Heroin has become more popular recently, partly because the most sought-after prescription drugs, Oxycontin and Vicodin are increasingly being monitored, as we recognize the growing problem of abuse. But as they become harder to acquire, the laws of supply and demand make them much more expensive, and inexpensive heroin, especially from Mexico is filling the gap. We look at the "War on Drugs" started by Nixon, inreaction to the grwoing use of heroin in the 60s, and the current changes in demographics, with the realization that heroin is not just the drug of the inner city, the poor and disenfranchised, but rather crosses all levels of society.
HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions, I am Howard La Mere. It’s hard to sort out what in the news is most interesting and that we can fit into 15 or 20 minutes of conversation, but we’ll try. One of the stories that I came across, I think it was on MSNBC or NBC was a story about the change in demographics of heroin users. Back in the 60’s we first began to see a change in the demographics - traditionally, most people thought heroin addiction was confined to inner cities, minorities, poor people and the shift we’re seeing today is a profound one. A lot more younger people, a lot of different social classes are becoming involved in heroin. In part, as a reaction to the prescription pill epidemic and the efforts to clamp down on that.
DARRYL: Well, I think it sort of validates my belief that history repeats itself over time. It’s not a steady, one directional thing - we go through cycles. I’ve seen this cycle before and actually I think the drug abuse treatment world and the science of drug abuse owes a lot to the fact that in the 1960’s, there was a real change in the demographics of heroin users in this country. For some reason, heroin is still viewed by the general public and maybe even by legislators and judges as the worst drug of all. The most powerful and the most controlling and the most dangerous of all drugs and it is just unfathomable that people who are educated, people who have some stake in society would actually use heroin. So in the 1960’s when addiction, especially heroin addiction was thought to be confined to people of color and people who were impoverished and people who were disenfranchised, who needed some escape from their poor conditions and all of a sudden, heroin was being used by a much more affluent, a much more educated and a much younger population. It just stunned the nation and fueled the beginning of a lot of resources and money being poured into the war on drugs. This was Nixon’s big thing. He started the whole…the drug czar’s office and the war on drugs back in 1960’s and his target was actually heroin - "how did this heroin thing get so out of hand and why is it affecting people we don’t think it should affect?"
HOWARD: That’s interesting because I think of the war on drugs as being started by and aimed directly at marijuana and LSD, so that’s interesting information.
DARRYL: Well, even those drugs were thought to be confined to people who were disenfranchised - the poor, people of color. In the 1930’s … William Randolph Hearst … took on marijuana because of his need to control the paper ...actually, I think, he derided marijuana by trying to make it look like it was affecting the white population due to the influence of minorities. LSD created the same kind of fervor we see about bath salts today because there were horror stories about very, very wonderful and intelligent kids who had committed suicide because of LSD. Art Linkletter’s daughter was one of those kids and when you get sensational stories like that, it just…it just fuels a lot of reactionary interest from the general public. PCP was another drug that created a big reaction, and now its bath salts creating this tremendous backlash because of the gruesome stories out there. But in terms of total addiction treatment, I think the opiates are more abused by a younger, more intelligent, white population and that stimulates the reaction - "we’ve got to do something. We’ve got to do something now and we’ve got to do something big to deal with this problem." And as the government starts to invest in programs they are totally surprised at the complexity of the issue and are just now starting to realize that, well, addiction has nothing to do with being poor. It has nothing to do with being dumb. It has nothing to do with being disenfranchised. It has to do with the biological differences, which I call anomalies, that makes one susceptible to being an addict. These are partially inherited, partially due to environmental trauma and stress, partially due to nutrition and partially due to the toxic effects of the drug itself. And that of course is where we are today - accepting that addiction is a true medical disorder and one that is worthy of treating much in the same way that a diabetic is worthy of treating or somebody with high blood pressure is worthy of treating.
HOWARD: And of course, our buddy, Stanton Peele, is going to disagree with you there as he often does. We should get him on the show some time. Dr. Stanton Peele is an author and often blogs on the Huffington Post. One story I ran across was a reaction to the story that we talked about a few weeks ago in the New York Times about the DSM-5 and the creation of addiction as a category, the redefining of it, actually - the word addiction is used in the DSM-IV at all. There is a clear change in the perception and that was one of the questions I asked you -what is it that drives people to this behavior, what is the larger over-arching social drive that creates the desire for using…for altering consciousness?
DARRYL: Well, first, Howard, let me comment on Stanton Peele, because I think you’re right, he would make an interesting guest and we would be into some very, very interesting discussions about addiction. But back to the DSM-IV, as you point out, the term addiction is not used, instead they use “substance abuse disorders” which they classify it as either dependence or abuse and what the DSM-5 proposes to do is bring everything back to addiction and include behaviors like gambling and possibly other behaviors. Addictions will have specific spectrums of mild to moderate to severe addiction and to codify each drug and behavior like gambling. It’s interesting because I find in reading Stanton he sometimes validates what is going on with the vast majority of people who look at this as a true biological disorder and one that requires certain types of treatment for people to do well. His comments on the DSM-5, saying that he advocated for gambling 2 decades ago to be included as an addiction, so…I don’t understand how he can jump from one end to the other. He is saying that gambling was an addiction all along, but addiction doesn’t exist, so I don’t understand how that works itself out, which is sort of a strange thing.
HOWARD: Because it wasn’t a substance and it wasn’t a chemical.
DARRYL: Right, but, having said that, I wish we could have him on the show and we could have a Point-Counterpoint, agree to disagree.
HOWARD: That was the name…you thought of the name.
