The Wrongness of Limiting the Administration of Naloxone

Rehab Helps Thousands of Addicts Quit. Who Answers?

The exponential growth of use of opioid pain medications, heroin, fentanyl, carfentanil and accompanying overdoses lead to a question that should make all of us squirm. There are cases of people overdosing and being revived multiple times on the same day.

Should people who have already overdosed and been revived multiple times with naloxone continue to be revived? Should there be a limit on the number of times a person is revived and if so, what’s that limit? These are brutal questions some elected officials have started to ask.

Anticipating – and Rejecting – Naloxone Limitations 

Dan Picard, a City Councilor from Middletown, Ohio, proposed a three-strike rule for receiving naloxone. He said, “John Smith obviously doesn’t care much about his life, but he’s expending a lot of resources and we can’t afford it.”

Picard is not alone among elected officials who have broached this topic. Ed Fielding, a county commissioner in Martin County, Florida raised the matter of limits on the number of times a person could be administered naloxone, while Governor Paul LePage of Maine argued that people revived by naloxone should have to pay for it. These questions arise in the context of the allocation of financial, personal, and communal resources.

While no limits are in effect anywhere in the United States at present, the possibility continues to arise. For this reason, we need to anticipate their arguments in order to have a better grounding for rejecting them.

Three Limitation Arguments

An argument for limits on the number of times a person may be revived by naloxone rests on at least three considerations. Let’s look at each one individually:

  • Consideration #1
    The first is that using drugs carry risk. He who uses drugs assumes a risk. However, this is true for any drug, whether legally prescribed or purchased over the counter. This is why medications come with warning labels about side effects, possible interactions with other drugs, and who should not take the medication.
  • Consideration #2
    The second consideration is the risk of drug use extends beyond those who use to those who come into contact with them – human and canine alike. The overdosed person poses a risk to first responders, medical personnel, and others who may be administering the naloxone. Three nurses in Ohio exposed to fentanyl with an overdosed patient had to be given naloxone. Dogs used in drug enforcement have also overdosed from contact.
     
    It is accurate that the use of drugs poses a risk to responders. However, this risk isn’t different in kind from other risks that responders encounter. A drowning person poses a very real threat to anyone who tries to save him. Can we really imagine a lifeguard not trying to save someone he has saved before? Or a firefighter not trying to save someone in a building because that person has been saved before? There may be compelling reasons for a responder not to jump into a situation, such as greater danger or no chance of a positive outcome, but surpassing a limit on number of times a person has been saved is not one of them.
  • Consideration #3
    The third consideration is the most contentious and carries the weight of the argument to limit the number of times naloxone may be administered to a person. The assumption is that repeated use and risk to life entails a forfeiture of a right to life. I use the expression, “right to life” quite intentionally. A right to life is understood as a natural or an inalienable right, which means that it can neither be given by nor taken away from a person in the normal course of events. There are circumstances in which taking the life of another may be morally and legally permissible such as self-defense, acts of war, stopping the commission of a crime, for example.
     
    Do we really want to broaden the category of warranted circumstances to people who have a health condition? Whether one believes addiction is a chronic brain condition, a matter of choice, a learned behavior or some complicated interaction of all these factors, addiction affects health. Do we want to include having certain health conditions as circumstances in which one’s right to life is forfeit? This beyond morally suspect; it is morally reprehensible.

Do we really want to broaden the category of warranted circumstances to people who have a health condition?-Peg O’Connor

Bottom Line: We Cannot Forfeit the Right to Life

In some ways, I have been shadow boxing or jousting with a straw man. I am anticipating arguments and identifying the assumptions behind them carrying the weight. The bottom line is raising the possibility of limits on the number of times a person may receive naloxone is a backdoor way to ask whether someone deserves to live.

Most fundamentally, the question assumes two things: some people are less valuable or worthy (and so don’t deserve to live) and addiction makes a person less worthy or valuable (and so doesn’t deserve to live). History is replete with examples of the travesties that follow from each of these assumptions. We who reject these assumptions will confront people who either have never interrogated them or hold them.

We need to be ready because there will be some people who move to make limits on naloxone an actuality.

 

 

 

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