DebateGate

General Category => 3DHS => Topic started by: Universe Prince on May 02, 2008, 07:02:26 PM

Title: life-threatening drug overdose, problem or deterrent
Post by: Universe Prince on May 02, 2008, 07:02:26 PM
There is a treatment for opioid overdose. It's called naloxone. In the case of morphine, heroine or oxycodone overdose, for example, naloxone can be administered to save the overdosed person's life. Most of the time this requires a visit to the emergency room. There is a version of naloxone that could be administered outside of a hospital setting and save many lives. Sounds like a good idea to me. But some people think this is a bad idea. Some people think life-threatening overdoses serve as a preventative to drug use and as a means of convincing people to stop using drugs. So distribution of a form of naloxone, Narcan, that anyone can administer (its a nasal spray) would be, to some people, a bad thing. I think saving lives is more important.

But I wonder what other people think about this. Some non-profit groups and state health agencies have been distributing kits of vials of Narcan and a nasal mucosal administration device (also known as a nasal sprayer) to people who are drug users or family members of drug users. Is this a good thing or a bad thing? Does it remove a necessary deterrent, or does saving lives quickly matter more?
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: kimba1 on May 02, 2008, 07:49:38 PM
the OD as a deterrent scenerio has one flaw
usually the person doing OD don`t know thier ODing till it`s too late
so the deterrent factor may not come into play at all
in fact I know several people who even OD again afterwards.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Brassmask on May 02, 2008, 08:07:08 PM
I would be willing to bet the same people against this are the same ones who are against their daughters getting that vaccine to prevent cervical cancer.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Rich on May 02, 2008, 08:25:46 PM
>>But some people think this is a bad idea. Some people think life-threatening overdoses serve as a preventative to drug use and as a means of convincing people to stop using drugs.<<

Excuse me, but who the hell are these people?
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: BT on May 02, 2008, 08:31:49 PM
n addition to Narcan, other resuscitative measures such as maintenance of a free airway, artificial ventilation, cardiac massage, and vasopressor agents should be available and employed when necessary to counteract acute opioid poisoning.

Abrupt postoperative reversal of opioid depression may result in nausea, vomiting, sweating, tremulousness, tachycardia, increased blood pressure, seizures, ventricular tachycardia and fibrillation, pulmonary edema, and cardiac arrest which may result in death.

http://www.drugs.com/pro/narcan.html
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: sirs on May 02, 2008, 08:57:01 PM
I would be willing to bet the same people against this are the same ones who are against their daughters getting that vaccine to prevent cervical cancer.

You mean those "people" who want the CHOICE to vaccinate their daughters vs being mandated they be vaccinated for something largely unecessary.  And no, those wouldn't be the same people either who think life threatening overdoses are a good thing, either      >:(     So, don't bet the house
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Lanya on May 02, 2008, 09:25:49 PM
This is the first I've heard talk of making Narcan available over the counter.
I think it's a great idea. 

I guess if you wanted to, you could make the point  that chest pain patients should not self-treat until they're seen by the EMTs or at the hospital, in case the aspirin they take causes a bleed in the brain. It's possible.  But boy, the many lives that are saved as a result of using aspirin are precious, in my opinion.  I want the option.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Brassmask on May 02, 2008, 09:45:17 PM

You mean those "people" who want the CHOICE to vaccinate their daughters vs being mandated they be vaccinated for something largely unecessary.  And no, those wouldn't be the same people either who think life threatening overdoses are a good thing, either      >:(     So, don't bet the house

Oh sure, now the people who were against the vaccinations from the get-go say it is all about choice and "freedom" but the fact is that the original reason was that the threat of cancer was a deterrent to pre-marital sex.

So, re-write history now but the facts stand.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Rich on May 02, 2008, 09:47:50 PM
>>Oh sure, now the people who were against the vaccinations from the get-go say it is all about choice and "freedom" but the fact is that the original reason was that the threat of cancer was a deterrent to pre-marital sex.<<

Really? Do you have some quotes from these people?
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Amianthus on May 02, 2008, 09:50:29 PM
Oh sure, now the people who were against the vaccinations from the get-go say it is all about choice and "freedom" but the fact is that the original reason was that the threat of cancer was a deterrent to pre-marital sex.

So, re-write history now but the facts stand.

