From the Washington Post: As opioid overdoses exact a higher price, communities ponder who should be saved

I was wondering when we’d see a backlash to efforts to stem the opioid epidemic. In this instance, it comes from a “conservative firebrand” and County Sheriff in southern Ohio who refuses to allow his deputies to carry Narcan, the lifesaving OD antidote. Of course,  not long ago he was urging the US military to bomb cartels inside Mexico, so he may not be the person best qualified to make life or death choices in a public health emergency.

Still, the problems of the epidemic are real and extend to urban and rural communities. For convenience, let’s break it down into three components:

a) The rising cost of medical services. In this case, naloxone. The article claims that “two doses of an injectable form… cost $4,500, up from $690 in 2014…[and] nasally administered Narcan.. typically range[s] from $70 to $150…” I’m sure that can be a budget-buster.

Paradoxically, fentanyl and carfentanil in the heroin supply have rendered naloxone less effective than it once was. More doses are required, which escalates costs. That’s led to efforts to minimize or restrict its use. As the article notes, users may deliberately avoid calling for help, afraid they’ll  exhaust their “eligibility” for the life-saving antidote.

The irony is that making Narcan less available isn’t likely to reduce the number of overdose fatalities, which is of course the goal. In fact, just the opposite. The solution: control the price of naloxone.

b) Repeaters— addiction is defined as a relapsing disorder, so it’s no surprise that some individuals overdose and are revived multiple times. What’s the point in saving them, some argue, if they’re just going to do it again? But a better question is: what’s the alternative? Let them die? That’s not exactly a good outcome.

Where the Sheriff makes his mistake is in lumping emergency rescue with “enabling”. Is it enabling when the EMTs show up and revive someone following a heart attack? Of course not; it’s what emergency services are intended to do — save lives. As a matter of fact, I’d be surprised if that isn’t in the Sheriff’s job description as well.

c) Attitudes— I’m always alert to the use of terms like ‘these people’, as if drug users are somehow a lesser or even alien species. But the nature of a drug epidemic is to extend the problem to a whole new segment of the populace. That was always the flaw with the concept of fighting a “war” on drugs– who exactly is the enemy? By now, the drug problem includes many of our own friends, family members, children. How do you ‘win’ a war with them?

I’m afraid there’s no easier softer way out of this. No law that can be passed, no sweeping campaign that will finally put an end to it all. The epidemic has been a long time coming, and it’s likely to be a long time going, as well. We’ll need a sustained, bipartisan effort to dig our way free.

A good place to start? by setting aside heated rhetoric in favor of the light shed by rational problem-solving.


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