DARRYL: That would be interesting. Now the other thing is that in the 60’s when the young educated middle class kids started to get into heroin and the government started to respond, - they had to throw out their belief system in terms of what they thought addiction was. They thought it was a way of coping with disenfranchisement and poverty, with not being accepted by society. The reality is …drugs are always going to make money because there is that segment of the population that will use regardless of how much it costs, they'll pay - supporting this industry. Look at tobacco. The cost of tobacco can go higher and higher, they can pass all the laws they want, but it’s so addicting that people are always going to buy it.
HOWARD: Its all about the money…
DARRYL: That’s correct so drugs are always going to be available. Somebody is going to profit from them…they’re going to be available. There is a tremendous amount of curiosity about drugs - especially when you’re an adolescent and you’re wanting to become your own person, you’re wanting to become independent. Adolescents tend to invest in the future, so they quit listening to adults by the age of 12, 13, maybe 14…they quit listening to adults because that’s not their future. Their future is with their peers, so they start listening to other kids.
HOWARD: It’s getting younger and younger, I think.
DARRYL: Right and there’s a lot of peer pressure. Young people have a strong desire to be included, to be accepted by their peers and when drugs enter the picture there is a lot of curiosity. Kids are curious, you know. When the news reports that some monster just ate off somebody’s face while on bath salts, - that’s gruesome and some kids might say, "Oh my God, it’s so horrible, I can’t even think about doing it". There’s another group - a certain percentage, a good percentage that will say….."what is that stuff? What is that all about? How can something have that much effect?" And - curiosity leads to experimentation and we know the vast majority, 70% will experiment with drugs and never have any issues with them, never want to do them again, but it’s that 30% that we’re talking about that have anomalies or differences in their brain chemistry and brain function. When they experiment they will be more vulnerable and could be driven to compulsive or dysfunctional use a lot quicker. They will continue to use regardless of the negative consequences - that’s the illness, that’s the disorder, that’s the anomaly, that’s the condition of addiction. It doesn’t affect everyone but the minority it does affect - those who are vulnerable to it are going to suffer horrendous problems because their body is different. For them, for addicts - it's a real struggle. Teaching this group what their brain is like….and most of all - having them accept that they have a different brain, that they have an anomaly, that they have to live their life differently. This is the same process a medical doctor takes when explaining to a diabetic that they have a pancreas that operates differently. They have to eat differently. They have to do different activities. They have to pay attention to blood sugar levels - and if they do, they can be very healthy. In the same way, when addicts who have anomalies that make them prone to addiction accept that they have a difference and they do things that promote help, they can live wonderful, wonderful lives, but it takes acceptance. And why does someone try a drug for the first time? I think everybody in their lifetime will try an addictive psychoactive substance, whether it is prescribed to them or made available by somebody else - like the prescription opiates that are growing into a huge diversion and abuse problem. So when an individual becomes addicted to opiates encounters a government crackdown on Oxycontin and Vicodin, well…what’s available out there? What can they buy? What’s going to be effective? The answer is heroin. Heroin out of Mexico and Columbia and other places in the world is dirt cheap because there hasn’t been a lot of demand for it. We’ve been in an upper cycle. They’re going to gravitate towards heroin because the prescription opiates have been taken away.
HOWARD: I still wonder about this article though and maybe I missed something in it, but it does seem like there are more people and wider swath of people - is it that we’ve made these kind of drugs more available than they used to be?
DARRYL: Well, I’m not sure.
HOWARD: Back to pain - do we have more pain in general as a society and thus people are more exposed to these pain medications?
DARRYL: That’s an interesting viewpoint. I was going to first say that the article just talks about the difference within the last 10 years and the increase in the number of emergency room visits and treatment reports so this is a short time frame. It doesn’t look back to the 1960’s and if we compare apples to apples, I kind of believe requests for opiate pain meds was greater in the 1960’s. But you make an interesting point here because we’ve been here before - where medicine and society claims that we are under-treating pain, then the pendulum swings to the other side saying we’re over-treating pain. We’re under-treating anxiety, slipping to the other side, we’re over-treating anxiety. And this has been going on for many, many…a couple decades anyway - that we’re under- treating pain and promoting more and more liberal use of only those drugs that became abused… Oxycontin, methadone, Vicodin, things like that. Well, now that pendulum has swung and maybe we’re over-treating pain and there is this phenomenon called hyperalgesia , or hyperpathia where the brain cells in the body adapt to constant exposure of pain killers, where a person becomes more sensitive to pain instead of less sensitive to pain and so they take more and more opiates or more and more pain killers just to get relief and it’s just a never ending battle to try to keep up with that. So maybe, by swinging from under- treating pain to being very liberal with pain treatment, we created hyperalgesia and people now need more pain killers. And when we clamp down and prevent people from getting pain meds they turn to heroin or whatever is available to treat their hyperalgesia states. So there’s some pharmacology as well as social political aspects of what’s going on with these drug trends.
HOWARD: It is interesting how they continue to change and evolve. We learn new things and then things then continue to change and evolve.
DARRYL: I submit that we haven’t learned.
HOWARD: We haven’t learned enough.
DARRYL: What happens is we react to them and react …nobody’s looking back to the 60’s and what happened. You know what I’m saying? We should learn from the past so that we can avoid making the same mistakes in the future, but we tend not to…we ignore the past and so we keep reliving it over and over.
HOWARD: That’s the old Chinese curse, I think. Some kind of old curse. Well, the curse of the time clock is upon us and we’re out of time, I find these topics quite interesting and you know, we kind of took different paths than where we started but I thought it was interesting and I hope our listeners did too. If you have comments, questions, suggestions, we’d love to hear them. You can do that by stopping at the CNS website, cnsproductions.com. And leave us a note there. Darryl, thanks as ever.
DARRYL: Thank you, Howard.
HOWARD: That wraps our pod for today. Please check back soon for the next in the series and visit our website, www.cnsproductions.com .