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ABOUT THIS EPISODE

More than 70,000 people died of drug overdoses last year — many of them from heroin and other opioids. One of the most widely-used tools to confront this crisis is a drug called naloxone. It can reverse an opioid overdose within seconds, and has been hailed by first responders and public health researchers. But earlier this year, two economists released a study that suggested naloxone might be leading some users to engage in riskier behavior — and causing more deaths than it saves. This week, we talk with researchers, drug users, and families about the mental calculus of opioid use, and why there's still so much we're struggling to understand about addiction. For more information about the research in this episode, visit https://n.pr/2OZfuGQ.
English
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TRANSCRIPT

00:00:00That's Our parents This episode contains strong language and mature themes If you're listening with young kids i strongly urge you to save this one for later This is hidden brain I'm shankar vedantam there's an old saying the best things in life are illegal immoral or fattening There's Another
00:00:22way to think about this many things that give us pleasure sex food adventure They contain risks As a smart species we've come up with ways to minimize those risks Condoms seatbelts drugs to lower cholesterol But something interesting happens as we do this As we move the risk benefit
00:00:46calculation for each activity away from the risk end of the spectrum to the benefit end of the spectrum we imagine people will become safer Seat belts for example will keep drivers from getting hurt Now that would be true if people kept doing things exactly the way they did
00:01:04before But some people make another calculation If putting seat belts and cars means you are likely to survive a crash There's now a temptation to go faster in an ocean swim i might go out a little further when a lifeguard is nearby Football players who know their heads
00:01:24are protected by helmets I might start to hit a little harder This phenomenon has a curious name Economists call it moral hazard it's a bit of a misnomer because moral hazard has little to do with morality it's about what happens when you move the risk benefit calculation to
00:01:47make things safer and people respond my taking more risks So there's ah paper ah while back by sam pelts hman that kind of lays out the classic case of moral hazard that economists like two point two this is economist jennifer dahlia hq at texas a and m university
00:02:06and his idea was that when seatbelts first became required in cars i think most people would assume when you have when you have seat belt that's unambiguous see a good thing it's going to save lives and he saw that and thought if you have a seat belt maybe
00:02:22you drive a little bit more recklessly some policemen found that while drivers were safer because of seat bells they also drove more recklessly that put pedestrians at risk He argued that the safety benefits of seat bells were canceled out when you took this into account Now subsequent studies
00:02:44have challenged this finding but the seatbelt example illustrates the dilemma posed By moral hazard Should you make things safer If people are just going to take more risks Or should you allow people to face the consequences of their actions by doing away with safety measures This dilemma has
00:03:08political dimensions Liberals tend to say the more safety measures the better conservatives worry about the negative consequences that interventions might have on personal responsibility so our safety measures useful The answer is it depends They can't be safety measures that costs so much moral hazard that they make things
00:03:31worse and there could be other interventions where the benefits far outweigh the risks Today we consider this dilemma in the context of a deadly public health crisis I know i was dead for four minutes by the time the ambulance got there but they were revived me What nor
00:03:48can The opioid epidemic is playing russian roulette They knew where the good dope waas a grain of small is a piece of saw can kill a human and it is ten thousand times more potent than morphine They were haul ass to get this ship and they figure ok
00:04:05well i'll just do a little bit so it won't hurt me Life death and trade offs this week on hidden brain support for hidden brain and the following message come from pocket the app for reading and absorbing the amazing content you find online with pockets New listen feature
00:04:26Any article you've saved can be read out loud You know kind of like a podcast download from your app store The centers for disease control and prevention recently released an astonishing statistic It estimates that in twenty seventeen about seventy two thousand people died from drug overdoses The vast
00:04:49majority of these deaths were caused by overdoses of heroine and other opioids Here how do you understand the magnitude ofthe seventy two thousand debts I don't know but i can tell you one story Front door Yes if you don't mind it unfold in a tidy ranch home in
00:05:13frederick maryland my producer jenny schmidt and i have made the hour long drive from washington d c we sit down at the kitchen table and start with introductions Yes my name is hope truck so hello my name is pete troxell Hope and p truck's still live in the
00:05:28neighbourhood on a hill just outside of town I've been here all my life and my husband and i both we've been married forty six years They're in the same area Hope exudes a comforting warmth She's the kind of person you want to hug Peter's tall and reserved with
