# Hot Take?



## MonkeyArrow (Jun 22, 2017)

*Stop sending EMS to respond to overdose calls, Ohio councilman says*
Some Ohio councilman wants to find a way to stop sending EMS on OD calls because the city is spending too much money on Narcan.

http://www.ajc.com/news/crime--law/...-ohio-councilman-says/7C7Ct6Bjv716ei4JmY34GL/


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## GMCmedic (Jun 22, 2017)

I really dont know where to start with this

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## Jim37F (Jun 22, 2017)

Please tell me AJC is satire like Duffle Blog or Onion? No? Well, shi.......


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## mgr22 (Jun 22, 2017)

At first I thought, no way, but then I realized EMS has nothing to do with this. If the state or county or municipality we work for narrowed the scope of our services, that would just become part of our jobs. Eventually, those of us who'd been around long enough would remember how busy EMS used to be when we responded to all 911 calls.


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## twistedMP (Jun 22, 2017)

Jim37F said:


> Please tell me AJC is satire like Duffle Blog or Onion? No? Well, shi.......



No AJC is the  local news paper from Atlanta, Ga it's a legit news site 


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## SandpitMedic (Jun 23, 2017)

Drug abuse with lethal drugs is a self limiting problem.

If we aren't there to "save them" (_this time/again_) then the problem will cease to be a problem.

Seems as though the world may be a better place without some people... just sayin'.

The current climate of healthcare abuse and exponentially growing costs cannot be sustained forever. Eventually the chickens will come home to roost.

(To be clear I'm talking about repeat offenders, high drug call districts, etc... problem areas. Not a granny who ODs on Amlodipine or a kid who downs a bottle of ASA... I'm talking about adults who continue to make poor choices with no repercussions.)


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## NomadicMedic (Jun 23, 2017)

So how do we determine who lives and who dies?

If they look like a dirtbag, "sorry no Narcan for you"?

If it's a kid, they can has resuscitation?

Sorry. But that's BS. As medics, it's not our job to judge. And every person who's overdosed is someone's kid. Or brother or sister. Or mom or dad.

Think about it.

Seriously. Think about a poor choice your or your friends or family member may have made. Then think about some paramedic showing up and judging if their life is worth saving.

That leaves a bad taste in my mouth and if you really think that perhaps we as a profession should consider letting some people die based on poor decisions, you need some help.


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## SandpitMedic (Jun 23, 2017)

All I am saying is that Darwinism is simple.

I have little sympathy for someone who would repeatedly go out of their way to knowingly harm themselves just because they know that at their demise someone will be there to rescue them, so that they can do the same thing again tomorrow.

That is completely different than doing something once or twice or three times, or making a mistake or having an accident...
These people are parasites on our society. Contribute nothing and demand everything.

On top of that, it's not free.
I am not in the "healthcare is a right" category.
I would not deny someone healthcare, but I decline to pay for it in some cases.

I'm not to judge anyone... if I show up I'll do my job. I'd rather have never been dispatched in the first place.


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## Carlos Danger (Jun 23, 2017)

SandpitMedic said:


> All I am saying is that Darwinism is simple.



Following that logic, why do we treat ANY medical problems at all? Why not just let the genes for hypertension and heart disease and diabetes and risky behavior all die out?



SandpitMedic said:


> I have little sympathy for someone who would repeatedly go out of their way to knowingly harm themselves just because they know that at their demise someone will be there to rescue them, so that they can do the same thing again tomorrow.



Except that isn't how addiction works. These people have a mental illness that prevents them from making rational choices. And a majority of them recover and live productive lives.

The type of utilitarianism you are advocating is a very slippery slope, and I would argue has no place whatsoever in modern healthcare.


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## SandpitMedic (Jun 23, 2017)

Remi said:


> Following that logic, why do we treat ANY medical problems at all? Why not just let the genes for hypertension and heart disease and diabetes and risky behavior all die out?



That's not a daily choice, and they aren't smoking, snorting, and shooting up things that are known to be immediately detrimental to their health.

That argument is apples to oranges.


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## SandpitMedic (Jun 23, 2017)

I understand that my opinion may be an unpopular one.

I lost my father to substance abuse. I nearly lost my mother who still battles today. Currently, I have a brother who is having an issue with meth and heroin who consistently wreaks havoc on the emotional investment of the family.

Don't lecture me on addiction. You're entitled to you opinion, but I am deeply intimate with substance abuse. 

Modern medicine? Modern times are wrought with a lot of things that are different than say, old timey medicine? Every junky deserves to live because every life is precious? 

Do you feel the same about other tragedies of our lifetime? Everyone can't be saved.


