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The opioid debate: could reversing overdoses worsen the epidemic?

2018-03-20

An economics working paper finds that access to Naloxone, a drug to reverse opioid overdoses, may increase opioid abuse. Sarah and Ezra explain the paper that started a social media firestorm — and what it means for combating the opioid epidemic. References: Doleac and Mukherjee working paper A good summary of the debate from The Atlantic Health Affairs blog post  Working paper from Daniel Rees People are dying because we misunderstand how those with addiction think A lifesaving drug for overdoses doesn’t reduce opioid deaths? Be skeptical Trump’s opioid crisis plan: more death penalty, fewer prescriptions, more treatment

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
I guess I should actually make in front of me. Well I'm ready when nobody else ready, ten, also ready. low and we do not observe the weeds unlocks media costs network. I am as refine I'm here with Sarah clear. I am not here with magic. Laziness isn't askance and care where he is he's. Not here, That's what matters to me to be anywhere, but he's not here, but we are here and or really excited about this episode. We, sir I've, been working a lot on this episode over the past couple of days. We want to dive into this debate on the locks own, which is a treatment for opiate abuse and end. There's been a big paper on it and it has split the public of community split the drug treatment community split the twitter sphere.
It is the most raging debate on a working paper. I've seen in a wider war is raging in the weeds is here to make sense of it. Also, Sarah, can you make some of it all. I can try I think I can do it, so I think, before jumping into the paper, it's hopeful just to set some context around the size of the problem are dealing with why the locks on matters by access to the locks on matters is because the A epidemic is really really bad right. Now there were nearly sixty four thousand people who died of drug overdoses and twenty. Sixteen of these two If those were linked to opium aids in some way anything from prescription painkillers to heroin, defend in all deed, we'll drug overdose, deaths were higher than deaths, links to guns, car crashes or even HIV Aids during the height of the epidemic, so weird
about a really massive public health crisis and the CDC does not think this is getting better. Some preliminary data from twenty seventeen suggest last year was even worse. So what The things you ve seen states doing is true: to pass laws that address the operator. Denmark and one They're doing is trying to expand access to lock zone a drug that has become increasing available to reverse the effects of an opium eight overdose. This is something administered and pretty easy to administer either nasal years. An injection that It can essentially start started withdrawal process from what I understand. It's pretty uncomfortable to take no auctioned off, which is off document fevers, chills, sweating vomiting, but it's better than die. you know it saves your. It saves your life and so what we ve seen over the past few years is growing access to.
lock sown in every state to some level liberalizing there. No oxen laws is starting with letting first responders carrying it moving underlies em, something like a standing order were. Essentially, you have a public, the fish provide a prescription to everybody in their community for Num Lock. So if I go into the pharmacy, I don't need to go, Doktor first, they can just give it to me. They did this in Baltimore, whose inches interest Galeano. When the health commissioner, there is a huge advocate for the locks access former as recline, show just how so there you look at them and you also to see another popular type of law immunity for people who are prescribing or administering the drug, so if you know what happened to have zone, but also are carrying some kind of illicit drug, the to make sure you use that unlocked zone. If you see someone else, thing they don't want you to be, wary of using at bringing that person into an emergency room, and this for bystanders that I cannot get in trouble
delivering not remarks on to someone and harming them in some way. The idea is, I was trying to be a good Samaritan too. There's a wide range of these laws paper we want to talk about today essentially looks at what effect these laws of had. It comes from economists Jennifer Dolly ACT at the University of Virginia. I needed Could at the University of Wisconsin and they to see what this is doing. So they go through, through a whole amount of data. Looking at possession, Gobio, AIDS, crime, data, arrest, tummy, Debar, dying from periods. How many people are going to emergency room for opium, related incidents, and the findings that have been most controversial from this paper are that first, there to me that there has been an increase in opium deaths in the Midwest, that they a tribute to the expanding the locks on laws and second, There has been an increase in monthly or best for opiate sales about in point nine per million people. So the theory that
he's too economists come up with the part of his paper that has been so controversial. Is they make an argument that a dry like the lock sound, it creates a level of moral hazard that it makes it look costly and less dangerous for someone to use opium because you have this drug that can essentially reverse the effects. So the make this argument- and they argue that the data that they present in this paper shows that in the locks on may be having the unintended consequence of increasing obviate abuse that we want to use this as a way to tempt down and be weighed obesity. We want to use this as a way to tempt the opium aid crisis that again like no oxen could, even though everyone is implementing these laws with the best of intentions, could actually make it less costly for people to use Obiang AIDS to move on to more deadly oboloi like Fenton all because they know that there is this back