00:05:47long white hair and a thick white beard It's not easy for them to share their story Hope fidgets Pete clenches his hands They begin by telling us about the life they once had A life that made sense Their first child was their son jeremy he's Very easy going
00:06:07He don't get upset He's Very quiet He never said a whole lot When he was young four years later alicia arrived My daughter is more of a strong person She was determined more so than my son alicia was south possessed outgoing a people person She took risks like
00:06:30the time when she was just seven and decided she wanted to compete in a beauty pageant hoping p drove us to virginia pete or a tux course she didn't win but she was so upset but we had to tell her that you know life is full of disappointments
00:06:47but you got to go one and you gotta move on on dh She did and she i mean she got over seventy years old she got over it she was top ten she didn't come in the first place but she was in the top ten hours The girls
00:07:05dream of what she wore I remember she had little gown on but it had a little crown thing and all that I can't remember what color but it's a little long gown and you're just so cute That memory off their little daughter in her long gown still makes
00:07:25them both smile hope says As the kids grew older they stayed close with their parents Jeremy started working for his dad's trucking business hopes as she and alicia were like two peas in a pod You know she had to call me every day or i had to be
00:07:40on the phone with her After alicia finished high school hope convinced her to apply for a job But for dietrich a nearby army installation hope worked there too Alicia started is a cleaning person Within a couple years she was walking in the main room She was thriving she
00:07:58met her soon to be husband and she was pregnant with twins and then my daughter decided um i'm going to go back to college i said how can you go to college when you're pregnant Gonna have two little kids and go to college So she says i'm going
00:08:17do it online She would put them girls to bed and then she would go online and do her college and she got her associates degree in business so from there from that she moved up again and went to administrative assistant and my daughter was making good money really
00:08:41good money They were proud Pizza's Alicia was the first person in his family to graduate from college and a decade of hard work It for dietrich had paid off and i mean things were going really good for but alicia also had scoliosis and as the years went by
00:09:00it got worse Of course she had back problems and of course you went to the doctor on dh They put a room oxy code on It's a story of our time Alicia started taking oxycodone in twenty fourteen Her twin girls were now about eight years old Besides her
00:09:26back there were other things in alicia's life that weren't going great She had split from her husband and was in the midst of a divorce She had moved back in with pete and hope and the twins lived there too part of the time The oxycodone didn't just help
00:09:42with the back pain It made alicia feel better about everything Then one day hope realized her own pain pills The one she had been prescribed following a rotator cuff surgery We're running suspiciously low I would leave my pill set on the counter on dh Then i could see
00:10:05that may be one too Appeals are being taken and i'm not taking them Well then i really started counting I actually would start writing them down when i would take my pills and my pills should be guys to me longer And of course i approach my daughter one
00:10:22day and she said well mom um my friend needed he's having back trouble Said my friend needed the pain pill I said you don't take my pink pills You come to me first and asked me looking back on it Hope things alicia was already hooked There were signs
00:10:44like her work going to work late saying mom i need to use this extra time from work I have all this vacation time I need to use some of this time for more I would myself take the girls down school drop him off knows that mohr maur she
00:11:02was like well i will be late that can you do This on i'm like we're already late for work soon skipped hours turn into skipped days I told her one bass and you're gonna end up losing your job You've got a very good job don't don't mess it
00:11:19up but she she did after a while and they left her They left her go from four dietrich and then things just got worse She is She just had a real hard time Uh what i'm going to say functioning you know she just couldn't seem teo get herself
00:11:40together Tio tio babel teo even with her girls eventually she last shared custody of the twins She was able tio get her girls If she would do pee test If she could get a clean yours she could visit her girls at the department of social services It was
00:12:02after one of these visits that hope and pete believe alicia finally last Whatever will she had to keep her life together She drew in with her parents for a supervised visit Hope and pete waited in the car They watched alicia walk inside her arms filled with toys But
00:12:21when she came out of there i could see her felling Because she came out and she was really crying she said that they won't even let me help him They won't even let me kiss him and that took my daughter down Hell i am She come out there
00:12:37with her toys The girls didn't want the toys didn't wantto get close to her They left early and when she come out that day that in my heart and i believe one hundred percent that that was to turn around point her to get on carolyn Once alicia started