Actually, you're the one rewriting history.

The group mentioned (which was actually a pretty small group, not the entire GOP as implied) was only against mandatory vaccinations. It was the implication of the poster that being against mandatory vaccinations meant that they were against the vaccine in general and trying to have it banned, but that was never true. Feel free to go back to the original articles to verify this.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Brassmask on May 02, 2008, 09:52:07 PM
>>Oh sure, now the people who were against the vaccinations from the get-go say it is all about choice and "freedom" but the fact is that the original reason was that the threat of cancer was a deterrent to pre-marital sex.<<

Really? Do you have some quotes from these people?

Why, yes, yes, I do.

Despite the benefits of the vaccine, conservative organizations began to rally against it last year. One of the most vocal opponents was the Family Research Council. The council ?promotes the Judeo-Christian worldview as the basis for a just, free, and stable society.? Last October the council?s president, Tony Perkins, spoke decidedly against the vaccine. Mr. Perkins proclaimed, ?Our concern is that this vaccine will be marketed to a segment of the population that should be getting a message about abstinence. It sends the wrong message.? He even stated that he would not vaccinate his 13-year-old daughter.

Another organization that promotes abstinence is the Physicians Consortium. The head of the consortium, Dr. Hal Wallis, was also critical. In his opinion, ?If you don?t want to suffer these diseases, you need to abstain, and when you find a partner, stick with that partner.? The founder of the National Abstinence Clearinghouse also opposed the vaccine. This organization was formed ?to promote the appreciation for and practice of sexual abstinence (purity) until marriage.? Leslee Unruh, the organization?s founder, stated firmly, ?I personally object to vaccinating children against a disease that is 100 percent preventable with proper sexual behavior.?

http://www.counterbias.com/665.html
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Rich on May 02, 2008, 09:57:18 PM
<chuckle>

Come on brass, it's hardly the same thing. This vaccine doesn't protect from all STD's, so saying the only way to truly avoid them is abstinence, isn't saying "don't have sex you'll get cancer."
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Brassmask on May 02, 2008, 09:58:43 PM
<chuckle>

Come on brass, it's hardly the same thing. This vaccine doesn't protect from all STD's, so saying the only way to truly avoid them is abstinence, isn't saying "don't have sex you'll get cancer."


Whatever, Trevor.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: sirs on May 02, 2008, 10:00:53 PM
You mean those "people" who want the CHOICE to vaccinate their daughters vs being mandated they be vaccinated for something largely unecessary.  And no, those wouldn't be the same people either who think life threatening overdoses are a good thing, either      >:(     So, don't bet the house

Oh sure, now the people who were against the vaccinations from the get-go say it is all about choice and "freedom" but the fact is that the original reason was that the threat of cancer was a deterrent to pre-marital sex.  So, re-write history now but the facts stand.

Actually, the "re-writing of history" is being performed by yourself.  (Funny how the left's accusations are so often a manifestation of what they're doing.  Go figure).  Point being, it was ALWAYS about freedom of CHOICE.  Feel free to ignore history, at your leisure
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Universe Prince on May 02, 2008, 11:52:41 PM

>>But some people think this is a bad idea. Some people think life-threatening overdoses serve as a preventative to drug use and as a means of convincing people to stop using drugs.<<

Excuse me, but who the hell are these people?


Apparently the folks who run the White House Office of National Drug Control Policy are at least some of those people.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Universe Prince on May 02, 2008, 11:56:18 PM
http://www.npr.org/templates/story/story.php?storyId=17578955 (http://www.npr.org/templates/story/story.php?storyId=17578955)
      But Dr. Bertha Madras, deputy director of the White House Office on National Drug Control Policy, opposes the use of Narcan in overdose-rescue programs.

"First of all, I don't agree with giving an opioid antidote to non-medical professionals. That's No. 1," she says. "I just don't think that's good public health policy."

Madras says drug users aren't likely to be competent to deal with an overdose emergency. More importantly, she says, Narcan kits may actually encourage drug abusers to keep using heroin because they know overdosing isn't as likely.

Madras says the rescue programs might take away the drug user's motivation to get into detoxification and drug treatment.

"Sometimes having an overdose, being in an emergency room, having that contact with a health care professional is enough to make a person snap into the reality of the situation and snap into having someone give them services," Madras says.
      
