Nicomachean Ethics, Aristotle

The Hierarchy of Ends

In his book Nicomachean Ethics, Aristotle argues that every art, inquiry, action, and pursuit aims at some good. He defines the good as "that at which all things aim."

Aristotle distinguishes between two types of ends: activities and products. Activities are what we do, while products are what we create. For example, the activity of playing the piano is an end in itself, while the product of playing the piano (e.g., a beautiful melody) is not. Aristotle also argues that the ends of different arts and sciences can be ranked in a hierarchy. The end of a master art is superior to the ends of the subordinate arts that fall under it. For example, the master art of medicine is health, while the subordinate arts of medicine (e.g., surgery, medication, and therapy) are all aimed at achieving health. Finally, Aristotle argues that the ends of actions are preferred to the products of actions. This is because the ends are what we aim for, while the products are the only means to achieve those ends. For example, the end of a medical procedure is to restore the patient's health. The product of the medical procedure (e.g., a healthy patient or a cured disease) is not as good as the end of the medical procedure itself. Aristotle's hierarchy of ends has important implications for our understanding of morality. If the ends of our actions are to be preferred to the products of our actions, then we should always strive to act in ways that achieve the highest good. This means that we should not only consider the immediate consequences of our actions but also the long-term consequences.

For example, if we are considering whether to steal money, we should not only consider the immediate benefit of getting the money but also the long-term consequences of our actions, such as the damage to our reputation and the guilt we may feel.

Aristotle's hierarchy of ends is a complex and sophisticated theory that has been debated by philosophers for centuries. However, it remains a valuable tool for understanding the nature of good and evil and for making moral decisions.

Here are some additional thoughts on the hierarchy of ends:

• The hierarchy of ends is not always clear-cut. Sometimes, there may be competing ends, such as when we have to choose between our own happiness and the happiness of others.
• The hierarchy of ends can change over time. As we grow and mature, our understanding of what is good may change, and our priorities may shift.
• The hierarchy of ends is not absolute. There may be cases where the ends of a subordinate art are more important than the ends of a master art. For example, the end of a medical procedure may be more important than the end of medicine itself if the procedure is necessary to save a life.

Despite these challenges, the hierarchy of ends remains a valuable tool for understanding the nature of good and evil and for making moral decisions.

References

Aristotle(2023).NicomacheanEthics.HayesBartonPress.https://bookshelf.vitalsource.com/books/L-    999-70090

 What You Should Know About Xylazine

What is Xylazine?

Xylazine (also called “tranq” or “tranq dope”) is a non-opioid sedative or tranquilizer. Although not a controlled substance in the United States, xylazine is not approved for use in people  (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

How are people exposed to xylazine? 

Illegal drugs such as cocaine, heroin, and fentanyl can be mixed with xylazine, either to enhance drug effects or increase street value by increasing their weight. People who use illegal drugs may not be aware of the presence of xylazine. DEA has seized xylazine and fentanyl mixtures in 48 of 50 states, and the DEA laboratory system reported that approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA in 2022 contained xylazine. Xylazine is usually injected, although it can be swallowed or sniffed (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Should naloxone be given in the case of an overdose involving xylazine?

YES

Naloxone will not reverse the effects of xylazine

However, because xylazine is often used with opioids like fentanyl, naloxone should still be given. It’s important to call 911 for additional medical treatment, especially since the effects of xylazine may continue after naloxone is given (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

What should be done for someone with signs and symptoms of a possible opioid overdose or an overdose involving opioids and xylazine?

• Call 911. Stay with the person until first responders arrive. Overdose is a medical emergency. First responders can assess the situation and provide treatment (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).
• Give naloxone. Naloxone can reverse the effect of any opioids and will not cause harm if opioids are not involved in an overdose. However, because naloxone will not address the impact of xylazine on breathing, the effects of xylazine may continue after naloxone is given (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).
   
• Give rescue breaths. First responders have reported that rescue breaths are especially helpful for people who have used xylazine because it causes breathing to slow down. To give rescue breaths to adults, make sure the person’s airway is clear; place one hand on the person’s chin, tilt the head back, and pinch the nose closed. Place your mouth over the person’s mouth to make a seal and give two slow breaths. Watch for the person’s chest (but not the stomach) to rise and follow up with one breath every 5 seconds (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

 For people who use illegal drugs, the following strategies can help reduce the risk of overdose.

Never use it alone. A trusted contact can help reduce overdose risk by giving naloxone or calling 911 in case of an emergency. People who don’t have a trusted contact nearby can take advantage of services that allow people to seek non-judgmental support over a phone or video call when they are using drugs. Never Use Alone is a nationwide service that connects callers to trained volunteers who will gather basic information about the caller’s location, stay on the line to support the caller if they plan to use substances alone, and alert 911 if the caller becomes unresponsive  (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Carry naloxone and learn how to use it. Because xylazine is often mixed with opioids like fentanyl, naloxone should be given in response to a suspected overdose to reverse any possible opioid effects. Importantly, naloxone will not reverse the effects of xylazine. In the event of an overdose, call 911 for additional medical treatment (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023). 