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## Carlos Danger (Jun 23, 2017)

SandpitMedic said:


> That's not a daily choice, and they aren't smoking, snorting, and shooting up things that are known to be immediately detrimental to their health.
> 
> That argument is apples to oranges.


Ok, then why don't we at least apply your approach to everyone with a BMI over 30 and who uses alcohol and other things that are known to be bad for them? It would be logically consistent. Illicit drugs certainly aren't the only risk factors for expensive health problems.

You might think yourself an expert on substance abuse just because you've been affected by it, but you'd be very wrong.


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## SandpitMedic (Jun 23, 2017)

The


Remi said:


> Ok, then why don't we at least apply your approach to everyone with a BMI over 30 and who uses alcohol and other things that are known to be bad for them? It would be logically consistent. Illicit drugs certainly aren't the only risk factors for expensive health problems.
> 
> You might think yourself an expert on substance abuse just because you've been affected by it, but you'd be very wrong.


The key word was immediately.
The abuse of illicit drugs has immediate effects, and we utilize a lot of resources on it.

I'm not an expert on substance abuse, but I know enough to know that you can't help people who don't want to help themselves.
And I am not a proponent of spending an exponentially increasing amount of manpower, resources, and money on this particular issue.
If you want to hit a drug house with some squatters and quit breathing for the 6th time this month perhaps someone should just let you escape that from which you're running from.

As I said, I know my opinion is an unpopular one. Many folks have the bleeding heart for every tragedy of mankind's own doing.


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## Carlos Danger (Jun 23, 2017)

It has nothing at all to do with having a bleeding heart. It's about having an opinion based on reason vs. emotion.

Just so I understand:

Let people die from an easily reversible cause for which we have a cheap, readily available antidote even though the choices that led to their situation were arguably not even completely freely made - because darwinism.

But, lets keep spending massive amounts of resources on people who willingly make themselves susceptible to "accidental" trauma by speeding and not wearing seat belts and all sorts of other tomfoolery, as well as on those who make other poor lifestyle choices that they know are likely to eventually lead to expensive chronic diseases. Because darwinism?

Seems logical to me.


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## SandpitMedic (Jun 23, 2017)

Well we aren't talking about those other causes of illness and disease. Again apples to oranges.

It seems as though you are the emotional one.

You'd probably hate to hear how I feel about those on dialysis who don't care for themselves, with diabetes who don't manage themselves, and all those other wonderful self induced illnesses of which people continue to do harm to themselves and worsen their conditions- ever dependent on someone in medicine to bail them out for their continued poor choices while expecting someone else to foot the bill.

My point is, in regard to the topic of _this thread, _that I am against throwing unlimited resources at this problem, whereas if they were allowed to do what they do without so much intervention they would cease to be a problem. Thus, self limiting.

Fear not, in our society your viewpoints are more likely to play out. We will continue to pour resources, equipment, money, and careers as well as other lives that could be actually be helped away to tackle this problem.

Until we as a society decide enough is enough, or until we have a major disruption in our society and the rules of comfort and convenience go out the window.

It's all good. We can disagree.


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## VFlutter (Jun 23, 2017)

Mixed views on the matter. I agree it's a slippery slope and I don't see much of a difference between the drug addict the the COPD patient who gets intubated once a month and contiues to smoke while refusing to wear oxygen. Seems illogical to condem one and not the other. 

However opioid addiction is a pandemic that is a huge drain on society and there should be consequences for actions. Just because it's a simple and cheap antidote doesn't mean it should be treated as a free pass. Should all those treated with narcan due to illegal drugs be arrested and forcibly enrolled in a rehab program? Should you get unlimited chances? Don't know the answer. 

Wish they had a long acting opioid antagonist shot, i.e months, that could be utilized.


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## SandpitMedic (Jun 23, 2017)

Right, the answers... I don't know.
I only know the current model is unsustainable.

And I agree with the councilman in the article.

No more free rides, and put the fear in them that they may not be saved.


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## Carlos Danger (Jun 24, 2017)

SandpitMedic said:


> Well we aren't talking about those other causes of illness and disease. Again apples to oranges.
> 
> It seems as though you are the emotional one.
> 
> ...



I'm the emotional one? "I know you are but what am I?" Lol

Look, I'm the one pointing out the logical inconsistency in your position and trying get you to explain your rationale. Your are the one who has offered an opinion without any supporting justification other than personal anecdote.

Of course it is fine if we disagree, but if you are going to participate in a discussion with professionals about an important issue of the day, then you should be able to support your opinions.



Chase said:


> However opioid addiction is a pandemic that is a huge drain on society and there should be consequences for actions. Just because it's a simple and cheap antidote doesn't mean it should be treated as a free pass. Should all those treated with narcan due to illegal drugs be arrested and forcibly enrolled in a rehab program? Should you get unlimited chances? Don't know the answer.



