Healthcare
Trump’s epic drug fail: The case for safe, legal heroin
President Trump declared that opioids are now a “National Public Health Emergency.” At the same time he demonstrated his ignorance of important facts. That is likely the fault of Chris Christie’s chairmanship of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Only one of the Commission members, Dr. Bertha Madras, has any subject matter expertise. The other five are elected officials, all of whom have publicly demonstrated allegiance to the idea that the Drug War is the proper way to deal with an epidemic of overdoses.
To say that this is wrong-headed would be the observation of an astute student of the obvious. The War on Drugs was officially declared by Richard Nixon in 1971, but has been going on at least since the Harrison Narcotics Act of 1914. In a century we have experimented with banning one addictive drug, alcohol, only to discover that prohibition does not work. Yet politicians and their lapdogs in the press have slavishly insisted that if we do more of the same, we will eventually get a different result. Albert Einstein famously noted that this is one definition of insanity.
Widely distributing Narcan to drug addicts will probably save some lives when they overdose, but that’s like calling a wrecker to tow you to the tire store when one blows out after all four have been bald for a year. Sometimes you’ll get in safely, but other times you’ll end up injured or dead in an accident.
Dr. Madras is an expert in the cellular biology of addiction, but it is clear from her writings that she is most comfortable with remedies based in formulary controls, claims data surveillance, and education of physicians on reducing opioid risks. This top-down regulatory approach is shared by the congressman, state attorney general, and three governors who fill out the commission. In short, the Commission’s prescription was printed and signed before the Commission ever met. It completely ignores a century of experience in the field.
Opiates 101: A short course
In my 36 years in Anesthesiology, I became intimately familiar with the salient fact that all opiates are essentially the same drug. (See table) All work on the same receptor in the brain. All depress breathing so that in an overdose, the victim completely forgets to breathe until he is completely dead. All cause constipation, nausea, and vomiting. All change how one sees the world, and once your body is used to them, they all cause horrible withdrawal symptoms.
The only material differences between opiates lies in how quickly their effects start, how long they last, and how the drug is administered. In a sense, Remifentanyl is short acting Fentanyl, while Morphine, Heroin, and Dilaudid are delayed release Fentanyl. Oxycodone is essentially an oral form of Morphine. I could go on, but you get the point.
Knowing those facts made it easy for me to administer literally gallons of opiates safely. Had Heroin been legally available, it could have joined Fentanyl, Morphine, and Dilaudid as my front-line drugs for pain. After all, it has the same onset, duration, and side effects as Morphine and Dilaudid, with potency between them.
History 101: Why opium was banned
By now it should be painfully clear that there is no medical reason whatever for Heroin to be banned. It’s a good drug with definite medical utility. And Fentanyl has proven itself to be a very good drug since it was introduced into clinical medicine over fifty years ago. Yet suddenly there are wild cries to eliminate a “public health emergency” from a drug we’ve used safely for decades. Why should this be?
Opium has been used for both intoxicant and medical purposes for as long as we can trace history. It is an extract from a pretty flower that grows wild in many countries. It dulls pain by working more effectively at the endorphin receptor than endorphins, which your brain makes. As long as the strength of the drug is known, it is extremely safe. But do-gooders can’t leave well enough alone. Could it be they see some benefit for themselves?
Opium has been a cash crop for millennia, but by itself isn’t that highly profitable since harvesting and refining it is inexpensive. An addict can easily be supplied for a couple of dollars a day. A supplier needs a large market. Or he can have a smaller market at a higher price.
Our current obsession with the bad habits of others took full flower at the pen of William Randolph Hearst. During the building of the Trans-Continental Railroad, large numbers of Chinese laborers were imported. They took their one day a week off in the nearest shanty town where many smoked opium, got high, and slept it off. Hearst was a blatant racist with the largest megaphone in the country, the Hearst newspapers.
His hatred for the “coolie” sprang vividly from the headlines, cartoons, and editorials of his papers. Soon the “opium fiend” was a matter of public condemnation, even though the demon created in the printed word never existed, since opium does not lead to aggressive behavior. Shortly Congress passed the Chinese Exclusion Act of 1882, which prevented further Chinese immigration.
This did not end the frenzy. In 1914 Congress passed the Harrison Narcotics Act, again in the complete absence of evidence that individual consumption of narcotics caused harm to those not engaged in its use. Further, many, in the footsteps of the “coolies,” were able to use the intoxicating drug and continue to live a productive life.