Provide rescue breaths. Rescue breaths are especially helpful for people who have used xylazine since xylazine causes breathing to slow down. Harm reduction experts also suggest rolling individuals on their side, into the recovery position (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023). 

Know the risks of using illegal drugs with unknown ingredients. Illegal drugs are unregulated—they don’t come with an ingredient list. As a result, dosage and purity are difficult to determine. Heroin, fentanyl, and cocaine may be mixed with xylazine or other substances. Counterfeit pills that closely resemble prescription medications and contain illegal substances are increasingly common in the illegal drug market  (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Seek medical care for skin wounds. Skin wounds may become infected and worsen quickly. When treated early, wounds can be managed with basic wound care techniques. If left untreated, wounds can lead to amputation or become life-threatening  (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Reduce injection-related risks. According to the National Harm Reduction Coalition, the risk of infection can be reduced by using sterile injection equipment, rotating injection sites, allowing skin veins time to heal before another use, and taking drugs in other ways besides injection  (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Test drugs before using. There are commercially available test strips to test for the presence of xylazine in a sample of drugs  (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Fentanyl test strips can be used to test opioids, stimulants, or prescription medications for fentanyl. When people have knowledge that their drugs contain fentanyl, they can take steps to reduce their risk of opioid overdose (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023). 

 

Resources

 What You Should Know About Xylazine | Drug Overdose | CDC Injury Center. (2023, May 5). Www.cdc.gov. https://www.cdc.gov/drugoverdose/deaths/other-drugs/xylazine/faq.html

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Naloxone

 Frequently Asked Questions about Naloxone

What is naloxone?

Naloxone is a life-saving medication that can reverse an overdose of opioids—including heroin, fentanyl, and prescription opioid medications—when given in time. There are two forms of naloxone that anyone can use without medical training or authorization (Frequently Asked Questions about Naloxone, 2023): 

Nasal spray – Prefilled devices that spray medication into the nose.

Injectable – Medication (solution) given by injection into a muscle or under the skin.

How much does naloxone cost and where can I get it?

The cost varies depending on where you get the naloxone, how you get it, and what type you get. Check with your insurance provider to see if naloxone is covered under your plan. Community-based organizations and local health departments may offer naloxone at little to no cost. Naloxone is available in all 50 states and at pharmacies in most states without a prescription. Healthcare professionals can co-prescribe naloxone with high-dose opioids. Your state and local health departments or community-based organizations may offer a naloxone locator on their website (Frequently Asked Questions about Naloxone, 2023).

 Can I use naloxone on myself?

No, naloxone is administered to someone after an overdose has occurred. Because the individual who overdosed is likely unconscious and/or their movement and breathing are restricted, they would need assistance (Frequently Asked Questions about Naloxone, 2023). 

 

Can naloxone prevent an overdose?

No, naloxone cannot be taken prior to using drugs to prevent an overdose(Frequently Asked Questions about Naloxone, 2023). 

 Is naloxone addictive?

No, naloxone is safe to use and is not addictive (Frequently Asked Questions about Naloxone, 2023).  

Is naloxone easy to use?

Yes, naloxone is easy to use and medical training is not required. Check out CDC’s videos on how to use naloxone nasal spray and how to use injectable naloxone (Frequently Asked Questions about Naloxone, 2023). 

How many doses of naloxone do I need to give if someone is overdosing?

Naloxone is a fast-acting drug that can reverse opioid overdose and restore normal breathing within 2-3 minutes.3 Additional doses of naloxone may be needed for larger quantities of opioids or more potent opioids, like fentanyl. If the person who has overdosed remains unresponsive, keep giving additional doses (if available) until they’re alert or until emergency assistance arrives (Frequently Asked Questions about Naloxone, 2023). 

What to do if you think someone is overdosing:

1. Call 911 immediately.
2. Administer naloxone, if available.
3. Try to keep the person awake and breathing.
4. Lay the person on their side to prevent choking.
5. Stay with the person until emergency assistance arrives.

Does naloxone have side effects?

Naloxone can (but does not always) cause withdrawal symptoms or unpleasant physical reactions, in people who are physically dependent on opioids. Withdrawal symptoms may include fever, anxiety, irritability, rapid heart rate, sweating, nausea, vomiting, and tremors (Frequently Asked Questions about Naloxone, 2023). 

Is naloxone harmful?

Naloxone won’t harm someone if they’re overdosing on opioids or other drugs, so it’s always best to use it if you think someone is overdosing (Frequently Asked Questions about Naloxone, 2023). 

Can anyone carry naloxone?

Yes, anyone can purchase and/or carry naloxone to help respond to an overdose. It is not just for people with an opioid or other substance use disorder. Having naloxone available allows bystanders to help save lives by preventing a fatal overdose (Frequently Asked Questions about Naloxone, 2023). 

References

Frequently Asked Questions about Naloxone. (2023, July 5). Www.cdc.gov.          https://www.cdc.gov/stopoverdose/naloxone/faq.html#what

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