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Plane on May 02, 2008, 11:58:39 PM
Quote
Naloxone has been distributed as part of emergency kits to heroin users, and this has been shown to reduce rates of fatal overdose. Projects of this type are under way in San Francisco, New Mexico, Philadelphia, New York State, Baltimore, Boston, Los Angeles and Chicago, with pilot projects started in Scotland in 2006.

http://en.wikipedia.org/wiki/Naloxone


The patent for Naloxone has expired and the drug is currently available in various generic forms.



Is it really hard to get?
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Universe Prince on May 03, 2008, 12:02:31 AM
It has not been, to the best of my knowledge, previously been available in a form someone one could get without a doctor or paramedics administering it. Narcan, or at least the nasal spray delivery, is, I think, something relatively new.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Universe Prince on May 03, 2008, 12:06:36 AM

Abrupt postoperative reversal of opioid depression may result in nausea, vomiting, sweating, tremulousness, tachycardia, increased blood pressure, seizures, ventricular tachycardia and fibrillation, pulmonary edema, and cardiac arrest which may result in death.


Yes, I've seen it said that junkies who overdose "deserve" a strong dose of naloxone because its effects can be unpleasant. But I still think the kits are a good idea.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Universe Prince on May 03, 2008, 12:07:58 AM

I would be willing to bet the same people against this are the same ones who are against their daughters getting that vaccine to prevent cervical cancer.


Possibly, but you should consider asking rather than assuming.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Plane on May 03, 2008, 12:09:27 AM
Quote
We present the preliminary results of two pilot schemes to provide take home naloxone to opiate users.

http://bmj.bmjjournals.com/cgi/content/full/322/7291/895

This is the first published report of lives saved directly by the provision of take home naloxone. The drug was generally used appropriately. In only one case out of 34 was its use inappropriate, with two of doubtful benefit. No unexpected adverse effects were reported.

Ready prepared syringes of naloxone typically cost ?3.30-6.70 per 400 ?g. Since 10% of distributed doses were actually given, each use cost around ?33-67. Even if lives were saved on only 10% of these occasions, then each would have been saved at a drug cost of ?330-670.

Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Plane on May 03, 2008, 12:17:32 AM
I like Canoeing on the river , the State and the Coast guard require that I wear a life preserver.

Well Canoeing is still leagal even though it might get me killed , but I see a lot of people don't wear their PFD all the time , hey it is hot.

Do the Drug abusers want these antidotes?
Will they start thinking their hobby is safe ?
Does it matter?

I don't see why I should object to this being availible , it could certainly be handed out to all care givers and emergency personell who are likely to find a use for it on the job.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: BT on May 03, 2008, 06:20:00 AM
Apparently there is risk associated with the treatment. And it does have costs associated with it.

If the drug is available for purchase through approved distribution sources, even if the purchase is subsidized, that would mitigate govt liability.

And if those conditions are met, i don't have a problem with the spray being made available.

Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Stray Pooch on May 03, 2008, 10:59:06 AM
In looking over the thread I see that there are some good arguments for distributing this antidote and OTOH for keeping it out of the hands of amateurs; however, I think the benefits of distribution clearly outweigh the risks.  I have to say, though, that the arguments offered by the government rep are less draconian or simplistic than the tone of this thread imply.  There is a personal parallel here.  It is my own (bad) choice for which I am completely responsible, but being a diabetic I have drugs available which help to control my blood sugar.  Since I can "get away" with it to some extent (and far less than I delude myself into believing) I eat sugary junk foods.  When I recently had to go without my meds for a week or so (times is tough)  I had to be far more careful about what I ate - and I really felt the difference!  I do not think that the arguments presented here suggest abusers "deserve" OD or unpleasant side effects, but rather that providing them with the false sense of security this antidote might give is dangerous in itself - and I agree with that.  It isn't a moral judgement, but a rational look at the potential unintended consequences of making this drug available to the general public.

That said, I think the overall choice should still rest with the individual - even though that individual might not be entirely capable of making good choices.  After all, right or wrong this person is choosing to abuse hard drugs.  Anyone that stupid is likely to make bad decisions anyway.  He might choose to take more chances with the "lifeboat" of an antidote handy - and that could kill him.  But an overdose will kill him either way.  If he has the antidote immediatey available, it may well save his life.  I think the ratio of saved lives to lost lives in this scenario is likely to be favorable.  We have an awful lot of drugs on the market capable of killing people - and I take a few myself.   The rationale is that the benefits outweigh the risks.  I happen to subscribe to that theory. 