option and that they will have no oxen as a way to get out of an overdose. No, this is not widely accepted. This is exactly where the controversy is, I'm summarizing their argument, but they look at things. increasing arrests and increase in opium related emergency room visits, and I will say there is not. In national increase in mortality. They do not show opium deaths going up nationwide, but they do fine increase in opioid related deaths in the Midwest specifically, and we can talk about why they think that particular finding is happening in that particular place They essentially put out this finding that has been very controversial in the public health world that it is possible that these new locks on liberalization laws that they could have some harmful effects on the people that they are trying to help. So a couple things here so number one- and I think, is important- put this paper in the broader context. This a stunningly counter intuitive finding- or at least I must
when a car counter intuitive, because in some ways that actually isn't you have, but it is a finding that goes against the grain. It is not what previous research on the locks zone has found, which is what we will talk about. Ants, oh, it is attracted a huge amount of attention when there is a previous paper, the came out and found what a lot of people expected to find on the locks on liberalization laws, which is they save lives. Nobody talk about it at all. Like K, we did do we'd segment on it. There is a real interest in journalism in the media in the public health community in all these communities when he finds out surprising you get a lot of coverage. They wrote the paper controversial way. They talk about it and, I think, probably one of his worst moments. They talked about there being the locks and parties where people get together and take a bunch of opioids have, in the L'Occitane hand they source of that to some state legislators somewhere and if you ever studied any drug prices ever like, don't
things to shit, state legislators have hurried anything. That's like my own internet. Have I had a daughter is wrong, empirical strategy, but something I want to say about this paper will go, will go through it because I think we're going to structure this episode for We want to make sure you really we really stand what is in the paper, then I think we can talk about the criticisms of it and then Sir, the zoo mounted to the broader issues here, but I do want to read their conclusion. Because, as disruptive some of their findings are their conclusion itself. is almost been all and has gotten I've big, somewhat less coverage, so they write are fine, we do not necessarily imply that we should stop making no oxen available to individuals suffering from populated action or those who are risking overdose. They do imply the public health can be he should acknowledge and prepare for. The behavioral effects we find here are results. Show broad dioxin access may be limited in its ability to reducing epidemics death toll because it not Is it not address the root causes of addiction, but it may exacerbate them. Looking
Words are result suggests that milk, since effects may depend on the availability of local drug treatment when Tribune is available to people who need help overcoming their addiction. Broad, no oxen access is more beneficial and its effects increasing act. to drug treatment than might be unnecessary, complimentary, no oxen access in curbing the opulent overdose epidemic. Now, if you had can me aside before any this came out. and you said, Ashraf is a drug that takes People who have overdosed and are about to die and makes us if they don't die enough to stop the hope. an epidemic nazi that stupid if you said well if we're gonna roll out that job should be also be rolling out a comprehensive drug treatment prodigy, I would say, of course that is common sense, and so that is the conclusion of this paper and so for all the controversy over some of the industry findings, and I do think the controversy has called into question some of the findings and in a serious way. I actually think that,
the papers, authors and the people who they are in a dispute with largely agree on where things should go, which is one we should not outlaw no oxygen but to date in order to something is complex and difficult. As the opulent epidemic, you need a comprehensive treated strategy. Look if you are looking at heart disease, You said well when people having a cardiac event. We can do and emergency bypass and said to me what gonna happen. If the only thing we were allowed is free, cardiac emergency bypasses all across the country with nothing else and I would say well, you're not going to fix the heart disease problem you're, going to keep some people from dying during acute event, but they're going to die later from heart disease. I mean you need to help them with their. I had an and and and their health and their exercise, and knowing that the signals are when you go to a doctor and all kinds of different things that are important for people who are suffering from from this kind of element and I just want
that also the conclusion here. So this allow to begin to hear, but but also in some ways when it turned down the temperature on the debate, because I think those in point here that is more consensus oriented than one the writing in the rest of the paper would imply, and certainly the reception to the paper would imply a fix. It actually goes to one of the findings that has been the most controversial as this idea that opium aid that just in a war zone could increase opiate related mortality, which is a finding that they don't see nationally, but they do see in the MID West and then one of the other things they explore a little bit in the paper is ability of treatment and they buy, in the Midwest it as some of the lowest per capita opium treatment options, so that kind of backs up their argument that