The way to fix the problem is clear. Decriminalize all substances and start treating addiction as a health problem that requires treatment rather than as a criminal and moral issue that requires punishment. 

Prohibition has never worked, and we've known for at least a few decades that our drug policy was a failure, and the fix has been staring us in the face the whole time. But because the government derives so much power from the war on people with a chronic disease called addiction, they've worked hard to convince us that these people are a threat to us and that it is therefore in our best interest to give up many of our rights and much of our money so that the government can protect us from the victims of that mental illness. And the tens of millions of low-information citizens continue to cheer it all on, even though the problems with the approach are so obvious. 

Until we completely revamp our drug policy in this country we'll keep chasing our tails by imprisoning people with mental health issues and arguing over ridiculous ancillary issues such as how many chances an addict should get before we stop treating them with nalaxone.


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## SandpitMedic (Jun 24, 2017)

Good morning, Remi.

There's about as much a chance of a revamp of our drug policies as there is of us to start letting these people go without emergency resuscitation.

I gave you rationale... it costs more and more and more everyday, wastes valuable assets that could be used more wisely elsewhere, and contributes to EMS abuse, provider burnout, and wastes hospital resources as well.

Turn off the faucet. Drug abuse is not a medical condition akin to cancer or heart diesease.
I don't know why you're so insistent on people not paying their own medical bills and being allowed to do as they wish as they waste our resources without repercussions.

I don't personally believe everyone _deserves_ to be treated so special, and that those who are a burden on society and contribute nothing should be on the bottom of the "treated special" list (if there was one). I believe in personal accountability and responsibility.


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## VentMonkey (Jun 24, 2017)

Remi said:


> I'm the emotional one? "I know you are but what am I?" Lol
> 
> Look, I'm the one pointing out the logical inconsistency in your position and trying get you to explain your rationale. Your are the one who has offered an opinion without any supporting justification other than personal anecdote.
> 
> ...


While I agree with the overall generalization of your post, I can't say I agree that addiction is a disease; I feel it's a choice. That is, they choose their addiction, healthy or not.

You can _choose_ to smoke cigarettes in lieu of kicking meth, heroin, cocaine, etc. A slightly less healthy, albeit still ultimately unhealthy choice. Either way, they're their choices.

I do like--and have for sometime--the idea of decriminalization in The States. I think it's long overdue and would ultimately (ironically) force accountability upon the "addicted" masses. It also sends the message to the "addict" of it being _their_ _choice_.

All in all, I'm enjoying the discussion you and @SandpitMedic are having. Good dialogue, y'all.


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## Carlos Danger (Jun 25, 2017)

First, I think it is worth pointing out that we are really talking about different things here. The current wave of deaths over the past couple of years from adulterated heroin doesn't just affect addicts. The reality is that MOST people who use drugs - even hard drugs - never become addicted to them. I certainly can't say what proportion of recent deaths have been in casual users vs. frequent users (addicts), but the point is that many of the people who end up needing nalaxone prehospital aren't necessarily even addicted to the drugs. There are an awful lot of people who party with this stuff occasionally but still live otherwise pretty normal lives. For whatever that's worth.



SandpitMedic said:


> Drug abuse is not a medical condition akin to cancer or heart diesease.





VentMonkey said:


> While I agree with the overall generalization of your post, I can't say I agree that addiction is a disease; I feel it's a choice. That is, they choose their addiction, healthy or not.



Sorry guys, but you are both wrong. That line of thinking used to be widely held but is now outdated. What we were taught about drug use and addiction when we were growing up - that it is little more than a moral failing leading to a unique type of irresponsibility, and that addicts don't deserve the same compassion and resources that other people in need of help do, but rather deserve to be imprisoned - is long gone. The American Medical Association, American Psychiatric Association, and American Society of Addiction Medicine all define drug addiction as a disease. Slowly, more and more law enforcement associations are even calling for reform of drug policy, as well.

"But, but.....addiction is a result of conscious choices". Well......so what? So are most other chronic diseases, to at least some degree. So is almost all trauma. Taking addiction out of the equation, most of the healthcare resources in this country go to managing either 1) trauma, which is almost 100% a result of conscious choices, and 2) other highly preventable diseases (obesity, primarily, and all of its related sequelae) that result partly from individual choices and in many cases, at least partly from genetic predispositions. And that isn't even touching on the mental health aspect of addiction.

