PAINKILLER LAW BLOG POST: The Values Argument Over Opioid Antidotes

Today, many states struggling to cope with the rise in prescription opioid addiction, overdose and death are taking important steps in addressing the crisis. These steps include increased funding of prescription monitoring database programs, though many of these computerized systems are still underfunded, underused, overwhelmed or technologically obsolete. Other approaches include a proliferation of for-profit and non-profit prescription drug rehabilitation and treatment programs; they have popped up all over the country and I see advertisements for them every day. Still another step state and local governments are taking is to provide the “opioid overdose antidote” – a drug called naloxone – to police and fire departments, hospitals and doctors, and to adopt Good Samaritan legislation so that a person administering the drug to someone who’s overdosing will not face legal liability. Today’s post focuses on the values argument occurring in legislatures and communities about naloxone.

What does naloxone do? Basically, it can counteract or reverse the most deadly side effect of excessive opioid use: Respiratory depression. Opioids’ sedative properties can cause a person who has too much of the drug in their system to stop being able to breathe, to literally become unable to exert the physical energy necessary to take air into the lungs. Naloxone administered in time can reverse respiratory depression enough to save the life of someone in overdose, and can buy precious moments for the arrival of emergency medical personnel to render advanced aid. This is why many states and communities all over the US have enthusiastically undertaken to provide naloxone to first responders and to train medical and emergency personnel in the antidote’s proper use. It’s also why Good Samaritan laws are being passed in many states, so that if a private citizen comes upon someone in the midst of an overdose, the private citizen can render aid without fear of being sued civilly, or even prosecuted criminally, say, if the private citizen were doing drugs with the afflicted individual just before the overdose began. These laws, training programs, and providing antidotes to first responders are all good ideas, which is why they continue to gain traction and see widespread adoption.

There is, though, a values argument taking place around naloxone, even in states that really need it. The argument is that providing naloxone or immunizing private parties who administer it amounts to blessing substance abuse, condoning or turning a blind eye to misuse of opioid painkillers. The argument is familiar: It’s the same argument that has been made about sex education, wide availability of birth control, and it has figured into the ongoing debate about abortion.

The argument is also ultimately wrong. First, lots of people who don’t “abuse” opioid painkillers, but who instead follow doctor’s orders and take only a prescribed dose, are at risk of accidental overdose and all the attendant effects, including respiratory depression. Second, we have Good Sam laws for people who stop to render aid at the scene of a car accident. Why put life-saving Good Samaritans at risk of lawsuit or prosecution, when the stakes are so high? And third, we really are talking about saving lives here. Some people overdose because they are drug addicts. Others overdose because they had a second glass of wine while on their regular course of opioid treatment but had done it before and didn’t think there was a risk. We as a society don’t make life or death calls based on a person’s behavior, whether we approve of the behavior or not. That’s why police try to solve gang-on-gang murders, and why hospital trauma teams try and save every life, even if the shooting victim is a gangster with a lengthy and dangerous criminal record. Am I comparing pain patients to gang members? Of course not. The bottom line on naloxone is that regardless of the patient and the reason for an overdose, no one deserves to just die in the street when people around them and a readily available antidote drug could help pull them through.

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