Archive for the ‘History and cycles of drug use’ Category

Raves and club drugs return

Thursday, June 10th, 2010

Traditional summer events beginning saw the return of Raves and the use and abuse of club drugs, with several overdoses and one fatality at the Memorial Day rave-dance in San  Francisco. Dr Inaba shares his experiences including rock medicine in the 60s Haight.

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Transcript (edited):

CNS: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions.

CNS: Darryl, it looks like the big news this week is the big rave in California, in the Bay area at the Cow Palace where several people became very ill and at least one person died of an overdose attributed to ecstasy. Its summer now and there’s likely to be a lot of festivals and musical events. There is talk of banning raves, but not musical festivals. So, hearkening back to your experience in Haight -Ashbury, what are your thoughts as we move into summer and what kind of drugs and drug activity are we likely to see?

DARRYL: Howard, I was actually in San Francisco for the Memorial Day weekend and one of my nephews went to that rave, actually it wasn’t called a rave, and it was called some sort of music scene or music festival for 2010. And so, it wasn’t advertised as a rave, but obviously it turned out to be a rave. There were a lot of drugs floating around – club drugs and a number of real bad reactions – overdoses. I think one gentleman died from a suspected ecstasy overdose or whatever drug he bought there…5 are in critical condition. So, it appears to me that they didn’t have what we used to recommend for all large gatherings…rock medicine. We would have an actual medical group to deal with whatever trauma we encountered…injuries from just stomping around, falling off of curbs and things like that, which would have helped address some of these issues. From the stories and feedback from my nephew, it didn’t seem that they had any type of rock medicine group there to deal with the 16,000 kids that came to this event. And surprisingly, ecstasy was back on the map – along with LSD, cocaine, marijuana and methamphetamine. It’s pretty crazy. They had enough undercover cops at the event to make over 70 arrests, which means that cops had pretty good evidence of and enough valid information that arrests would stick. A lot of cops and a lot of activity resulted in a lot of arrests at one little gathering.

CNS: It would be nice of there was a medical assistance, if you’re going to put in that much resource.

DARRYL: Yes, that’s a real sad thing because anytime you get a group of people together, you’re going to see injuries, heart attacks, you’re going to see the same things that you would see in any small city…on any given day… and there should have been some sort of emergency preparedness to deal with it. But the most amazing thing to me is that after years of decline, since about the end of 1990’s, the club drugs have really gone by the wayside. There was more interest in methamphetamine. Now we are seeing more interest in prescription opiates, prescription sedatives and heroin has come back. We thought pretty much it was the end of the club drug scenes and especially ecstasy. Ecstasy at one time was used by about 8% of high school seniors according to a study by Dr. Lori Johnson. The latest report from Dr. Johnson, in 2009 reported that number dropped to just less than 2%. So, we thought after 9-11 in 2001 that club drugs were more difficult to bring in…so street chemists were making other drugs that could maybe more profitable, but this experience in San Francisco appears to herald things to come. …the club drug scene is back with the younger population – they like to go out and dance and party. And what that means is that it won’t just be ecstasy, but a whole host of club drugs – the GHB, gamma hydroxyl butyrate drugs. You’re going to have Nexus 2CB. You’re going to have a wave of interest in psychedelics, which we see from time to time, especially as we go out of a phase of uppers, which we are just now doing, and into the next phase of downers, or coming out of downers, and into the next phase of uppers. And during those times there is sort of a flurry of interest again in the all arounders – the psychedelics, the psycho stimulants, the club drugs, the entactogens and pathogens and all the various names they want to give these substances.

CNS: As a transition item?

DARRYL: It seems to be. That’s my observation of it starting back in the 1960’s when the psychedelics became an issue and were abused. Various psychedelics exploded and then came the alphabet soup drugs like PCP and MDA and ecstasy MDMA, things like that, STP. We may see a return of Ketamine or even PCP because these are very popular with people who like to go to music events where they can become emotionally stimulated by these substances, less inhibited and therefore dance. Dancing started back in the rave scene of late 80’s into the 90’s and unlike the couple dancing you and I might be used to, in this type of setting, people under the influence of these drugs dance so individually. They’re not dancing with anybody. They’re going through gesticulations by themselves and listening to music and in a way, it’s a wonderful thing to see. They’re sort of free with the music, but it seems to take a lot of psychedelic or psycho stimulant drugs to suppress the inhibitions in order to create the motivation that allows people to do that. So, this behavior and these drugs go hand in hand. The other worrisome thing we saw during the last club drug scene in the late 80’s was the drug combinations. People would take combinations of heroin with ecstasy, LSD and ecstasy….a variety of just drugs…on their own…they would mix up and take them which caused overdoses and created serious problems. On its own, ecstasy is very, very toxic or can be very, very toxic. In all fairness, when you compare the number of doses taken and the number of people using, there are not the number of overdoses as with other drugs, but those people who do have a toxic reaction, it’s a very, very severe toxic reaction. Usually what happens is you get a hyperthermia…a morbid hyperthermia, meaning your body temperature goes out of whack and your body temperature goes way up very quickly without any compensatory mechanisms for your body to lower that body temperature and it goes up so fast and so high that actually people’s blood begins to coagulate while it’s in their blood vessels.

