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Are We Reviving Too Many Opioid Overdoses? Is This Really a Question?

sigmond

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By JEREMY SAMUEL FAUST:SLATE

A new paper suggests the overdose-reversing drug naloxone presents a ?moral hazard.? The economists? case is built on an immoral premise.

A new paper by economists at the University of Virginia and the University of Wisconsin suggests that naloxone, the life-saving antidote for opioid overdoses, might actually be bad for society. The researchers decided to look at what happened before and after naloxone became more widely available in various parts of the United States and ended up drawing appalling connections between access to naloxone and an increase in opioid-related crimes, theft, and ER visits.

Suppose, for a moment, that these findings are true (though a thoughtful debate on the methodology broke out on Twitter almost immediately). The implication is that naloxone merely keeps criminals alive longer providing them the opportunity to do more crime, and that because of this, it would seem to follow, perhaps we ought to reconsider expending resources toward keeping these societal miscreants from dying at the hands of their own woes.

Until now, I had not realized that economists and public policy experts were in the habit of advocating, if obliquely, for de facto death sentences for opioid-related crimes. While the term ?moral genocide? seems extreme, it certainly comes to mind. As an ER physician, let me verify for the record that even if naloxone availability increases opioid-related ER visits, I?m just fine with that.

Knowing an oncoming train when they see it, the authors explicitly pre-empt expected accusations that they are arguing against naloxone availability. After 26 pages of hand-wringing, in which human lives are weighed against societal woes of theft and ER visits, with language peppered with demeaning terms such as ?opioid abuser? and cherry-picked anecdotes about kids having Narcan parties, the authors want us to believe that they are just simple economists innocently reporting the facts and that all they mean to say, dear reader, is that we need to do more than simply expand naloxone access. (They note in their conclusion that their findings ?do not necessarily imply? that naloxone access should be reduced but that local treatment options should be increased.) But if that were the case, they would not have titled their paper ?The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime,? and instead opted for something along the lines of ?Naloxone Is Not Enough: Factors Associated With Long-Term Health and Social Outcomes.?

Instead, their paper offers takeaways such as ?the moral hazard generated by Naloxone is indeed a problem.? While the term moral hazard is an economic term meaning that people engage in riskier behaviors when the consequences are lessened, the authors seem to have embraced a broader definition as well. They quote a Dayton, Ohio, police officer who complained of having to give naloxone to the same person 20 times, submitting that saving one man?s life repeatedly is, and this is an actual quotation, ?a waste of police resources.? Citing this quotation in an academic paper leaves very little room to think this data set was designed to be anything other than ammunition for righteous crusaders who think, from the perch of public policy, that a very good way to solve the problems of opioid users might be to just ?Let Them Die.?


Slate

research
 
That is disgusting. No reputable journal would publish an analysis like this if it claimed that, say, sports injuries shouldn't be treated because treating them encourages risk-taking, or that people having heart attacks should be left to die because knowing that one might survive a heart attack encourages overeating. On top of that, this is the type of social science research that makes specific claims of causatian based on broad correlatiobs that may or may not actually be related. To use such correlations to discourage the availability of a life-saving medication is reprehensible.
 
This is a prime example of utilitarianism

u?til?i?tar?i?an?ism
yo͞oˌtiləˈterēəˌnizəm/Submit
noun
the doctrine that actions are right if they are useful or for the benefit of a majority.
the doctrine that an action is right insofar as it promotes happiness, and that the greatest happiness of the greatest number should be the guiding principle of conduct.

This is a mindset behind many genocides.
 
Call my crazy but I think people's lives are worth a lot more than some shit getting stolen.
 
Don't get me wrong I'd put a hole in someone's head for breaking into my home.

On a societal level however I'm against cutting thieves hands off, never mind the death penalty.
 
Don't get me wrong I'd put a hole in someone's head for breaking into my home.

On a societal level however I'm against cutting thieves hands off, never mind the death penalty.

Not to get too far off topic. But breaking into your home in itself isn't a good reason to kill someone.

If you were saying you wouldn't hesitate to blow the head off someone who broke into your home AND posed a threat to you or your family you'd have my absolute support.

But just breaking in by itself is no justification to take someone's life.
 
If you do a home invasion you are a threat to my life. I'm not gonna play by gentleman rules and see who can draw quicker.
 
If you do a home invasion you are a threat to my life. I'm not gonna play by gentleman rules and see who can draw quicker.

