Via new acquaintance Tom Levinson of the Inverse Square blog comes an all-too-familiar story of our "compassionate conservative" administration putting their own morality above proven public health programs:
Fact 1: public health officials around the country...are distributing rescue kits [containing Narcan, see below --TS] that save heroin users from overdoses. The kits cost $9.50, and they are credited with reversing 2,600 overdoses in 16 such local programs around the country. For context: NPR reports that "overdoses of heroin and opiates, such as Oxycontin, kill more drug users than AIDS, hepatitis or homicide."
Great, right? Cheap kits, Narcan is easy to use (it can be given as a nasal spray), lives saved. What's not to love? Well... (after the jump)
Dr. Bertha Madras, deputy director of the White House Office on National Drug Control Policy, opposes the use of Narcan in overdose-rescue programs.
"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.
Got that? Can't trust someone without a MD to give a nasal spray that might save a life--besides, going to the ER might scare the user clear of drugs! That is--if they live to get to the ER, of course.
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.
Call in yet another example of argument from fire extinguisher.
We shouldn't prescribe EpiPens to people with a history of anaphylactic shock, since they would be more likely to go outside and get stung by bees in the summer.
Isn't the whole "if they know they can survive the overdose they will keep overdosing" argument eerily similar to the "if we give them condoms so they don't get AIDS they will all start sleeping around" argument?
Honestly, what is wrong with these people?
Man, there are so many things wrong with Dr. Madras' argument - an addict who dies before EMS comes into play can't go seek detox; a big fast push of Narcan is plenty aversive on its own if you really want to punish addicts beyond the existing agony of drug addiction; drug addicts have plenty of contact with ERs without overdoses since they are a population without routine health care and plenty of physical problems; addicts who get the Narcan are still probably going to be taking a trip to the ER to deal with the side effects.
There is an ongoing battle between harm-reductionists and absolutists about whether maximizing negative consequences of undesirable behaviors decreases the probability of those behaviors. I'm in favor of harm reduction, and the human and animal behavior-mod evidence are on my side (aversive stimuli are not a particularly effective way to alter established behaviors in rats or in people.) But evidence is hard-pressed to win against intuition and moralizing.
What disturbs me is the condemnatory style of the argument. I wonder if sometimes this sort of logic originates in a desire to simply do away with all of the bad people in the world. There are two components to the argument. On the one hand, they think people need to be scared away from immoral behavior -- education by threat. On the other hand, I think there is an underlying sentiment that anybody who gets hurt by an immoral behavior got what was coming to them. In both cases, the bad thing that happens is seen as punishment. That disturbs me a lot, for a variety of reasons.
I remember reading a letter to the editors of the WSJ a while back by a Catholic clergyman who wanted to defend what he saw as the church's principled stand against condom availability to teenagers:
It's as if you were to give them orange vests and tell them "I know you're going to play in traffic anyway, so try not to get run over."
What was most interesting to me was not that the good father and I had differing points of view (I expected that), it was that I found his analogy entirely appropriate. I really do care more about whether kids are injured than whether they pay attention to my warnings.
It takes a contorted kind of logic to conclude that humanity is best served by letting people suffer the fatal consequences of their bad judgment -- but some folks are so limber in their logic that it seems to come naturally.
Hm. We carry Narcan on the squad, and use it when appropriate. It can be a pretty aversive experience for the recipient; there's no need to kill 'em by making it unavailable in the event of an overdose.
Speaking as someone who has been saved by a Narcan shot from a friend (not a medical professional) a couple years ago while we were addicted to H and having lost another friend because I didn't have narcan around I have to disagree with this lady's statement most strongly.
First of all it hardly requires a genius to use it. Anyone who can shoot themselves up should be able to handle it (and with a nasal spray even those who can't).
Secondly the idea that herion/opiate addicts aren't competent enough to deal with an OD emergency is just the result of a stereotype. My friends and I were in top 10 grad programs and colleges while using (and except for my friend who died still are) but only I would have been known to anyone in the medical establishment as a user (well my friend when he died too). People assume that addicts are all incompetent people on SSI but they are just the ones who can't/don't hide their behavior well.
Finally any lives saved because people were scared straight are likely to be dwarfed by the lives lost because people don't want to be discovered and scared straight. Another time I recklessly did too much I refused to go to a hospital for fear of discovery and though I had a good non-using friend to make sure I walked it off I probably would have tried the same thing if I was alone or with users who might doze off. Narcan lets you deal with a problem as soon as you discover it rather than playing russian roulette hoping that you didn't do enough to die.
But I think lots of people do too much b/c they are too depressed to car if they live or die (why my friend who died and I both did) I'm not sure how much deterrence effect being scared straight can provide in the first place.
A fool says that people should act in a certain way, the wise man accepts that people will act as they will. Most people will behave sensibly most of the time, but there are those times when people will do non-sensical things. Bush is a populist, and populists have their hangups. The belief that people are idiots who need control is one of them. A belief they share with leftists and many in the Democratic and Republican parties.
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.
I understand their reasoning but sometimes you have to be pragmatic when lives are at stake! Maybe things will change with a new administration!
Dave Briggs :~)
I think it is a matter of purity.
Don't want to participate in impure things by providing condoms or needle exchanges or OD kits. Those things make you involved.
But purity is not good public policy, and even worse theology.
Personally, the person or people who invented Narcan are to blame. I'm sick and tired of saving scumbag junkies every time they overdose. A few less on the street isn't a bad thing for society. Furthermore, drug addiction is not a disease. Cancer is a disease. No cancer pt could trace their illness to buying a black balloon in a dark alley somewhere. You who defend the users should have to deal with them over and over again. If they aren't around to overdose a second time then there will be fewer ODs.