CNS: Not a good story.

DARRYL: No, a horrible situation with multiple hemorrhaging, internal hemorrhaging and death. And we saw a number…or a fair number of morbid hyperthermia deaths when the last club drug scene was happening.

CNS: And of course it is so difficult to tell when you get a legitimate drug versus a counterfeit one.

DARRYL: And that’s the next area that I was going to go to comment on…. you never know what you’re getting…especially at a dance. And at a club, you don’t know who’s selling it…when we did rock medicine, we would actually try and analyze the drugs that were being sold at the event, to make sure they were what they’re supposed to be. Oftentimes, 80% of the drugs sold as ecstasy, weren’t ecstasy, they were methamphetamine or MDA like ecstasy or paramethoxyamphetamine. These can be very toxic and more dangerous than actual ecstasy. And even those that did contain ecstasy were contaminated with other adulterants, they weren’t pure ecstasy. Then again, if people were at the event looking to buy some THC in a tablet, or something more organic or less dangerous, nothing will stop a dealer from saying, “Oh this is the best stuff you can ever buy” and misrepresent or sell off ecstasy, Ketamine or whatever he has and misrepresent it as THC or whatever somebody wants. So…you’ve got all of those problems with adulteration, misrepresentation. You’ve got mixtures of drugs and it’s a recipe for tragedy at these events and the kick off of happened on Memorial Day weekend in San Francisco at the big Cow Palace music event that ended with one death, 5 critically ill and several people arrested and maybe…my nephew said he saw several people were sick, which implies that the ecstasy might have been impure and tainted with some precursors or reagents. Some police are saying, no it wasn’t tainted, but the report on the drugs seized haven’t come back yet, so we don’t really know. Some people are saying that it was a wide variation in dosing. Things sold as ecstasy could range anywhere from 0 mg of MDMA, the actual methylenedioxymethamphetamine, the actual chemical that is supposed to be ecstasy, up to about 200 or 300 mg, which is about twice the actual dose of ecstasy it supposedly takes to get loaded. So, people buy from a candy raver who was dressed up like a little infant, sucking on a pacifier, that’s a candy raver…who says “I’ve got some stuff
… I’ve got the doses … pick from me”.

CNS: That’s interesting. And that makes me think of the 2 year old addicted to cigarette smoke in Indonesia which is so bizarre.

DARRYL: In this case, these are actual teenagers dressed up like infants, in little baby dresses, or …in my day, it was a nun. At big parades and events where people dressed up it was the nuns who had the best acid or the best doses, but it was a way to advertise that you’re a provider of these things. And people bought them….say someone bought one from a source and it was only about 10 mg or less of ecstasy…you need about 80 to 100 mg to feel the empathic effects people are searching for, and 10 mg, isn’t enough, so you go to the next dealer and you buy 4 more because you want to feel that, but this time 4 of them contain like 150 mg. …you are going to end up with these unwanted toxic reactions.

CNS: Obviously there’s no way to control the dosage and the purity of any given drug in a pop scene, in an illicit scene, and this compounded by a profit greed factor.

DARRYL: When we did rock medicine…one time we had Bruce Radcliff, a chemist working with us, other people would help too, we would actually set up a mini-lab to qualitatively and somewhat quantitatively test the drugs that were being sold at the event so that people would be warned that what’s being sold as THC is really PCP or something other than that. Unfortunately, law enforcement took a dim view of what we were doing and we were accused of providing quality control for dealers at these events and on the street. I told them that’s exactly what we’re trying to do! We’re trying to provide quality control…not for dealers…we’re trying to provide it for people who are going to buy the stuff whether….

CNS: So people don’t die.

DARRYL: Exactly…so, it was a sad thing when we had to quit and it’s sad that there was no rock medicine at this event because some of the problems could have been prevented or at least deal with more effectively.

CNS: Maybe we’re seeing resurgence…going back to pharming, especially by younger people. There was another article I saw in the last couple of days about a huge number, 1/3 of high school students, had …just messed around with pharmaceutical drugs. Any reader comments or critiques or suggestions are always welcome. Drop us a note and if it’s a question, we’ll try to get back to you on it.