So is addiction really as unique as we were taught? No, it isn't. There's little rationale for the idea that addiction is highly unique among health issues. The only reason is still appears so different is because of the legal prohibition of drugs. We don't see people getting sent to prison for making the mistake of spending their life of eating big macs and living a sedentary life style. We do see that happening to people who make the mistake of experimenting with substances and becoming addicted them. It changes the optics dramatically, but the difference is mostly an illusion.  

Maybe addiction isn't _exactly_ like other diseases. Maybe the results of drug abuse are _more immediate_ and _more predictable_ than other poor choices that people make. Maybe that does make the addict _more responsible_ for their own situation than people with other types of health problems. I don't know if that is all true or not, but for the sake of argument, I'm willing to concede it all. So......what now? How does that change anything about the way the problem should be approached? I'd say it doesn't at all. It's completely irrelevant, in fact. Drug abuse and addiction is a huge problem that needs to be dealt with, and the way to deal with it is not to keep holding on to the same attitudes and using the same approaches that have failed for decades.   

The only treatment models for addiction that have ever worked are those that approach addiction as both a physical and mental health issue, and the societies that have made the biggest improvements in dealing with serious drug problems are the ones that pivoted from treating it as a criminal issue to a health issue. Portugal is the best example, though not the only one.


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## VentMonkey (Jun 25, 2017)

Right, but I don't live life based off of every annal, or latest publication telling me what I think addiction is or isn't.

So, for the sake of argument, if I were to tell you that I have an addictive personality, which I most certainly do and _chose _to change my poor habits of addiction into positive ones, all without being diagnosed with the help of mental health experts where does this leave the debate? At least to me, or others like me.

I don't think the thought process is necessarily wrong, but perhaps not as current as the ever changing world of medical practice.

All I am saying is having turned my own bad habits into good ones on my own, and without having to seek professional help, but merely choosing greener pastures hasn't helped support your theory of it being a disease. It is a choice plain, and simple. I chose to zig while others around me chose to zag.

I don't not support clinics handing out Narcan and the like. I think decriminalizing all substances with obvious restrictions is not a bad thing. Why? Because they're choosing to continue to partake. When do we stop making up others beds for them @Remi? All I'm saying.


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## SandpitMedic (Jun 25, 2017)

Remi, just because all of those doctors needed a way to make sure the insurance companies paid the bills of all these addicts doesn't mean it is truely a "disease." Nice to have a billing code for it, but I am not buying it.

On that token, cigarette smokers are afflicted by addiction disease, thus their resulting afflictions are not their fault either? Everyone knows smoking is bad for you, and there are many campaigns against it. We have seen dramatically less tobacco smokers in this country. Prices raised, public shaming, taxes, etc... and there are less new smokers today than in the past. 

Or anything- gambling addicts... well jeeze, why not let them blow their paychecks, and set up a "clinic" for them to go and get a check to pay their rent or mortgage on the taxpayers dime? Seems legit; they are diseased. 

When you inject toxins into your body by choice it is just that. There may very well be psychomotor and psychosocial elements to that, and there is no doubt that it changes the chemistry in your brain... but everyone knows that, and that is why when you choose to do that to yourself then you alone bear full responsibility for your health and your actions while you are under the influence. 

People know smoking is bad and causes cancer, so they don't do start.

We don't give folks who kill someone in an alcohol related DUI a pass, but they have a disease. Maybe we should then?

Just because the topic is drugs does not mean everyone gets a pass and free treatment. They have to foot the bill themselves, and we should not spend billions, waste resources and risk our lives on a continuous basis responding to these people who continue to do this to themselves... I wouldn't stand in front of a drunk driver, and I won't stand in front of a heroin, PCP, etc user to save them either. 

Making a poor choice a few times is one thing. Live and learn.... and making a lifetime of poor choices dependent on the mercy of others is a totally different thing.... if you can't learn, I guess you can't live.


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## SandpitMedic (Jun 25, 2017)

For the record, I am for decriminalizing drugs for personal use, to include the hard drugs.
I am not proposing imprisonment as you keep stating. I am proposing we don't let an entire subset of miscreants dictate EMS responses and spending. "Sorry, we're out of Narcan. PSA."

Everything these days has a warning label... "don't put this plastic bag over your head."

Put a label on it, and let them have at it...
"Warning: this product may cause respiratory arrest and death. First responders may not arrive to revive you after use."

We both totally agree- this issue does need to be dealt with in some way different than in the past decades. We just disagree on the direction in which we need to go.

 I advocate allowing them to be responsible for themselves and their choices which may lead to sudden death... you seem to advocate for hand holding.


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## VentMonkey (Jun 25, 2017)

On the whole, I think we've seemed to have confused a _disorder_, and mislabeled it a disease, yes?


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## SandpitMedic (Jun 29, 2017)

__ https://www.facebook.com/video.php?v=1886076124967971
			





I'll just leave this here...