00:13:02using heroine she last the remnants of her former life first went the last few rights she had left as a mother The last time i was in court the judge will name allow our daughter to talk to her girls on the phone And i'm like people in prison
00:13:22get to talk to their kids on the phone So that's why did the judge not want Sometimes they felt when uh she did talk to the girls on the phone that she either she was nodding out or her speech was slurred It's hard I know it's hard for
00:13:42families with this situation with the drugs but when you haven't attic we have to help this person But most people simply turned away from alicia Isolated and addicted she burned through her savings She got evicted from her apartment She also started a new relationship and got pregnant She
00:14:06was a six months about the time bien and i told her i said lea show you have to get straight now light she just couldn't She could not help herself She had gone to rehab and she was only there five days and she left she just couldn't do
00:14:24it but pete and hope kept fighting for their child Do you work with her Pleaded with her Finally something shifted in Alicia she went back into rehab This time she made it through the twenty eight day program covered by medicaid When she came out pete and hope opened
00:14:44their doors to her She was seven months pregnant and very fragile She was home of week doing great She shop for baby clothes She watched tv at night with her parents she met a friend for lunch She and her dad had an honest talk He told her that
00:15:03he loved her Alicia said she was sorry for all she'd put them through one night hope fix alicia her favorite meal corned beef and cabbage And she was so happy that night matter fact After we got done dinner i went back with her She had thes little boy
00:15:20closed and in her and i was fold him up and put them away And she was going to name the literal way Camden was his name and her and i was sitting there like my husband said he'd come back there and that he told her that he loved
00:15:37her and that everything was gonna work out We all were going to work together Eventually hope and pete went to bed in the morning Hope walked to alicia's room to bring her the medicine she took to stave off withdrawal symptoms And uh i went in and her life
00:15:54was So when i went in opened the door and then i saw her and she was slumped over ah hard alicia and she did not answer and i hollered for my husband to come running and he went around where she was at and tried to pull her back
00:16:12and she was already step So when i called nine one one they told us to try to get her on the floor and you give her Compressions and i told the woman i said me and she's gone i know she's got camden was also dead Alicia truck so
00:16:39was thirty four years old She left behind her twin daughters her parents her brother hoping pete wouldn't allow an autopsy because they didn't want to disturb their unborn grandchild Hope says blood tests showed alicia had taken a deadly dose of fentanyl Having just finished rehab she was especially
00:16:59vulnerable to an overdose because her body had just being detoxed Alicia's addiction didn't just kill her It destroyed the family Hope and pete no longer have any contact with their granddaughters It's something that hope struggles with my daughter's mewing that night before was so amazing There was over
00:17:22one hundred fifty people there and i wish migraine hunters to seek net that could have seen how love my daughter wass i have loved their grand parents were Hopes grief feels like a physical presence thinking the air hard to move through We post a whole family I feel
00:17:58like okay i have lost my great dollars which was oh i have left What Alicia story took place seventy two thousand times in twenty seventeen to thousands of families rich and poor black and white and brown The scale of this tragedy has generated horror and desperation Legislators communities
00:18:59and families have tried everything to stop the deaths and then a few years ago something appeared that looked and sounded too many people like a miracle support for npr in the following message come from delta featuring free messaging delta strives to take the stress out of travel so
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00:19:54energy but also helps support millions of us jobs in other industries too Find out more about exxonmobil's planned investments at energy factor dot com Exxonmobil energy lives here Heroin sets off a chain reaction in the body Up to a point it makes users feel euphoric It takes away
00:20:20stress and pain But then if you increase the does heroin begins to affect vital functions The person system slows down to a point where they stop breathing and then their brain basically shuts down Leo beletski is a drug policy and public health researcher at northeastern university and that
00:20:46process typically takes a substantial period of time with traditional opioids It can be up to two hours or more often Heroin sold on the streets is now laced with fentanyl and car fat No the synthetic opioids are cheaper and stronger so overdose can occur in a matter of
00:21:07minutes Now there has long been a way to reverse overdoses The drug naloxone between nineteen ninety six and twenty fourteen The cdc estimates that more than twenty six thousand overdoses were reversed by laypeople Administering naloxone not medics not doctors ordinary people Naloxone has been given the nickname lazarus
00:21:34truck in the bible Jesus restores life to lazarus naloxone doesn't restore the dead but it comes close What happens is the person slowly starts to They're breathing starts to return to normal Their skin starts to turn from its kind of white ashen color which is what happens during
