To follow up on the excellent article by Madison Angell on the JOLT Foundation ("Reducing harm, saving lives," July 8), she references JOLT's commitment to make readily available injectable or inhaled naloxone (Narcan) to those who have regular contact with opioid users – all of whom are at risk for fatal opioid overdose. Naloxone saves lives because it immediately reverses the potentially fatal respiratory depression that opioid overdose causes. This is, of course, most laudable.

Angell does not mention, however, that after every dose of naloxone there is still more immediate work that is necessary to save the recipient if the recipient has been a chronic opioid user, something that is usually the case. The reason is that soon after its dramatic life-saving effect, naloxone always precipitates in the chronic opioid user an acute opioid withdrawal state that is generally intolerable to the user. The just-rescued victim now craves – insists upon, actually – an immediate opioid fix to attenuate the withdrawal. 

Therefore, the recommendation is that every chronic user-recipient of naloxone go promptly to an emergency room to begin medication-assisted treatment for opioid use disorder. The initial treatment ideally should consist of buprenorphine (Suboxone) or methadone in an inpatient setting, with provisions also to begin right away a program of intense psychosocial counseling combined with the maintenance medication – the real treatment regimen for opioid use disorder. 

Unfortunately, many opioid users reject this recommended transition to proper treatment, either because they have no means to pay for it or they prefer to return to their previous pattern of illicit use, regardless of the risks. It is, sadly, relatively common and ironic that many instances of opioid overdose death occur within just hours of naloxone rescue.

Naloxone is, therefore, only a temporizing measure. It plays little role in treatment or prevention. It is not an entity that combats addiction. Other entities are; but, unfortunately, access to these remains woefully limited relative to the need. 

Eli Goodman, MD

How to divide Lake Springfield?  Create an ordinance that permits deer hunting on unleased lake property owned by the City of Springfield and CWLP and you'll succeed.  Fliers about deer hunting recently were delivered to certain lake residents' homes.  Others were excluded.

How safe are lake residents going to be with hunters combing the woods in search of deer?  Wooded areas that are unleased parcels of land surround and/or are adjacent to lake-leased properties.  Too many people are packed around the lake for deer hunting to be safe.  People walk dogs in the woods, children play and birdwatchers look for birds.

The ordinance opens a door for people who do not like nature.  Which animals are next?  Already there is talk about killing geese at the lake.  Big yards with grass growing up to the shoreline are what geese like.  Geese are not fond of yards with bushes and large plants along the shoreline – a better solution.

People are the real intruders at the lake, not the deer or other wildlife.   I agree with people who are tired of deer eating their flowers and plants.  But is killing them the answer?  Why don't people consider a deer relocation program or the use of darts to sterilize deer?

For all concerned, I hope that the city and CWLP select a humane and safe way to solve the deer population problem at Lake Springfield.

Kay Cooper Watt

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