 
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Opiods and the cycle of downers continued

Tuesday, June 1st, 2010

Purer, high potency heroin coming from Mexico is causing significant increases in overdose deaths, also doctor shopping and ways for Rx management, and the continuing issues of addictions by health care professionals

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Transcript (edited):

CNS:   Heroin and opium are in the news this week.  There is a report about the purity of the current black tar or brown tar heroin coming in mostly from Mexico and how that’s creating a rash of overdoses increasing by many percentages or hundreds of percent the number of deaths occurring from heroin overdose.  In 2000 about 2000 deaths were reported across the U.S. and in 2008 the number is up to 3000, that’s still a significant rise.  And there is another story about pill pushing physicians and more about doctor shopping by drug abusers and the ongoing issue of abuse of prescription drugs by hospital personnel.  So Darryl, how do you view these things and their interactivity?

DARRYL:      It’s fascinating…I’m not sure they have a lot of interactivity, but they’re all timely and they’re all expected.  First of all, the heroin story – we’re kind of overdue for another downer epidemic.  We’ve been on this cocaine and methamphetamine thing for awhile, about 30 years, and that’s the limit of how long an upper or downer fad goes.  So, we’re now ready to turn the corner and go to downers.  We see here in Oregon as well as all over the country a rising abuse of heroin – increased heroin overdoses and also an increase of prescription opiates.  So maybe there is a tie-in with prescription drugs and the health care professionals and general public starting to use more prescription drugs, or abusing more prescription drugs.  But the heroin story is an old one.  In terms of overdoses, they are much more linked to the variations in purity of heroin than it is to anything else.  And when we see…we see rashes of them, you don’t see, you know, a steady number of heroin overdoses every year…when we see rashes of them, especially occurring in any municipality or any state or something, it’s usually linked to a pure form of heroin that’s come in.  The latest story…I think was in Montana or something, it could have very well have been California or Oregon or any place else…actually talks about tar heroin.  Tar heroin has always been a more pure form of heroin in terms of actual milligrams of drugs, but less pure in terms of separating all the adulterants and ingredients and things leftover from the processing of opium from the opium poppy into morphine and then morphine into heroin.  It was a Mexican cartel, a third one, out of 1980’s that learned how to much more easily process the morphine that’s in opium to concentrate it without eliminating all the other adulterants and all the plant materials and everything else in opium and then easily converting the morphine that was in that resultant product into heroin by adding acetic acid to it or concentrated vinegar.  And that really is a simplified process, but it also resulted in a much more potent form of heroin because it was hard to cut.  You know, when it’s a finished product, it looks like tar.  It’s tacky, sometimes has a great sheen, black sheen to it and it’s, you know, it’s very hard, so….

CNS:   What do you mix that with?

DARRYL:      Yeah, maybe tar or something else.  So, as it got to the street and it was sold in smaller quantities.  It’s in gram quantities instead of a bag of heroin, which is like 300, 400 mg of powder.  But powder you can do anything to, so everybody who touched it wanted some profit on it, or wanted to support their own habit, would step on it.  They would add all kinds of things – instant coffee – if you want brown heroin, they add any kind of white powder to it – quinine, lactose or anything to step on it or dilute it.  Well tar was hard to cut, so it comes in anywhere from 60 to 80% pure or 60 to 80% of it is actual heroin and that’s compared to you know, the street heroin in the 1960’s and 70’s was only like 1 or 2%…

CNS:   5% is what it said in that story.

