The rescue paradox

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MARY REICHARD, HOST: Coming up next on The World and Everything in It: combatting overdose.

The medication naloxone, can reverse opioid overdose in minutes. It’s become increasingly available in pharmacies, vending machines, and other public places.

MYRNA BROWN, HOST: But can that availability become a safety net? Some worry about the start of a new trend of more overdoses, more demand for opioids, and even more fatalities.

WORLD’s Lauren Smyth has the story.

LAUREN SMYTH: Nurse April Truitt wishes more people knew about naloxone, a medication that could have saved the life of her patient, who had overdosed on heroin.

APRIL TRUITT: She was young, like in her 30s. She was very gone, and her family member, or her friend, was like “Please, can you just do something? Do something!” And I’m like, “I’m sorry, I cannot….She’s been gone for too long.

If she’d been found sooner, a simple naloxone nasal spray, sometimes called Narcan, might have brought her back.

TRUITT: We give pain medications [at] crazy rates to people. I think giving people an option to save their family members and save themselves is very important. Being alive is always a chance to put your life on a different path.

Last year, 70,000 Americans died of drug overdoses. More than half of those patients could have been treated with naloxone, which causes almost instant opioid withdrawal.

JAMES NEUENSCHWANDER: Receiving naloxone is like enjoying a really fast drive on a highway at about 80 miles an hour, and then coming over a hill and hitting a parked truck—bam!

James Neuenschwander knows addiction from his own experience with alcoholism. Now, he’s a counselor, an ER doc, and a board member for The Naloxone Project, which advocates for easier access to the medication.

NEUENSCHWANDER: I encourage everybody to carry naloxone. These lives are worth saving. I’ve seen it over and over again, as I said—I’ve seen so many people who have bounced back from these addictions, who are now living fruitful and wonderful lives.

Naloxone used to be an injectable given only by medical professionals. Then, in 2015, it was repackaged as a nasal spray and has become easier for pharmacies to dispense.

The wonder spray almost immediately made headlines, but not for the lives it saved.

BRIAN BESSER: We’re hearing them called Narcan parties, Narc-me parties, Lazarus parties, like raising someone from the dead.

That’s DEA special agent Brian Besser, speaking to KSL News Utah. At Lazarus parties, drug dealers promised a safer drug experience that could be instantly reversed with naloxone if things went wrong. There were few first-hand accounts of these parties, but the possibility raised a question: If naloxone made drug use seem safer, would more people overdose?

JEN DOLEAC: Assume that anything you try, any good idea, might not work or could backfire in ways that you could be surprised by.

Economist Jennifer Doleac worked on a study to see if naloxone accessibility could encourage opioid abuse.

DOLEAC: One challenge in studying any sort of behavior that is illegal is that you often don’t have great data on it. People aren’t necessarily reporting honestly on surveys what their behavior is.

The researchers cobbled together what they did know: data on Google searches for naloxone and drug rehab, plus opioid-related ER visits and arrests. They used those numbers to estimate overdoses before and after naloxone became widely available.

DOLEAC: People do seem to be getting help more often, which is amazing. But somehow that didn’t result in a net reduction in the number of people who were dying. So that, to us, meant more people are using opioids in a risky way.

In economics, this effect is called moral hazard. People tend to act more recklessly when the consequences of risky behavior become less severe.

Doleac’s research received fierce criticism. Some argued that her statistical methods were invalid, while others said she just wanted to let addicts die. Doleac had hoped it would be a launching point for more public policy research on naloxone, but she believes other researchers are afraid of backlash.

DOLEAC: I knew a lot of junior scholars who said, “I don’t want to risk being attacked in the way you all were attacked,” and that is not good for science. And it’s not good for solving problems.

Back to the ER, where James Neuenschwander regularly prescribes naloxone. He agrees Doleac’s question is worth researching, but says he’s never seen any evidence that the medication creates a moral hazard.

Neuenschwander likens it to the folk tale: thousands of starfish stranded on a beach after a storm. An old man sees a little girl throwing the starfish back into the water and thinks she’s wasting her time.

NEUENSCHWANDER: “You’re not going to be able to save them all. What you’re doing—it doesn’t matter.” And she looks at him, and she takes the starfish, and she throws it back into the water. And she says, “It does to this one.” So … yeah.

If given quickly enough, naloxone can reverse an overdose and restore normal breathing in just three minutes. For an addict, those three minutes could mean a chance to make a change.

For WORLD, I’m Lauren Smyth.

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