00:21:59an overdose On dh lips Start to return from blue to normal color and they they start breathing again In late twenty fifteen the food and drug administration approved a new form of naloxone that was much easier to use It was a nasal spray and it was a game
00:22:22changer It was called narcan and it came at a critical time Debts from drug overdoses was skyrocketing across the country Massive education campaigns spread the word about the magic drugs we'll go ahead and start but before i start if you could pass your application school on a thursday
00:22:42morning i'm in a pac conference room at a maryland county health department About thirty people said in three rows they fall silent as a woman steps to the front right So my name is jasmine pearce on the overdose response coordinator for the animal No county department of health
00:22:57from you All are here for the naloxone narcan training This training should be about thirty it's a free training event for the community that officials hold a couple of times a month People are here to learn how to administer narcan toe over those victims At the end of
00:23:12this training you will receive in the locks on kid This kid has two doses of enter nasal naloxone On we give to now due to the car fence in awe and fentanyl overdoses that have occurred within our county fentanyl and car fentanyl are so powerful that it often
00:23:28takes more than one does of narcan to bring the victim back If you're not familiar with carpets and all that is a tranquilizer used to put large animals down such as elephants a grain of smalls apiece is thought can kill a human and it is ten thousand times
00:23:42more potent than morphine Um always mentioned that we do provide gloves inside of the kids as well to protect you from any type of contamination because with both of those drugs they can actually see your skin with skin to skin contact And you can overdose yourself The people
00:24:00sitting in the three rose Listen some look shocked Some take notes There's a high school knows a minister an athletic trainer a mother a friend and lots of heartbreak After the training session their stories come tumbling out My friend jeff is his niece died of a heroin overdose
00:24:25since a friend of mine's got son died and then my son died It was he was twenty two you know and he just couldn't didn't want to stop that's what it down And you know he had already overdosed like five times this year so he knew it was
00:24:41playing russian roulette and then my sister she had overdosed In october came back they were able to bring her back with the narcan And then last month she died of an overdose at work on break Trainer jasmine pearce has their own story It's the one story everyone here
00:25:04wants to be able to tell story with a happy ending Um i was going to seven eleven one morning before work and i noticed there was a man in his car He looked like he was sleeping but i started to get a little worried because when i came
00:25:20back out he looked blue to me so i knocked on his window He didn't respond so thankfully his door was open I opened his door checked his paws and i noticed that he was unconscious and i didn't even think i just went ahead and spray the narcan and
00:25:36within thirty seconds he came back This is the power of the lazarus drugs Across the country legislators have rushed to pass laws increasing access to naloxone Some have urged every family in america to keep the drug close at hand Public health officials have a short people that if
00:25:56they administer naloxone to someone who is not high on opioids it won't do anything with most drugs You have to worry about misuse and unintended consequences That wasn't true of naloxone but then in early twenty eighteen a study came out that suggested the lock's on might indeed have
00:26:17an unintended consequence One so cruel that it called into question all the good the drug was doing This finding set off an uproar with many experts rejecting its conclusions The controversy reflects the mind marling complexities off the opioid epidemic on the labyrinth that confronts anyone who finds themselves
00:26:41in this world The growing interest and public push teo broaden access to naloxone was has been really interesting to me for a while This again is texas a and m economics professor jennifer dahlia jennifer and a colleague economist anita mukherjee from the university of wisconsin knew that naloxone
00:27:02was effective but there are always tradeoffs it's something way think about all the time is economist what air the tradeoffs involved The biggest trade off jennifer and anita were interested in was moral hazard So when it's less risky to consume opioids because no oxen provides a safety net
00:27:19we might see opioid abuse increase In other words could having the safety net of naloxone prompt drug users to take more risks like injecting bigger doses of heroin or stronger drugs like fentanyl Answering such a question scientifically is very very difficult The ideal experiment would be to randomly
00:27:40assign naloxone access to some states but not others Obviously that's not happening here but it's helpful to think about that ideal experiment because it gives you ah treatment a control group since the ideal data were not available and jennifer and anita came up with an indirect way to
00:27:57measure whether naloxone news was affecting opioid use some states were passing laws making it easier to get naloxone The researchers decided to use these new laws as a proxy for people actually using the locks on and then compare it states that had broadened access with those that had
00:28:16not they would then test if there was any difference between these two groups in terms of opioid overdoses and mortality it was an imperfect experiment but this was the data they had but even that you know it's not random and so we need teo we need to be