What bullshit. As unlikely as it already is for you to be victim of a home invasion. The odds that the home invader has any desire to hurt you or indeed interact with you whatsoever is staggeringly lower.

I firmly believe in everyone's right to defend themselves. I'm supportive of armed self defense too. But just shooting someone for breaking into your house is too much.

It's that shit that gives people who have a gun for self defense a bad name.

Your stuff is not worth someone's life. I'll defend your right to shoot someone because you honestly feel your life is in danger all day long. But there's no sensible justification to believe your life is in danger just because someone broke into your house. You might believe it if you have no idea how criminals think and believe everything Hollywood tells you, but someone like that has no business owning a gun. Having a gun for self defense imposes on you a higher standard.

You don't shoot someone until you feel your life is in immediate danger. That's the standard. Someone breaking into your house isn't in itself a threat to your life.

Saying you'd shoot someone just cause they broke in is totally irresponsible. People like that are the ones who end up shooting their kids when they sneak into the house and such shit. They make people who own a gun for self defense all look bad.

You don't shoot unless you have reason to think your life is in danger. Or the life of someone else. Not because you're a paranoid nut who think all criminals are sadistic evil monsters.

It reminds me of my mother in law, she had a break in and she made some remark that she was glad they didn't hurt the cats. Like wtf? Why would you think that. If someone's breaking into people's house it's virtually always because they're desperate. Not just sadistic all cruel and evil.

But then no doubt I see things slightly differently to normal people because I've known a lot of people who used to commit these kinds of crimes. But it doesn't change the truth in what I'm saying. Which is that self defense is for when you or someone else's life is in danger. When you have good justification to feel your life is threatened.

Saying you'd kill anyone just for breaking into your house while you're there is disgusting and irresponsible. And far more inherently criminal as an act than the actual burglary.

Look man, if someone breaks in, that's reason to pull a gun on them sure. And if they make a move that suggests they're about to attack you or get too close, you shoot. What you don't do is shoot the second you see them no matter the context or circumstance as you're suggesting.

That you describe it this way suggests you have the wrong attitude. You shoot to defend yourself. Not to defend your stuff. To defend yourself or other people. Property isn't worth anyone's life. The right attitude is that youd shoot once you perceive a threat to your life or your family or similar. Not as soon as you find an intruder no matter what they're doing.
 
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I semi agree for real
this new generation of fiends that started in the last year or two ARE reckless IMO. It wasn't like that when I started back in 2012. Not saying people shouldn't be narcan'd but I've watched as all the newer people drop like flies because of being reckless.
Hate all you want, idc. I did that shit for years and I only ever had to be narcan'd once, because i caught some badly cut fent bags (they were fine, we had been buying the same joints a few days straight, when I OD'd i dropped off a smaller than normal size shot back in 2015. I was with someone in the whip so they took me to the hospital...)
Half the reason I quit was i saw the writing on the wall that shit isn't even dope at all, straight fent+filler no D. All you gotta do is taste it and you can tell instantly, no D taste is fent...
I guarantee if I hit my old people I'd get fent, thats how shit is nowadays and if you wanna do that shit buy the ticket take the ride. When I wile out off crystal I'm not a victim, thats me being an idiot same shit applies imo
 
LSDMDMA&14285641 said:
I semi agree for real
this new generation of fiends that started in the last year or two ARE reckless IMO. It wasn't like that when I started back in 2012. Not saying people shouldn't be narcan'd but I've watched as all the newer people drop like flies because of being reckless.
Hate all you want, idc. I did that shit for years and I only ever had to be narcan'd once, because i caught some badly cut fent bags (they were fine, we had been buying the same joints a few days straight, when I OD'd i dropped off a smaller than normal size shot back in 2015. I was with someone in the whip so they took me to the hospital...)
Half the reason I quit was i saw the writing on the wall that shit isn't even dope at all, straight fent+filler no D. All you gotta do is taste it and you can tell instantly, no D taste is fent...
I guarantee if I hit my old people I'd get fent, thats how shit is nowadays and if you wanna do that shit buy the ticket take the ride. When I wile out off crystal I'm not a victim, thats me being an idiot same shit applies imo

So glad this hasn't happened in Australia yet. I can still get good very pure H here. In Sydney at least. Must suck to be a junkie in the US right now. Fucking fentanyl.
 
What bullshit. As unlikely as it already is for you to be victim of a home invasion. The odds that the home invader has any desire to hurt you or indeed interact with you whatsoever is staggeringly lower.

I firmly believe in everyone's right to defend themselves. I'm supportive of armed self defense too. But just shooting someone for breaking into your house is too much.