DARRYL:      5%…later on…and compared to that it’s a huge difference.  So if somebody is used to injecting an amount of drug to get a certain effect, but that drug they’re injecting is much stronger in its concentration of heroin, they’re going to more likely overdose and that’s what we see happening.  But heroin is growing.  There’s more treatment requests for heroin.  There’s more overdoses from heroin and I think it’s just right…the vanguard…well maybe the vanguard is actually the prescription opiates – the Vicodin, OxyContin, and this is coming in.  As people get addicted to opiates, they often times develop a much more rapid tolerance than you do to other drugs so they need more and more and for whatever reason, opiates lend themselves very quickly to injecting it for that rush, you know, that euphoric rush you get from opiates.  Heroin is a drug that offers that so it’s been very commonly seen that you graduate from the Darvons and the codeines and into the Vicodin, OxyContin, heroin very quickly.  Also when they bring in heroin like this, they usually introduce it as “chasing a dragon”.  You know, smoking it.  Putting it on aluminum foil and heating it or heating up a knife and pressing a knife onto the surface of the tar while you’ve got a straw stuck in your mouth…a McDonald’s straw – and breathing that vapor in, which is…the heroin is strong enough that you’re going to get high by causing it to sublimate or causing it to go into smoke and then smoking it.  But as your need for it gets more and more and you want more quantity and stronger rush, it lends itself to addiction.  So that’s what we’re seeing with the heroin.  Now the story about nurses becoming addicted and as you mentioned, medical professionals are much more likely to be an addict, per capita than the general population.  That’s always been…studies have been borne out.  Why?  Maybe they have access to drugs.  Maybe they see the effects of drugs more.  They’re in high stress situations, as you say, or occupations.  So whatever reason, there is a lot more addiction amongst nurses and doctors.  Now, what that story, I think was trying to point out is, that in nurses as well as physicians and also pharmacy programs, you usually have peer programs — when a nurse is suspected or caught diverting or misusing drugs, the peer organizations move in.  They usually intervene on the person and they usually have a contingency.  You know, you go through treatment.  You will take a leave from work.  Your license is going to be suspended for a year or more.  You’re not going to work and you’re going to participate in rigorous drug treatment and you’re going to do better or we turn you over to the law and you lose your license forever plus you get criminally prosecuted.  And what this article is saying, is that they don’t like that.  They don’t like if somebody say has diverted, they’ve diverted their Vicodin or their Percodan or morphine tablets from their patients or Fentanyl tablets from their patients to abuse them, that they think those nurses should be immediately turned over to the criminal justice system and fully prosecuted for their crime.  I think that’s a little bit short sighted in that it may discourage nurses from coming forward on their own and in a lot of the treatment programs right now, many of the medical professionals will come forward on their own.  They want to seek help and get treatment and want to maintain themselves as a medical professional and realize how much of a threat this is on their profession.  The other thing is that it may encourage sort of underground or secret practices that may harm patients even more.  Places like Oregon have wrestled with this question and unfortunately they have moved the treatment systems for all medical professionals out of the hands of their peers.  You know, it used to be peer pharmacy program, peer nursing program, peer medical program, but this article may be a result of what happened in California…where in California, nurses and medical physicians programs were felt to not really monitor, not really rigorously ensure that their fellow professionals were participating in a program, which led to patient harm.  And that’s a big concern that is driving this…patient harm.  And patient harm does result from an impaired physician.  You know, you’re going to have a surgery performed by somebody who’s loaded at the time…well errors are going to happen or if you’re going to be given medication by a nurse who is stealing your morphine to inject you with salt water, well, that’s not a very good thing.  So, there is that concern about it.  But I really think that the programs I’ve seen – the peer programs are good.  And they have a way of contingency planning with their addicted professionals and a really good way of monitoring and then covering the patient care.  Making sure the patients they were treating get good care so that the professional can get involved in treatment and ensuring that they are in treatment.  And if they don’t…if they drop out of treatment, if they’re not participating, they get a positive UA, well then there really is a signed agreement in the contract that the only option we have if this happens is to turn you over to the cops.  You know, and to violate you because you’re a danger not only to your patients, you’re a danger to yourself.  So, I’m kind of mixed on that.  I’m not sure how I lean on that.

CNS:   Yeah, it is… you know, we talk a lot about the need for more treatment, so it’s…you want to encourage that rather than toss them into jail.  But it is…it is a case where there is a potential for greater harm to other people being in that kind of healing profession.

DARRYL:      Yeah…that’s a rough one.  The other story that you mentioned is about the doctor shopping and that’s been a chronic issue with prescription drugs ever since there has been abuse of prescription drugs.  I remember I had a client in San Francisco…actually an Asian client who, as a little kid got his ankle mangled in a lawn mower or something like that…a power lawn mower, and so as an adult, it healed, but it was the worst looking, ugliest ankle you ever saw in your life.  And it was just his money train.  I mean he would go into a doctor’s office, undo his shoe, show his ankle and complain of pain and there it was…you know, the Vicodin, Darvon, whatever it was and that was his money train.  But the situation is doctors are going to try and monitor you and also pharmacists and nurses are going to monitor you.  They get one patient with an exorbitant amount of drugs and prescriptions, they’re going to bust you.  So it’s not just doctor shopping.  It’s actual pharmacy shopping.  You go to multiple pharmacies.  You take that mangled ankle or you complain of something, a migraine headache that is so severe, some difficult pain, fibromyalgia is a good one right now that you can’t really see what’s causing the pain, but we know people have severe pain and need treatment and you complain about the same symptoms, you know what the symptoms are going to prescribe to and you go to multiple doctors and get a prescription from each one and then go to multiple pharmacies to get them filled.  So you end up with a huge stock of prescription opiates and that you can abuse – or prescription sedatives – or prescription stimulants.  And then you can either sell them or you have enough to abuse.  You see there’s a difference when somebody takes something for pain, it’s different than when they take it for abuse or addiction purposed.  I’ve even had people in severe pain, save up their medication…not take the Vicodin or OxyContin, 1 every 4 to 6 hours, but take all 50 of them at a time, then go without the medication for several days because they’re more interested in the addiction and less interested in getting relief for their pain.  So it’s a whole different process.  But an easy way…or maybe a more modern way of dealing with this, and I’m surprised that this story came out because in Oregon, and California moved on this…many states are moving toward schedule 2 and schedule 3, maybe even all scheduled prescriptions being in a national computer base.