00:28:31really careful about making sure we're controlling for everything else that might be going on in those states that we think might have an impact control for pre existing trends control for just for existing differences across across states an opiate in levels of opioid use and other policies they
00:28:47might have implemented to address the crisis With all those controls in place they thought they may be able to answer the question What effect was no locks on having On the heroin epidemic on net was it saving lives It seems reasonable that a drug that saves lives ah
00:29:03yeah wood wood on average have beneficial effects when you look at mortality rates I think when we first got into this caper we really expected to see a big drop in opiate related mortality as a result of these laws but that is not what they found In fact
00:29:17what we found was that on net we're not seeing any decline in mortality and in some places we actually see an increase in mortality It was a stunning result To be fair jennifer and anita found that some states did see a decline in mortality when they broadened access
00:29:33to naloxone but on average nationwide mortality did not decline and it places like the midwest We're finding that than a lox on access laws caused a fourteen percent increase in opioid related mortality relative to what would have happened without the law and and also a big increase in
00:29:56fentanyl related mortality again relative to the counterfactual would have happened without the law Jennifer and anita have a theory about what is going on Our interpretation is that the risk of death associated with a a kind of unit use of heroin or or prescription pills has fallen now
00:30:19dude in a lock zone But the number of uses and the potency of uses has gone up so much that it actually it doesn't just reduce thie immortality benefits But it completely counteracts them in the in the midwest in particular on dh So so what seems to be
00:30:37happening is that opioid use is going up so much as a result of broader access to naloxone that that we're actually seeing an increase in mortality rather than a decrease Shortly after jennifer and anita disseminated a working paper about their results the pushback came fast and hard from
00:31:01public health experts Critics pointed to studies that have reached very different conclusions At the university of colorado denver for example daniel reece and his colleagues found that a state's expanded access to naloxone There was about a ten percent decline in mortality And at the federal substance abuse and
00:31:23mental health services administration China Mcclellan and his colleagues found an even bigger decline in mortality between the only two thousands and twenty fourteen Public health researcher leo beletski says jennifer and anita's paper was based on flawed assumptions and flawed methodology It's basically what computer scientists call garbage in
00:31:51garbage out For one thing leo says the paper argued that state law's expanding the locks on access signaled and increased availability of naloxone in those states My leo says this is wrong laws making drugs more available and a drug actually being available are two different things so let's
00:32:11say you know the state of new york there's the state of new york have a dna locks in law or doesn't have The law is not necessarily a proxy for whether or not it locks in is available on the streets of new york state Leo has worked on
00:32:27getting such laws passed and say with certainty that in many cases the presence of the law was actually a consequence of matlock sin being available in some areas So you know in new york city lawson distribution started back in the late nineteen nineties For example the first locks
00:32:47on law in new york state was passed in twenty thirteen Now it's what noting that this critique of jennifer and any test paper also applies in part to the papers we mentioned that found that naloxone reduced mortality leo says Jennifer and anita's paper not only misconstrues what's happening
00:33:06on the ground but jeopardizes hard one advances We have worked for a long time to get these locks in laws passed and in many cases they were There was a lot of resistance based on the moral hazard argument in legislatures to get these locks on los passed It
00:33:24was only the skyrocketing death toll that caused lawmakers to act Leo worries that the moral hazard paper will cause legislatures to pull back Jennifer and anita stand by their results It's not lost on us at all That these air thes heir lives that we're talking about and that
00:33:46the increase in mortality that we're seeing you know these air thes air actual people who who have lost their lives due to addiction And it's depressing Just how with so many smart people thinking about this it feels like we're no closer to solving the problem The truth is
00:34:09we don't fully understand how addiction works We're still figuring out how to help people quit We have trouble identifying even what's happening in the course of an epidemic because addiction is stigmatized and people can talk honestly about their behavior The data are incredibly messy regardless of whether you're
00:34:27wearing the hat of an economist like jennifer dole yak or a public health scholar like leo beletski At the same time that states were expanding access to naloxone for example there was an influx of powerful synthetic opioids into the country Heroin is increasingly laced with them It's possible
