One Way to End the Opioid Epidemic. Let Them Die

This article first appeared on Reason.com.

While more Americans are coming around to the idea that drug addiction should be treated as a public-health issue rather than a crime, the recent rise in opioid overdoses threatens this shift in public opinion, especially in the areas most ravaged by this new epidemic.

In Cincinnati—my hometown— 174 overdoses took place in less than one week last year. Many counties in Ohio no longer have enough room to store all of the bodies of overdose victims, forcing the state to lend out mobile morgues that are normally reserved for large-scale disasters. The lieutenant governor of the state has even opened up about her family's struggle with opioid addiction.

The desperation to end this epidemic has not brought out the best in everyone. Recently, Middletown, Ohio, city councilman Dan Picard proposed that paramedics not respond to addicts upon a third overdose.

Critics decried the proposal as unbelievably cruel. Picard countered that many didn't understand just how bad the situation had gotten in his city, where "out-of-the-box thinking" was now required.

By Picard's estimation, each overdose response costs the city $1,104. At this rate, he says, emergency services eventually won't be able to respond to other calls and "the city's going to run out of money." The city, meanwhile, is not even sure Picard's proposal is legal. However if lawyers determine that it is, it will come up for a city council vote.

Should the proposal pass, supporters may be surprised at how little it does to stop the onslaught of overdose calls. Middletown Fire Chief Paul Lotti, a critic of the proposal, noted that 85 percent of the department's overdose runs involve first-time callers, who would not be subject to the three-strikes rule.

Effective or not, the policy still raises ethical concerns. Paramedics should not become, at the direction of ill-informed politicians, arbiters of who deserves to live and who deserves to die based on one's lifestyle choices. Even the sorts of serial overdosers who grab headlines—such as a Dayton, Ohio, man who has been revived by paramedics twenty times —do not deserve to just be left for dead in the streets.

Addicts need access to treatment, not ultimatums.

But seldom is treatment readily available. An arcane federal law has inhibited the growth of drug-treatment centers in places where they are needed the most. Centers that accept Medicaid patients are prohibited from having more than sixteen beds.

With a population of less than 50,000, Middletown has already seen 577 overdoses in 2017 alone. Permitting drug-treatment centers to expand at the local level would be a step in the right direction, giving addicts more opportunities to get the help they need and relieving pressure on emergency services and overcrowded jails.

More treatment centers are only one part of the equation, of course. Currently, these centers are limited in what they can provide for addicts by America's outdated drug laws. When Switzerland experienced a heroin epidemic in the early 1990s, it started treating addicts with substitution therapy, using opiates like methadone to taper off addiction to other opiates and even giving prescription heroin to some heavy users. It worked.

Methadone treatment is becoming more common in the U.S., despite being hampered by Medicaid rules regarding its use, but the nation is still a long way off from taking on major reforms like the Swiss did.

In fact, the Drug Enforcement Administration (DEA) is still sticking to its old ways of prohibiting any drug they set their eyes on, including Kratom, another substitute drug addicts can use in place of more dangerous opioids.

Despite the rhetoric of the DEA and other government regulators, drug prohibition has made many drugs like heroin far more dangerous than they would be otherwise.

Large spikes in overdose deaths often involve influxes of heroin laced with synthetic opioids like fentanyl or carfentanil, which are far more potent than heroin itself. Because these drugs are bought on the black market, users have no way of knowing what they're really buying, and thus no way to adjust their dosing accordingly when synthetics are in play.

This doesn't seem to matter to the DEA. U.S. drug-prohibition laws aren't set up to solve drug addiction so much as satisfy the need to punish what is viewed as bad behavior (and make Uncle Sam a few bucks in the process).

Picard himself says that the proposed three-strikes rule for drug overdoses in Middletown is "not a proposal to solve the drug problem." He says he wants to "put a fear" in people thinking about overdosing in his town.

But drug addiction makes people do irrational things. Addicts are not going to ask themselves if they're within Middletown's city limits before shooting up.

As long as politicians and government officials continue to view the opioid epidemic as a war to be fought against drug users, rather than a battle to save them, many more lives will be lost.

Ben Haller is a summer 2017 Burton C. Gray Memorial Intern with Reason magazine.