I recently came across a headline in the Health Affairs news feed: “Does Naloxone Availability Increase Opioid Abuse? The Case for Skepticism.” Naloxone is a drug that quickly reverses the effects of opioid overdose. The authors critiqued a recent article in an online journal that is not peer reviewed that put forth the case that naloxone use was actually increasing opioid use and crime.
The article in question, “The Moral Hazard of Life Saving Interventions: Naloxone Access, Opioid Abuse and Crime,” concludes that naloxone availability results in reducing fears, increasing the use of opioids, increasing the number of people using opioids, and increased crime due to people stealing to support their addictions.
I read both the article and the resulting comments with interest and, while I can see both sides of this dilemma, even the authors state that naloxone is an effective harm reduction strategy. In reviewing the articles, I was reminded of a small, red cap that I kept on my desk for over a year. I had collected the cap from a medication vial containing naloxone.Before joining HealthInsight, I was the director of a regional public health office. One day someone came into the lobby asking for help in the parking lot. A young man was in the back of a car: his lips were blue as the result of arrested breathing due to an overdose. I watched public health staff spring into action and deliver two doses of naloxone to the young man while I assisted with rescue breathing.
I saw this person revived and able to walk to the ambulance when it arrived.
Did that young man end up continuing to feed his addiction? Did he engage in ever riskier behaviors? Did he steal to support his habit? Or, conversely, did this experience cause him to seek treatment? Did those with him also decide their lives were at risk and work toward abstinence? I don’t know the answer to any of these questions, but I do know that this young man was given another chance.
The moral questions in this dilemma are huge, and I ask myself, would we withhold lifesaving treatment from someone who has heart disease, even though the person may continue to engage in risky behaviors such as an unhealthy diet and lack of exercise? I think the answer is no.
Without naloxone and people who knew what to do, I am certain the young man would have died in the parking lot. I choose to believe that harm reduction strategies offer hope: keeping people alive until there is a better answer.
I used to speak with people coming in to the public health office for needle exchange, I’d often ask how their heroin addictions began. They’d often report, “I injured my knee, shoulder, back (fill in the blank), and when the opioids got too expenses or I couldn’t get a prescription, I went to heroin.” Addictions often began with a medical intervention for pain and then spun out of control.
We have a huge and complex problem in our nation that is the result of readily available and highly addictive drugs and a host of other factors. We have little in terms of national strategy beyond holding providers accountable for prescribing practices. Access to treatment is abysmal. Until we have a robust national response and effective strategies, I am an advocate for harm reduction and trying to save every life we can.
HealthInsight is committed to identifying and promoting best practices to prevent and address harms from the misuse of opioid medications. Visit our website for opioid safety tools and resources.