A deeply humane friend recently suggested that medics stop saving people on their third opioid overdose. The subject was naloxone, a medication that can yank users from the jaws of death. It can be given via Narcan nasal spray or injection.
My friend surprised me. I thought that if a life could be so easily and cheaply salvaged (a Narcan kit costs about $40), why not do it?
I do hear the arguments. Addicts usually have brought their problems on themselves. Keeping this rescue drug handy gives them an excuse not to seek treatment. And, something few say out loud, these addicts are drags on society, and their departure would be no great loss.
Arthur Caplan, who heads the medical ethics program at the New York University School of Medicine, doesn't go there at all. "The revival drug should be around everywhere," he told me. "Around all events." If you have an addict in your family, you should stock a kit.
Agreed, but the naloxone dilemma doesn't stop there. Public libraries have been urged to keep Narcan handy because many users head to their bathrooms to take drugs. Many libraries fear becoming hangouts for addicts who believe they've found a place to both take drugs and be saved in case of an overdose.
Stock Narcan anyway, Caplan says. "I don't see why we don't use it as a defibrillator. Let's go." Defibrillators are devices that restore an abnormal heartbeat and are now commonly kept on airplanes, in shopping malls and wherever people congregate.
Obesity, untreated diabetes and smoking are all tied to behavior, but the medical community continues to treat the consequences, Caplan notes. "If you cleaned out all the sinners from the health care system, things would be cheap."
As for using public restrooms to do drugs, that's a worry shared by fast-food restaurants and other establishments. The remedy is for these locations to keep keys to the bathrooms and monitor their use.
The Narcan question is easy next to one facing hospital cardiac units. Drug use leading to bacterial infection ravages hearts. The cost of treating endocarditis, an infection of the heart valves, can easily exceed $150,000. The opioid epidemic has burdened hospitals with an avalanche of drug-related endocarditis cases, often involving the poor with little or no insurance. That many such patients are young — meaning they have hearts that could be salvaged — complicates the decisions on whether to provide this expensive surgery.
Boston hospitals found that only 7 percent of the endocarditis patients who continued to do drugs lasted a decade without a return infection. Some doctors hesitate sending them home with IV lines for treatment out of concern they would use them to inject illegal drugs.
Are these users to get a second chance at this costly surgery? Some doctors tell addicts going into surgery that this is it. They won't operate again if the person is still using drugs.
Caplan concurs with this policy. He suggests making patients sign a contract accepting that if they get into trouble again, the heart surgeon may not take them back.
Eventually, the issue gets solved, however. Patients run out of valves, and then the surgeons can't do the operation.
Finally, hospitals must ensure the patients are in a drug rehabilitation program before releasing them. Well-run rehab centers now have excellent medications for those determined to kick their habit. Those who are not so determined will die before their time. Revival drugs may just delay the date.
One thing most of us can agree on is that drug rehab should flow like water. It should be everywhere. The rest of the argument, though necessary, is simply sad.
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