Save Heroin OD's? "Heck No" says the Office of the Drug Czar

January 28, 2008

I missed this story at National Public Radio initially but luckily multiple sources have been all over it, see below. The nutshell from the NPR piece on a Cambridge, MA heroin-addict treatment center is as follows:

Elissa has been on methadone for six years, but she confesses that she used heroin a couple of days in the previous month because she was under a lot of stress.
Like most long-term heroin users, Elissa has had scary experiences with overdoses – her own and others’. Once, her partner became unresponsive after taking a mixture of heroin, benzodiazepine pills and alcohol, she says.

“Where to start, where to start?”, muses Your Humble Narrator. Where indeed. From the start we have the concepts of agonist therapy for drug abuse, the generally poor performance of interventions for drug abuse at present, relapse, overdose in users, whether in treatment or not, and drug combinations resulting in medical emergency. Are you getting the impression this stuff is complicated? Good. Because people in the Office of National Drug Control Policy (aka “Drug Czar”) seem to think this is duck soup. Even when they should know better.

Okay, back to the NPR piece:

Many times, drug users and their friends don’t call 911, which is why overdoses are so often fatal. They’re afraid the police might come, and they could get arrested — or lose their housing or custody of their children.

Imagine someone not calling 911 when suffering an obvious heart attack, hoping desperately that they will recover to “good enough” without medical intervention. Because otherwise they’d end up jailed or losing their kids. Imagine having to pledge not to get leukemia on pains of losing that public-housing slot. Still. This is not even the issue of the day. Today we are discussing a product called “Narcan“, used here to rescue life-threatening overdose with heroin or other opiates (like, say, OxyContin of Rush Limbaugh fame).
Back to NPR:

The nasal spray is a drug called naloxone, or Narcan. It blocks the brain receptors that heroin activates, instantly reversing an overdose.
Doctors and emergency medical technicians have used Narcan for years in hospitals and ambulances. But it doesn’t require much training because it’s impossible to overdose on Narcan.
The Cambridge program began putting Narcan kits into drug users’ hands in August. Since then, the kits have been used to reverse seven overdoses.
New data compiled for NPR by researcher Alex Kral of the consulting firm RTI International show that more than 2,600 overdoses have been reversed in 16 programs operating across the nation.

One would think this would be a GoodThing. One would be wrong it seems:

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.

Loathe as I am to do so, props where props are due to Mark Kleiman at The Reality-Based Community who opined thusly:

Got that? Preventing thousands of deaths isn’t “good public health policy” if it doesn’t involve the appropriate laying-on-of-hands by the medical priesthood. Anyway, if heroin addicts aren’t afraid of dying, they might keep using heroin.
I get angry at the people who call themselves the “drug policy reform movement” for their insistence that we could make more drugs legal without having more addiction. But unlike their counterparts in the equally reality-challenged but politically dominant “drug-free America” movement, the “drug policy reformers” lack the power to kill in the service of their dreams.

Wait, what? Kleiman is angry at the legalize-eet-mon folks? Hmm, perhaps I’ve misjudged him.
Next up is Thomas Levenson of The Inverse Square Blog notes:

These are at least nominally empirical claims. They can and should be tested. But as far as we can tell, Madras pulls these statements out of her gut (I’m trying to be polite here). To the extent that there is any real data, NPR’s story also reports that “one small study suggests that overdose-rescue programs reduce heroin use and get some people into treatment.”

Preach on, my man, preach on. Go read. He’s got poppy pictures and everything. Actually, paging through this rather young blog, looks like there’s a bunch of good stuff here. Go read.
There really isn’t much to say on this one. This was a spectacularly unnecessary thing for the ONDCP to come out on. Really. This is one of thousands of pilot projects going on around the world, trying to get some traction on the host of medical problems that are associated with drug abuse and dependence. They didn’t need to stick the stupid neck out. The thing that bothers me the most about this is that Dr. Madras knows better. This is not some political hack or think-tank reject. This is a long time drug abuse researcher. If you read what she had to say closely you will note that she was trying to find the path that did the least insult to the available science. It was all about trying to justify on the basis of an opinion (read “political position”) that had the least possible chance of getting attacked on scientific grounds. Very deft, Dr. Madras!
The takehome is that getting scientists into even quite senior positions is insufficient. Because they obviously get themselves into positions in which they are forced to prioritize the political over the scientific. And for that state of affairs, DearReader, we have only ourselves to blame.

