The way I see it, hospital ERs are using tremendous amounts of resources in treating chronic drug users. An OD case can easily cost 10-20,000$! Moreover, in the inner cities,many OD cases will repeat. In this ear of tight money, it does not seem fair (to me) to deny needed medical care to children, while continuing to offer free rescusitation to chronic drug users.
So, should hospitals stop treating OD cases? One could also argue that once word gets around (in the drug user community),that “mistakes” are not going to be corrected, maybe daid users will be less careless.
OK, I’ve put on my chain mail…have at me!
A civilized people does not allow members of its populace to die when the care necessary to treat them is available.
What next? Don’t treat heart attacks for people who eat a lot of red meat?
No saving sugar lovers who go into diabetic shock?
Sorry, granny, no respirator for you! You stupid smoker!
Um, you do know that most drug users live in the suburbs, and that rural drug use is also at alarming levels. Right?
I was not aware that ODing was exclusively an inner city problem.
In answer to your question-- NO.
You cannot make any sort of policy that requires doctors to deny treatment to patients (unless they’ve requested it, as in a DNR). How can you possibly know that this isn’t a one-time user, a possible suicide attempt that needs psychiatric help, a candidate for counseling and rehab, etc? YOU CAN NEVER KNOW THAT A PERSON IS BEYOND HELP.
Your OP even admits this, in a way; You put some qualifiers on your statement:
“… in the inner cities, many OD cases will repeat.”
Your sentence says that in certain places, many but not all people will throw away the medical help. This means that the help will save some lives in the inner cities and many lives elsewhere. Also, once they’re in the hospital, they have access to the hospital’s rehab and treatment facilities, thus reducing the possiblity that they’ll go back to OD again. You say we shouldn’t treat them because they’ll throw the treatment away in another OD, but helping them saves their lives and then gets them in an environment where they can get help.
And since when should cost be a determining factor in saving lives? I agree that sometimes it does come into play, but we shouldn’t reinforce that awful status quo by saying that willful drug users are a financial drain, so we shouldn’t help them.
And from where do you get the information that denying treatment to kids is ever a result of treating drug ODs? And under what circumstances is medical care being denied to kids? I’d like some information there. Also, if you’d like to play that way, let’s consider: There are tons of organizations and fund drives directed solely towards raising money for medical care for needy children. How often do we raise money to save the life of the mangy guy in the alley with needle marks on his arms? It’s a two-way street. Needy children get help, but drug users aren’t treated with such benevolence.
And let’s think about what happens when a right is denied any particular group. An advocacy group is formed, petitions are filed, websites set up, etc. Drug users can’t come out of the woodwork to fight for their rights. “You can’t deny me medical care!” “I’m sorry sir, but you’re under arrest.” There would be no one to fight for their right to life. This policy could be implemented dictatorially and the injured parties wouldn’t be able to protest.
To address the fact that you think this policy would encourage more cautious behavior in drug users: THEY’RE USING DRUGS. If they’ve OD’d, that means that they’re using hugely dangerous drugs. No one doesn’t know that, including the users. No one thinks, I use cocaine, but cocaine isn’t harmful. Everyone is perfectly aware of the possible danger, but drug use happens anyway. Common sense and self-protection isn’t really leading concerns here.
“I was going to shoot this heroin even though I know I’m killing myself with every injection, even though an air bubble could kill me instantly, even though a fatal dose is just one mL more than I’m using, but now that I know that medical care will be denied me if I OD, I will resist the addiction that I’ve been nursing for the last ten years and just go cold turkey.” That WILL NOT HAPPEN.
So this would only result in more dead people. Let’s not even go into the fact that you never want to open the door on policies that would allow ANYONE in need of medical care to go untreated; I think these reasons are more than sufficient.
I’d like to see how an OD could cost $10-20k to treat. A figure that high would need to involve either hospitalization or surgery; OD treatment would never require surgery and would rarely involve hospitalization for more than a few days. Perhaps if the figure includes rehabilitation treatment it could be that high; but then you have to consider the possibility that the treatment might actually work.
In reality, OD cases would cost far less to treat than $10k. Sometimes a few dollars can save someone’s life. A heroin overdose, for example, can be fatal if left untreated, but can be reversed almost instantly with an injection that can’t possibly cost more than $10, including the syringe and needle. (The ‘antidote’ for benzodiazepine [Xanax, Klonopin, etc.] overdose apparently costs in the hundreds, but recreational benzo overdoses are probably extremely rare.)
Another factor to consider is that drug overdoses are quite rare and almost unheard-of except among heroin, cocaine/crack and methamphetamine users. From what I know about treating overdoses for those drugs, treatment cannot be particularly expensive. Nor are there any other drugs which, to my knowledge, would be expensive to treat in overdose.