As for the side-debate about HPV vaccine, I think the truth lies between Brass's position and the position of those advocating the choice issue.  One objection to HPV vaccine has to do with making it mandatory, and some people object to mandatory vaccinations in general - since they often have bad and even deadly side-effects.  Many object to mandatory vaccinations on civil libertarian grounds - and I agree with them.  Those people may or may not be concerned with the "morality" issue.  Some of the latter group would no doubt volunteer to use the vaccine if they happen to be sexually active, yet still disagree with forcing children to get the vaccine.  OTOH there are those who would object simply on moral grounds, and some of those might even object to allowing the vaccine at all.  That latter group might well be of the mindset that those who get the cancer "deserve" it and they would fall justly under Brass's condemnation. 

But here is where Brass's analogy falls short.  There is a fundamental difference of perspective between those who object to making something mandatory (whether or not that objection is grounded in moral values) and those who object to making something available.  The former group advocates choice and the latter objects to it.  There are legitimate reasons for both groups to take the positions they took - and they are not the simplistic viewpoints this thread seems to suggest.  Fighting against mandatory vaccination is the right thing to do.  The government should not be allowed to force someone to take medications without their consent.  Questioning whether the distribution of a particular drug may actually make a bad problem worse is also the right thing to do.  The road to hell is paved with simplistic assumptions.  In the end, I think both the HPV vaccine and the OD antidote should be available but not mandatory. 

As to assuming that someone "deserves" what he gets, the AIDS virus is the best example of that mindset.  There were those who felt that we needed no cure, because the only "cure" necessary was appropriate behavior.  There wasn't a question of mandatory drugs, since nobody suggested that, and there was no issue of the treatment being worse than the disease, because NOTHING is worse than the disease.  Many suggested that those who get it were being punished by God and that this was a result of their own behavior.  My response to that was always that if someone forgot to look both ways before he crossed the street and got hit, I would still do everything in my power to save him.  Just because he did something stupid does not relieve me of my responsibility to do what I can to help him.  That's ultimately the way I feel about this issue.  Unless compelling evidence can be given that making this available would cause more problems than it would solve, it makes no sense to deny this lifesaving option.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Stray Pooch on May 03, 2008, 11:50:06 AM
My wife brings up this interesting side point.  I wonder where those who insist on mandatory vaccination of children to prevent the spread of the HPV stand on the issue of abortion?  I would be willing to bet that those who object to HPV vaccination on moral grounds are more likely to be pro-life.   I would also bet that those who insist on mandatory HPV vaccination are more likely to be pro-choice.  In the case of those who are pro-choice, they cannot be consistent in insisting vaccinations be mandatory, since they claim the right of each person to control their own body.   The pro-life objector to mandatory vaccination does not have a similar contradiction, since (in spite of what pro-choice people suggest) pro-life is not anti-choice, but only believes that the right to choose ends where it affects another (in this case the fetus). 

If the pro-choice person suggests that control over a woman's body should be given over to the state in the case of potential overriding good, they implicitly endorse at least the logic, if not the correctness, of the pro-life argument.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Universe Prince on May 03, 2008, 11:52:46 AM

I do not think that the arguments presented here suggest abusers "deserve" OD or unpleasant side effects,


If you ever get a chance to see or hear EMS people talking about this, you might just notice someone talk about the overdose victim deserving the side effects of a strong dose of naloxone. Slightly disturbing, but not entirely difficult to understand either.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: Rich on May 03, 2008, 12:54:01 PM
>>Madras says drug users aren't likely to be competent to deal with an overdose emergency. More importantly, she says, Narcan kits may actually encourage drug abusers to keep using heroin because they know overdosing isn't as likely.<<

Whatever other reasons there may be, this is just plain stupid.
Title: Re: life-threatening drug overdose, problem or deterrent
Post by: fatman on May 03, 2008, 01:25:40 PM
Whatever other reasons there may be, this is just plain stupid.

Wow, Rich and I agree on something other than Johnny Cash.