When Harry Anslinger became the first Director of the Federal Bureau of Narcotics in 1930, the War on Drugs (by other names) became fully fledged. Never again would the wisdom of the effort to stamp out drug abuse be seriously questioned in the halls of power. Prohibition of one intoxicant, alcohol (1920-1933) was extended to other intoxicants, the opiates. Unlike alcohol which is consumed across wide socioeconomic classes and has been released from constitutional imprisonment, opiates remain the forbidden fruit.
The benefit of prohibition: Risk premium
While it is clear that, in the absence of proper medical indication, opiates are detrimental to well-being, addicts who are maintained on their meds are no threat to society. Many are able to function at a high level. So what benefit arises from prohibition? As James Carville famously said, “It’s the economy, stupid!”
When intoxicants are prohibited, a “risk premium” is created.
A risk premium is the return in excess of the risk-free rate of return an investment is expected to yield; an asset’s risk premium is a form of compensation for investors who tolerate the extra risk, compared to that of a risk-free asset, in a given investment.
– Investopedia
When drugs are legal, there is no legal risk, and the cost to the consumer is the basic economic cost of the steps of production and distribution. As we noted earlier, this is less than the cost of your daily Starbucks latte’. It’s enough for a basic business but simply lacks the margin to support a criminal enterprise.
When drugs are illegal, a market still remains, since a significant portion of the population has wanted intoxicants throughout history. But now there is a notable risk to supplying the demand. So price increases to cover that risk. The curbside pharmacist has to get his supply somewhere. His supplier has the same problem, so the price goes up more. Now the customer has a problem.
If he’s going to empty his wallet to pay for all that risk, he wants a real bang for his buck. After all, he could end up in jail, too! This potency requirement raises the price on the other steps… again. It’s a vicious cycle. What started out as something cheap has become very expensive. And now there is profit for criminal enterprises.
Those enterprises will want to protect their turf from competition, and now we see violent crime start to appear around the drug trade. Customers who become addicted now have to find ways to support their habits, and various other crimes become common. Note that every level of crime was absent in the open trade for opioids. As soon as drugs became criminalized, bigtime crime moved in, because prohibition creates profits for them.
One more problem arises. How does a dealer keep his customers? He has to provide high quality product. This was demonstrated very well in the late 1960’s when Laotian General Ouana Rattikone marketed “999” heroin. It was a very consistent product so that a safe dose could easily be administered. When competitors made more highly refined heroin, he upped his game and produced “Double Uoglobe Brand” heroin. Reliable quality led to large sales.
Rattikone was in a protected area. Your distributor can’t do the same thing without attracting attention. But he can mix his product with other things. If he cuts it with inert materials, he can spread it further, but competitors will attack his poor quality. On the other hand, if he adds something a bit more potent, such as fentanyl, he will give the appearance of a better product.
Unfortunately, this competitive commercial response is now being seen in multiple markets with radically differing amounts of fentanyl. Now each addict is taking on a new risk every time he administers a dose. It may be worthless or it may completely stop his breathing until he is completely dead.
What if we legalized heroin?
Let’s review the chain of events. Prohibition introduces a risk premium, making crime pay. It also prevents the customer from knowing what dose he is getting. Many users will get overdoses, and many will die. Should we be surprised when that is today’s headline?
Suppose we legalized drugs? Apologists for prohibition claim we’ll see more addiction and more deaths. Instead “we need more detox and rehab programs.” Should we be surprised that this approach is promoted by people who profit from those programs?
Fortunately, we have laboratories that show what works. One of them is called Portugal. There, heroin was made legal in 2001. Sixteen years have shown that overdose deaths have almost vanished.
Addicts are maintained on steady doses of drugs they get for free from clinics. The total cost is less than that latte’ we mentioned earlier. And, curiously, addicts are slowly weaning themselves off of opioids in an average of ten years.
Imagine that! When they don’t have to resort to crime, addicts are able to maintain relatively normal lives and then act in their own self-interest. And no funds are diverted to unnecessary detox and rehab programs. And, by the way, no funds are spent on expensive drug interdiction efforts. No undercover cops infiltrate drug rings, because there aren’t any.
Suppose the United States was to do this? Our expensive rehab programs would go away, allowing money to be spent where it can actually do some good. But more important, the profit that fuels the Mexican drug cartels would dry up. We wouldn’t have Border Patrol agents running up against heavily armed drug gang members. There will be no need to prosecute the next El Chapo, because he won’t get rich enough to matter or to export his crime to the US.
