Kill ‘Em All; Let God Sort ‘Em Out

Sunday, January 27th, 2008

Some truly astonishing behavior at ONDCP:

Public health workers from New York to Los Angeles, North Carolina to New Mexico, are preventing thousands of deaths by giving $9.50 rescue kits to drug users. The kits turn drug users into first responders by giving them the tools to save a life.

[...]

The nasal spray is a drug called naloxone, or Narcan. It blocks the brain receptors that heroin activates, instantly reversing an overdose.

Doctors and emergency medical technicians have used Narcan for years in hospitals and ambulances. But it doesn’t require much training because it’s impossible to overdose on Narcan.

[...]

John Gatto, executive director of the Cambridge program, says such dramatic results are unusual in the world of substance abuse treatment and prevention.

"In the work that we do, oftentimes the results are very intangible," Gatto says. "This is amazing to be involved in something that literally can save people’s lives. Why wouldn’t we do it?"

Indeed. Why wouldn’t you?

But Dr. Bertha Madras, deputy director of the White House Office on National Drug Control Policy, opposes the use of Narcan in overdose-rescue programs.

"First of all, I don’t agree with giving an opioid antidote to non-medical professionals. That’s No. 1," she says. "I just don’t think that’s good public health policy."

Madras says drug users aren’t likely to be competent to deal with an overdose emergency. More importantly, she says, Narcan kits may actually encourage drug abusers to keep using heroin because they know overdosing isn’t as likely.

Madras says the rescue programs might take away the drug user’s motivation to get into detoxification and drug treatment.

"Sometimes having an overdose, being in an emergency room, having that contact with a health care professional is enough to make a person snap into the reality of the situation and snap into having someone give them services," Madras says.

Digest that for a sec. Better to let a heroin user die than administer a product that, in some cases, may remove the threat of overdose death from people who use heroin to excess. This is the mentality of your modern drug warrior. We’re fighting drug use not because it’s dangerous or harmful, but because they believe drug use is, in and of itself, immoral.

Today’s drug war isn’t about saving lives, it’s about saving souls. it’s the same mentality that led some family values types to oppose the marketing of Gardasil. Remove the threat of cervical cancer from premarital sex and, golly, some girls might have more premarital sex. If a few have to learn an important lesson by dying of cervical cancer, so be it.

Via Mark Kleiman, who adds:

Why not just go all the way and poison the heroin supply? If withholding Narcan in order to generate more overdoses in order to scare addicts into quitting were proposed as an experiment, it could never get past human-subjects review. But since it’s a failure to act rather than an action, there’s no rule to require that it be even vaguely rational.

Kleiman is hyperbolizing. But it probably won’t surprise you to learn that there are idiots out there who aren’t.

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21 Responses to “Kill ‘Em All; Let God Sort ‘Em Out”

  1. #1 |  Swimmy | 

    That final link is atrocious. I’ll never cease to be amazed/amused at the smug piety people exhibit whenever they say something monstrously evil.

  2. #2 |  Eric Crampton | 

    Radley,

    My prior would be that distributing the packs is a massively good thing and almost certainly saves lives. But there’s something of an empirical question here, as there is for Gardasil. Again: I’m in favour of both being distributed. But I can imagine a model where the provision of either safeguard leads to a sufficient increase of the base behaviour that, even though a smaller proportion of those engaging in behaviour are harmed, more people in total suffer the downside consequence. It’s an empirical question at least. And I don’t doubt that Madras is coming at it from the moralistic view that you’re describing.

    It should be a resolvable empirical question though: what’s the elasticity of heroin consumption to the provision of these packs, what’s the proportion of overdoses that lead to fatalities in either condition, and what’s the likelihood of overdose in either condition.

  3. #3 |  Mikestermike | 

    And why should we be worried about behaviour changing in the first place? The problem is that people WANT to change other’s behaviour to suit their selfish selves, not for the common good.
    The common good is this: “Do as you will as long as it doesn’t harm others, and if ya screw up, here’s some nasal spray to cover for that”

    Jeez. empirical question? How about a common sense answer….stop trying to change me to suit you.

  4. #4 |  Scott Clark | 

    There was a novel i read a long time ago with just that premise, a few DEA agents make a big interdiction and decide to poison the drugs they intercept, and then put them back out on the streets for people to die, and voila, an immediate drop in demand. I never made it to the end of the book, but it always seemed that this is the strategy to employ to win the war on drugs. It is from this that you see we should not at all be trying to win the war on drugs. War should never have been declared in the first place. It is a mixed blessing then, that the DEA and other drug warriors do not really want to win. THey, like other government agents tasked with solving a particular problem, do not want to work themselves out of a job. If they really wanted to win, if they really thought it was a problem to solve, or an enemy to destroy, I am afraid they wouldn’t hesitate to substitute de-natured drugs that kill users. It is clear enough that they don’t particularly care about the individual life of the user, as can be inferred from some of Radley’s work .

    THe ONDCP’s behavior is despicable and disgusting, but, unfortunatly, not astonishing. War makes people do and say terrible things.

  5. #5 |  j a higginbotham | 

    So that’s why they’ve been shutting down so many trauma centers – their existence just encourages people to take needless risk driving, etc.

  6. #6 |  ParatrooperJJ | 

    First off, Narcan is a controlled substance, who is authorising this? Secondly it is a lot cheaper to just let them overdose.

  7. #7 |  Ahcuah | 

    Hmmm. Why does this bring to mind the whole paraquat controversy?

    See http://en.wikipedia.org/wiki/Paraquat#Paraquat_Pot

  8. #8 |  Dave | 

    If you hadn’t used the Gardasil analogy in your argument I would have brought it up myself, it’s the perfect analogy.