Increasing knowledge zone. Access on its own is not going to be the thing that solves that if you look at a place like the Midwest, which appears to have very few treatment options that you'd think about what happens to someone who use num lock sown in that, in that area. I think one of the things our colleague Carmen is written about pre astutely as that addiction. The disease and it is very foolish to expect someone who uses no luck, sound to you know, come back from an overdose, spend a few days in a hospital and be cured as an opium, eight attic. That is not how the drug works it treats in it Situation does not treat an addiction, but I think what makes no sense and maybe a kick it you Azra. this kind of walk through like what is actually happening paper, because I think a lot of the debate that has been happening that can be a bit confusing to follow is really in the methods of the paper in the data, how they prove what they say they are proven. I think it's worth and you have some notes ready on this kind of walking through
what exactly it is. What data studying and how that gets them to the conclusions that they get to yet so the main thing they're doing is they're doing what economists do, which is trying to take advantage of what they would call natural experiment. Different states are rolling out. These now accept laws a different moments, and so they are trying to look at the immediate aftermath of these laws and see what happens- the state now one big criticism of the paper is They are rolling together. Three kinds of laws were kind of law, provides legal immunity to prescribers of dollar zone, which there's not end. evidence of anybody has ever been to my knowledge, prosecuted prescribing now extends its clear. Why that would have a big effect on anything. Another is proof adding legal immunity to lay persons who administer Alex on another is allowing third party prescriptions for now, Exxon right, like in Baltimore, I can go in and get a prescription for now it sounded than I can use vices
many o deed on a street corner, so that their main treatment variable day The estate rod some kind of law, any kind of law that in any way, can be seen increasing access or cultural permission to use now. Exam they also assume that these laws, once rolled out, have an immediate impact, which is not how laws like this tend to work. That's another big piece of criticism that will we'll get toolbar later so that they be trying to look at what is a cultural affected these laws and ensures four things on a single dicey. So they say that using data On Google searches, we find that no oxen access laws, increased internet searches from the locks him by seven percent. They then find that after the access law takes effect, grew Google. It for drug rehab, which is a proxy for interested drug treatment, fell by one point. Four percent. Now, in a note, something here that we point four percent is in streamline small change, they say it
is small but marginally significant to it does not have a p value of point of five, which is normally what you're looking at its peak value of a little bit better than point one. So one it is not a strong effect. It is small both in its total size and in whether we are statistically sure whether it even happened two. There are a lot of possible reasons, something like that can happen, particularly due to the fact that small, they, then save lock the door action of the change is consistent with our policies that now and access reduces opiate abusers interest in treatment for their addiction. I do not know, a statement like that is honest, justified by the level of France were seeing there and how indirect the measurement tool is So that's the kind of thing where this paper that gets into some trouble. They also say the. In the aftermath of these laws, you get a arrest for possession and sales of opiates increased by seventeen percent and twenty seven percent opiate related visited
emergency room increase by fifteen percent opium belated theft increase by thirty percent. They also find that places with fewer drug treatment, facilities per capita experience, bigger increases in mortality, broadened now extend access, alternate easier access for treatment is associated. More beneficial policy affects service going on in this paper. But basically what they're doing is are taken. This treatment variable did the state liberalize. It's now accept laws there then looking at some stuff, some of which seems directly related like what been two mortality from opiates, which we more SK measure and some of which is very like third order, but what happened to people searching drug rehab and then they use to draw some pre big conclusions, not just about what is dollar zone doing directly, but how the changing the culture how's, it peut changing people's interest in getting rid of their addiction or treating their addiction, Hausa, changing their propensity to do crime on one thing on the couch,
I'm that I do think is notable is that they do find an increase in opium related crimes. But then they do something else that I think is important, which is they say. Well, look if you're thinking about because it could be that with now excel in all of a sudden people are getting picked up. They are getting brought back life, somebody notices a stall and always in its very clear that the theft is related to opium crime. So they say the policy The question is whether the total amount of crime increases and this it look. This is hard to estimate but problem but maybe not so they find a point eight coefficient, which I want to get into what that means, but they on a very, very, very small possible. Increasing crime, but it is not significant overall, so they say this.