No Responses Yet to “Save Heroin OD's? "Heck No" says the Office of the Drug Czar”

  1. PhysioProf Says:

    “This is not some political hack or think-tank reject.”
    Fixed for you: “This was not some political hack or yet a think-tank reject.”
    There, that’s better.
    Why did she sell her soul to a lame-duck sick-bastard like Bush? They’re gonna be clearing out her ofice in less than a year. Maybe she wants a nice wingnut-welfare position as Drug Policy Fellow at the Heritage Foundation afterwards?


  2. It’s a difficult issue, isn’t it? If good, dedicated scientists refuse to accept positions in anti-science administrations, then there is no hope at all that things will change for the better.
    But by accepting such posts, they accept, too, that they will at best be able to move things slowly, if at all. I guess if one were being generous, one would assume that there were back-room deals being made that would at least be limiting the extent of the damage that the unadulterated political hacks can do.


  3. PhysioProf Says:

    “If good, dedicated scientists refuse to accept positions in anti-science administrations, then there is no hope at all that things will change for the better.”
    It doesn’t help science (or policy) to collaborate with anti-science governments. This is the kind of mistake Democrats have been making in relation to the Republicans for decades:
    “If we don’t help the Republicans at least enough so they don’t completely destroy everything normal human beings hold dear, then we’ll get the blame.” Then they collaborate just enough with the Republicans to keep things barely afloat, and the Republicans turn around and successfully blame the Democrats for the fact that things aren’t much better than just barely afloat.
    The right-wing has been pulling this shit for decades, and the left just keeps falling for it. It’s like Lucy, Charlie Brown, and the football.
    If you want to prevent right-wing ideologues from permanently fucking up everything you hold dear, then you will *not* collaborate with them. You will allow their fuckwittitude completely free rein–and full ownership by the right wing–and then voters will see how morally abhorrent and pragmatically harebrained their sick ideologies are, and use their votes to kick these bastards to the curb for a long, long rest in the gutter where they belong.


  4. DrugMonkey Says:

    “Maybe she wants a nice wingnut-welfare position as Drug Policy Fellow at the Heritage Foundation afterwards?”
    It is not completely unheard-of for scientists who go into government positions like this to return to scientific careers. perhaps changing university or even focus.
    “It doesn’t help science (or policy) to collaborate with anti-science governments.”
    I don’t know that I endorse such a hardline approach. Responsible adults don’t let the kids crash the family car into a tree with everybody in it just to make a point about the responsibility of driving!
    Personally, I take my hat off to those professionals in the various agencies that keep their heads down, do their work, try to do whatever they can to keep the ship sailing and will be there to make repairs when the climate improves…
    I don’t know Madras’ personal political or policy positions so I can’t say whether she’s a cheerleader on this, a collaborationist or a reluctant harm-minimizer. What we do know is that ignorance of the available science is not a plausible interpretation.


  5. Casey Says:
    Different take on the same article.


  6. kaptinemo Says:

    Although I cannot claim to be a scientist or medical professional, being an engineer forces me to deal with hard facts every day. So, when I see science being Lysenko-ized, I bristle. When I see it being Lysenko-ized to the point of negatively affecting an entire nation’s population, that bristling becomes snarling anger. “Dr.” Madras should re-take that Hippocratic Oath of hers again, and if she can still reconcile this country’s drug policies and the enormous damage they do (compared to the purported ‘benefits’ they are supposed to provide) then perhaps she should have her title revoked. After all, what happened to “First, do no harm”?


  7. Klem Says:

    To DM and other scientists concerned about Dr. Madras’ comments, please consider sending her a short letter, people listen to feedback from their peers. I’m thinking of an interview with Robert Dupont from a PBS Frontline doc on the drug wars, he says, “I’m the know-it-all head of NIDA. I get letters from people, and I read the letters. I didn’t get that many letters. And I read this letter. My recollection is it was two pages. . . . But I looked at that letter, and I said, ‘She’s right and I’m wrong.'”


  8. PhysioProf Says:

    The abject partisan hackfuckery going on in the executive branch under Bush–identifying and dismantling every nook and cranny of genuine expertise and replacing it with craven dispshits who attended some fucked-up Jeebusland University–is orders of magnitude worse than any President since the establishment of the modern administrative state during the New Deal. Madras chose–for reasons one can certainly speculate about–to sell her soul to an anti-science hyper-partisan delusional right-wing ideological enterprise.
    She and all the rest of her despicable collaborators are going to most likely be gone in January. The only appropriate response to the profane cruel ideological sewage emanating from Madras’s office is to debunk it and the sick bastards who promulgate it repeatedly and mercilessly. Sending a polite letter to someone like Madras is a as useful as trying to discuss theology with the deranged maniac in Times Square waving around a photograph of an aborted fetus and screaming at you as you pass by on the sidewalk that you are going to burn in hell if you don’t repent. She has chosen her master, and it sure as fuck ain’t you or me.


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