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I've mentioned before that Mexico allegedly limits naloxone supply. By "limits" I mean it doesn't allow US advocacy groups to mule across a bunch of drugs to clinics at will. AMLO also said a few things that was skeptical of harm reduction and Narcan's role in the opioid crisis. Not exactly prohibition, but legacy scheduling laws that haven't changed looks like something less than harm reduction.
Narcan is the cheaper, easier solution to overdose treatment. A 20 year old EMT can administer it. Your little sister can administer it. Take Narcan out of the equation and EMS will still respond to overdose calls. They'll pick up junkies, apply whatever alternative medical attention they are able, then go and stick them in the ER.
Napkin math. Around 80,000 opiate overdose deaths in the US as of late. Pick one of the guesstimates, say the NSDUH surveys, on number of opiate users and decide to 2 million opiate addicts is fair enough. At 82,000 deaths a year we get an annual mortality rate of ~4%. To me, this suggests addicts are actually pretty good at not dying from drugs given the drugs are as potent, addictive, and dangerous as ever. If we want to be extra generous with the numbers (decidedly not generous to addicts) then what do you think happens when Narcan is removed as a treatment? My guess would be the annual mortality rate of addicts rises by 2 percentage points for a time. Possibly less. What do we solve with such policy?
You suggest we stop treating overdoses with the best, relatively cheap treatments we have available. Enabling drug use is bad so we should remove tools that enable drug use. Medicine is one such tool, because it enables an addict to live longer to do more drugs. You do not suggest we don't provide medical treatment at all. If we wave the magic wand and blink Narcan out of existence we still the same stressors in the system. EMS arrives, does all the not-Narcan treatments, keeps someone alive if they can, and drives them to the ER. Some greater number of addicts are dead on arrival, but the rest receive the same or possibly greater treatment.
As I've gotten older I find myself more sympathetic to moral hazards. If the cost to widely available, easy to use treatments such as Narcan nasal spray is a 60% increase in opiate deaths (50k in 2015, now 82k) then, yeah you may have a point. The obvious incentives fire up my neurons, too. That said, in writing this post I did not find a study or review that gives Narcan substantial responsibility for the rise opiate use (now plateauing) and deaths. Even if we remain skeptical of harm reduction as an industry, lobbying group, and advocacy movement-- of the motivations of researchers in the field -- Narcan is so widely used there ought to be some. It's an old drug that was subject to innovation in response to increasing opiate use.
Wand waving Narcan does not look like compassion or tough love to me. Withholding the best medicine available doesn't sound decent to me. Tough love is giving someone Narcan, then immediately throwing them in the back of a paddy wagon to some farm in California to get clean and clear wildfire brush as punishment. Zero tolerance prison might work as well, but the cost of addicts taking up space in prison is fairly high. Withholding emergency medical treatment is a half-measure against a population that is filled with friends and family. Psycho Joe on the corner who demands medical attention twice a month is but a slice of the drug addict pie.
Here's one that made the rounds a few years ago: The Effects of Naloxone Access Laws on Opioid Abuse, Mortality, and Crime
Author's website has some additional commentary and appendices. Most interesting is the regional analysis where their estimates are that naloxone access led to a 14% increase in opioid-related mortality in the Midwest in particular (in the West and Northeast: insignificant decrease in mortality; South: insignificant increase). They give two explanations:
Their main policy recommendation is to expand drug treatment programs and find ways to ensure people get help post-overdose. Your paddy-wagon idea might have legs.
Thanks, register as Seen. Felt like they should be some push-back in this direction somewhere.
I can't take a major gander today but will come back. Curious how they control for all the gunk and if they look internationally at all. Estonia was a yuge fentanyl place for a time, but they went at the issue hard as I recall -- law enforcement wise -- and its OD rates got better. Canada, like the US, is bad and I assume has similar maximal harm reduction approaches.
This is interesting and makes sense.
This is what people always say though, hehe. I commiserate with the people tired of hearing it as things progressively get worse. Sounds rather uncontroversial to say that involuntary commitment will save some number of souls. This doesn't have to be attached to naloxone prohibition.
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That's two things. They'll get separated, so they get the Narcan but not the punishment.
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