the costs of knowledge, so laws in terms of additional property crime are small. Again. I think, you're reading the big picture of this paper, you would think. Oh, it has huge effect on crime and then you read into the details and they say well, actually, crime doesn't really go up. A crime that were classifying opium, related crime may be does, and then people say well, maybe that's because the laws are leading to an increase in classification of crimes that were otherwise opiate related, but people know that before and that the papers has a lot of stuff like that in it. I think reading this, that there is a lot to be said for the over Why do you have this paper, which is it if you just give people Malik's own? It's not going to make them better. It's going to stop them from dying, that's what that drug. I I think some of the other stuff is not is firmly grounded, but I also think that the that there is a kind of like, but but
Macao and would call mood affiliation. This paper feels like it is against treatment to even I think it isn't, and so it has been very upsetting to people, I think from the people who written about it. I think there is a sorry class of writer who likes embracing hard policy truths and is a very quick to go. What's it like, we'll see, ok, doesn't help anybody Melick Zone, you Know- and this is one obviously often aren't true- but to it then create a debate. Is more controversial and dogmatic, and black and white in the underlying research itself actually is- and I think that happened here- that's it that's my my overall take on the paper yeah. I think one of them's it's going on in this paper is that it's coming to a controversial finding through some methods that are decently easy to quibble. This is the most have ever seen,
Journalists, like twitters academics, digging into the methods of a paper looking at all the medicate organ wars that, without and whatever, but even that there's a personal. It was less personal. It felt less I remember the Oregon Reno Medicaid wars of the: u know Baker era and it felt less personal Dan, also the papers more mixed, the paper, was more mixed, stand genome. So that's that's an episode for another day, but I think one of things that's going on with the Google search data with the arrest data is that this is a but that left itself somewhat vulnerable to some pretty strong critiques and by taking that data in coming to some very strong conclusions. You, even though I think at the end, like you said they get wretched, ed down a little better. I think its thinking
see like the public health reaction, that the big fear- and I do understand this- that you are going to see legislators and conservative states. Look at this and say you don't worry, we'll see like. Why are we? Why are we doing these laws? You know we should limit access to knowledge zone. I don't think that's the right way to read this paper, but I think it is written in a way that would make it easy to justify those. Do you wanna, take a break and then get into these criticisms? Yes,
I gotta admit that I have advertise and strange things across my time and by gusting some things that you didn't seem to me to be highly related to the UN's for abolishing by gas but we're. Nevertheless, I hope he bought them. I hope you are probably got but great courses which has been a supporter of the show from the beginning. It is right in our sweet spot. The great courses is a service to sign up to get access to nine thousand video lectures. You can watch em on tablet on your smartphone on your computer can listen to him. Anything you want to do any can learn about anything I mean if you want to learn real skills. I cooking and photography can do that. If you want to learn about economics and law in psychology and social psychology and politics, and in all the things we talk about on the show, you can do that you can do in of one to another. I mean it is a way to do the kind of learning that, hopefully we're hoping you do on the show, but directed by you. It doesn't have to be what were interested in that we can do what you're interested in that day. That moment that our particular course that I think the way to something we wish we are covering a little bit more on the weeds, but putting your would be fascinated by is thinking about cyber security from cybercrime. Disorder warfare is a service. Glittery expert toddlers like he's exploring big data. Digital ass, be knowledge. The tools we can use to protect ourselves from cyber crime if you're following the noose right now, you know that service currency and several warfare are driving it, and this is only going to be more true in the coming years. To should sign of the great crisis plus check out this course and beat primed on it and and and ready to understand it on a theory level on a conceptual level as we go into these stories coming up, I know you're gonna love the great courses plus, and even if you don't, you just need to give it a try. There's no risk here at all. They are giving listeners of the weeds special free month of limited access to all their lectures, but only if you sign up through our special rules, that is the great courses plus the calm, such reason against the great courses pasta, com century to get a three month. They don't like it. You cancel but you're gonna like you, gotta keep on that is at the great courses, pasta, com, such rates.
So now that we ve gone through the paper itself in its methods and its finding. It makes it to turn to kind of the controversy in the firestorm that it has turned. But I think I kind of divided into two buckets in my head, One is a criticism of the the methods that they use their research tack, x and whether those are valid and another is of the conclusion that they draw, and I think there are intertwined and that you can attack the conclusion by attacking the methods so by thinking. It helps me over to think through those separately actually, as summary, gets at some of the quota, of the methods that its there's a lot of space for confounding variables for things that could affect the outcomes. One of the things that there's a great blog posts turn on health affairs, that kind of runs through some of things. One thing the tapping in the background, for example, is medicate. Expansion in some of these states are expanding,
a case at the same time, which is a huge confounding variable, given that Medicaid expansion is going to get a lot more people covered is going to likely increase access to knowledge sound in a way that will pretty significant to his own. Brings people to be. Are it brings people onto the emergency room? So you can question, you know. Is this increase an emergency room relate Ed opium, that is that, due to more people using operators and more people having insurance and being able to go to the emergency room, their thing. That's a little bit hard to sets out that we have had a great peace at vocs from someone who works well with a lot of opium attics that people who are using the locks oranges may become more connected to them care system that an Greece in opium aid related emergency room visits, doesn't necessarily mean. It certainly means more. People are seeking treatment for overdose and addiction. It does. more people are getting addicted and more people are overdosing. It's just that they are finding their way.
