HELPING HEROIN ADDICTS A MORAL IMPERATIVE

If we came up with a sure cure for lung cancer, we wouldn't withhold
it because it might encourage people to smoke. But something about
heroin addiction tends to cloud our thinking on public health policy.
On this subject, though, Los Angeles is currently enjoying a moment
of sunny clarity.

The federal Centers for Disease Control reported in July that more
than 16,000 people died in 2002 from drug overdoses. Philadelphia now
loses more lives to heroin than to homicide. Chicago has witnessed
nearly 200 deaths in the last 18 months from overdoses of fentanyl,
an exceptionally powerful opiate that is often mixed with heroin.

One way to prevent people from overdosing is to stop them from using
drugs. But as smokers have demonstrated, knowing you should quit and
actually quitting are two different things. Despite all our law
enforcement and education efforts, there are nearly 120,000 heroin
users in the United States.

Abstinence is best, but when it's not universal, other remedies are
needed. Luckily, one has emerged. Naloxone is a medicine with one
conspicuous attribute: It can stop a heroin overdose in its tracks.

Last week, the Los Angeles County Board of Supervisors voted to spend
$100,000 to dispense naloxone to community organizations that offer
treatment and other help to addicts. It's the latest government to
acknowledge that the first step toward curing drug abuse is keeping
the abuser alive.

Fatal drug overdoses in Los Angeles have hit the highest level in a
decade. Among whites between the ages of 25 and 44, they now are the
leading cause of death. In 2002 and 2003, there were more than 900
known deaths involving heroin, or more than one every day.

The fiercest critics of drug use may think overdoses are not such a
bad thing, since they get rid of troublesome lowlifes. But even by
that harsh logic, naloxone is worthwhile, if only because not all
excessive ingestions are lethal. Hundreds of heroin users are
admitted to Los Angeles County's public hospitals every year with
nonfatal overdoses, at a typical cost of $16,000 apiece. Many others
get emergency room care. All this means an overdose of tax burdens
for local residents.

There is no question that naloxone (also known as Narcan) works.

Emergency medical service providers in Los Angeles County already use
it about 1,000 times a year.

In Cook County, Ill., a naloxone distribution program operated by the
Chicago Recovery Alliance helped to bring down the number of deaths
from 466 in 2000 to 324 in 2003. Dan Bigg, director of the program,
says that since January 2001, it has documented 478 episodes of
reversed overdoses -- most or all of which would have been fatal.

But even though deaths for heroin overdoses are rampant in many
places, we have held back from mass deployment of a medicine that can
save lives. The White House Office of National Drug Control Policy
has been wary of naloxone, arguing, "We don't want to send the
message out that there is a safe way to use heroin."

No, we don't. But it's entirely feasible for governments to
proselytize against drug use while trying to keep drug users alive,
just as we preach against tobacco while providing medical care to
smokers stricken by emphysema.

Naloxone has several great advantages beyond its capacity to
instantly avert death. One is that it's very cheap -- about 26 cents a dose.

Another is that unlike methadone, which is used to wean addicts off
heroin, it has no recreational use. So there is no danger addicts
will abuse it or sell it in the black market.

Saving heroin users from killing themselves is not as good as
persuading them to give up heroin entirely. But naloxone is a
priceless tool for addressing drug problems. After all, as Dan Bigg
notes, you can't cure an addict once he's dead.