Opioid Problem

     This country has one, and I'm not talking about a radio host getting nicked for popping pills.  Nope; from hardscrabble ex-factory towns and rural hamlets where the grain elevator is the tallest thing on the horizon for miles to the mean streets of the big city, people who can't get pills to pop are shooting up heroin (bad) or various versions of fentanyl (way worse).  A significant proportion of them are overdosing, too: it seems that while old-fashioned, street-grade heroin tended to a roughly consistent strength and was generally sufficiently diluted that rule-of-thumb dosage measurement was survivable, fentanyl's another thing.  From Wikipedia: "its extreme potency requires careful measurements of highly diluted fentanyl in solution."

     This is a high-falutin' way of saying that while a little dab'll do ya, an only slightly larger dab will do you in.  Working yesterday near a set of scanners covering police and fire in the Indianapolis city-county* only, I heard two "overdose" calls in the first twenty minutes -- with no "suspected" or "probable" tacked on, either -- and several more over the next hour.† 

     Opioids have a seductive allure (remember that radio host?).  If you're taking them for pain (and I have, quite long-term at times), they work great, but that warm & fuzzy feeling, a glow similar to a couple of mixed drinks in quick succession, is dangerous without the undercurrent of pain.  Oxycontin pipeline shut off?  Stronger drugs let the user clock out of life for awhile -- and the rest of the time, gives them something other than the grinding, hollow emptiness of a country with a shrinking middle class.  Not a good thing -- see William Burrough's The Junky's Christmas for a horrible-yet-sanitized version -- but a thing.

     I don't think we're going to fix this one treating it as a crime or merely addressing the overdoses by putting a supply of single-dose Naloxone injectors in the pockets of every police officer, fireman and paramedic in the country: by the time a user is standing on the threshold of death, it's been too late for a long while.  In conservative Indiana, a lack of needle exchanges has also led to clusters of HIV and hepatitis infections among users.  The state has -- finally -- been allowing counties to set up needle exchanges‡ for about a year now; it's not easy, and in in least one county, has been stymied by a severe "NIMBY" reaction.  So, Mr. and Mrs. America, is a dead junkie on the back porch a better solution?  Maybe it is; maybe the kindest thing to do is to let the addicts die off -- but there will be more, and their dying weighs on the tax rolls. 

     A comparative study of results in the United States and some country that treats use and addiction as public health issues might be informative; as it is, I have seen no more than anecdote.  Even that much has me wondering if something other than the present approach might offer improved results compared to making cops and EMTs haul people back from the edge of death time and again, until, inevitably, the day that help doesn't arrive in time.
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* Back when Marion County was a thin and ugly doughnut and getting smaller all the time, city and county governments merged.  Except it was more like a hostile takeover.  This essentially replaced two tottering monstrosities drowning under their own paperwork with one; and that's progress.  Dick Lugar orchestrated the change and gave it the totally non-Soviet name, "UniGov."

 † Plus the usual things you hear over a police scanner -- a man who locked himself in a business's washroom for two hours, responding only "I'm in here!" when they got worried and knocked; an apparent hostage standoff at a motel complete with multiple officers and directions how to stay "out of the line of fire" that eventually ended without a shot being fired.  It also appears we have an officer who sounds exactly like the late Larry "Bud" Melman.  I'd like to think that somewhere in the city, a short, dumpy, white-haired policeman in thick-lensed hornrimmed glasses is plodding though the challenges of modern policing, gamely triumphing over the entire panoply of modern dangers with a faint smile.

 ‡ While this clearly runs counter to the "whatever you subsidize, you get more of" rule, with Narcan injectors, society is already subsidizing addiction and the choice becomes one of disease-ridden addicts vs. addicts without additional health challenges.  The latter group at least has long-term prospects.