What do you think about a recent proposal to let addicts die of overdoses?

[Kangaroo Feathers]

I have little issues in using resources for people as I described. I favour a return of involuntary institutionalization before the 3rd OD. First OD which is on record is grounds for institutionalization. Get to the problem before the 3rd OD.

Institutionalisation without addressing underlying causes is rarely effective.

 

[Kangaroo Feathers]

Two words. Portu. Gal.

 

[Shad]

Institutionalisation without addressing underlying causes is rarely effective.

I proposed institutionalization so that people have to finish treatment rather being tossed on the streets and a hope they seek help.

 

[allfoak]

What do you guys think of proposal online to let addicts die after their third overdose? I think it could have merits. If by the third time you still haven't learned, then it seems reasonable to just let them do what they want. In conjunction with more counselling and help for the first or second time overdosers, this could be much more effective by weeding out repeat offenders who soak up public services. The money saved from repeat offenders could be devoted towards helping with drug rehabilitation programs that will ultimately save more people and money.

I'd like to hear some moral and utilitarian arguments for this proposal given the huge problem the United States has with drug overdose. Also, please no fallacious arguments from moral outrage. I'd like arguments from a rational ethics and or a utilitarian perspective.

It's complete crap.

 

[SomeRandom]

What do you guys think of proposal online to let addicts die after their third overdose? I think it could have merits. If by the third time you still haven't learned, then it seems reasonable to just let them do what they want. In conjunction with more counselling and help for the first or second time overdosers, this could be much more effective by weeding out repeat offenders who soak up public services. The money saved from repeat offenders could be devoted towards helping with drug rehabilitation programs that will ultimately save more people and money.

I'd like to hear some moral and utilitarian arguments for this proposal given the huge problem the United States has with drug overdose. Also, please no fallacious arguments from moral outrage. I'd like arguments from a rational ethics and or a utilitarian perspective.

That's quite frankly despicable. Save more money? Yeah money that's what people value over people. Figures. Whoever proposed such a thing ought to be ashamed of themselves. I don't see how anyone can call themselves ethical whilst alowing people to literally die. That is the least ethical thing I've ever heard. Perhaps they got the idea from Big Brother.

 

[Jumi]

How do you know someone's an addict? And if you don't, do you just let people die, just in case? What about if someone kidnaps someone else drugs them daily and they end up overdosing...

 

[Kangaroo Feathers]

I proposed institutionalization so that people have to finish treatment rather being tossed on the streets and a hope they seek help.

Cool. And then what?

 

[serp777]

That's quite frankly despicable. Save more money? Yeah money that's what people value over people. Figures. Whoever proposed such a thing ought to be ashamed of themselves. I don't see how anyone can call themselves ethical whilst alowing people to literally die. That is the least ethical thing I've ever heard. Perhaps they got the idea from Big Brother.

Uh, yes save money. Do you know what money can do? A few billion dollars can end world hunger or save millions from preventable diseases. Don't act like saving money isn't important or significant. If you want to make changes to the lives of millions you need millions of dollars to do so. You would use the money you saved to help addicts that could actually benefit from treatment and rehabilitation.

 

[serp777]

Are we talking about utilitarian arguments regarding the addicts themselves, or the effect on the wider community? Addicts don't die without effecting their friends, family and communities negatively.

Short answer, though, assuming we're talking developed Western nation, and considering a full Naloxone kit costs ~$40, I really don't think "greatest good for greatest number" triage is an appropriate paradigm. If we're talking about something with expensive, limited supply, like donor organs, that would be very different.

its not just a naloxone kit.

The average cost to treat overdose patients admitted to hospital intensive care units climbed from $58,517 in 2009 to $92,408 in 2015—a 58 percent hike, according to a 2017 study that analyzed 162 hospitals in 44 states.

This doesn't include the cost of an ambulence, of emergency services, of the police's time, insurance, etc.

And a simple naloxone kit fix actually averages about 6000 dollars.

The cost was 25 million dollars in 2017 for opiod related overdoses.

http://www.modernhealthcare.com/article/20180220/NEWS/180229993

Are we talking about utilitarian arguments regarding the addicts themselves, or the effect on the wider community? Addicts don't die without effecting their friends, family and communities negatively.

Well Utilitarian arguments generally apply to the greater society. The whole point of utilitarianism is lets do whats generally best for the society at large. How will this decision impact people? Will it have a net positive effect? If it does then lets implement it.

 

[Shadow Wolf]

Short answer, though, assuming we're talking developed Western nation, and considering a full Naloxone kit costs ~$40, I really don't think "greatest good for greatest number" triage is an appropriate paradigm. If we're talking about something with expensive, limited supply, like donor organs, that would be very different.

When Naloxone is administered the recipient still has to seek medical attention. It doesn't last very long, and the drugs are still there once it has passed.

A few billion dollars can end world hunger or save millions from preventable diseases.

But you are advocating letting people die from a treatable disease? Addiction treatment is anything but "take one pill twice a day for 14 days." People who have finished treatment are themselves in a high risk group for relapse. There simply is no truth to this idea that a first time overdoser will have a better chance of recovery. Some addicts don't overdose at all.

 

[Shadow Wolf]

And a simple naloxone kit fix actually averages about 6000 dollars.

A naloxone kit isn't that much. About 20-40 dollars. You can even get them free at some places. The county library here even keeps about a dozen of them on hand, and they certainly don't have the money for one of them if they cost about 6,000.
And naloxone is the generic form of the name brands Narcan and Evzio. And at least here health care providers "on the field" and police are using generics - I see no reason this Ohio city would be any different in that regard.