Also, around 80 to 90 percent of even the most ‘chronic’ drug users are employed and therefore probably insured to some extent, so the public burden would be limited to the 10-20% that can’t pay for health care by themselves. (I’m writing this as if I were American.) So, multiply the real cost of treating an overdose by the percent of addicts who actually overdose by the percent of uninsured addicts, and you have the actual public burden.
Last, refusing treatment to addicts would have no deterrent effect on drug use. None whatsoever. To ‘hardcore’ addicts who have been using for years, the only effective deterrent to drug use is the unavailability of drugs – and if that happens, they’ll try to find something else. To beginning users, the thought of overdose is sufficiently distant that it wouldn’t matter whether or not such an overdose would be treatable. (Many people probably aren’t even aware that overdoses are treatable.) The only thing this proposal would do would be to allow people to die who could have been treated and saved by a few dollars worth of naltrexone.
There are better alternatives to threatening addicts with death or jail as an inevitable consequence of drug use – especially since these threats, when unfulfilled, are meaningless. Rather than trying to make drug use more dangerous, the ‘public burden’ – the cost to society of drug use – could perhaps be substantially reduced by the implementation of needle exchanges, education programs and safe-use sites. Consider the cost of free sterile needles versus the cost of years of anti-HIV drugs and months of hospitalization. Consider the cost of safe-use sites versus the costs of treating overdoses that wouldn’t happen if dangerous drugs could be used under medical supervision. Or the cost of education against the cost of treating overdoses and diseases that are the result of ignorance. Or the cost of rehabilitation treatment against the cost of imprisonment. (You’d have to consider how often rehab actually succeeds in turning unemployed addicts into Productive Members Of Society, but I think it’d still end up being favorable.)
I’ll overlook the slippery-slope argument that might ensue, that soon obese people might be denied treatment for heart disease, or that inner-city black males between the ages of 14 and 25 would be denied treatment for gunshot wounds.
“Drug abuse is a public health problem, not a legal problem.” – R. Julien, A Primer of Drug Action
It would be a violation of the Oath most doctors take, and their code of ethics.
I also doubt that a handful of “daid” addicts will prevent overdoses, given that a large portion of ODs are not only unintentional. That’s not to say that there wouldn’t still be some detternce effect, but probably not much given that drug addicts ALREADY know they face all sorts of horrible things.
However, it DOES seem wrong to allocate money to drug users when it would necessarily mean less money available for others.
Also, we DO have a stange “heroic” obsession with medical care in this country, in that we are willing to spend TONS of money on very expensive emergency treatment, but look down on paying for preventative care that would prevent such expensive proceedures. Both are a form of charity, but one would not only cost us much less, but lead to better quality of life as a side effect.
I suggest that this is a sign of serious nonsense in our moral judgements, akin to things such as Peter Singer has pointed out (i.e. we would condemn a man who wouldn’t save a drowning child for fear of getting his clothes wet, yet we don’t condemn a man for not spending the price of some clothes to save the life of a starving child whom he knows about just as surely as the drowning child) as well as another author (I forget the name of) who found that people would come to radically different decisions in certain moral decisions when certain factors even they themselves agreed were irrelevant were added to the description (like, in order to save 10 people, you have to knock a man to his death- but people were willing to do it when all they had to do was push a button, by not willing when they had to push him themselves).
On top of everything that everyone else has mentioned, I have a few points as well. To begin with, there are many other pathologies that have similar symptoms to drug use, including diabetetic ketoacidosis, and head trauma. It’s impossible to differentiate many of these without beginning treatment (tox screens, etc).
You’d also be creating many new problems for EMTs & paramedics including issues of who to treat, and how. Did this pt OD on heroin or prescription medications? Was it an accident?
Lastly, there’s nothing to keep someone from ODing the first time they try a drug. Why should these people simply be written off?
St. Urho
EMT/Firefighter
No. Fuck no. I know people who have OD’d, cleaned up, and gone on to lead perfectly wonderful lives. I know people who didn’t get medical help for whatever reason and died. I repeat, fuck no.
OD’s don’t necessarily happen through carelessness. Sometimes a drug may be of far greater purity than a user knows. Sometimes it is through carelessness, but the sort of carelessness that is just plain going to occur with intoxication. Sometimes an OD isn’t due to recreational use at all, but just due to accidental misuse of a prescription or a bad reaction. It’s actually rather rare for medical treatment to be called in the case of an OD because the user is alone or those with him are afraid to call the authorities. Most OD’s are discovered after death. An OD getting life-saving medical treatment is a matter for rejoicing. All refusing a OD medical treatment will result in is more deaths.
