Life or Addiction?

Should the government give heroin addicts a drug that could save their lives in the event of a drug overdose—but that some believe will increase risky drug use? This might sound like a hypothetical question posed by Professor of Government Michael J. Sandel, but it’s a topic that the federal government and local governments across the country face. Unfortunately, many have decided not to directly give addicts the heroin antidote naloxone, commonly used by emergency personnel for over 35 years, for fear that addicts might be more reckless in their heroin use, more reluctant to call 911, and more willing to instead administer the drug themselves. We hope officials change their tune—which puts drug control ahead of life—and support programs that distribute naloxone to heroin users.

Although there is little scientific evidence that naxolone distribution programs saves lives—a favorite point of critics—estimates suggest that such programs have saved 1,000 lives since they were first introduced. Because a heroin overdose shuts down the part of the brain responsible for controlling breathing, waiting for the paramedics to arrive to inject naloxone wastes precious minutes during which a person stops breathing. Quite simply, naxolone distribution programs deserve to be supported on the federal level for their potential to save lives, which should be the first aim of governments when approaching public health or drug policy.

The debate over naloxone is reminiscent of the debate over needle exchanges. Created to staunch the spread of HIV via contaminated syringes, needle exchanges allow heroin users to exchange used syringes for sterile ones. Although some have argued that needle exchanges facilitate drug use, they have spread based on the false notion that the societal harms of HIV are far greater than those due to heroin.

Critics of such programs—including many of Bush appointees—argue that distributing syringes with naloxone at needle exchanges not only facilitates heroin use, but also encourages it. In a twist on the classic economic argument known as moral hazard, they argue that naloxone acts as an insurance policy against overdose—much like car insurance makes people feel free to drive more recklessly. If a user has the antidote readily available, he or she will be less careful in avoiding overdose and less likely to call the paramedics when an emergency happens, preferring to treat themselves.

While this line of argument may make sense for car insurance, it falls flat in this context: Heroin addicts on the verge of overdose are far from rational. And even if they were rational, the downside to excessive heroin use—possible death—is a powerful disincentive to tempting overdose. Comparing death to a possible speeding ticket simply makes no sense.

But regardless of the possible perverse side effects, programs to distribute naloxone at needle exchanges—which already exist in cities such as Boston, Chicago, New York, and San Francisco, as well as several states—save lives. That basic concern for life should supersede any concerns about drug use or policy.