CNS:   Well that’s what I was just going to say.  You would…I mean this sounds like a logical, if not national, then statewide …

DARRYL:      Yeah, statewide computer bases.

CNS:   Of course that…you know, like we’re close to the border of California here, so you would want to…you might want it to be federal…but then there’s privacy concerns that come out of that one, but if it is … I mean clearly it’s a problem and this article refers to a new law in Wisconsin.  It doesn’t go to the question…it’s aimed at the drug abuser.  It doesn’t resolve or even address the issue of doctors who will too easily write prescriptions and what to do about that.  I don’t know.

DARRYL:      Yeah and that’s also been a difficult one, Howard.  Just in Oregon especially and other states, there has been initiatives for the last 10, 20 years where doctors are accused and sanctioned for under prescribing things like pain medication and for comfort medication…that they’re not prescribing enough and so…they’re in between, you know, making sure they give adequate medications to patients who need it, but trying to weed out those doctor shoppers and you know, the people who are scamming to get drugs.  So that’s a very difficult position to put doctors in, but the computerized system, see we had triplicates for medication in most states for very long and they were extremely effective.  When I was in California, when a prescription that was a schedule 2, a class 2 drug – something like morphine, something like Percodan, something like Nycental, something like Fentanyl was prescribed to a patient, you could only do it on a triplicate prescription form that was provided by the attorney general of that state.  And many states had the same law.  And one of the triplicate – one copy is retained in the patient’s file in your record as a doctor.  Patient gets 2 copies and he takes it to the pharmacy and the pharmacy that fills it sends one copy….retains their copy and sends one copy directly to the attorney general every month.  And the attorney general without computers, I guess had a lot of aids in the staff, would sort through that and pick out of there was an excessive amount of both doctors who were prescribing because doctors were looked at…you know, if one doctor had a small practice and 90% of them were getting Valium, so to speak, then there’s definitely an issue there unless that doctor is specializing in care that needs to do that, but they weeded out doctors who were prescribing.  And that’s one of your questions, how do we address the professionals that are prescribing, but they also picked out patients who were doctor shopping, getting a lot of duplicate prescriptions for the same problem and abusing them.  Now here’s the deal.  In all the studies, I remember in California, the day that a medication was deemed to be a scheduled 2 in that state and therefore went on a triplicate prescribing practice…on that day…from that day forward, 75% of the prescriptions for that drug in that state disappeared.  So…that’s effectively controlling it.  Now there’s criticisms on both sides.  You know, one side says this shows you how effective this is and there’s 75% over prescribing of these medications and a huge amount of people doctor shopping.  But the other side is saying, no…you know what happened is that so many doctors are so afraid and patients don’t want to be identified that they just go onto other drugs and they’re never going to be into this if it’s a triplicate drug and that there are other patients who need it and doctors should prescribe it but don’t because they’re afraid of the attorney general looking at them.  Although it is controversial, I think from the history of triplicate prescriptions, we have a way of now, in this state moving toward it and other states where they can actually take every controlled drug and computerize…I mean feed it into the computer and monitor it on computer bases prescription wise and have the computer spit out if there’s any unusually high amounts of drugs going to single patients or high amounts of certain abusable drugs that are coming out of one physician’s writing habits.

CNS:   Well, it’s interesting and it’s all related and it’s not going to go away.  So we will continue to talk about it and keep you apprised as we can.  As ever, comments and questions are most welcome.  Stop by the website, which is cnsproductions.com.  You can also stop by and look at our forum section, which is right next to the blog section there in the website and there’s some interesting comments from Darryl, answering people’s questions there also.  And of course you can leave a question there as well.  So Darryl, any closing thoughts?

DARRYL:      Thanks for some great stories.  You picked out some good ones, I think that are interesting and highlighting what’s happening right now in terms of the drug trend or the drug pulse of America.

CNS:   OK.  We’ll talk soon.  That wraps our pod for today.  Thanks for visiting the CNS Podcast.  Please check back soon for the next in the series and visit our website, www.cnsproductions.com

 
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Downers and the cycle of drugs of choice

Friday, April 16th, 2010

Several states are reporting a record number of deaths from opiod overdoses as well as related increase health issues from the misuse of prescription drugs. People who might start by experimenting with vicodin or oxycodone (OxyContin) can find themselves rapidly becoming addicted, and discover they cannot afford to continue on the pills due to the cost on the streets.  So we are seeing a shift to opiods, especially heroin, fueled by the low prices and increased purity of what is coming in from Mexico and  Afghanistan. We  continue our discussion with a look at the cycle of drug use and what appears to be the beginning of a new period of downer popularity.