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## Carlos Danger (Jun 30, 2017)

Sorry guys, but the only effective approaches for curing drug addiction is to treat it as a disease process.

It has nothing to do with giving people a pass, or allowing people to not take responsibility for their choices. It's about what works to make the situation better, vs. what doesn't. 

You don't have to believe me if you don't want. That's fine. Do a little digging into the issue. Your point of view on this is out of date.


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## PassionMedic (Jul 1, 2017)

Chase said:


> Wish they had a long acting opioid antagonist shot, i.e months, that could be utilized.



Don't be fooled, you know we would just have patients suffering from withdrawal effects, or people finding a new drug that has a higher affinity than the long lasting antagonist. 


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## PassionMedic (Jul 1, 2017)

Also, my knee jerk concern with not responding to repeat offenders (aside from feeling like it's against what I signed up for in this field) is what if it's NOT who/what we think it is? How often has your 55M chest pain pt, turned out to be a 45F? Are we just going to assume we know who we are responding to?

What if Johnny Junkie's family is in town, and his nephew who has no hx happens to inhale a buttload of something and is actually our patient? Bc Johnny has his 'three strikes' already, we aren't gonna respond to save his nephew we have never treated before? Or are we gonna respond, see that it is Johnny again and say 'sorry ma'am, we have already helped him 3 times before, I'm not allowed'. Bc THAT won't increase violence and contempt against EMS...


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## SandpitMedic (Jul 1, 2017)

PassionMedic said:


> Don't be fooled, you know we would just have patients suffering from withdrawal effects, or people finding a new drug that has a higher affinity than the long lasting antagonist.
> 
> 
> Sent from my iPhone using Tapatalk



Correct! By choice. Not because they are diseased.


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## VFlutter (Jul 1, 2017)

SandpitMedic said:


> Correct! By choice. Not because they are diseased.



To play Devil's advocate, there are very significant changes in the brain and neurochemistry that occur with addiction and in some people I do not think they truely have a choice. Just like a Tourette's or manic bipolar patient they may have little control over their actions at the time.


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## SandpitMedic (Jul 1, 2017)

Chase said:


> To play Devil's advocate, there are very significant changes in the brain and neurochemistry that occur with addiction and in some people I do not think they truely have a choice. Just like a Tourette's or manic bipolar patient they may have little control over their actions at the time.


I'm not denying that neurochemical changes exist... but I am not granting that as a blanket pass to call drug addiction a disease.

If you *choose* to do that to your body _*repeatedly*_ until it changes your biology then you made several choices leading up to that point. It's not a disease process, it is making poor choices, so at the end you can claim you have a disease. No!

People give other people a hard time for smoking because we know it will likely lead to cancer and other diseases.... they become addicted to nicotine... correct? People choose to stop smoking everyday! And everyday others are shunned for smoking... ridiculed... "You know that'll cause cancer right? You should stop smoking."

Why then should heroin and meth (illicit drug) users get the sympathetic treatment instead of the shaming treatment? I'm not saying they don't need help, and many folks hit rock bottom before they decide for themselves they want to change. However, we are largely enabling the "stupid" to persist with modern medicine and technologies, whereas in the past these people would die off before becoming a public burden or nuisance that is prominent in our society.

I maintain my orginal statements, and would like to see programs developed that prohibit _known and repeat_  offenders who burden the system from continuing to burden the system. Put the fear in them that next time they won't be saved from their own doings.


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## SandpitMedic (Jul 9, 2017)

http://tribunist.com/news/ohio-sher...let-deputies-administer-narcan/?utm_source=BP


Ohio Sheriff takes a hardline stance on opiod addicts. Says his deputies will not carry or administer Narcan to overdoses.
Actions have consequences, he says.
He also makes plenty of other great points which I support. 

The free ride is coming to an end for a lot of these people.


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## Carlos Danger (Jul 9, 2017)

SandpitMedic said:


> Actions have consequences, he says.
> 
> The free ride is coming to an end for a lot of these people.



I agree 100%.

Hopefully soon we'll also stop wasting money on responses to MVC's, considering they are almost 100% a direct result of intentional actions.

It's time that these losers start paying the price when they choose to exceed the speed limit and/or not wear their seat belts.


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## SandpitMedic (Jul 9, 2017)

Apples to oranges.

Besides, most drivers/parties in MVAs have insurance which covers some of the costs.

Your whole base principle is off target.

A driver would stop at that red light if they *knew *they would be hit.
A junkie would still slam that heroin *knowing *they would stop breathing.