What’s not to like?
Culture and Religion
President Trump affirms abortion exceptions for rape, incest, and life of the mother
Q&A
Q: Is it ever ethical to take a human life?
A: Yes.
WHY?
Killing is not always murder.
SELF DEFENSE
In most societies and most jurisdictions, preventing another person from taking one’s own life is justifiable even if deadly force is required.
LAW ENFORCEMENT
If a law enforcement officer fears for his or her life or to protect the life of another, the Use of Force Continuum must be applied. There are various models but this is the basic one that has been taught to federal officers.
WARFARE
Taking the life an enemy soldier with a rifle pointed at you may not cause ethical anguish when considered abstractly. It must not cause a moment’s hesitation on the battlefield.
Today, sometimes the person who “pulls the trigger”, or launches the drone in the Middle East or Southwest Asia could be sitting in an air-conditioned room in the Nevada desert. He or she is in no immediate danger. But it is warfare none the less.
But when an Al-Qaeda or ISIS operative is taken out in Pakistan or Afghanistan, for instance, his family including possibly small children are going to be in the wrong place at the wrong time.
I would submit that the toughest decision ever made by a U.S. President and Commander-in-Chief fell upon the gentleman from Independence, Missouri. The war of attrition continued in the Pacific after Germany had already been defeated in Europe. The Empire of Japan would never have surrendered had not the atomic bombs been dropped on Hiroshima and Nagasaki in August 1945 under orders from Harry S. Truman.
I personally served in the United States Air Force for 5 1/2 years between December 1968 and June 1974 during the Vietnam era with assignments for nearly three years in the Philippines and on Okinawa. But I never faced combat.
Friends and family who did fight in Vietnam understandably did not like talking about it. War is hell. No doubt. That particular war should never have happened. But the blame is upon political leaders not the soldiers who just did their duty. They just did what they had to do to protect themselves and their fellow soldiers.
CAPITAL PUNISHMENT
I live in Hawaii which does not and surely never will execute criminals for any crime whatsoever. Byran Uyesugi committed the worst mass murder in Hawaii history on November 2, 1999 murdering 7 people at Xerox on Nimitz Highway in Honolulu. I haven’t seen an article or heard word mentioned about him in years. No need to Google it again now.
But of course I hear about executions in many states on the U.S. mainland, many of them in Texas. I can’t say whether Byran Uyesugi would be a threat to public safety if he ever was released or escaped. Life imprisonment may well serve the cause.
Executing a prisoner as punishment or retribution is something that I would not personally want to happen. But if a person is liable to harm others, and if the people of a state support capital punishment, that is a decision they and their elected officials must make and bear responsibility for.
TERRORISM
This is a separate category from warfare per se. Some may call it asymmetrical warfare. But here we are not dealing with nation-states and formal military combatants.
I have no problem whatsoever with KSM having been waterboarded. If he expired during that, and it resulted in information that saved innocent lives, it would have been justifiable in my book. He’s still in Gitmo and they may as well throw away the key.
ABORTION
It was an abortion issue that led me down the path of this ethical dilemma. But first I wanted to address other scenarios where we as human beings, even the most moral among us, usually agree that there are limited circumstances where one may and must take another human life.
IS ABORTION EVER NECESSARY?
That is the key to dealing with the ethical dilemma.
In the strictest sense, the answer is no. The possible exception to that would be the life of the mother. If a medical doctor determines that either she or her baby can survive but not both of them, both lives have equal value.
There are mothers who will sacrifice their own life to bring new life into this world. If she is not medically capable of making her own decision, then that is the most heart-wrenching choice her husband could ever have to make.
Life begins at conception. A sperm or an ovum by itself is not yet a life, but when the DNA of both mother and father form a zygote, it is a new distinct life which is not a clone of either parent. Therefore, I would not even support the morning after pill.
EXCEPTIONS?
The part that we as Christians and as conservatives may legitimately differ over is the matter of rape and incest. Either way, an abortion kills a living child. There’s no getting around that.
Therefore I believe that in both cases, the pro-life position is that exceptions should not be made. This is not as simple a conclusion to reach as it might at first seem.
RAPE
A woman’s life is already tragically impacted when she is raped. Adding to that, killing her offspring in her womb due to the circumstances of the conception and the unknown hereditary traits that might be passed along from the rapist will further traumatize any woman with a conscience.