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Transcript (edited):

CNS:    Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions.

CNS:    Hi and welcome to the CNS Addiction Podcast.  I am Howard LaMere here with Dr. Darryl Inaba as we look at the news this week. A story from the Oklahoma Bureau of Narcotics and Dangerous Drug Controls reports that last year they saw the highest number of deaths from drug related incidents ever,  and another news item covers the fact that the governor of Ohio commissioned a new task force aimed at curbing that state’s growing prescription drug abuse problem.  We’ve recently talked about the apparent decline in traditional illicit drugs – cocaine, marijuana and heroin – and the upswing in prescription drugs even though heroin is less expensive than it was back into the 60’s. How does the cycle of use go?

DARRYL:    Well, Howard, it’s not just heroin it’s actually all the opiate and opioid drugs that are increasingly being prescribed. Oregon has seen that for the last 5 years or so.   Ohio and Oklahoma are now seeing a massive increase in the diversion of OxyContin, and Vicodin.  I think Oklahoma is the first state to computerize and monitor their entire schedule 2 and maybe even schedule 3 drugs – controlled substances that are prescribed in the state – to see where they go and how they are being handled.   But this all hearkens back to our prediction years ago – we noticed this strange phenomena of 10 to 30 year cycles in which the prominent drugs of abuse and/or those catching the general public’s attention through the media move back and forth between uppers and downers.

CNS:    It seems like meth has at least stabilized for the time being.

DARRYL:    Right.  We’ve been in an “upper” cycle since the 1980’s when crack cocaine exploded and that was followed by Ice and crystal meth through into the 2000’s and if we’re right on track with past cycles, we’re due to go into a heavy “downer” cycle where the major drug abuse will involve sedating drugs, drugs that depress the brain, numb the senses and induce sleep.  Prescription drugs are sort of leading the way with the comeback of opiate abuse – Vicodin, OxyContin, codeine and the other opiates – and what we’re going to now see, is a growing increase of use of heroin.  The last time I looked, OxyContin was selling for 50 dollars for an 8 mg pill and Vicodin was selling for 25. Because of the influx of heroin from various sources and our inability to stop drugs from entering our borders, the price is down to 5 dollars – a nickel bag, you know, which was unheard since back in the 1960’s and 50’s. We had “nickel bags” but then they were 10 dollars and then 25 dollars, but now because it is readily availability and the new growing populations of opiate abusers, heroin is back on the radar. Heroin and other opiates are tremendously addictive – causing a very rapid onset of addiction.  I do not think addiction is as quick as nicotine, which is probably the fastest, but the path from experimentation to full scale addiction is rapid. Heroin lends itself to injection and very quickly we have people injecting opiates as a form of use, more so than with cocaine, methamphetamine or other drugs.  So much so that back in the 1960’s and 70’s, when I was working with Dr. George (Skip) Gay we published a paper with Dr. John Newmeyer warning “Heroin, it’s so good.  Don’t even try it once”  because we’ve found people who went from just experimenting, just trying to see what it would do when they smoked it, to full scale addiction very quickly.  Because heroin is more often injected than other drugs that has resulted in an increase of the hepatitis C epidemic which is much more virulent than an HIV infection.  It is easier to contract, much more rapidly spread into a much broader population and it seems like we may be unable to corral the hepatitis C epidemic as well as we did the HIV epidemic.

CNS:    People who experimented just one time ended up with that disease.

DARRYL:    Dr. Newmeyer just published a paper stating that the consequences of slippage, or from using an IV needle – either sharing or not sharing or using the rigs …a person has a 1 in 40 chance… (1 in 40 injections) of ending up with HIV, whereas with HCV or hepatitis C it was more like a 1 in 10 or 1 in 5 chance.

CNS:    Which are not very good odds.

DARRYL:    Absolutely. And as you mentioned – a lot of people just got infected from one experiment.  There are a couple of  cases in San Francisco where cocaine addicts just used a snorter…a tooter…that they stuck up their nose to snort  cocaine and they got  hepatitis C.  So, it’s just much easier spread than other viruses.

CNS:    And of course, increasingly these viruses are immune to the drugs that we’ve developed to treat them, creating an even larger problem.  Once you get it, you’ve got it.

