The MetroWest Daily News of Framingham (Mass.), Feb. 20, 2014
Engulfed in violent protest, Ukraine has reached the brink of civil war. Blame-mongering for how this happened will have to wait. Instead, European Union foreign ministers must focus on pressuring the government of President Viktor Yanukovych to curb its “anti-terrorist” operations, uphold the fragile truce reached earlier this week, and make sure the dialogue it has started with the political opposition is productive.
This week’s clashes in Kiev, in which at least 67 died and hundreds were injured, grew out of an increasingly brutal standoff that began less than three months ago, when Yanukovych spurned a free-trade deal with Europe in favor of Russian aid and energy supplies. Since then, the conflict has also tapped into long-running divisions in a country naturally positioned to be in the middle of a tug-of-war between Russia and Western Europe.
Yanukovych’s unfortunate decision to send riot police to clear the square came shortly after he returned from a visit to Russian President Vladimir Putin at the Winter Olympics in Sochi, and one day after Russia came to Ukraine’s aid by buying $2 billion in Ukrainian government bonds. At this point, the violence has not only spooked investors, undermining the benefit of Russia’s largesse, but it has also sparked threats of secession in Ukraine’s west.
After months of feckless diplomacy - including a statement by EU High Representative Catherine Ashton as the crackdown commenced that made no reference to any adverse consequences - the EU has a chance now to push Yanukovych in a more constructive and peaceful direction. European officials are moving toward imposing “targeted measures, such as financial sanctions and visa restrictions against those responsible for violence and the use of excessive force.” It would be smart for the EU to interpret that responsibility broadly.
Sanctions should include, for instance, travel bans, financial investigations and asset freezes against many people associated with the president’s family who are in the cabinet and have economic holdings that merit scrutiny.
Notwithstanding Vice President Joe Biden’s many telephone calls to Yanukovych, the U.S. has relatively limited leverage. It can, however, usefully broaden the visa sanctions it already has in place against Ukrainian public officials and complement whatever the EU does on targeted individual financial sanctions.
Sanctions may work only at the margins, but they send a signal that Western leaders will press for political leadership needed to resolve the bitter divisions laid bare over the last few weeks. For that to happen, Yanukovych must leave office, and elections must happen soon. A trusted international mediator could help in achieving both outcomes. Ukrainians of all stripes, however, must first be willing to return to the path of peaceful dialogue as the only way forward.
The Portland (Maine) Press Herald, Feb. 18, 2014
There’s a lot of noise surrounding the debate over naloxone, a drug that can reverse the effects of an opiate overdose if administered quickly.
The debate overlaps with discussions on Medicaid expansion, and coincides with Gov. Paul LePage’s push for more drug enforcement. It even shares elements with the recent arguments about welfare reform in Maine.
But the bottom line is that naloxone is a simple way to save the lives of dozens of Mainers each year, and it should be made available to the people most likely to reach an overdose victim in time.
Naloxone, also known by the brand name Narcan, works by binding to the opioid receptors in the brain, stopping the effects of opiates such as heroin and reversing deadly overdoses. It comes in a nasal spray, as easy to administer as a decongestant. And it’s safe, too - naloxone has no effect whatsoever on someone who is not suffering from an overdose.
In Maine, only licensed paramedics can administer naloxone. A bill now being considered in the Legislature would make the drug available to emergency medical technicians and family members or friends of those at risk of overdosing. Police officers and firefighters may be added to that list as well.
Last June, Gov. LePage vetoed a similar bill, citing the “false sense of security” that nearby naloxone would give users, making it easier “to push themselves to the edge, and beyond.”
That same argument is being used this time around, along with claims that Medicaid reimbursement for naloxone would stress a system that already is struggling financially.
In addition, another administration official, speaking against the bill at a hearing last week, argued that naloxone can cause an overdose victim to become violent or ill.
There’s no evidence that the availability of naloxone increases the intensity of heroin abuse. In fact, some research suggests that active outreach as part of a distribution program can cut drug abuse and push more people toward treatment.
Cost should hardly be a factor, either, as a dose of naloxone costs as little as $22, with only several dozen used each year, and only minimal training necessary.
It is true that people given naloxone can come out of an overdose agitated. But the point is, they come out of it. It makes no sense to dwell on a medication’s limited side effects when the alternative is death.
The truth is, naloxone has been effective wherever it has been used. In San Francisco, overdose deaths fell from a high of 155 in 1995 to 10 in 2010 after distribution began in the late 1990s. Police in Quincy, Mass., began carrying naloxone in October 2010 after the city experienced 47 overdose deaths in a span of 18 months. Since then, there have been 16 deaths. Naloxone has been administered more than 200 times by Quincy officers, with a success rate of more than 95 percent.
Similar results can be expected in Maine, which has one of the highest rates of prescription drug addiction among youths and young adults, as well as a growing heroin problem.
Every year, 160 or so Mainers die of a drug overdose. In both 2010 and 2011, seven of those were related to heroin.
With stronger and cheaper heroin flooding the market, however, that number jumped to 28 in 2012, and the surge has continued unabated since.
Mainers addicted to opiates need access to treatment methods that have been proven to work. Unfortunately, the overdose victims of the last few years will never get that chance.
Putting naloxone in the hands of the people most likely to be on the scene of an overdose will make sure that others do.
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