00:34:44The recent rise in opioid debts was driven by the surgeon synthetic drugs that have flooded the streets It isn't just families and researchers and policy makers who are grappling with these life and death issues Drug users engage in these debates as well using a mental calculus off their
00:35:07own mentioned They got that their batch app now on your phone and people pen where bad batches of dough bar and there's people download that just to go find the bad batches and do it Yeah Yeah coming up The dangerous logic that seeks to balance the risk of
00:35:29death with you for you Support for this podcast is brought to you by td ameritrade investing lesson number one don't pay for lessons td ameritrade's education is free so you can use your money for trading not learning to trade no matter what your level you'll be ableto learn
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00:36:35or renewable energy joined them at swell investing dot com slash brain and get a fifty dollar bonus swell Invest in progress this is hidden brain I'm shankar vedantam On the day that i attended the narcan training at the anne arundel county department of health i met two people
00:36:51who had come to the onsite clinic for their daily dose of methadone It's a drug that has produced withdrawal symptoms from heroin One person was using it to stay off heroin the other to keep from using too much We sat down at a picnic bench to chat We'll
00:37:11only be using their first names My name is james Let me get you to tell me your name please Tiffany is twenty four with dark hair and glasses James is fifty nine green and whether they should have little in common and yet their stories are painfully similar James
00:37:35started using heroin when he was just routine A poor kid he says from east baltimore Well well when we grow up my father left us with no mother He had six children and my father left us with nothing to help his mom James says he started hustling on
00:37:52the streets and carrying guns for drug dealers Then he started carrying their dope and using it It made him feel better about his life and want to go to school hope school because all my clothes are wrong Holy this that none of the mother had a good church
00:38:08is the veteran or just like a nickel pair of pants nickel parish shirt ten cent pair of shoes you know and you get tired And then tiffany started her drug habit at exactly the same age as james I started doing I started doing the percocets when i was
00:38:26thirteen Unlike james she says she was pretty unhappy as a kid Percocet field the missing part of her life When the pills got harder to obtain she moved on to heroin and it was just easier to get around More was cheaper I mean really got higher off of
00:38:50it in a less amount So it's a logic that's cominto opioid use some users would prefer heroin to percocet because it's cheaper and stronger and then they might prefer synthetic opioids to heroin for the very same reason what public health officials warn about drugs like fentanyl Some users
00:39:11go looking for them if they knew where the good dope wass and people were phone out and dying from this shit right They would run right Teo get certainly was before they sold out They were haul ass to get this shit and they figure ok we'll just do
00:39:28a little bit so it won't hurt me Yeah there's plenty of people to do it And if there's even people that have mentioned they got that bad batch app now on your phone and people pen where bad batches of dough for and there's people that download that just
00:39:45to go find the band batches and do it Tiffany is referring to a text messaging service that uses data From public health officials she says that figuring out where the best dope is available at the cheapest price is part of the daily calculation of heroin use For her
00:40:02part she spent about fifty dollars a day on her heroin huh I know i know Fifty dollars that's that's Not really a lot compared to some people i know Yeah i know someone you know Well that one's going through you Oh how I had a dealer Two hundred
00:40:15fifty dollars Dealer habit since he was setting the stuff himself James had easy access to both money and dope Sometimes he take a little bit for himself before passing the rest onto his customers Just take the head Alavi is one You skimp it Yeah but then i was
00:40:36back I was capping it up Well there were a lot of moments like this when james and tiffany rift off each other building on their shared language of heroin Another thing they share They've both overdosed multiple times The first time for tiffany was when she was seventeen Just
00:40:53didn't fell out remember I know i know I was dead for four minutes By the time the ambulance got there but they were revived Me What Narcan I've seen it happen so many times Overdose nine times twelve tiffany is overdosed nine times james twelve they all their lives
00:41:18to narcan James says he now always keeps a life saving drug close at hand I've got five or six nasal spray narc hands up in my room So somebody falls out around may a no am elam's I just take the narcan it's like a nose No i mean
00:41:36you just put your hold your hold your fingers on it It looks like a long stem and it goes like that It's got another thing Point comes down here that you push in like that So you're catching when you're breathing in and then out Then once they're breathing
00:41:51back in that's when they shoot shoot up their nose Not even ten Fifteen seconds later they're arrived there they're back It's um whoever made that narcan isms has some serious ways of saving people's lives So but narcan also does something unpleasant to users who are high It brings