DARRYL:    The reason for heroin’s attractiveness has always eluded me.  We do animal experiments that show that cocaine is the most compulsive inducing drug and the second most compulsive inducing drug is heroin followed by the other opiates.                                                                                                                                                                                                                Why they have that magic, that ability to attract people…I’m not always sure.  When you ask for descriptions of cocaine and how it affects the brain, users talk about brain orgasms and heightened senses and an ability to manifest and experience things and feel great and marvelous about yourself – so those are reasons to be attracted to cocaine.  But when people talk about heroin, they often refer to it as a euphoric.  I’ve tried to figure out exactly what constitutes euphoria and the closest I’ve come was an explanation given by a female pharmacist who was addicted to opiates – she told me that euphoria is the total abolishment of pain, both physical and emotional pain while under the influence of heroin or opiate drugs and that it lasts for at least for the duration of the time that you’re under the influence of the drug. It totally dissolves all the pain that a person suffers.  Both physical pains, emotional pains and all of the feelings of frustration and lack of confidence don’t bother you anymore. I still don’t see how that can have such a heavy influence on people that they get so addicted so quickly but it happens. When a person uses heroin the first time their brain stem is stimulated in an area called the chemotrigger zone this causes severe nausea and chances are you will throw up all over the place – especially if you try to move because that actually intensifies the nausea – that sounds very unattractive to me.

CNS:    You would think so.

DARRYL:    It actually causes projectile vomiting.  Sometimes in the hospital when patients are post-surgical, are on morphine doctors often prescribe Compazine or Phenergan to block the effect on the chemotrigger zone so when the patient gets a shot of morphine for pain relief they won’t be nauseated and throw their cookies up all over the sheets, which is not very attractive to the nursing staff.  If someone forgets the Compazine and a patient gets their first shot of Demerol or Dilaudid or morphine they will get very sick and throw up, even in the hospital.  Given all of that – it eludes me as to why people develop such an attachment to something that they’re willing to inject something in their arm – suffer the nausea and vomiting, suffer the pain from the injection in order to seek what?  I’m going to have to study this further and try and get more information from those clients who are addicted to heroin.

CNS:    Maybe we should put that out there as a question.  Send in your comments…your experiences. Without some kind of clarity of understanding treatment becomes more difficult.

DARRYL:    The treatment for opiates is less successful than the treatment for alcohol, cocaine and methamphetamine.  More people addicted to opiates relapse, are unable to maintain long periods of sobriety compared to people addicted to other drugs.  That doesn’t mean that treatment is bad – we still get good results from treating opiate addicts, but there are fewer positive outcomes and it may be, as you say, because we really don’t fully understand that attachment and what people are gaining from it so we can compete some other way in order to  get people clean.

CNS:    It will be interesting to see how the research continues and to watch the trends to see if we are indeed in a new downer cycle. As always – your comments and questions are most welcome.

 
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Coffee can be good for you – according to new studies

Wednesday, January 6th, 2010

A recent story in the Wall Street Journal highlights some significant benefits to drinking coffee. Also a look at the new “anti-energy” drinks like Drank, containing calming herbs like chamomile, melatonin, valerian root and rose hip. Dr Inaba comments include the every-few-decades cycling of the kind of drugs that are popular.

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Transcript (edited):

CNS:    Hi and welcome once again to the CNS Addiction Podcast. I’m Howard LaMere, here with Dr Darryl Inaba. One of the topics we focused on recently was the negative aspects of coffee and caffeine, and here is an article in the (December 31, 2009) Wall Street Journal about the positive aspects of coffee.

DARRYL: Quite a surprising story, an amazing one published by the WSJ which is fairly investigative and conservative in their reporting, and they published this just before Christmas, when people are gearing up for the Holidays  – the after-dinner coffees, and coffees during the day, so it was good timing. Contrary to many older studies which outline the negative aspects, the hazards and the addictive properties of coffee, this study showed positive results, amazing results from the practice of drinking coffee. Six cups of standard coffee lowered the risk of prostate cancer, 5 cups lowered the risk of Alzheimer’s by 65% in a Finnish study … that alone is enough to inspire me to go back to drinking coffee after I have been clean from coffee for some 30 something years.  I haven’t touched a drop of coffee because when I start I can’t seem to stop, I’ll go way above 6 cups, I’ll go up to 20 cups a day. But if 5 cups per day can lower the risk of Alzheimer’s disease by 65% that is saying something. It also cuts the possibility of stroke in women, and reduced the risk of developing Type II diabetes, which impacts a huge number of people in the United States. Close to 80 million people are pre-diabetic or diabetic type IIs so if 4 cups a day can cut that by 25 – 35 %, that’s a huge health benefit.

