Why carrying Narcan is a mitzvah
Saving lives with this overdose-reversing medication takes precedence over fears of drug normalization
A staff member holds a Narcan nasal spray, used to treat narcotic overdoses in an emergency situation, at St. Ann’s Corner of Harm Reduction in New York City on April 24, 2023. Photo by Angela Weiss/AFP via Getty Images
Contributing Columnist Jay Michaelson September 1, 2023
This week, the U.S. took an important step forward in the fight against the deadly opioid crisis, which kills over 100,000 people per year: Narcan, which can save the life of someone who has overdosed on opioids, is soon to be available over the counter.
This step has been a long time coming. Narcan, a nasal-spray version of the drug naloxone, essentially blocks the effects of opioids on the brain and can help pull someone out of an overdose that could kill them within minutes. For years, every EMT and drug treatment facility has had naloxone on hand, but the truth is, we should all have it in our medicine cabinets.
We’re living in a horrifying new reality in which lethal quantities of fentanyl — an opioid 100 times more powerful than morphine — can be found in substances posing not only as ketamine and cocaine, but as oxycodone and Xanax as well.
The fact is, the opioid crisis is inescapable. It’s in impoverished rural communities, on the streets of every city, in every suburb and small town. And because of fentanyl’s ubiquity, kids have accidentally overdosed on it, thinking they were just popping their mom’s prescription pill.
Will Narcan encourage drug use?
There’s no one silver bullet that will end this crisis, but widely available Narcan (and fentanyl testing strips, also now approved for over the counter sale) will be an important weapon in the fight against it. It’s an example of what policymakers call harm reduction: evidence-based ways to save lives in the context of a seemingly intractable problem.
Yet there is resistance to harm reduction in some quarters. Doesn’t ubiquitous Narcan normalize illicit drug use? And won’t that encourage more people to take drugs?
I’m not sure I personally agree with this, factually speaking: studies have shown that making clean needles available, for example, has no effect on rates of drug use. But, for the sake of argument, let’s stipulate that over-the-counter Narcan could increase the use of some drugs, and that some of that use could be abuse that society should seek to minimize. (I’m not sure I quite agree with that either, but stay with me here.)
In this light, the problem with harm reduction is like the Jewish transgression of leading someone astray. Even non-Orthodox Jews know this one: It’s the last word in Yom Kippur’s alphabetic confessional: titahnu, we have led others astray. Lo t’kallel heresh v’lifnei iver, says Leviticus 19:14: Don’t place a stumbling block before the blind, which the biblical commentator Rashi interprets as a ban on giving someone bad advice that will cause them harm.
Leading someone astray is its own transgression, even if you aren’t engaging in a problematic action yourself. And it is ideologically neutral. For example, a conservative might say that flying a Pride flag normalizes sexual and gender diversity, while a progressive might say that posing for a family photo with firearms normalizes the glorification of guns and violence. We disagree about the underlying value, but we agree on the principle that our words and actions can influence others.
Likewise, some would argue, with Narcan, and with more controversial harm reduction strategies such as syringe service programs and legalization. These policies, critics say, lead people astray. Rather than seeking to curb bad behavior, they encourage it. A similar argument was made against sex education in the 1980s and 1990s: Teaching kids to use condoms, it was argued, normalized having extramarital sex.
But while not leading someone else astray is a Jewish value, there is another Jewish value that takes precedence over it: pikuach nefesh, the saving of a life.
Harm reduction is a Jewish value
As is well known, Jews are commanded to violate 610 of the 613 commandments (all except murder, incest, and idolatry) in order to save one’s own life or the life of another. If the only way to save someone’s life is to drive to the hospital on Shabbat, then that’s exactly what you must do, according to Jewish law.
Harm reduction strategies are analogous. Making Narcan widely available accepts that intentional and unintentional opioid use is part of our society now, and that no amount of exhortation of users or interdiction of dealers is going to stop that. The mission is to save lives.
It’s not either/or; perhaps “all of the above” is the right response to the fentanyl scourge: fighting producers and dealers, treating addicts, ensuring that users don’t contract deadly diseases on top of their addiction, and saving the lives of those who have overdosed, for whatever reason.
So, yes, in a sense, carrying Narcan is a mitzvah. More specifically, it’s the mitzvah of pikuach nefesh. Even if seeing Narcan at cash registers sends a message about the acceptability or or prevalence of opioid use — and again, I’m not sure it does that, but for the sake of argument let’s say it does — still, the value of saving a life takes priority over the value of not leading someone astray.
Moreover, I would suggest that other opioid harm reduction strategies, from making clean syringes available at clinics to treating drug addiction as a matter of public health rather than criminal justice, similarly align with this same Jewish principle. Saving lives trumps (almost) everything else.
Conservative politicians usually oppose these policies, in part because they are politically beholden to moralists who are opposed to the underlying actions, whether it’s drug use, extramarital sex or non-heterosexual sex. But I want to suggest that Jewish conservatives and progressives alike should support harm reduction, because it properly elevates pikuach nefesh above any other value.
Which is exactly where it belongs.
To contact the author, email opinion@forward.com.
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