Into the emergency room if there is more and locks on use? One of the instructions, as often given is to go to the e after no oxen because you're going be going through these terrible withdrawal systems that we need better managed in a professional healthcare setting. So I think there is doubt some questions about the emergency room findings and if they indicate what the authors think that they and I think that's a big wine- that I've been a low bits. To call about that particular part of the paper. So one thing about this health affairs: peace is its by Richard Frank, Keith, Humphreys and friend, of the pod, Harold Pollack, and these are the boy asked drugs and crime researchers out there thank you see in their peace is just a much more sophisticated understanding of the drug and crime and policy response context going on. So here too, I want to quote whether actual that their full on conclusion is. We believe the bed preparation of delay and bogus findings is our main treatment. Variable now accept laws thus far
had little impact on Alex own use or non medical opiate used during the period study. This disappointing pattern commands attention and follow from both public health practitioners in public health researchers we find powerful. since for scepticism regarding a strong claims. It now it's almost created offsetting, and the feeding, moral hazard effects. We therefore believe the papers, title and main argument overstepped. The empirical results. What they are doing. Is they take aim at like the foundation of the paper like what Dolly Cambodia are studying is how these laws changed. Everything what they're saying? What what what frank companies and polychrome saying is these us probably didn't change anything
these are weak that a bunch of started in twenty fifteen they're, not gonna, move that fast that in some of the cases we know that the law was passed and like the West Virginia sheriffs for refusing even carried Alex onto the idea that there's got to be some huge effect from that is very, very, very unlikely that a bunch of these laws were too small to be expected to have any impact again, some his immunity stuff, while people are immune in practice, for nobody was getting prosecuted, for this is not a reason to think that would change anything. The idea that Google results for Alexandre changing over this time. We are pass a law- people- google it. Seven percent off of a low base of googling Alex on anyway, is not that huge. one hand they say the actual thing that original paper saying is mixed, Michael an undeniable all else: equal any life, saving intervention for opioid users won't crease the number of living opioid users, just a reviving people after heart attacks increases the number of people with heart disease, but they just look at the basic
the other. These laws are such a big deal and they say: there's no. And I believe that in studying these laws, which these three people do that, that's not how these laws work, that jeez also aren't nearly as big as the authors of the original paper think they are, and that aside all of these conclusions, almost whether their right or wrong, they can't possibly follow from the analysis again. I found myself in a little bit of a weird middle ground on this paper, because I find the criticisms of it very persuasive, and this A kind of side debate about you know was the debate on twitter who personal I should have looked at some of those that oh, these people don't use the twitter, I? U rising, aren't we like my hair yelling everything- oh my god, people getting so personal on Twitter as a yes
Yes, they are taking a look. It has just vendetta. Come look like all the people for their shopping. My head, going into an audience like don't tell me about our personal twitter gets a one. There's been this kind aside. Debate are worthy people being jerks about the paper on Twitter, which definitely some people are being, and I think, like the public health community, is how this moment of reckoning be like. We have this nice little toward her community over a year and all of a sudden, all you assholes or in it, and I'm not comfortable that at all. But in a in a broader sense, I think that the papers point that bringing people back from death within Alex OWN is not going to treat their underlying opiate addiction is not Prague and to treat underlying opiate mortality over a time period because people, if they keep using a than Alex and hissing going to be there and that there could be some positive people, smartly, which is what the supposed to be doing, keep out so near by when they're using opiates, I mean shore, in some kind of, as the others here put it mechanical way. That is how something