The study also claims coffee cuts the risk of gallstones, and lowers the risk of committing suicide. That surprised me because one of the problems with drinking coffee in excess is the crash.  According to this study, people that drink at least 2 cups of coffee a day cut the risk of suicide by 60%.  All these positive things are quite amazing. The older studies found increased hypertension – high blood pressure, cardiac or heart irritability with a propensity to develop irregular heart beat, increased stroke risk, and risk of miscarriage. A recent study says that pregnant women who drink 3 cups a day increase the risk of miscarriage. A lot of major hazards, GI irritability, maybe even some cancers of the stomach are on the opposite side of these health benefits. So the jury is still out about if it’s positively good for you, or positively bad for you, but it seems like there’s a lot of good news about coffee drinking.

CNS:    How are these studies conducted, it’s hard to do a regular double-blind test.

DARRYL: This is purely anecdotal. These are just reports – asking questions of people, and that’s why these studies are controversial. Researchers will ask people how many cups of coffee they drink a day, over how long a period of time, because they want to gage results on a longitudinal basis, to see what risks are connected. A lot of people aren’t going to remember how many cups of coffee they drank over the last ten years. And people are either stimulus-augmenters, or stimulus-reducers, I find very few people who are stimulus-normal.  And that means, some people are going to exaggerate – think they drank a higher number, and some will be stimulus-reducers; thinking they drink a lesser number per day.

CNS:    So what do make of the effect you mentioned of the stimulant effect on blood pressure – high blood pressure and heart disease – it sounds like its very contradictory. The article also mentions other substances beside caffeine in coffee, which might have a counteracting effect.

DARRYL: Caffeine is linked to increases in ergotamine, which is implicated in a number of health issues, so there is a concern, that’s these good studies are going to be outweighed by more of the untoward effects of coffee. I’ve always felt that caffeine addiction – drinking more than 5 cups a day or more than 500 mg, contributed to a number of deaths associated with GI, cardiac, blood pressure problems, and stroke in the US. It comes down to – what are you at more risk for, heart disease, diabetes or Alzheimer’s, so what’s better for you to take?

CNS:    That leads to wanting more information on a person’s individual biology, and we’re getting closer to that with different ways of assessing the DNA, we’re able to access much more than the family history. Where do you see that leading, in terms of how people make the kind of decisions you are talking about.

DARRYL:  That’s interesting because in medicine now, in pharmacy schools across the nation, in medical schools, they’re talking about genomics and genomic therapy. Today there is an easier method of looking at peoples genes, getting peoples vulnerabilities.  Gene clips take a snapshot of somebody’s gene’s vulnerabilities, to determine what type of medication is best for somebody with hypertension, with diabetes, with asthma. This matches the medication with the person’s vulnerability. If this continues to develop it will explodes into an era of medicine where everyone is treated not only by their diagnosis and symptom otology, but also by matching the treatment to their actual genetic code – what will be healthiest for them, and cause the least side effects. This could extend to nutrition, and maybe even determine whether you should drink coffee and tea or not.

CNS:  An interesting reverse side of that – Salon magazine calls 2010 the year of the “anti-energy drink.” New products have been introduced that are like the opposite of Red Bull … what do you know about that?

DARRYL:  It’s a historical thing; I see it purely in the form of history and the addiction cycle. Dr. Musto’s book (The American Disease: Origins of Narcotic Control) talks about a historical pattern in which there’s an era, of upper abuse, then there’s an era of downer abuse – and this sort of conforms to that. A methamphetamine addict can only stay up so long before they start to crash and have all the negative side effects – paranoia, irritability. If you ever stayed awake on caffeine, or on energy drinks, it’s not a real comfortable place to be, and you feel it. That leads to eras spanning 10-20 to 30 years where people are facilitated by the uppers – cocaine and meth, but leads them to a crash. So then they seek something to help them come down, to get some sleep, be more relaxed and rested.

Speedballs combine both uppers and downers. In the last 5-10 years we saw an explosion of Red Bull bars, where a shot of Jagermeister or whiskey is dumped inside an energy drink like Red Bull, Monster or Rock Star, and downed to get – in effect- a speedball. Research shows that taking an upper and a downer at the same time provides a person with one of the best feelings you can ever get from drugs … heroin and cocaine taken together, or meth with Vicodan, or Ecstasy with heroin. A small slice of people go from one to the other, and discover that the combination was the best of both worlds, only to discover that they have become addicted to both.  The same energy drink companies are now coming out with these opposites. These are like an antihistamine drink, they contain some kind of valerian root, some kind of chamomile or some other natural herbs to help sedate a person or help them come off their energy rush. There’s one called Drank which was the street name for that old hip-hop drink that abused antihistamines called Purple Drank. So it’s apropos for this whole upper-downer cycle including the speedball cycle to be part of that. Now we are in transition – headed toward downers again. The street is fascinating – they figure out things way before pharmacologists or doctors or scientists.

 
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