Governor Cuomo has signed a bill into law allowing the drug Narcan to be available over the counter at participating drugstores. Narcan blocks opium, morphine and its derivatives at the cellular level.
This law is certainly better than nothing, and no doubt it will save some lives. I’ll leave aside hectoring about who answers for all the lives lost before we came to this enlightened point. This is the bittersweet truth of any improvement. There are, unfortunately, many practical flaws to the Governors’ approach. We might have done so much better, so much earlier, and it’s important to remember that the opium folks get a vote in how successful this program is. If they don’t participate and instead stay underground, that’s a fatal veto.
Let’s start with the logical flaw that prevailed before the change: taking a set of people, abusers of the opium family of drugs, making them outcast, making them hard to doctor, and then insisting Narcan only be administered by doctors, (or their agents) thereby Catch 22ing them to their doom. This conundrum has long created medical havoc among the outcast groups of substance abusers. By havoc, I mean that a misadventure by a drug abuser can easily lead to admissions to the ICU, and since these people are almost always uninsured, bills well into the six figures will have to be eaten by the taxpayer. I once saw a crack cocaine addict have a stuck ring swollen onto his finger cause gangrene and systemic poisoning; he never felt the pain of it on his crack run.
The purer logic of harm reduction strategies has been proven before: how many people have been saved from HIV with our clean needle programs? Every HIV patient costs society.
There is no possible way to abuse Narcan. I have used it countless times in my adventures at work. Narcan is so powerful an antagonist to morphine-like drugs that opium people fear its name. We have to refer to it as “vitamin N” in front of them, like a dog owner’s spelling “G-O- O-U-T.” Actually giving the medication to the overdose victim is as simple as sticking the medication up a nostril and squirting it in. The patient’s recovery can look like a magic trick: one minute he is blue, barely breathing, one foot in life and the other straddling the eternal, and the next minute he is alive, and very displeased with Mr. Narcan for spoiling his big fun.
It seems to me that there will be a Narcan access problem because of the price-point: The $25-40 Narcan cost, for a drug that wipes out users’ raison d’être, is steep. Plus, there is a big question as to the likelihood of dope fiends carrying it around reliably. Denial and resistance to personal responsibility is their creed.
There are some treatment institutions that might get Narcan easier, but these workers are often afraid of doing medical procedures. Institutional risk managers tend to fire them aggressively over issues that cause lawsuit exposure.
Part of Governor Cuomo’s law has a provision making a hospital trip mandatory for someone successfully treated with Narcan. In New York City we paramedics and the police have a sort of gentlemen’s agreement that if the doper is overdosed he is ours, if he is holding unaffected, he is theirs. If the culture of entrepreneurial law enforcement gets any deeper, and the police become more aggressive looking for trade, this deal will not hold up. It’s very impractical for us to say no to them, and I’m skeptical less salty EMS services have ever done it.
If there is a whiff of trouble, drug addicts will stab each other in the heart before they will seek outside help. Once a cop told me about how he interviewed a witness who described an overdose victim being hauled out of a dope house by his feet, head conking audibly on every step. So it seems reasonable to speculate that an OD victim’s companions may still abandon him, rather than draw the heat. If they have their minds together, obviously a big if, they will deposit the victim on the street, antidote them, call 911 and skedaddle. There needs to be total legal amnesty for calling in overdose emergencies. The terms of the amnesty has to be as simple as the Narcan rules are bloated: dopers do not appreciate subtlety when it comes to their freedom.
Incidentally, the gentleman who created Narcan once had an emergency, and was treated by my colleagues. They made a great fuss over him and asked for his autograph. Mr. Fishman’s wife was touched to see the homage. He was an unassuming man, and told her her he worked in a lab. He was a superstar, God rest him, and saved the lives of God-knows how many people. Nobody can know how many of his Narcan-children have moved forward to do great works themselves. Every successful drug counsellor I know of has had an overdose happen to him in his abusing days, sometimes more than once. Harm reduction, redemption.
So, the demands we make of drug addicts might not, and I say will probably not, be heeded. The policy does not need to be logical and useful for us (The Man), it needs to be logical and useful for them. Anything else is public onanism. All and still, if one person is saved, that would mean the world.
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