As thousands of Americans continue to die from opioid overdoses this year, the debate continues to rage over how to best manage this epidemic from the perspective of public health, health care and public safety. Towns and cities are feeling the pressure to provide emergency medical services to their communities while sending expensive and limited resources to narcotic overdose patients.
One town in Ohio has gone so far as to publicly suggest withholding EMS responses to people who have been resuscitated repeatedly from narcotics overdose. As you can imagine, this has provoked a fair amount of controversy and outrage among EMS professionals nationwide.
We are not God
As medical and public safety professionals, we are ethically and legally obligated to treat patients equally, without regard to sex, ethnicity, religion, age, medical conditions, or ability to pay. We have laws and regulations in place that allow us to withhold care under very specific circumstances (i.e., determination of death or a living will).
We don’t have the ability to say when one life is worth any less than another, nor should we. Ever.
Why would we ever want to have that overwhelming responsibility?
How would that conversation go? It would be like saying, “Let’s see. You’re a drug addict, so you’re worthless and suck up precious resources that we just won’t spend on you anymore.”
“You have serious problems controlling your pain control medications for that advanced cancer you’ve been dealing with for many months, and we have come out to reverse your overdose a few times in the past month? No EMS for you.”
“And you, over there; you’ve been eating junk food and not exercising and we roll out for your multiple episodes of chest pain or diabetic condition annually. Guess we should stop that too. We just can’t spend that level of resource anymore.”
When does one draw the line?
Opioid addiction is not a choice
The fact that our society stigmatizes drug addiction is problematic. The mistaken view that addiction is somehow a desirable choice that someone makes willingly leads to the wrong conclusion – one that concludes incarceration and withholding prehospital medical services as punishment will lead to cessation of drug use.
In this TED talk, Johann Hari makes a compelling case that in fact, stigmatizing drug use has the opposite effect. Cutting services to addicts worsens the problem. Incarceration doubles down on addiction and associated problems, like preventing people from being hired into jobs that could possibly lift them from poverty and help them re-establish bonds with society.
Hari argues that by homing in on the environment that promotes addiction – poverty, lack of self-respect, wrecked familial structures and a general inability to create deep bonds with society itself – we stand a far better chance of reducing addiction.
In fact, that is exactly what Portugal has done over the past two decades. By decriminalizing all forms of addiction and focusing on job training and therapy, the country has dropped rates of addiction by half.
A complex solution to a complex problem
EMS has been a reactionary profession, making drug overdose response and other treatments an expensive proposition. Novel ideas are needed to staunch the tidal wave of the opioid epidemic. We’ve started with dispensing the antidote naloxone to the public, as a stop-gap measure. It’ll take serious debate and consensus on public policy, reducing access to prescription narcotics and societal desire to make real change in how it perceives drug addiction.
Naïve reactions, simplistic solutions are not effective; remember the “Just Say No” approach of the ‘80s? We’re wiser than that.