The driver wouldn't think, "jeeze im gonna get hit anyways, I know an ambulance will come to save me." People who violate traffic laws leading to a collision are also often cited or punished the courts depending on the severity.
An overdose patient rarely, probably never, faces criminal charges or gets chased down to pay a fine or fee.


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## Carlos Danger (Jul 9, 2017)

SandpitMedic said:


> Apples to oranges.



No, it isn't apples to oranges.

Opioid OD = someone choosing to do something irresponsible that they know may cause an imminent threat to their life.
Reckless driving = someone choosing do something irresponsible that they know may cause an imminent threat to their life, _as well as_ the lives and/or property of others.

Reckless driving is actually much worse than doing drugs, because that choice often results in harm to someone other than than the person making the choice, unlike someone doing heroin or pills, which normally harms no one but the person taking the drugs.

MVC's, I would wager, cost the public A LOT more money than opioid OD's. Up until very recently and for a very long time, MVC's killed far more people than drug overdoses. I have never heard calls for leaving MVC victims in their car because "choices have consequences".

So whether you are looking at it from a moral or a cost standpoint, if you want to make people face the "consequences of their actions", it is logically inconsistent to not include MVC's in that judgement.



SandpitMedic said:


> most drivers/parties in MVAs have insurance which covers some of the costs.



How do you know that some of the people who OD don't have health insurance?

If that is a relevant fact, then shouldn't we at least check for valid insurance before we help MVC victims OR opioid OD's?



SandpitMedic said:


> A driver would stop at that red light if they *knew *they would be hit.
> A junkie would still slam that heroin *knowing *they would stop breathing.



This is an absolutely, 100% baseless statement. The fact that you would make that assumption shows your absolute ignorance about issues surrounding addiction.


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## SandpitMedic (Jul 9, 2017)

We are clearly never going to agree or even come close to agreeing on this issue.

It's not the same thing, and it is something that can be changed to reduce the load of EMS, reduce the amount of junkies in the gene pool, and make people think twice before hitting that needle or that pipe... regardless of the causality.

You view it as a disease process, and I do not.
I anticipate this issue and the debates will continue as more and more sensible people speak up from positions of power that can effect change in the current way we do business.

You know what camp I am most decidedly in.

I've already made several statements on how I view addiction. It doesn't change the choices people made or make to get to that point. The burden must be lessened, and unfortunately that means it is necessary that some people won't be revived. Societies' kindness must have limits on the "takers." Perhaps that will encourage others to seek counseling or rehab for their addictions.


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## SandpitMedic (Jul 9, 2017)

Also, that last quote is not baseless.

That is spot on. If you can't concede that my statement rings true then you have never been around true addicts. They would almost always use even if they knew they would probably die. Their addiction consumes them and they lose all rational thought processes.


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## DrParasite (Jul 10, 2017)

Ok, I'm confused..... on one hand, you said


SandpitMedic said:


> Put the fear in them that next time they won't be saved from their own doings.


but a few days later you said


SandpitMedic said:


> They would almost always use even if they knew they would probably die. Their addiction consumes them and they lose all rational thought processes.


so if they don't have any rational thought processes, wouldn't they not have any fear that next time they won't be saved?


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## SandpitMedic (Jul 10, 2017)

You can't lump them all into one basket.

I thought that was a given.

In extreme cases, people are consumed. They are likely goners.
The rest, hopefully it gives them another reason to quit.

There is human error everywhere, mistakes; I'm not advocating being punitive towards simple human error. Then there is intentional and repeated at risk behavior that must be curbed.


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## Harleyjon (Jul 12, 2017)

People who have not fallen into an addiction have no idea of what it is. It does not matter if it is titled a disease. What does matter is that choice is thrown out the window once one has succumbed to it. The point of delineation between falling into addiction and having succumbed is very grey and the time frame can vary greatly. For some people it may take years to develop a full blown addiction and for others the first involvement with the object of their desire can spiral them deep into addiction immediately. No matter the time frame once someone falls into addiction the ability to chose is lost to the sense of "this is the answer to my situation, and nothing else will work". For some people life is very difficult to bear, so difficult that the idea of something that will ease the pain by even the smallest amount is worth any and all consequences. The thought that "this might kill me" is not even in the equation or it is simply a passing thought. Anyone who thinks that an addict considers that the thing of his addiction would kill him or that something such as driving drunk is "dangerous", obviously has no understanding of addiction. There are two forms of addiction The Physical and The Mental. Physical addiction is when the body develops a need for a substance and the body experiences physiological reactions to the lack of something. This happens after some sustained period of use of some substance. Mental addiction is something altogether different however. Mental addiction is manifest as an obsession which blocks out all other thought processes. The addict can only focus on one thought "I MUST have this thing" it will fix me. There does not need to be any rational thought process behind this thinking, it is what it is. All addictive behavior begins with the mental obsession.  