It's that shit that gives people who have a gun for self defense a bad name.

Your stuff is not worth someone's life. I'll defend your right to shoot someone because you honestly feel your life is in danger all day long. But there's no sensible justification to believe your life is in danger just because someone broke into your house. You might believe it if you have no idea how criminals think and believe everything Hollywood tells you, but someone like that has no business owning a gun. Having a gun for self defense imposes on you a higher standard.

You don't shoot someone until you feel your life is in immediate danger. That's the standard. Someone breaking into your house isn't in itself a threat to your life.

Saying you'd shoot someone just cause they broke in is totally irresponsible. People like that are the ones who end up shooting their kids when they sneak into the house and such shit. They make people who own a gun for self defense all look bad.

You don't shoot unless you have reason to think your life is in danger. Or the life of someone else. Not because you're a paranoid nut who think all criminals are sadistic evil monsters.

It reminds me of my mother in law, she had a break in and she made some remark that she was glad they didn't hurt the cats. Like wtf? Why would you think that. If someone's breaking into people's house it's virtually always because they're desperate. Not just sadistic all cruel and evil.

But then no doubt I see things slightly differently to normal people because I've known a lot of people who used to commit these kinds of crimes. But it doesn't change the truth in what I'm saying. Which is that self defense is for when you or someone else's life is in danger. When you have good justification to feel your life is threatened.

Saying you'd kill anyone just for breaking into your house while you're there is disgusting and irresponsible. And far more inherently criminal as an act than the actual burglary.

Look man, if someone breaks in, that's reason to pull a gun on them sure. And if they make a move that suggests they're about to attack you or get too close, you shoot. What you don't do is shoot the second you see them no matter the context or circumstance as you're suggesting.

That you describe it this way suggests you have the wrong attitude. You shoot to defend yourself. Not to defend your stuff. To defend yourself or other people. Property isn't worth anyone's life. The right attitude is that youd shoot once you perceive a threat to your life or your family or similar. Not as soon as you find an intruder no matter what they're doing.

This is an interesting post because I'm a big self defense buff who doesn't YET own a gun but will probably buy one eventually, but at the same time, I believe in only taking one's life if you absolutely HAVE to.

I don't really know whether or not I agree more with you or Treezy though, cause to be honest, I feel if someone enters your home you can't POSSIBLY know FOR SURE whether or not they mean to harm you or not, but to be reasonable, you probably have to assume the worst if you want to be safe, ESPECIALLY if you have kids or a wife to defend.

I personally would probably not go immediately for a head shot, or if using another weapon go for the kill, but I'd attack quickly to injure the person in such a way that they couldn't possibly injure me, like shoot their leg or hit their leg with a bat in the knee, or since I do Brazilian Jiu-Jitsu, most likely rush them, take them down, then choke them unconscious and call the cops.

I see where both you and Treezy are coming from, but I think you are certainly being a bit too easy on people who break into homes here.

How would you know for sure whether or not the guy wants to hurt you until it's actually too late and he already has a gun or knife out?

If you've entered my premises I am going to automatically assume you MIGHT want to hurt/kill me or my loved ones, and while I don't WANT to kill you, or even hurt you, it's at that point that it's quite possibly you or me and it's damn sure not going to be me.

I don't have sympathy for people who break into houses for any reason, and while they don't deserve death for stealing, self defense situations escalate VERY quickly.

To presume that it should be so easy to assess what kind of damage a person who enters your home might intend to do in possibly a matter of SECONDS when you wake up groggy in the middle of the night and there's a masked man in your living room is expecting WAY too much of a home owner.

Adrenaline will be running wild and truly having a drug-inducing effect on both you and the attacker, and you can't possibly be likely to know whether or not they mean to hurt you until it's already too late.

In a PERFECT world you draw your gun, they freeze, you call the cops, no one is injured, and a less perfect one you take out his knee.

But we don't live in a perfect world, and so I think maybe you are being overly empathetic towards these types of people.

Lets not forget, many rapists and killers break into homes and not only petty thieves.

In a situation like that, if a someone wakes up from a dead sleep and a masked man is in their home and they shoot and kill them, I'm not going to be blame the shooter.

He/she defended their home and invader shouldn't have been there.

I also won't blame an animal for defending its territory if I invade it.

If you don't want to possibly end up dead don't break into someone's house cause you have no right to be there.

Interesting discussion though.
 
