This past Thursday, the FDA approved a hand-held device called Evzio which delivers a single dose of the drug naloxone, the medication that reverses the effects of an opioid overdose. Rather than being administered as it is now—which is mostly in hospitals and other medical settings, when it is often used too late to save the patient—the medication is designed and marketed so that it can be administered by caregivers, family members, coworkers or anyone else in the vicinity. And it’s so easy to use that you just might some day find the life-saving medication in a first aid kit, as you would an EpiPen or even a defibrillator. In the case of an emergency, just by following the device’s simple instructions, you could save someone’s life.
Who could possibly object to this?
Well, for one, there’s James Rathmell, chief of the division of pain medicine at Massachusetts General Hospital. According to an article in the New York Times, Dr. Rathmell is worried that the drug’s approval will create “a false sense of security” among drug users. “Like, ‘O.K.,” he imagines drug users thinking, “I’ve got a naloxone pen, we can party all we want, no one is going to die.’ ”
Big. Fucking. Sigh.
It’s Not a Fun Drug in Itself
For starters, no one wants to be stuck with naloxone. It takes you out of your high and throws you into immediate, acute opioid withdrawal. That means diarrhea, nausea, vomiting, overproduction of bodily fluids—sweat, tears and a runny nose—and pain, the kind of pain that makes your hairs stand on end with every nerve in your body scream, “Go get high!” Which is a real problem if you just did your daily dose and don’t have money for more.
Opioids work to block the body’s pain pathways and so it makes sense that when you withdraw from heroin—or take a drug such as nalaxone, which reverses its impact—there’s a rebound effect. You feel achy all over, particularly in the back and legs, and even more sensitive to whatever pain had caused you to take it in the first place.
Nalaxone is not fun, but it’s certainly a better alternative than what it prevents: overdose and death—which is what’s likely to occur if not from the overdose itself than from deprivation of oxygen to the brain and which is wholly preventable if the person receives help sooner than the time it takes to get them to the hospital.
But Opiates Aren’t Either
Of course, opioid use is not usually about having fun—or, as Dr. Rathmell puts it, “partying.” I mean, opioids generally aren’t used recreationally. As with many drugs—but particularly something as physically addictive as heroin—what might begin as recreation often quickly and uncontrollably develops into dependency. Drug addicts are, well, addicted and when it comes to curing addiction, punishment doesn’t work. Most drug users are dependent on drugs, getting high not for merriment but to desperately avoid the psychological and physical side effects when they stop using.
Like many ignorant people—most of whom are not charged with being chief of the division of pain medicine at a major medical facility (egads!)—Dr. Rathmell’s “concern” implies a belief that drug use is a reckless and wholly conscientious decision made by morally defective people simply looking for a good time. Selfish and irresponsible as children, he seems to believe that all a drug user needs to be cured of their dependency is a sense of hearty consequence, a strong dose of “tough love.” And if a drug user can’t realize that drugs are dangerous? Well then, perhaps they don’t deserve to live at all.
This attitude is particularly egregious in light of the fact that 60% of opioid overdoses occur in patients using their medicines as prescribed by their physicians—physicians like Dr. Rathmell here—who basically just said that in the case of accidental overdose, his patients ought to die.
According to one troubling report, fewer than one in four surveyed physicians had even heard of naloxone and the majority reported that they’d never consider prescribing it; I’d venture to say that they don’t prescribe opioid overdose interventions like naloxone because of their negative attitudes towards people who do drugs.
Thankfully, there are people out there to educate the docs.