00:42:11them crashing down really fast One you when you put that narcan and you eat everything in your any narcotic anything you've got in your system eats it all out I mean he's like like scrubbing bubbles movable just goes right through you so fast and that is not a
00:42:30good feeling to go from a heroin high to an in total scrub feels awful that's Why many people who are revived within our can immediately try to get high again Tiffany when the first time this happened Teo do you recall the you obviously don't recall the emergency people
00:42:49coming to your house but you recall what happened right after i remember going into the emergency room they sat there and i had to stay there until i was fully coherent Did you have a sense that you actually can pills to dying Yeah anu they're in a soon
00:43:07as i got out and did more and haven't Every single time i overdosed I did maura's soon as i got out of the hospital Six it was a revolving door heroin overdose narcan heroin overdose narcan My ass tiffany and james where the narcan was causing users to take
00:43:31risks that they would not have taken otherwise They rejected the idea that narcan was the reason anyone would choose to get high But they said the drug might affect how much heroin people use where i've no people say all right because i got nor can i like They're
00:43:50just going to amp it up more Tiffany has a friend who was quite explicit about what narcan does for his drug habit I know he's mentioned him in quite a few times that you know if he falls out we'll come back that will come give him narcan and
00:44:06bring them back So what Her friends stop using heroin if he didn't have not can't know very no way Tiffany sees the moral hazard dilemma of heroin and narcan I think that it makes people not being careful about it but i also think that bearing no way that
00:44:36they should take it away because then people are going to be dropping left and right Look everybody than it seems And among the everybody that it saves is tiffany After multiple overdoses and a blood infection from shooting up the destroyed part of her heart she finally had enough
00:44:55I was just i don't know it's just done with that kind of life like i'm just really sat down and thought about it one day and how i imagined my life to be and who i was going to be Not just wouldn't how i wanted to live no
00:45:08more When you thought about how you imagine your life was supposed to be and how it turned out what went through your head what did you see in terms of what your life has become Just everything that addiction does to you like i wouldn't even mean no more
00:45:25you do things that aren't you and and no one of how many times i've died just none of it even made any sense to me tiffany now needs methadone to keep withdrawal at bay She has a heart that beats only because the damaged portion was replaced with part
00:45:43of a cow's heart but tiffany is alive and a twenty four She really does have a whole life ahead of her she's grateful for the chance and would willingly give it to someone else that's Why even though she isn't using anymore she always makes sure she has an
00:46:00r can close at hand Yeah i don't want nothing to happen to somebody and may not be able to save him I couldn't I couldn't live with being able to see somebody die and no one that i could have did something The opioid crisis in america is like
00:46:21a wildfire racing through towns and cities consuming individual lives and families and whole communities Which shocking speed Sometimes amidst all the smoke and fire you can barely see what's going on it's likely In the coming years there will be more hard data on the effects of naloxone For
00:46:42now the best we can do is to come to terms with the trade offs To accept that the interventions we develop to save people might sometimes lead to unintended and unwanted consequences At those times it's worth remembering what we're doing right The people we pulled from the flames
00:47:04charge damaged but not yet destroyed This episode of hidden brain was produced by jenny schmidt and parts shop It was edited by tara boyle and commit a vargas restrepo Our team includes raina cohen thomas liu and laura coral Special thanks this week to actually messenger marked mehmet and
00:47:40near crew Our unsung hero this week is alan jones the public information director at the ana rhonda county department of health Ellen invited us to sit in on one of the county's narcan training sessions She also encouraged community members to speak with us Ellen and her colleagues at
00:48:02the anne arundel county department of health are the frontline responders to the opioid epidemic Even as we focus on helping families and those struggling with addiction we should all be immensely grateful to folks like allen who are dealing with a difficult and heartbreaking job of keeping people alive
00:48:23For more hidden brain you can follow us on facebook and twitter If you like this episode please consider sharing it with a friend and then sitting down to chat with your friend about your reactions to it Good people will disagree when it comes to questions about moral hazard
00:48:39but we would all be better off if we can learn from the views of others I'm shankar vedantam and this is npr Olympic gymnastics dr larry nasa are abused hundreds of women and girls for more than twenty years Before he was caught hear how a team of women
00:49:03brought down a serial sexual predator believed a new podcast from michigan radio and npr This message comes from npr Sponsor espn They're critically acclaimed Thirty for thirty Documentary Siri's is now a podcast Stories about the heroes the controversies and how sports can change everything Listen to the new
00:49:32season of thirty for thirty wherever you get your podcasts

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