The only way to arrest this "THING" is with a complete psychic change. To try to "scare" someone into stopping addictive behavior is a fools play. I have no idea for sure but I would be willing to bet a lot of money that most if not all of the contestants on that TV show Intervention are continuing their addictive behavior. No one is going to make any change in their life unless they want to. When it comes to addictive behavior, generally the only reason someone makes a decision to change is because their "fix" no longer fixes things (and has not for a very long time). An addict will chase a shadow of a dream for a long time because maybe the next time "it will work"

There is a whole lot to this subject it could (and does) fill volumes. the problem is that nobody other than an addict will ever understand it and they don't totally grasp it either.


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## Bruce Gormley (Aug 11, 2017)

I would think that knowing this, would-be 911 callers would just call EMS directly, and then what would you do. I know i'd respond.


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## GMCmedic (Aug 11, 2017)

Bruce Gormley said:


> I would think that knowing this, would-be 911 callers would just call EMS directly, and then what would you do. I know i'd respond.


Tell them to hang up and call 911. 

Sent from my SAMSUNG-SM-G920A using Tapatalk


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## Salty Fox (Aug 13, 2017)

I haven't even passed my registry yet, so I can't claim a deep insight into EMS or any sort of experience outside of the fact that I know some addicts personally, but the concept that we wouldn't treat people who needed it seems to imply a deficit of compassion antithetical to what I believe EMS is supposed to stand for.

I understand that a lot of people in this business become jaded after being exposed to the worst that humanity has to offer on a daily basis, but are we not called upon to be better than that? Denying your EMS providers a chance to help everyone they can seems like a slippery slope.


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## FirstResponder (Feb 12, 2018)

MonkeyArrow said:


> *Stop sending EMS to respond to overdose calls, Ohio councilman says*
> Some Ohio councilman wants to find a way to stop sending EMS on OD calls because the city is spending too much money on Narcan.
> 
> http://www.ajc.com/news/crime--law/...-ohio-councilman-says/7C7Ct6Bjv716ei4JmY34GL/


I'm not sure how the replies to this post have even gotten to the point where this has become a discussion... What's scary about this "discussion" is that it primarily involves EMS personnel...who are entertaining the idea that certain circumstances (or patients) shouldn't be helped. This is a conversation for people outside of EMS. Outside of healthcare. Those are the people who are supposed to be wasting their time debating over who should live or die, which problems are more important than other problems etc. Whether or not you feel certain people are a "burden to society" or if they meet your personal standard of "responsibility and accountability" has absolutely nothing to do with your responsibility- to HELP them. We can go on and on about the problems with addiction treatments, the amount of users who don't stay clean etc. We can go on and on about whether or not an addiction is a disease, and even throw in a "REAL disease" that we have to deal with in our families, and how that's "more important" than a drug addict's problems. 
Or we can choose to step aside from the ignorance and leave that to the general public. I'm shocked at the hot takes people have with the use of narcan and drug addiction in general. Not from the general population,  but from the people who they call when they dial 911. Who cares how many times you've been to the same location for the same patient? Until you come up with a solution that doesn't involve punishing people for needing help "too many times," you can keep doing your job and treat these emergencies for what they are: emergencies.


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## ChewyEMS13 (Feb 13, 2018)

What about the hard-of-seeing grandmother who takes a wrong medication, or maybe too little? Poor Grandma Eugene is lumped into the same legal category as John the Junkie shooting heroin? Because as far as I know, both scenarios are OD's?


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## Mike Hammer (Feb 13, 2018)

SandpitMedic said:


> All I am saying is that Darwinism is simple.
> 
> I have little sympathy for someone who would repeatedly go out of their way to knowingly harm themselves just because they know that at their demise someone will be there to rescue them, so that they can do the same thing again tomorrow.
> 
> ...



That's a tough stance. Complicated topic..I'm not sure if most people who aren't compromised in another way are just going out of their way to harm themselves for the fun of it. Sounds like you have some rough connection to the topic...Mostly I wanted to say I'm sorry you've had to have so much substance abuse so close in your life. That's tough stuff!


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## FirstResponder (Jun 20, 2019)

Curious to see if anyone has evolved over the past year or so in terms of their positions on this topic?
The "No More Narcan" thing is still tossed around a little too frequently. Are there still people out there who think this is comparable to cutting somebody off at the bar for being too drunk? Or is that just an ignorant few?


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## Virgil (Jun 21, 2019)

*Appleton firefighter, father of 3 is shot and killed by patient they brought back with Narcan





 *

I can understand the sentiment, but I'm too uneducated on statistics for this to form a full opinion. Also, how did they not pat him down right before or right after they administered it?


