The Republic of T.

Black. Gay. Father. Vegetarian. Buddhist. Liberal.

Overdose Is Not The Enemy

Unfortunately, PZ, this kind of thing—from this administration—is all to believable.

Every year, overdoses of heroin and opiates, such as Oxycontin, kill more drug users than AIDS, hepatitis or homicide.

And the number of overdoses has gone up dramatically over the past decade.

But now, 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.

Sounds good so far, right? After all, before you can get someone into recovery or treatment, you’ve got to keep them alive. I’ve never yet heard of a dead junkie graduating from rehab. So fewer overdoses is a good thing, even if it’s only the first step towards maybe getting some people the help they need.

You’d think so. Right? Well, if you do, you’re likely not a part of the Bush administration. Keep reading.

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.

You’re right on one count, PZ. We are ruled by monsters, alright. Here we have a woman, a medical professional who would rather have someone overdose than get something that might keep them from overdosing. Sure, an intervention with a medical professional might do someone some good. But that’s if they overdose in a place where someone is likely to find them, if someone finds them, if whoever finds them is sober enough to call for help, if EMTs or paramedics get to them in time, if paramedics can keep them alive long enough to get to an emergency room, if the emergency room team can keep them alive, if they regain consciousness, and if they don’t suffer so much brain damage that they can’t walk or talk or communicate at all. After all, the more time that passes before someone in that situation gets help, the more likely they are to die or suffer irreversible damage.

People can die at any point along that chain of events. And if they don’t die, they can suffer a great deal of damage, from which they might never recover. And apparently that’s just fine with Bertha. Never mind that $9.50 to save a life is a hell of a lot less than will be spent once someone overdoses and is lucky enough to end up in the emergency room.

Now, it might be easy to say, “Well, that’s just part of being a drug addict. They already put themselves at risk.” But that’s already making a judgement that whatever an addict suffers is what they have coming to them anyway, and just beneath the surface of that assumption is the idea that it might be a good thing for them to overdose, and preventing an overdose is actually a bad thing because it takes away one of the consequences of using drugs.

It’s a Puritanical preference for the punitive over the preventative that’s all to prevalent in Bush administration. It’s most clearly reflected in the philosophy behind “abstinence-only” education, and most eloquently expressed by a fundamentalist “abstinence-only educator” I quoted in a blog post a while back.

At Reclaiming America for Christ, [Pam] Stenzel told her audience about a conversation she’d had with a skeptical businessman on an airplane. The man had asked about abstinence education’s success rate—a question she regarded as risible. “What he’s asking,” she said, “is does it work. You know what? Doesn’t matter. Cause guess what. My job is not to keep teenagers from having sex. The public schools’ job should not be to keep teens from having sex.” Then her voice rose and turned angry as she shouted, “Our job should be to tell kids the truth!”

“People of God,” she cried, “can I beg you, to commit yourself to truth, not what works! To truth! I don’t care if it works, because at the end of the day I’m not answering to you, I’m answering to God!”

Later in the same talk, she explained further why what “works” isn’t what’s important—and gave some insight into what she means by “truth.” “Let me tell you something, people of God, that is radical, and I can only say it here,” she said. “AIDS is not the enemy. HPV and a hysterectomy at twenty is not the enemy. An unplanned pregnancy is not the enemy. My child believing that they can shake their fist in the face of a holy God and sin without consequence, and my child spending eternity separated from God, is the enemy. I will not teach my child that they can sin safely.”

It’s the same ideology that prevented D.C. from spending its own tax money to fund a needle exchange program, even though a third of new AIDS cases can be traced to reused needles, and we now have a bigger HIV/AIDS epidemic than we might’ve had otherwise.

It’s the same “compassionate conservative” philosophy which holds that people ought to spend some “time in the pit,” before they receive help.

Read the part about the architect of Bush’s faith-based initiative, who believes “An emphasis on freedom should include a willingness to step away for a time and let those who have dug their own hole suffer the consequences of their misconduct. …The early Calvinists knew that time spent in the pit could be what was needed to save a life from permanent debauch (and a soul from hell).”

In that context it doesn’t matter that even one study shows there are benefits to the overdose-rescue kits.

Karen Seal, an author of the study, says the study showed rescue programs have a tremendous impact.

“It was one of those great studies where we just all walked away and said, ‘Whoa! This is terrific!'” says Seal, of the University of California, San Francisco. “I mean, by our sheer interaction with these folks around these life-saving behaviors, we’re actually creating some real positive change here.”

And health educator Wheeler says putting overdose-rescue kits in the hands of drug users sends them a positive message.

“There is a real potential culture change among drug users because of Narcan,” she says. “Because, from my experience, I feel like drug users internalize a lot of stigma that’s out in the world about them. They come to believe that dying is just part of this life that they’ve chosen.”

Wheeler says it doesn’t have to be that way.

But it does have to be that way in Bertha’s world, and in Pam’s world, because “the wages of sin is death” and anything that gets in the way of that death is getting between people and punishment. They might “sin” and “get away with it.” In that context, it doesn’t matter whether a particular intervention works or doesn’t work. In Stenzel’s case, it’s preferable to push something that doesn’t work. In Madras’ case, it’s preferable to withhold something that does work, because it takes away what “ought to be” a consequence of drug use.

Stenzel would actually rather see a sexually active young person get an STD, or a young woman end up with an unwanted pregnancy (yet she’ll be denied access to abortion too, and get no services or support if she decides to keep the baby) or get HPV and end up having a hysterectomy than get information that will help them protected themselves and reduce their risks for all of the above. And Madras would rather see an addict go through an overdose that he or she may not survive, and which may damage them for life, than give them access to something that might at least prevent them from overdosing.

Because AIDS is not the enemy, even if a kid who learns how to use a condom or birth control might live long enough to end up sitting on a pew in some church or another. An overdose is not the enemy, even though the addict who gets or has access to a overdose rescue-kit might live long enough to make it into rehab or at least walk through the door of a 12 step meeting. Because prevention isn’t the point. Punishment is. Prevention, then, is the enemy.

And people will die. Ideologues like Madras and Stenzel will make sure of that, by withholding the information and help people need to maybe keep themselves alive.

As someone whose been in recovery for 15 years, and someone who spend years as an HIV/AIDS prevention educator, I can tell you that in order to be effective doing that kind of work you have to meet people where they are and give them the information they need to save their own lives as they are. If approach either situation with judgments about where you think people ought to be, how you think they ought to live, and what you think they ought to believe, you won’t reach them.

If you set policy in the same way, you will prevent other people from reaching them. I might think someone would be better off not shooting up, but if I can convince them not to reuse needles and make it easy for them to get clean needles, they might avoid infection, disease, and death. If I can help them prevent or reverse an overdose, they might avoid death. The every day they’re still alive is another day they have a shot at recovery. (Of course, there aren’t even enough beds in drug treatment facilities for all the people who wants treatment. But that’s another subject for another post.)

But if I have an antidote for overdose, and I withhold it, drugs are no longer the enemy. An overdose is not the enemy. I am.

One Comment

  1. Say the words: Harm Reduction. The ultimate evil, as far as too many otherwise qualified, intelligent, thoughtful folks in substance abuse and addiction treatment are concerned.

    Also say the words: Alternatives to 12-Step Programs, particularly SMART Recovery for folks who don’t find the 12 steps particularly helpful.