In 2016, Rachel Winograd began to see methadone patients who relapsed or left the treatment program where she worked start overdosing and dying at unprecedented rates. The culprit was illicitly manufactured fentanyl, which is generally 50 times as strong as heroin — with some variants an astonishing 5ph dream,000 times as potent. Fentanyl had begun to overtake heroin in Missouri.
“We were just seeing people drop like crazy,” said Dr. Winograd. But to her utter shock, staff members did not distribute naloxone, which is also known as Narcan, a nasal spray or injection that can reverse opioid overdose, to try to save their lives.
While fighting to change this policy, she discovered that many counselors, police officers, emergency medical technicians and even some doctors believed that handing out naloxone would do more harm than good. It would “enable” continued addiction and deter treatment, she was told. Or, others said, reducing fatalities would increase risk-taking among people who were already using drugs — and encourage children to try heroin.
Dr. Winograd, who is now the director of addiction science at the University of Missouri-St. Louis’s Missouri Institute of Mental Health, had encountered a concept known as moral hazard, the idea that reducing exposure to the negative consequences of a risk makes people more likely to take that risk.
While this phenomenon is a demonstrable concern for regulators of financial institutions — the 2008 crash is one infamous example — there’s little evidence it holds true in matters of health and safety. Here, moral hazard is far more of a political cudgel than a proven principle. As we face the worst overdose death crisis in American history, we can’t allow moral panic over moral hazard to drive out policies that have proved to save lives.
The University of Chicago economist Sam Peltzman introduced the idea of moral hazard to health policy in 1975. His data, he claimed, showed that seatbelt laws backfire because when drivers feel safer they take more risks, canceling out any benefit. Also known as risk compensation, the concept rapidly caught on as an argument against regulation.
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