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Should Taxpayers Pay for the Junky’s Substitute Smack?

And what accounts for the sudden increase in the volume of prescriptions?

by
Theodore Dalrymple

Bio

February 17, 2014 - 1:00 pm
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The problem with banks, say their critics, is that they privatize their profits but nationalize their debts. But this is perfectly normal behaviour for human beings: did not Bastiat say that the state is the means by which everyone seeks to live at everyone else’s expense? How many people seek the freedom to behave as they wish while expecting others to pay for the adverse consequences? Moral hazard has become our way of life.

An article in a recent edition of the Journal of the American Medical Association advocates the distribution of a drug called naloxone to heroin and opioid addicts. Thousands of such addicts die of overdoses of these drugs each year in America, and naloxone is an effective antidote to them that reverses their effect. More than half of the 38,000 deaths from overdose in the United States are from prescription drugs, and 16,000 of them from prescribed opioids, more than from illegal heroin.

The article cites evidence from Wilkes County in North Carolina (the county with the third highest rate of deaths from opioid overdose in the country) that the distribution of naloxone to addicts has almost halved the death rate from overdose. Not all those whose lives were saved were either prescribed opioids by pain clinics or addicted to street heroin: they were foolish friends or acquaintances of either of these types of people who had been induced to try their drugs.

What is completely lacking in this article is any wider perspective. The people who pay for the naloxone are often not the people taking heroin or opioids; one might have supposed that those who can afford street heroin, at the very least, could also afford to buy their own naloxone. If they do not care enough for their own safety to do so, it can be argued that no one else should care – unless, of course, they are deemed, like Ophelia, to be “incapable of their own distress.” But if so, why should they be left free to take the heroin in the first place? In other words, like bankers, addicts want to be free to indulge in their own excess but  want someone else to pick up the pieces when the excess leads to a smash.

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Top Rated Comments   
I need to argue with the headline for openers. Naloxone is NOT a substitute smack.
Naloxone (brand name Narcan) is an antidote for opioid effect. It's especially valuable for improving respiration when it has been depressed by an opioid narcotic. It is a rescue drug. It's routinely used when babies are born after c-section and the mother was premedicated with opioids as is usual.
Paramedics normally carry naloxone, although there are concerns about using it in the field because it may improve respiration while producing withdrawal symptoms.
More broadly -- 38 thousand overdose deaths annually? Is that figure accurate? And does it represent only "personal" use of drugs, not medication errors or deaths related to appropriate therapy? If it's true, then drug overdoses represent a far greater threat than firearms do.
But if 38k includes things like elderly who react badly to a medically appropriate dose, then the numbers are skewed.
38 weeks ago
38 weeks ago Link To Comment
All Comments   (11)
All Comments   (11)
Sort: Newest Oldest Top Rated
It's a cheap fix...the alternative is expensive rehab or increasing theft....
38 weeks ago
38 weeks ago Link To Comment
NO.
38 weeks ago
38 weeks ago Link To Comment
We are already paying for "substitute smack" in the form of methadone clinics. Making naloxone readily available to addicts is likely to increase deaths rather than decrease them. Naloxone is very short acting, so when it is used in an overdose situation it is infused over time. A one time dose is likely to leave an addict feeling that they've dodged a bullet, but shortly thereafter they could succumb to the effects of the opioid when the naloxone wears off.
38 weeks ago
38 weeks ago Link To Comment
With respect Mr rxpc, there is much misinformation around regarding this issue. Allow me if you will to tell you that with the exception of the VA (Veterans Affairs), all Methadone clinics are *private* and thus all Methadone is fully paid for by the patients. These methadone clinics make a profit like any other business.

I have no idea what the VA does and if and to what extent they "subsidize" their Methadone. By all means, I fully understand your desire to require the patient to fully pay for his methadone so that you, the tax payer, is not subsidizing it.

However, in the vast majority of the cases in the USA (as opposed to the UK for example) Methadone is fully paid for (and more so that the clinic turns a profit).

There simply is no tax-payer subsidized Methadone in the private sector. This is why it should be a no-brainier for most people to simply "leave the methadone clinic alone" in order to turn tens of thousands of potential criminals into tens of thousands of usually full-tax-paying members productive members of society.
38 weeks ago
38 weeks ago Link To Comment
I need to argue with the headline for openers. Naloxone is NOT a substitute smack.
Naloxone (brand name Narcan) is an antidote for opioid effect. It's especially valuable for improving respiration when it has been depressed by an opioid narcotic. It is a rescue drug. It's routinely used when babies are born after c-section and the mother was premedicated with opioids as is usual.
Paramedics normally carry naloxone, although there are concerns about using it in the field because it may improve respiration while producing withdrawal symptoms.
More broadly -- 38 thousand overdose deaths annually? Is that figure accurate? And does it represent only "personal" use of drugs, not medication errors or deaths related to appropriate therapy? If it's true, then drug overdoses represent a far greater threat than firearms do.
But if 38k includes things like elderly who react badly to a medically appropriate dose, then the numbers are skewed.
38 weeks ago
38 weeks ago Link To Comment
If people want to use drugs they will get them, legally or not. The question isn't whether the taxpayers should fund their antidote; the question is, should the taxpayers be involved in ANY part of this equation?
Keeping drugs underground doesn't stop anybody from getting them if they want to, it only funds vast criminal organizations who are willing to provide them. Drug prohibition causes untold grief. Murders, robberies, deaths from overdose; Most of these would go away if the nannies just left people alone to do what they choose.
38 weeks ago
38 weeks ago Link To Comment
Doctor, my last job was working with Homeless Veterans, and in that capacity, I dealt with literally thousands of them. What I observed doing so over a six-year period of time is, Physicians today simply *throw* medications at patients. A pill for what ails you, rather than quality time spent with the patient. I have seen a Client appear, go to be seen for various ailments, and within weeks, they are now on up to a dozen or more medications, seemingly inappropriately so.

