathologists say is “incompatible with life.” Naloxone is ineffective when taken orally because it is metabolized too quickly and, even if it wasn’t, wouldn’t reach the brain in time to compete with heroin/morphine binding to these receptors. But when administered in a nasal spray, Narcan 1) bypasses metabolism by the liver and 2) gets to the brain much more rapidly.
Since being distributed in 16 communities the overdose-rescue kits have saved 2600 lives, nearly the number of people who perished in the combined terrorist attacks of 11 Sept 2001.
James Hrynyshyn at the Island of Doubt reminds us that this story, currently making the rounds of the blogosphere, first aired on NPR on 2 Jan. This story was originally brought to my attention by Dr Tom Levenson who writes the excellent blog, The Inverse Square (there’s a reason he is a MIT full professor of science writing and author of several books). I believe that Mark Kleiman of The Reality-Based Community is responsible for starting this latest round of complete and utter disbelief of the hypocritical “compassionate conservatives” currently occupying positions of power over US public health policy.
The money quotes from Dr Madras are as follows:
“First of all, I don’t agree with giving an opioid antidote to non-medical professionals. That’s No. 1,” she says. “I just don’t think that’s good public health policy.”
Madras says drug users aren’t likely to be competent to deal with an overdose emergency. More importantly, she says, Narcan kits may actually encourage drug abusers to keep using heroin because they know overdosing isn’t as likely.
Madras says the rescue programs might take away the drug user’s motivation to get into detoxification and drug treatment.
“Sometimes having an overdose, being in an emergency room, having that contact with a health care professional is enough to make a person snap into the reality of the situation and snap into having someone give them services,” Madras says.
As the inimitable Dr PZ Myers then mused on how the administration might extend this compassion:
Hey, here’s another suggestion: let’s stop teaching people the Heimlich maneuver. Not only does it put a medical procedure in the hands of mere non-medical professionals, watching a few fat people in your local McDonalds choke and die, turning purple, thrashing on the floor, and clawing their throats, would be an excellent salutary lesson in the dangers of gluttony and poor dietary habits.
The very sad issue associated with this policy is noted by new ScienceBlogs colleague, DrugMonkey, in that Dr Madras is not some tool of the Bush administration; instead, she has had a distinguished career in the trenches as a drug abuse researcher:
The thing that bothers me the most about this is that Dr. Madras knows better. This is not some political hack or think-tank reject. This is a long time drug abuse researcher. If you read what she had to say closely you will note that she was trying to find the path that did the least insult to the available science. It was all about trying to justify on the basis of an opinion (read “political position”) that had the least possible chance of getting attacked on scientific grounds. Very deft, Dr. Madras!
The takehome is that getting scientists into even quite senior positions is insufficient. Because they obviously get themselves into positions in which they are forced to prioritize the political over the scientific.
Epidemiologist Dr Tara Smith gives her take from a public health policy perspective:
I don’t doubt that this “scared straight” effect works for some drug addicts, but it’s absurd to base a public health policy on something so unlikely. This is much like the uproar over needle exchange programs–they’d been shown to work, shown to reduce the spread of disease and to save lives, but many conservatives opposed them because they “encouraged” or somehow gave validation to injection drug use as a lifestyle; or like arguing to withhold the HPV vaccine for fear of increasing promiscuity.
We return to James Hrynyshyn who follows up on Tara’s point in discussing how the ends do justify the means:
Please. As any honest ethicist will tell you, sometime the means are justified. Sometime they don’t, but often they can. The case of abortion is a perfect example. If you want to reduce the number of unwanted children, and therefore the demand for abortion, then the best way is to make sure everyone has ready access to contraception. And because the demand for abortion is unaffected by the laws governing the procedure, the best way to reduce the maternal mortality associated with the process is to make it legal and easy to procure.
The bottom line is that public health policy should be defined by experts in public health, independently of any political influence or alliance with a party line. Drug abuse is an extensive problem in the US and evidence has accumulated that much of the propensity toward substance abuse is genetically determined; of all the experimenting with drugs that occurs on college campus, only a small fraction of those go on to abuse drugs in their later adult years. Treatment and rehabilitation are two of the answers. Look around you: you are certain to have family members, co-workers, and/or other people you love who are substance abusers and deserving of help.
In prohibiting the distribution of the Narcan kits, Mike the Mad Biologist noted succinctly,
And desperate people won’t get the help they need to stay alive.
*the title of this post pays homage to Steve Martin on his 1978 “A Wild and Crazy Guy” album (Warner Bros, HS3238) in a monologue about his failed attempts writing cheers for his high school – yes, I still have my own original copy of this record.