If ODs truly cost us that much, that is yet more evidence that it would be cheaper to legalize drugs. Why? Because the strength of drugs could then be monitored and regulated, and information available to the user.
Regulation of strength would also probably help users to cut back and eliminate use. I, for instance, have cut down to approximately 6 ounces of Mountain Dew a day worth of caffiene. Cigarette users, I would imagine, could either cut off part of a cigarette or use patches that regulate the dosages to slowly taper down.
Whereas illegal drug users, who use street dosages that have been cut how many times and with what, don’t know exactly what they are getting when they use.
Sure. Why not? Of course, we should as well refuse treatment to drunks who wrap thier cars around trees. Treating them is expensive, and everybody knows alcoholics deserve to die.
How about just letting those with obvious bad taste slip away? Look for clues like sterling jewelry with brown tweed, industrial- strength bras, run-down heels, fake designer handbags.
Absolutely not. Not only do some drug addicts clean up, but I am very leery of denying medical care to ANYONE on the basis of their lifestyle. It would not stop with drug addicts. They’d refuse help to smokers and fat people having heart attacks, and then they would quit saving car crash victims who weren’t wearing their seatbelt. Soon ER doctors wouldn’t touch anyone but a vegetarian gym bunny with 12% bodyfat and a BMI of 20.
And I’m not sure where you live, but I’ve never heard of an ER turning someone away who needed treatment, especially a little kid, because they couldn’t pay. If you don’t have coverage, they treat you anyway and then their collectors hound you for about 5 years before they eat the cost.
Can you IMAGINE the PR shitstorm that would ensue if some ER turned away a poor kid with, say, pneumonia who died a couple of days later?
Absolutely not.
If you want to save money on treating overdoses, prevent the overdoses! Decriminalize the drugs people overdose on, and sell drugs of regulated strength and dosage through state liquor stores at reasonable prices. It won’t just reduce overdoses, it’ll reduce crime.
**A civilized people does not allow members of its populace to die when the care necessary to treat them is available.
**
The whole point is finite resources are making this a problem.
How many accident victims are dying because ODs are being treated?
**What next? Don’t treat heart attacks for people who eat a lot of red meat?
**
Why not? What’s this aversion to personal responsibility?
Probably none. Are you thinking that a hospital only has one doctor, one bed and one needle at a time? Are you thinking that a doctor can only care for one patient at a time, to the exclusion of all others?
Even during extremely busy times, hospitals do a fine job of managing the care of all of their patients. I’ve never heard of a case in which a patient died because no one was available to treat him. Worse comes to worse, they move the patient to another hospital.
It should be noted that OD’s could be virtually eliminated by regulating the given dose and ensuring it was free from impurities, all by processing it in a modern laboratory for a few dollars a gram than in somebody’s basement from which it is bought for upwards of $50 per gram.
But that would be too easy.
That’s bloody stupid…anyone’s heels can get rundown.
And to the OP - only 1% of herion users die of an OD the large majority live and give it up.
We absolutely should not stop giving care to drug users who OD. As many others have pointed out, that would simply lead to denying all sorts of medical care to people whose problems are (at least partially) self-inflicted.
Where do you get your employment statistics? Drug use is fairly heavy in my neighborhood, and while many of these users are employed, they are not employed in industries that provide health insurance.
It goes much deeper than an aversion to personal responsibility. For instance, when my FIL began smoking, more than 60 years ago, the health risks were not understood. Eventually, he had a heart attack. He was appropriately treated (and did, incidentally, stop smoking). So, what are you doing to your health, right now, that 25 years down the line will be found to be harmful? If what you’re doing now is considered to be safe, but causes you damage down the line, does the responsibility to deal with it fall directly to you? Also, how much time should a doctor spend deciding whether an illness is self-inflicted before deciding whether to treat the person? He could spend two hours debating whether the patient was sufficiently non-liable to treat, while the patients’ life is on the line. That seems to me to be in direct contradiction to the Hippocratic Oath.
To do so would be asking the medical profession to make moral judgments and it seems likely that this would render them more vulnerable to lawsuit; a case of accidental poisoning where treatment was refused, for example.
Why not refuse treatment to people who injure themselves with chainsaws? - Shouldn’t they have just been more careful? What about people run down by cars? Shouldn’t they have looked both ways before crossing?
Since everyone has pretty much let you have it, I ask you this-Did you really think about what you wrote?
I really hope you pay close attention to all the prescriptions/otc drugs you take, your child(or a child close to you) never accidently gets into medication, and no one your close to tries drugs or has a drug problem. If your idea became a reality-you are screwed and so is everyone else. Something this unethical is not debatable.
I think this may be a time you should step outside your self-centered box.