Hot Take?

Remi

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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.

Drug abuse is not a medical condition akin to cancer or heart diesease.
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 That line of thinking used to be widely held but is now outdated.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.
 

VentMonkey

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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.
 

SandpitMedic

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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.
 

SandpitMedic

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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.
 

VentMonkey

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

Remi

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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

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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

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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

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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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Correct! By choice. Not because they are diseased.
 

VFlutter

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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.
 

SandpitMedic

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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.
 

Remi

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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

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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.
 

Remi

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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.

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?

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.
 

SandpitMedic

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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.
 

SandpitMedic

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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.
 

DrParasite

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

SandpitMedic

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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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