To fight opioid epidemic, treat drug use with compassion, not judgment – USA TODAY

If news is what happens to editors, I suppose that scholarship is what happens to professors. At least, that was the case for me.
As a researcher at the Johns Hopkins Berman Institute of Bioethics, I didn’t start thinking about America’s problems with pain and drugs through dispassionate research. I got there thanks to a motorcycle accident, after which I was given lots of prescription opioids and then left to my own devices.
The result was that I formed a profound dependence on the drug, and then went through the agony of withdrawal as I tried — with no help from my doctors — to get off the meds.
That experience gave me a new perspective on the risks and benefits of prescription opioids, as well as a deep desire to help the millions of Americans who are suffering from addiction (and to prevent some of the tens of thousands of overdose deaths each year).
Schumer & Cotton: Our bipartisan ‘Fentanyl Sanctions Act’ targets traffickers like China
I’ve since turned my intellectual and professional energy toward thinking about America’s drug overdose epidemic. That has taken me far from my initial experience of withdrawal management, eventually leading me to what many people find a rather uncomfortable conclusion.
We often hear that we know what we should do regarding the opioid epidemic; we simply aren’t doing it. But we’re only sometimes right about this, and it’s often much harder than we think.
For instance: If you’ve been reading the news for the past five years, you might think that doctors are the problem, and that they simply need to stop prescribing so many pills. But this response is too ham-fisted, and risks harming pain patients. It also won’t solve the drug overdose epidemic, which has transitioned to a crisis driven largely by heroin and illicit fentanyl.
It’s also regularly said that we need to massively scale up addiction treatment. True enough, as only about 10% of those with substance use disorder get specialty treatment. But it also hides some nuance, as the fact remains that not everyone with an addiction is ready to seek treatment.
Thus, policy that focuses only on the supply of opioids and on capacity for treatment leaves out something important: Some people are and will become addicted despite their best efforts, and they are at risk of dying until we can help them recover. This means we need more. We need to keep people struggling with an addiction alive until they are willing to enter recovery. We need harm reduction.
Many of the harms of drug use can be mitigated or avoided entirely if a society is willing to put resources and effort into doing so. Needle exchange programs can reduce the disease burden for people who use drugs. And the drug naloxone can reverse opioid overdoses, saving lives.
More radically: Safe injection sites provide a physical space for people to use drugs, offering a respite from the street, sterile equipment, contact with health care and recovery services, and naloxone on hand in case of overdose. In more than a hundred such sites around the world, not a single fatal overdose has been recorded.
All of these strategies save lives and reduce harm from drug use. Yet many Americans reject some, if not all, of them. To date, the United States still hasn’t opened its first sanctioned safe injection site. Why? It’s clearly for moral reasons. Some people don’t want to do anything they see as enabling drug use, which they take to be morally wrong.
They may also have a view that people are responsible for their own actions and so deserve the consequences. These notions of personal responsibility and a sense of “dirty hands” are perfectly understandable to most of us, and even professional ethicists and philosophers continue to debate the use of these concepts.
This is why ethics can make a real contribution here. It’s not that I agree with the criticisms of harm reduction. To be clear: I don’t. But too many of us working in public health or drug policy dismiss arguments against harm reduction as unscientific and not worth considering.
We hammer on the evidence — noting that needle exchange programs reduce disease burden among people who use drugs, that naloxone saves lives, that safe injection sites prevent overdoses and connect people who use drugs with the health care system, and that virtually all harm reduction approaches have positive side effects, like saving money in the long run and keeping used needles off the street.
Opioid epidemic: Fight addiction and chronic pain together to save lives
We think that if we quote these claims from the literature loud enough and often enough, we’ll win the debate through sheer volume. And this is a mistake. Because the objection isn’t, generally, about evidence; it’s about ethics. Opponents of harm reduction think we shouldn’t “help people to do drugs,” whether doing so saves lives or not. We need to have the discussion clearly in the moral realm.
My view, in short, is that an ethic of personal responsibility is the wrong justification for health policy. If a person is injured in a motor vehicle accident in which she was speeding, we don’t thereby refuse a life-saving operation. Although she chose to speed and is responsible for her actions, it is not the case that she should therefore be forced to accept the potentially deadly consequences. That’s not how we do, or should, think about medicine and health care.
A complete defense of harm reduction, then, must offer a counterproposal for how we justify health care for people who appear intent on harming themselves. Having gone through my own struggle with opioids, I learned something important both when I gratefully took high doses of the drugs to quell the pain, and when I tried to quit and went through hellish withdrawal: People take drugs for reasons. Opioids can appear to fix us, or make life worth living. Quitting can feel impossible. Whether the drug is oxycodone or heroin, they do many of the same things. And when people find themselves in mortal danger because the drug has its hooks in them, the appropriate response is compassion, not judgment.
As the drug overdose crisis continues to burn across the country, I know that many people have similar close encounters with drugs, dependence and addiction. Too many of us — and our friends, loved ones and neighbors — have been hurt. But we can lessen that hurt. If we see people who use drugs as people we know and love, people who deserve respect and health care, we can save many of them. But we have to replace our instinct to punish what we see as bad behavior with an instinct to care.
This is not a discussion about evidence. It’s about ethics and the dignity of human beings — about what each of us deserves.
Travis Rieder, a faculty member at the Johns Hopkins Berman Institute of Bioethics, is the author of “In Pain: A Bioethicist’s Personal Struggle With Opioids.” Follow him on Twitter: @TNREthx
You can read diverse opinions from our Board of Contributors and other writers on the Opinion front page, on Twitter @usatodayopinion and in our daily Opinion newsletter. To respond to a column, submit a comment to


Leave a Comment

Your email address will not be published. Required fields are marked *

Shopping Cart