This works, but the the big picture interpretation being in a late rest on these laws. This does I feel the me like economy, like a couple of economists, went out. They found the kind of thing that economists really love finding, which is a natural experiment, and then because they found that they over read what the experiment was telling them. They they wanted the laws to do more work than those laws could do for them, as well as an expert try variable again. I want to know that there is another paper here that uses somewhat different than not, I think, incredibly different methodologies and finds the opposite conclusion, which is it it somewhat ready mortality, be no over time period by bringing people back, and you know that the data I don't feel so sure footed adjudicating the debate between them two papers by it. It's me more confident in the Frank, Humphreys Pollack argument, which is that, if what you're doing looking at these laws and depending on how you read the
aftermath coming to somewhat different conclusions about them. It makes me a little bit skeptical the laws. Are this primary variable? Cuz, we're basically doing is looking at different ways of trying to control for the other variables for such a powerful instrument that they're getting you to this to this big place, yet so that you actually brought sums did on the papers. Are those enjoyment or look at as a contract. So this was a papers from Daniel Reese at the University of Colorado. Those published just about a year ago, in February. Twenty seventeen also as a work paper which has become another huge, citing oh yeah. I have to say that we do a lot of work in progress on the weeds. I think there is a big difference between public health academia, where you would not really something towards peer reviewed verses, economics, academia, our releasing working papers as a normal practice,
That is also got caught up into this anyway hours like have out at all, but this is urgent vapours, robbery body, and this is of course, and envy are working paper this Daniel Reese. When one thing I liked about the methods of is that there are looking a particular types of laws so in the Dolly ACT, Mukherjee Paper were kind of grouping them altogether. This one gets a little more specific said, fly zone access laws and a good samaritan law. So the good samaritan law essentially protect someone's from any sort of prosecution if they distribute. Sound and the locks on access laws are ones that are trying to make it more readily available at pharmacies their findings are you said: SARA are pretty to the opposite. They don't get into crime in the sort of things they are just looking at mortality rate data they find it. adoption of Access laws is associated with a nine eleven percent reduction, opium deaths and the
estimated Ed effect of the good samaritan laws is comparable, but I'm going to get into the methodologies it's less statistically significant, and they do find an increased use of recreational proscription painkillers so in one of the things I do see because they are able to trace these over years? Is that the effects of do get stronger over? time in that kind of make into a deadly right that the more people know about these laws. The boar people realise that, oh, I saw someone else use no oxide on a friend and they were fine, like I'd. Be ok doing that on my friend. What everything and that health affairs blog posts you're reading from Azra, and I think the thing that I've kind of been frustrated to see some of the criticism wave is the grievance to that, if we have treatments like Num, lock, sound will likely. have more opiate at alive, live and United States, and that's that's fine. That's Good outcome of your keeping. These people
alive. That is better than having you know the number that the CDC reports you know sixty four thousand in twenty sixteen go up to seventy thousand up to eighty thousand, I That is a unit. framed essay negative of knock sound in some ways in this paper, but I don't think that's necessarily a word finding the worrying binding as what happens to those people going to be a cycle of knowledge zone, use in overdose and continuing through that. or is there going to be a treatment option for those people which is kind of where this paper land but I've seen some of the criticisms seemed like brush this aside and try and say you know it's dangerous to put our research like this, because people are going to tempt down on the locks. Access and it's going to be bad for opium? Eighty users I knew I could see this Reese paper, the one I was just summarizing having very similar, similar facts. You know if they were to measure the amount
Oh boy, abuse could see. You know increases in that space in that wouldn't really surprised me either kind of an interesting questionable. What is what is the goal of increasing the locks on access, and if your goal is saving lives. we need to do it in a way that the authors of this paper are talking about in conjunction with some kind of treatment, and yet this is too weirdness to this whole discussion. So I think the way too, ask yourself is no locks on working is to say when somebody is dying from an overdose and you administered deluxe sown do they die and the answer is no. And so then you ask yourself Reno cause now: here's broader policy question, but the opiate epidemic long term are opium users dying and high numbers, and the answer is yes and so, well, that's not a num, lock zone problem that's like everything going on probably know oxen is like a treatment for it.