While I would hope that a loving Christian mother would want her child no matter what, I would not condemn her for whatever she decides. If she does not choose to raise the boy or girl herself, adoption is a far better option than abortion.
Testimonies of people who were conceived by rape confirm that their lives do matter. The ethical dilemma comes in whether we criminalize abortions in cases when the baby was conceived via rape.
I want the children to live. But do we really want to tell a doctor he cannot abide by the decision of the woman who suffered the rape?
I pose the question but I’m not going to try to provide a conclusive answer. You will have to decide for yourself on this.
INCEST
This is a harder issue to deal with than rape. The reason is that hereditary and genetic anomalies may occur as a result of inbreeding. An entire extended family will be disrupted by any case of incest.
Incest is one of the most unpleasant subjects to even have to consider. It totally disgusts decent people. Unfortunately, in this world it happens all too frequently.
That’s why I believe that a baby in the womb conceived by incest must lead to respect of a professional medical evaluation of the situation.
I will not go into how the birth of such a child complicates any family structure. You can visualize that easily enough for yourself.
Yes, every human life has value from the moment of conception. That is why it is one of the most difficult choices a pregnant woman will ever have to make on behalf of her entire family.
Again, as with rape cases, do we really want to bring felony charges against a medical doctor who is caring for a mother who has an incest-conceived child in her womb?
WHO MAKES THE LIFE OR DEATH CHOICE?
In the case of a civilian facing a deadly threat to himself or herself, or of a police officer or a soldier in the line of duty, he or she must make a split-second decision whether to use lethal force. It is an irrevocable decision, the consequences of which are the alternative to possibly dying on the spot.
With capital punishment, it is a decision which each sovereign state must make. There is a federal death penalty but it is used rarely for people such as Timothy McVeigh.
Concerning terrorism, this will continue to be a thorny issue as long as our leaders refuse to properly focus upon the underpinning ideology of Jihad. Suffice it to say here, this is an existential issue that is just going to have to be dealt with realistically.
BUT IS ABORTION A CHOICE?
That is tearing our society apart at the moment. Both the Bible and the Constitution were written before modern technology existed. We can never fully comprehend the eternal and infinite wisdom of Almighty God as long as we are still here on this mortal sphere. We must also apply the U.S. Constitution to technology which did not exist in the 18th century or in the minds of our Founders.
For Christians, this is very much a spiritual and religious issue. But how do I present an argument to U.S. Senator from Hawaii Mazie Hirono who is a Buddhist? She does not accept or acknowledge the Judeo-Christian tradition. I have no idea if Buddha ever had any concept regarding abortion nor does that line of reasoning hold any promise in this present context.
Therefore, I hope she can realize that defining the object of abortion as a human life is not just a modern conservative invention. When she talks about decades of precedent set by Roe v Wade, that pales in comparison with millennia of respect for life in the womb.
Of course I realize that neither I nor any other of the people she was elected to serve here in Hawaii will ever convince Mazie that abortion is not just a woman’s healthcare choice.
It’s hard to imagine that anyone can seriously look at an ultrasound in this day and age and declare that abortion-on-demand up to the moment of delivery is a constitutional right.
If they cannot see that it is a human baby in the womb, then they suffer from cognitive dissonance. No further discussion or debate will change their mind.
If they say it is already a child but they don’t care, likewise they have made their choice and it is a choice of death.
OUR ORIGINAL QUESTION
Is it ever ethical to take a human life?
Yes, but abortion on demand is not one of those circumstances. Children conceived in rape or incest have a right to life.
The question with which I will leave you is:
Will you prosecute medical professionals who perform an abortion at the behest of the mother in cases of rape and incest? That’s what state laws that will inevitably be decided by SCOTUS will determine.
EPILOGUE
In Hawaii, we must elect conservatives to Congress because none of the incumbents will ever change course and support pro-life legislation. If your U.S. Senators and Representatives in your state are more reasonable, please contact them with your views. The same goes with state legislators.
This could go either way when it reaches the U.S. Supreme Court. It’s possible that Roberts and Kavanaugh could go the wrong way and let Roe v Wade stand. I’d rather see this reach that ultimate arbiter after President Trump has the opportunity to nominate someone to succeed RBG.
YOUR ANSWER
The ethical dilemma does not extend to the wanton slaughter of pre-born babies. But, you must answer for yourself what should be done in cases of rape or incest. Do you believe abortions under such circumstances should be criminalized and doctors prosecuted? Don’t tell me; contact your legislators.
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