Well Utilitarian arguments generally apply to the greater society. The whole point of utilitarianism is lets do whats generally best for the society at large. How will this decision impact people? Will it have a net positive effect? If it does then lets implement it.

It won't have a net gain. All it will achieve is spiking the deaths from opioids even higher.

 

[serp777]

A naloxone kit isn't that much. About 20-40 dollars. You can even get them free at some places. The county library here even keeps about a dozen of them on hand, and they certainly don't have the money for one of them if they cost about 6,000.
And naloxone is the generic form of the name brands Narcan and Evzio. And at least here health care providers "on the field" and police are using generics - I see no reason this Ohio city would be any different in that regard.

It won't have a net gain. All it will achieve is spiking the deaths from opioids even higher.

I just gave evidence in the post above. You're making this way more simplistic than it should be. Its not just using the naloxone. Most of these people need urgent care, ambulances, doctor support, bloodwork, police work, counselling, monitoring, etc.

And it will have a net gain over time if money is devoted towards improving rehabilitation programs or giving more access to the poor.

Also so you think they should be saved an unlimited number of times? Just picking a crazy totally unrealistic example to discuss the principle--say a total person continuously overdoses and eventually costs up to a billion dollars. Would you still think they deserve to be saved? At what point would you draw the line is what i'm getting at.

 

[serp777]

When Naloxone is administered the recipient still has to seek medical attention. It doesn't last very long, and the drugs are still there once it has passed.

But you are advocating letting people die from a treatable disease? Addiction treatment is anything but "take one pill twice a day for 14 days." People who have finished treatment are themselves in a high risk group for relapse. There simply is no truth to this idea that a first time overdoser will have a better chance of recovery. Some addicts don't overdose at all.

If you've overdosed numerous times in a row then I don't think its treatable.

There simply is no truth to this idea that a first time overdoser will have a better chance of recovery.

Its actually simple bayesian analysis. You have a true dichotomy in the set of people can be treated and people who can't. The first overdose comes around. Some portion of the people who can be treated are successfully rehabilitated and no longer overdose. You subtract from that set and so the set of people who can be treated is smaller.. This occurs again, and again until after several times the set of people who can be treated is proportionally very small. So the question is would it be better to take the money that would normally be spent on these repeat overdoses to improve the odds for people who can be treated in the first few overdoses. The bayesian analysis suggests that yes, that would ultimately save more people.

 

[SomeRandom]

Uh, yes save money. Do you know what money can do? A few billion dollars can end world hunger or save millions from preventable diseases. Don't act like saving money isn't important or significant. If you want to make changes to the lives of millions you need millions of dollars to do so. You would use the money you saved to help addicts that could actually benefit from treatment and rehabilitation.

We already have that much money, if world spending is to be believed. World hunger is still a thing, so are preventable diseases. As if anyone is actually using money to help people (with the exception of charities I suppose.) don't pretend that we're all a bunch of golden hearted hippies. We live in a capitalist society. We could all today help end world hunger or inoculate babies in Africa with our monies. Do we?
I mean some of us give to charity, I guess.
If we are going to pontificate on helping save lives, it's a bit rich (pun intended) to do so in the same breath as saying we should let people die. Addiction is a national health problem, not a criminal one. Why aren't we treating it as such?

 

[Shadow Wolf]

I just gave evidence in the post above.

You claimed a naloxone kit cost around 6,000. That is false.

If you've overdosed numerous times in a row then I don't think its treatable.


Its actually simple bayesian analysis. You have a true dichotomy in the set of people can be treated and people who can't. The first overdose comes around. Some portion of the people who can be treated are successfully rehabilitated and no longer overdose. You subtract from that set and so the set of people who can be treated is smaller.. This occurs again, and again until after several times the set of people who can be treated is proportionally very small. So the question is would it be better to take the money that would normally be spent on these repeat overdoses to improve the odds for people who can be treated in the first few overdoses. The bayesian analysis suggests that yes, that would ultimately save more people.

That dichotomy doesn't exist in addiction treatment, and there is nothing to confirm the idea that a first time ODer is more likely to be successfully rehabilitated. We really do need to improve rehabilitation, and saying "you get no more after your third OD" is not the way to go about it. All that will accomplish is increasing the death toll in this epidemic.

 

[Augustus]

What do you guys think of proposal online to let addicts die after their third overdose?

How would this even work in practice?

When faced with an OD, instead of aiding the patient, the paramedics/doctors should first try to identify the patient (which might be challenging seeing as many addicts don't carry photo IDs around with them), then they should get someone to check their medical records, and only then should they start to administer treatment?

Paramedics/doctors would also be told to allow someone to die rather than treat them, which could lead to immense guilt, PTSD, etc. and could destroy morale and relations between management and practitioners?

You might end up paying out more in sick leave, counselling, legal costs, etc, than you actually save.

 

[Shad]

Cool. And then what?

If they passed treatment relocation to a group home for reintegration into society be it working a job or towards education.

 

[Kangaroo Feathers]

If they passed treatment relocation to a group home for reintegration into society be it working a job or towards education.

Uh-huh.

Well, as long as you're happy to adequately fund it, great.

 

[Kangaroo Feathers]

When Naloxone is administered the recipient still has to seek medical attention. It doesn't last very long, and the drugs are still there once it has passed.

I'm aware that it isn't a total treatment in and of itself. However, it is the immediate treatment for an acute OD.

 

[Shad]

Uh-huh.

Well, as long as you're happy to adequately fund it, great.

Some of the funding already exists via current government programs. If institutionalization become policy many of the existing voluntary programs which receive government funding are no longer necessary. That funding can reallocated to programs under said new policy. Income assistance which is normally used for food and housing likewise can be reallocated as a patient no longer requires income assistance as housing and food is provided.