Somebody is overdosing right now. It is not a treatment for the opiate epidemic adjust isn't There is a another piece that to me has been actually despite coming up before. I believe this paper dead, the most helpful peace for me in this, but all this and it was published at a website- boxed outcome heard that heard of it, but it's by Philosopher Brendan diplomacy. You could search philosophy. VOX Opiate addiction, but I could be something like people die. And because we have the wrong theory of addiction and what he goes through. as somebody with a real training in philosophy of the mind is we have gone way way way way way back to Socrates. This idea that the to understand. Somebody's preferences is to understand the actions they undertake the way, understand what somebody wants to see what they actually do. End
in modern times. We have an overwhelming amount of empirical evidence. That's not true! This idea. You know you're revealed preference, which preference, which is two to use. Papa. He uses that a father took Opie. I'd say to father: elected heroin into the picking his children from school that that represents his true self is bullshit vet does kinds of biochemical things going on, and that we do a lot of things that we wish. We didn't do it. He writes we are in the grip of a simple but misleading answer toward the oldest questions of philosophy? Do people always do what they think is best? In other words, your actions reflect our police and values. When some of the diction chooses to take drugs, does it show that what she truly cares about is taking drugs or might someday be more complicated? It's actually go non and the reason this matter is. Is it if you have the theory of the mind, if you have a theory that people are doing reflects a girl, like a semi Ellie, Stephen, a semi, rational process of what to do. That's where you get into these idea
that moral hazard and rock bottom by again going back to Kennedy Rights, consider the popular idea. that summit with addiction has hit rock bottom before she could begin to recovery, if addiction is due to a failure to appreciate the bad consequences, getting high then sure the best route recovery might be for the person to experienced first hand how bad those consequences really are you take that idea than in the long run the way to save attics in themselves as to make it harder not easier to pursue the lifestyle they so clearly prefer. I think understanding that is it we're. Having puts into a different belief what the debate about this paper really is because if the idea is that People are making a decision like a somewhat logical decision, based on a weighting of the benefits and consequences well no now zone, so you can't be brought back. If you overdose, maybe I don't want to die, and that makes you less likely overdose like. That is a moral hazard theory of this, but that does not help work again and put on paper
the University of Michigan neuroscientist can bear. It calls the wanting system which regulates are cravings for things like food and said and drugs using signals based on dopamine has powerful control over behaviour. Its cravings are insensitive to long term consequences, and the research indicates that addictive drugs can hijack the wanting system, manipulate help me directly general cravings that are far stronger, particularly people with a biological predilection to addiction than the rest of us experience desire for heroin, wins out, that does mean a father. Doesn't care does mean care more about getting high? Did he cares about his children? It means at the rational side of him lost. The struggle has behaviors being controlled by another part of his mind, and that to me is the thing here: Herman has written about how the central, after years of covering drugs, he says, the single biggest, he's in America's failing in its response to the appeal to the epidemic is the stigma around addiction. The belief that addiction is a moral failing on the part of of the attic. and when you believe that, then what you begin
about doing, is ratcheting up the consequences higher and higher and higher and higher and higher, and we have just seen time and time again that it doesn't work. That means consequences in these people's eyes are already beyond all, for their whole. Life is regulated by trying to get in there These cases operates at this point, not even to feel good. Just a fuel normal just do not have withdrawn by the weight withdrawal that now its own puts you into one of the weird things about this whole thing, which I got it by reading the conclusion regional papers it if you listen to people talk about the policies as well as an argument here. Nobody thinks we should have drug treatment, but the reason I think this has aroused so much upset is that in truth, American drug policy, american thinking and an intrinsic most people just generally there, like always
I'm a knife said it is work to remember. Addiction is a disease, it is work to remember. The people who are addicted do not want to be doing the things they are doing. It has worked, remember that at a certain point, like people who are like you and me not advocate on that, if you and I it is possible- I don't know I transmitters alike, if exposed to opulence really. But it is possible that a week it fall into this and not be able to get scout and there were always on a knife's edge of falling back into that view and that the that the Daleks on debate will will kind of push us back that right. It just shows what look you give way to come back from the dead after an overdose, and they do it more, and I think that if you take the right theory of mind here and also, if you take the correct interpretation of every paper and every piece we have talked about it just says: addiction is really high and you need a really comprehensive, multi dimensional strategy to deal with that. That takes very
seriously both people probably gonna use and that to get them out of using is gonna, be a dick gold, trial and error. Halting too Epps forward three steps back four steps forward, two steps back process and that, like you, just have to be ready for right in a weird wade's at one of the worries at this, paper raises idea that you might take away some kind of like stigma from knowledge so that no oxen shouldn't be the thing just rely on and again like. I think there isn't it the great evidence that people are going to know hucks zone parties but is essentially suggest one of the bad things that can happen around the lock sound. Is that the will to see it as our bring this I'll, be it up some party involving heroin in the locks and we'll be there, and that will make the safe situation, I think the stigma. That is much more worrying to me as the stigma that still exists around treatment for opiate addiction,
