Re: “Fentanyl disaster wants a turning level, so what’s being carried out?” [March 3, A1]:
The fentanyl overdose epidemic warrants novel approaches supported by proof. Traditionally, when a affected person’s in poor health well being introduced a danger to others, as in a tuberculosis epidemic, well being officers had the authority to quarantine and make sure the in poor health particular person obtained sufficient remedy earlier than returning to the neighborhood. There understandably must be limits to habits that places others at important danger, not to mention the person. The legal authorized system shouldn’t be the primary to impose these limits when a treatable medical sickness exists. The legal authorized system was not designed for and doesn’t guarantee skilled medical care.
Proof strongly helps contingency administration in addressing substance use problems. Profitable contingency administration rewards wholesome habits, typically with nominal rewards. That is in distinction to the present punitive and shaming approaches.
We should ultimately tackle social determinants, the supply of abusable substances and different danger elements. The precedence is to make sure these struggling and who’re at important danger of dying obtain well timed care. I urge care to be free and to implement a public well being and contingency administration method the place punitive and shaming approaches are hardly ever wanted. We preserve doing it in the identical outdated methods whereas anticipating completely different outcomes.
J. Kimber Rotchford, MD, MPH, FASAM, FACPM, Port Townsend