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## DesertMedic66 (Jun 22, 2019)

Virgil said:


> *Appleton firefighter, father of 3 is shot and killed by patient they brought back with Narcan
> 
> 
> 
> ...


It’s not extremely common for anyone in my area to pat down patients.


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## Virgil (Jun 22, 2019)

DesertMedic66 said:


> It’s not extremely common for anyone in my area to pat down patients.


In general, I can understand that. But in the case of an overdose, from whatever narcotic, I would have thought it would be SOP on either PD's part or EMS to pat the patient down for needles or additional narcotics. 

And if not, doesn't that exacerbate the problem? If this guy were to go shoot up his choice of drug 20 minutes later, first responders have to return and utilize more time and resources. Seems like throwing buckets of water out of a sinking ship.


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## 9D4 (Jul 2, 2019)

Virgil said:


> In general, I can understand that. But in the case of an overdose, from whatever narcotic, I would have thought it would be SOP on either PD's part or EMS to pat the patient down for needles or additional narcotics.
> 
> And if not, doesn't that exacerbate the problem? If this guy were to go shoot up his choice of drug 20 minutes later, first responders have to return and utilize more time and resources. Seems like throwing buckets of water out of a sinking ship.


In my area, SOP was a LEO would do a pat down. 
Now, I've never seen it happen, but I doubt anyone I worked with would've been cognizant enough to do that themselves if PD happened to arrive a significant amount of time after us, myself included; but I worked in Phoenix, so arguably it was a few minutes response time for either group, so it wasn't a thought that ever crossed my mind. 
I'm still curious about how many people would agree with the old line of thinking and that it's their choice. I'd like to say I can see both sides, but I definitely agree more that it is a necessary evil. 
What I'm really, really curious about is how many medics actually talk to these patients when they're cognizant enough. I'd argue for more training in the mental health department; be able to treat the physical symptoms and have some slight bit more understanding for the mentally underlaying conditions.
I'm by no means advocating that EMS should be counselors; not their pig, not their farm. We should always be patient advocates though, a better understanding of psychiatric conditions could encourage that. If we present ourselves with a giant chip on our shoulder that they're wasting our time, of course they'll pick up on that and not listen to a single word when someone encourages them to get clean; they're picking up on the fact that someone else doesn't care and just wants them to get clean to stop wasting their time. 
That being said, yes it is an epidemic, yes it uses a ton of resources. Something needs to be done to curb it, but arguably the issue with an epidemic; it's an epidemic. It's large scale, it's hard to combat. That's part of the nature of the beast.
Overall, yes there should be accountability on their end. That's not my place to figure out, though on what that entails.
If we get really into it, some places have tried force rehab after hospital admittance. I do recall seeing a story a long time ago though, that someone had a poor reaction to prescribed pain pills and she was forced into the program by the hospital psychiatrist. The alternative method of "force" that's used is the very obvious criminal charges. 
Ultimately, this isn't an easy question to answer. Medics get a chip on their shoulder that they have to go see their frequent flyer "again," a private prison group waiting in the wings to increase their population, or a forced rehab that's unfortunately has the same issue as anything else, which is human error.
Ultimately it falls down to an ethical question; resources or human life? Until the day comes when there's a massive drug policy reform, which is very much necessary, I'll answer for myself that I'd choose human life. 
Interestingly, someone brought up Portugal, which I love. Decriminalization occurred their in 2001 I believe. Overdose rates are about 3 out of 1,000,000 citizens. They treat addicts with a small fine and a mental health referral. 
Excerpt from an article in regards to it;
"Portugal decriminalised the use of all drugs in 2001. Weed, cocaine, heroin, you name it — Portugal decided to treat possession and use of small quantities of these drugs as a public health issue, not a criminal one. The drugs were still illegal, of course. But now getting caught with them meant a small fine and maybe a referral to a treatment program — not jail time and a criminal record.
Among Portuguese adults, there are 3 drug overdose deaths for every 1,000,000 citizens. Comparable numbers in other countries range from 10.2 per million in the Netherlands to 44.6 per million in the UK, all the way up to 126.8 per million in Estonia. The EU average is 17.3 per million."
Link to articles I mentioned 
Forced rehab:








						New Laws Force Drug Users Into Rehab Against Their Will
					

Involuntary commitment laws are being opened up to allow some people to be detained for overdosing or even having visible track marks—in some cases up to 90 days.



					www.thedailybeast.com
				



Portugal rates:








						The EU country where drugs are decriminalised – and hardly anyone dies of an overdose
					

The country has 3 overdose deaths per million citizens, compared to the EU average of 17.3




					www.google.com


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