I semi agree for real
this new generation of fiends that started in the last year or two ARE reckless IMO. It wasn't like that when I started back in 2012. Not saying people shouldn't be narcan'd but I've watched as all the newer people drop like flies because of being reckless.
Hate all you want, idc. I did that shit for years and I only ever had to be narcan'd once, because i caught some badly cut fent bags (they were fine, we had been buying the same joints a few days straight, when I OD'd i dropped off a smaller than normal size shot back in 2015. I was with someone in the whip so they took me to the hospital...)
Half the reason I quit was i saw the writing on the wall that shit isn't even dope at all, straight fent+filler no D. All you gotta do is taste it and you can tell instantly, no D taste is fent...
I guarantee if I hit my old people I'd get fent, thats how shit is nowadays and if you wanna do that shit buy the ticket take the ride. When I wile out off crystal I'm not a victim, thats me being an idiot same shit applies imo

Well isn't it the fent/analogues' fault not the generation's?
 
Well isn't it the fent/analogues' fault not the generation's?

exactly - it's not the users' faults - they're just trying to stay well, and many of them probably have no idea how lethal fent analogues are.
fent adulterated dope has taken over the heroin market in north america pretty damn quickly, and of course street users aren't the best educated people out there - even the media and politicians are still blaming "the opioid crisis" on doctors prescribing too much oxycodone or whatever.

LSDMDMA&AMP said:
Half the reason I quit was i saw the writing on the wall that shit isn't even dope at all, straight fent+filler no D. All you gotta do is taste it and you can tell instantly, no D taste is fent...

yes, but this is far from a foolproof test. i mean, if you were to do this with fent-adulterated dope, and managed to get a hotspot, it could very easily be lethal.

most people aren't aware of the risks, and it don't think it's fair to blame them.
i think the dealers and the government misinformation that insists all drugs are bad, all drugs can kill (and denies the importance of harm reduction) carry far more blame that the poor addicts themselves.


as above, i think it's a disgusting sentiment to suggest that people shouldn't receive life-saving medical care. truly sickening.
 
Personally I'm happy to put almost all the blame on the government. Everything else is a result of the nature of the system. The government are the primary actors who have central responsibility and should know better and make better policy.
 
It's definitely a question as to why someone is overdosing 20 times... I just think the question is why is there so little effective addiction treatment available? Or why aren't people being referred to effective treatment?
 
If you get your dope off of different dealers and live in an area where fentanyl is prevalent, it can be a crap shoot as to how pure your drugs actually are, multiply in the fact that fentanyl withdrawal leaves people more desperate than any other opioid (save for maybe hydromorphone) and you probably have a lot of OD's simply from a person in w/d being too generous with their eyeballed dose of unknown purity. I imagine when you're hurting badly you're not going to carefully measuring your dope and doing back of the envelope math to calculate the mg/kg dosage level and comparing to the LD50.

In areas where fentanyl is a chronic problem it can be sold at almost 10% purity or more due to the severe problem of escalating tolerance coupled with a desire for dealers to "stay competitive" and "have the best shit", it's quite scary actually. Obviously new customers would get more heavily cut shit, but all it would take is one mistake in dosing or packaging and fatalities are gonna be happening.

This article is so naive. Should we also stop providing treatment for atherosclerosis and heart disease? If the fat people die young then we save massively on medical care for the elderly. Or how about stopping police service entirely for the less affluent, so we don't waste tax money on prosecuting crimes under $5000.

If widespread acceptance of opioid replacement therapy was a thing (Rx diamorphine/hydromorphone/dihydrocodeine as needed, 2-3x a day) somehow I don't think opioid-related crimes would be a thing any more.
 
It's definitely a question as to why someone is overdosing 20 times... I just think the question is why is there so little effective addiction treatment available? Or why aren't people being referred to effective treatment?

It's because the money's in not giving drug users the services they need. Treatment recidivism means more money for the recovery industry, even if it means less money for the rest of us.

And for inexpensive effective treatments like buprenorphine and methadone, folks in the recovery industry like to pretend recovery via ORT isn't as legitimate as their abstinence oriented approaches, even though their abstinence oriented approaches tend to cost everyone exponentially more. But it does pay the bills for folks in recovery who work for the industry, so I guess it's helping some addicts...

The reality of course is that ORT and abstinence behavioral therapies aren't better or worse than one another, they each have their appropriate application and can be mutually reinforcing in positive ways, just as long as someone knows how to use them so...

The way profit motivations and the ideological divisions/small mindedness of the vast majority of recovery industry players is depressing verging on disgusting.
 
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