    Arguing a hypothetical problem when a proven life saving method is there for you to take is asinine.

  9. #9 |  Nick T | 

    “Madras says the rescue programs might take away the drug user’s motivation to get into detoxification and drug treatment”

    And what effect does Dr. Madras think making heroine illegal has on a drug user’s motivation to get into treatment? Hypocrite.

  10. #10 |  Alien | 

    I am certainly in favor of things like Narcan and Gardasil being available. I would be fine with them being distributed ‘for free’ if funded on a voluntary basis.
    However, I would be against government funding of such interventions. I am also still pissed with Merck regarding the Gardasil issue. It looks like it will be a great vaccine and will save many women from cervical cancer. I hate Merck, though, because they lobbied to make it a required vaccine to attend public school. And it just so happens that my state, Texas, had the misfortune of having Rick Perry as governor since he basically handed down an executive order making Gardasil a required vaccine for school attendance. Parents can opt out for religious or philosophical reasons by filling out some form, but come on. You don’t catch HPV from sitting next to an infected individual in class. Furthermore, I believe insurance regulations in Texas require insurances to pay for any required school vaccinations. This increase in expense will be passed on to the insured, further raising insurance prices even for people who would not be interested in using the vaccine or would not otherwise be candidates for the vaccine.
    I don’t put weight on the “they’ll-have-more-sex-if-we-vaccinate” argument, but I am against this being mandated by government and for personal choice (or parent/guardian choice).

  11. #11 |  ZappaCrappa | 

    I live in TX also Alien. I sent a letter to the Gov. telling it would be a cold day in hell before I let him use my child as a lab rat to appease his campaign contributors. You are aware that they were a major contributor to his campaign? This is kind of off-topic…so I apologize.

  12. #12 |  Zero | 

    So if easy availability of Narcan will encourage heroin addicts to continue using heroin what other thing should be eliminated to make life harder on addicts? Perhaps we should eliminate any possibility of an addict going to drug treatment instead of jail? In fact why not eliminate all drug treatment completely? Also why not make it illegal to buy, sell or rent anything to an addict? That would really make their lives miserable. Anything else would be coddling criminals. After all addicts are not really human beings are they?

    Dr. Madras is a first class dick.

  13. #13 |  Ochressandro | 

    ParatrooperJJ: It’s only cheaper to let them overdose if no one finds them. If they make it to the ER, the ER has to keep working on them until they’re fixed, or they expire.

    If they come in already on a dose of Narcan, there’s a lot fewer physical problems to repair.

    There’s an entire chain of things I object to about this idea, but it all boils down to “we should just legalize the shit, and let people buy metered doses at Walgreens.” Given the absence of that, and the fact that ERs *are* tax funded at the moment, reducing the cost via predistributed mediation drugs is probably the “best” plan.

    I just hope the people handing these kits out are making sure to be very clear that Narcan wears off fairly quickly, so you still have to get the OD to an ER.

  14. #14 |  pris | 

    Along the same vein:
    It is indeed fine and dandy to provide injectionable epinephrine to anyone allergic to bee stings because after all they are not drug addicts- injection vs nasal spray narcan.

    The real issue is that drug prevention is big business and keeps many governemental agencies in business. Legalizing drugs would put these people out of business and our economy would collapse.

  15. #15 |  AK | 

    Today’s drug war isn’t about saving lives, it’s about saving souls. it’s the same mentality that led some family values types to oppose the marketing of Gardasil. Remove the threat of cervical cancer from premarital sex and, golly, some girls might have more premarital sex. If a few have to learn an important lesson by dying of cervical cancer, so be it.

    I may be wrong, but I don’t remember “family values types” opposing the marketing of Gardasil. I remember them opposing compulsory vaccination of students at taxpayer expense. But if you have a link to a news story to the contrary, please let me know.

  16. #16 |  dsmallwood | 

    i only caught the end of the comments, but in the “why not poison the heroin” comment there is a lot of truth. remember the paraquat scares of the early 80s? people were concerned ’cause the paraquat didn’t always kill the plant and it left some of it smoke-able. and supposedly, if you smoked the tainted plant it was poisoness. when this was pointed out to the DEA chief, he said that perhaps that would make the recreational user think twice …

    ya gotta kill a few to save a few

  17. #17 |  Woog | 

    “I may be wrong, but I don’t remember “family values types” opposing the marketing of Gardasil. I remember them opposing compulsory vaccination of students at taxpayer expense. But if you have a link to a news story to the contrary, please let me know.”

    I want to echo this comment; what private citizens choose to do regarding their own personal health care should be up to them, and is something I have not one problem with. The FORCED injection of children with STOLEN money is something I’m liable to blow at least one fuse over!

  18. #18 |  Woog | 

    “The FORCED injection of children with STOLEN money” should more accurately be read as ‘the forced vaccination of children, paid for with stolen money’. ;)

  19. #19 |  Skywyze | 

    Believe it or not, back in the early 90′s my father wanted to poison the drug supply for the exact same reason (no shit) so that idea is nothing new to me.

    I asked him how he’d feel if I died in such a way and he just called it “collateral damage”.

    Ah…..the good ole days.

    I still smoke pot….I like it and I’m not ashamed of it but he damn sure scared me away from everything else, including him BTW.

    Take from that whatever you want. If nothing else, have peace in the fact that Mark Kleiman’s kids (if he has any) might still turn out okay. ;)

  20. #20 |  ZappaCrappa | 

    I wonder what his reaction would have been to poisoning the alcohol supply Skywyze? Probably would have blown a fuse?

  21. #21 |  Mr Mister | 

    They can’t poison the heroin supply because that might cut into all of the local drug-lords’ profits. It’s just not good business.

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