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Moral Hazard

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Moral Hazard

Some states are teaching children how to administer naloxone to overdosing opioid addicts. February 13, 2018
Healthcare

More than twice as many Americans have died of opioid overdoses (often taken with benzodiazepines such as Valium) as have been killed in all U.S. military actions combined since World War II. When the history of our times comes to be written, let us hope that this epidemic of overdoses will long have been regarded as something extraordinary rather than as something normal, current, and inevitable.

Opioid overdose is now the leading cause of death of those under 50 in the United States. This reflects extremely poorly on at least a portion of the American medical profession. Sixty percent of deaths by overdose involve prescription drugs, and more than four-fifths of heroin addicts begin their career as addicts with prescription drugs. When one considers that, in the great majority of cases, there was no proper medical indication to prescribe these drugs, the medical profession’s responsibility in the production of this hecatomb of deaths is clear: and yet, even now, more of these drugs than ever before are being prescribed. Enough of them are prescribed each year, in fact, to kill the entire population of the United States by overdose.

Unfortunately, we always find ourselves in the situation we are in rather than in the situation we should have been in had people behaved better or more wisely. The question thus arises, irrespective of affixing blame, as to what to do, now that more than 30,000 people each year are dying in this unnecessary way.

A drug exists that reverses the fatal effects (principally, respiratory depression) of opioids. One way, therefore, to reduce the number of overdose deaths would be to make this drug more widely available, not only to doctors and to addicts themselves but also to their friends, relatives, and even children. Indeed, in some states, elementary school children are being taught how to recognize the signs of opioid overdose and how to administer the antidote. In effect, then, they are being made responsible for the safety of their parents and elders—a peculiar reversal of responsibility that (let us hope) will cause incredulity among future social historians. Learning how to administer naloxone (the antidote) is becoming the new sex education. Perhaps there should be naloxone cabinets in public places, as there are defibrillators.

Some doctors fear that distributing naloxone will normalize opioid abuse. In medical journals, addicts are no longer described as abusers of heroin but “users” of it, as if opioid overdose were a natural hazard, like anaphylaxis in persons allergic to wasp stings or cardiac arrest in persons with heart disease. And if the effects of opioids are so easily reversible, why deprive oneself of them, if one likes them?

Other doctors say that it is their duty to save as many lives as possible among people as they find them; therefore, in present circumstances, naloxone should never be far out of reach. It could save many lives.

Whatever the “correct” answer—it is possible, probable even, that the vogue for opioids will pass—I cannot remove from my mind the sheer oddity of prescribing unnecessary and even contra-indicated drugs for adults and then teaching children to save them from the dangerous side-effects. Man is a problem-solving creature, no doubt, but he also creates problems.     

Photo: Donald Gruener/iStock

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