The Opioid Harm Reduction Trap

“I would love to see a world in which Boy Scouts make handing out naloxone as their Eagle Scout project,” said addiction scholar Stefan Kertesz in the Washington Post. Naloxone prevents opioid overdose deaths — which is a good thing.

But soon federal regulators are expected to approve the over-the-counter sale of a nasal spray of the drug — its brand name is Narcan — and I’m thinking that the so-called harm reduction movement is about to inflict a world of pain on damaged people and degraded cities.

It’s one thing to legalize the drug’s availability at health care clinics and pharmacies. It’s another to normalize self-destructive behavior that kills people by hyping more Narcan for more people in more places.

“If we’re teaching our kids how to put condoms on bananas, we can teach them how to put Narcan up somebody’s nose,” a child psychiatrist offered in the same Washington Post story.

I disagree. Let social workers, medics, police, and other professionals carry Narcan. But not Boy Scouts.

The mantra of the “harm-reduction” movement is: “Every life matters.” I fear that telling the world that Narcan is a handy antidote will spur dangerous behavior and loss of life.

“As a medical tool, there’s clearly benefit” in making Narcan available, noted Robert Marbut, a senior fellow who specializes in homeless issues with the Discovery Institute, where I also am a fellow. Nonetheless, Marbut fears that in expanding availability, “misuse or overuse” will follow.

Marbut offered three areas that he believes have not been subjected to sufficient study ahead of expanding access to Narcan.

For one, repeated use of Narcan could lead to resistance to the drug.

For another, Marbut warned, while the single use of Narcan can save a life, perhaps even scare a user into seeking treatment, addicts who frequently overdose could experience “minor brain damage for each use” — damage that accumulates.

Then there’s the issue of whether more Narcan changes the public’s behavior by normalizing overdoses.

“One event in and of itself is not horrible,” Marbut said of emergency use of the drug, but when users overdose regularly, that may not be sustainable. Keeping Narcan at so-called safe injection sites sends the wrong message — that it’s OK to shoot poison into your system because there’s a safety net.

“People think that Narcan is this magic medicine,” Marbut warned, even though the drug’s effects have not been tested sufficiently.

The Biden administration credits its policies, including “getting life-saving tools like naloxone into communities,” with “a steady slowing of the rate of increase in overdose deaths.” That’s not exactly great news.

I see magical thinking.

Years ago in the video “Worth Saving,” a young San Francisco resident named Kai Adame lamented that a couple of times a year he’d hear about “one of my friends dying because someone wasn’t taught what they need to be taught.” To Adame, that meant having Narcan readily available.

Adame said he had stopped breathing 13 times in his life, and credited naloxone with giving him a second chance.

It’s tragic, of course. Adame later died of an overdose. More than 100,000 Americans die from opioid overdoses each year. Maybe more Narcan means fewer overdose deaths. Or maybe more Narcan signals to impressionable people that if they OD, no worries, they can fix it with another drug.

Debra J. Saunders is a fellow at the Discovery Institute’s Chapman Center for Citizen Leadership. Contact her at dsaunders@discovery.org.

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