Last summer I was doing some reporting in a city in West Virginia that has been super super hard hit by the opium epidemic and talking to a guy there, who you know essentially lost his job because he was using methadone. He was trying to come off of an opium aid addiction. Get a prescription for methadone His employers basically said well, we can't have a Matthews are being working here and It was. What are you? What are you gonna do with that like loser, livelihood or continue to seek treatment. You know he decided to stick with the treatment but though there are situations that people are facing. the energy and like the I would be two more worried about in around those sorts of treatment still being quite strong, then some kind of Sigma against the lock zone decreasing, because I think we're talking about actually getting we're having recovered opiate attics, like that is the one that is going
stand stand in the way of getting their yeah and look. I think you see it and our president is what one to me great ironies and sadness is of our policy age. Is that. you have this whole discourse about her Donald Trump God elected because of this matter despair in white working class communities at a ravaged by opium way to an end, they were demanding to be noticed and then they needed help, and so they they went for the guy. Who's can be just a wrecking ball on system and whether not that's true That is a true account of why people voted for Donald Trump. The fact of the matter is Donald Trump has not spent fifteen fucking minutes trend understand the acute crisis when he talks about it. He talks about it in a completely ridiculous way. Hillary Clinton for her part from very early on in the campaign had decided. This was a real problem, had really thought about. It had gathered extremely good experts hunted had come out the detailed plan on it, but instead of how
that we have justice these absurdities from tromp. So he should come out with a new plan to combat the opulent epidemic which, but her mom Lopez, describes as more punishment fear prescriptions more treatment. He says a plan can be broken down into three parts: a slew of law enforcement, focused policies aiming to increase penalties for drug dealing and trafficking, including mandatory minimums and, in some cases, the death penalty. The white ass, his else, taking steps to cut back on opiate prescriptions, hoping to be sent by as much as a third and then their vague promises. On creeping access to addiction, treatment and adopting harm reduction approaches. I dont think you need to spend a huge amount of time looking at the history of drug pulse in America to say that just continuously trying to crack down drug dealers is not done the trick, and nor do I think that you have to spend a lot. I am wondering why is it the doll chumps him so uninterested in how to increase access tradition, treatment had adieu? Do addiction treatment have funded Dixon treatment,
suppose, being very interested and talking off the cuff, a of how great a b to execute drug dealers right he's got like a real crime, it punishment intuition. He has a view of how this works. It is, I think, like its quasi medieval and let us not get anywhere on it, we're not getting a we're on it, because people power not taking it seriously and the way they don't have a strong model of of what's going on here, aren't they that middle prong also isn't that's already happening, and it really isn't a government wine as much like the air may and, like you see a huge decline in opium prescriptions all already before the government intervenes, but that's not the, albeit epidemic is anymore. You know it's more moving towards heroin in front and all and other and this is one of these things where it would be nice if what was happening in the government's opiate response is we were funding huge, lots of research into what works? Here? We were having discussions about what is the sweet of
policy decisions and policy approaches in which an networks should be embedded right. Sure, liberal, is now its laws. But what else? How do we do it? All? How do we have a comprehensive policy? I think you want to see this done in an interesting and strong way should search a piece from on Lopez did on for months approach. The opulent epidemic, we'll put it in, show notes, but you could do it right. You could do you you can take this seriously and you can try to cop of conference of responses which, either then, because this is hard or only can be somewhat successful, but we're not doing it or not. You know we have these papers. People are arguing over them, but but they're not. I mean by. I just do wanna at the very least, This imagine that at the very top levels of the american government at the places where we need this to be to be taken seriously as a sort of off and strange as a debate over these different papers has been really those release. A real debate over over what to do, whereas at the
of the american government for all the talk about it. There is a Chris Christie, Opium Commission, just nothing of real value is happening there, not they're, not appropriating nearly enough money, they're not bring in the best research and best science and best theory of how addiction works and were not making a lot of progress I think there is actually a lot more agreement on how hard this is and that you need comprehensive treatment plans, and you know that's true in that. Paper saying Alex Zone, it is a moral hazard to the paper saying it isn't it's true in response to the paper and at the top levels of the american government, it is just not the case that the the level of interest seems to be in creating comprehensive treatment and harm reduction strategies
that's the weeds, though he is thank you to all of you for being here for listening, does talk about appears likely to set clear, of course, tell us to pleasure. Thank you. Our producers, Griffin, Tanner and Bridget Armstrong. The weeds we'll be back on Friday,.
Transcript generated on 2021-09-12.