I can also say from my work that in virtually no case that I can think of, did placing an addict on Methadone lead to their being free of addiction. They simply trade-off using Methadone for using Heroin - and in many, many cases, *still* used Heroin despite their Methadone maintenance. And I can also think of no instance in which they were weaned off of Methadone, either.
38 weeks ago
38 weeks ago Link To Comment
Even if never weaned off Methadone, the fact is that *many* many many opioid addicts are living highly productive lives with daily oral Methadone. It's half life is *so* incredibly long and it is so stable (taken for "maintenance" there simply is no "high") that it allows the addict to, if he wants, lead an entirely normal life.

Whatever the percentage of Methadone patients are that continue to abuse other opioids, the fact is that their bad behavior should not in any way jeopardize the truly miraculous effects that Methadone can have on a person's life. The existence of some bad apples shouldn't risk the entire endeavor. Also, Methadone is virtually *always* paid for by the patient in full -- so, that some people continue to abuse is mostly irrelevant.

Make no mistake, Methadone *is* a wonder drug. It takes a a non-violent opioid addict who may have engaged in criminal behavior and often turns him into a productive member of society. Whatever the *very* small cost is to society to provide this drug (and I'm not sure that in the USA at least there is *any* cost due to the patient being required to pay in full for Methadone), it is highly worth it. Countries like the UK have "Methadone on demand" -- the USA does not have this. It must be fully paid for -- the "cost" to society is non-existent.

-- (most will not be interested in this last bit) ---
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In response to the question you pose indirectly when you state, "I can also say from my work that in virtually no case that I can think of, did placing an addict on Methadone lead to their being free of addiction." -- I understand why you and others think along these lines. My response is that I don't necessarily dispute this.

But the salient fact is, that the goal from the point of view of society is not necessarily to "fully cure" the heroin addict -- as in many many *many* cases it's entirely unclear whether such a person can *ever* be "fully" cured. The real question (and importantly: the fully obtainable goal) is can this person be
(1) given an alternative (Methadone) to his illegal activities (to stave off withdrawals) and whereby
(2) returned to being a *fully* productive and contributing member of society? The answer to that is a resounding "yes" when Methadone is used for daily maintenance.

It's often the case that even those who still abuse other opioids while just starting on Methadone maintenance, tend to drop the abuse and (properly) stay with only their maintenance dose of Methadone as they become older. In this way, Methadone allows people to "grow out" of their addiction (to illegal, dangerous, and "high"-producing opioids).

-----------------------------------------------------------

On the final point (of the article) -- as to whether Naloxone should be offered free of charge at society's expense to known addicts. Assuming, as I believe the case is, that naloxone is a very cheap drug, then sure, why not?

In the same way (and I'm not equating these *morally*) that a person who has life-threatening allergies to say bee stings carries an "Epi-Pen" I don't see why the same cannot be offered to the dangerous addict. However I'd quickly add that all the "standard stipulations" should apply -- namely, assuming the person can afford the Naloxone injector, he should by all means pay for it. I would assume that is the case for *most* people. If not, and only in those cases would I offer it to them for free. (Because) It's ultimately in society's best interest not to have to maintain a vegetable (brain-dead from overdose patient). Better that a companion saves his miserable life and keeps him out of the ER.
38 weeks ago
38 weeks ago Link To Comment
Of course, and well-said. I suppose in my defense, working in that type of environment, I tended to see far less functional people than other environments. I'm also aware to be careful to not assess everyone and every situation through my "Professional Filters," sucjh as it were (rather like a police officer is always scrutinizing and judging, whether on duty or on vacation).

And, sure, if the goal was to regain a semblance of functionality out in the real world, then yes, Methadone works fairly well. However, the mindset of the Clients I had were always a bit of the "Player," always on the make a bit. They were all (or mostly all) addicted in their heads as well as physiologically. That's a hard thing to break. So naturally, even on Methadone Maintenance, they tended to seek back out their old friend, Heroin, for almost anything that stressed them out or made them depressed.

Narcan is good. Where I work, we've all been to training for it's use, should it be necessary. You never know, after all.
38 weeks ago
38 weeks ago Link To Comment
Hi Allstonian,

It's probably too late for you to see this response, but I wanted to say I appreciate what you wrote. I certainly wasn't in any way meaning to "come down" on you -- I understood what you wrote to be simply a reflection of your own experiences.

Furthermore, I fully understand and have seen myself the "player" mentality (as you put it I think) in Methadone patients (I'm constantly tempted to shorten that to "Meth" but people will inevitably confuse that with Methamphetamine.

In any case, yes, the younger Methadone patients will exactly as you say still seek to get high *somehow* by (Often) any / some means, typically illegal. My point though is that -- and this obviously occurs at different ages -- when men hit the age of (sometimes as early as 30 or 35) 40, or 50, they often simply "grow out" of their constant desire to get high. Now, by all means they do not want to suffer the misery of withdrawals, but luckily, that's exactly the job Methadone excels at.

No question though, you should keep your guard up against cons of all types. I fully support you in that :-)
38 weeks ago
38 weeks ago Link To Comment
the patient gets what he pays for.........
38 weeks ago
38 weeks ago Link To Comment
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