Posts Tagged ‘heroin’

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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Posted in Addiction Education / Prevention, Downers, Dr. Darryl Inaba, Heroin & opiates, History and cycles of drug use, In the News, Podcasts, Prescription/OTC drugs | No Comments »

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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MCAT, prescription drug abuse leading to heroin, and more about pot

Friday, April 9th, 2010

A look at mephedrone or MCAT -  a  synthetic verson of the eastern African khat plant – is  a strong stimulant, with reports coming from UK, where it has become very popular, of  serious overdose issues.   Prescription drugs misuse and abuse continues as an escalating problem especially among young people – and the increased possibility of addiction to opiod pain medication leading to heroin use — made more pronounced by the flooding of the market with high potency and low cost heroin coming in from Mexico and Afghanistan. Also more on the implications of legalizing marijuana.

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Transcript (edited):

CNS:   Hi and welcome once again to the CNS Addiction Podcast.  I am Howard LaMere with Dr. Darryl Inaba.  Looking at the recent news of addiction, drug use and dependency, I see a lot of stories about things we’ve talked about recently, like the addicting qualities of eating, especially high fat/high flavor items like bacon, chocolate, potato chips and desserts, a big story just came out in Scientific American (http://www.scientificamerican.com/article.cfm?id=addicted-to-fat-eating) about that.  Also the continuing story on legalizing marijuana in California where the question will be on the ballot – what will that mean to the people using it medicinally, the people growing it and the government.  If it passes in California, it’s still going against federal law. We’ll have to wait to see what happens. Let’s talk more about prescription drugs and some of the substances that are being abused and causing serious illnesses.  There are some stories about a sharp upturn in the last few years especially among adolescences in the use of pharmaceuticals and what that leads to. Kids start on the OxyContin from their parent’s drug cabinet and because it is such an expensive drug, they end up substituting heroin. The other interesting item out of the UK is this new craze going on with something called MCAT.

DARRYL:      It is mephedrome and it’s been around for awhile. It is related to khat which East Africans have chewed for generations, maybe up to 1000 years. The shrub produces leaves which must be picked fresh because the (drug substance) cathinone is destroyed by the environment within 24 hours.  So because it was found Africa and the leaves needed to be fresh – it has never been a big item here. But what happened in the United States in the early 90’s was the development of a synthetic version called “methcathinone” by putting a metho group on it, a CH3 group on the apparent compound cathinone, it became more stable in the environmental and it could be sold off as a pill or powder.

CNS:   Is it just as strong?

DARRYL:      Yes, they claim it was just as strong.  Pharmacologists say it wasn’t as strong, but what we’re seeing now in Europe is a number of deaths related to its (methcathione) use.  We don’t see many deaths associated with methamphetamine abuse, so it must be that the methcath is much stronger than even methamphetamine.  But it’s growing there (in Europe) and its potential for abuse here stems from the fact that there are no laws that prohibit methcathinone.  So, like many other new drugs, it’s finding its way on the internet and you can buy it. I’ve also heard of people in this country gaining access on the internet to fresh cut khat leaves, and have heard that the chemical properties really don’t get destroyed within 24 hours, so it can be cut and shipped and people can get high.  On a personal note – Amnesty International contacted me once and asked me to detoxify a person from Somalia who was trying to come into the United States to be with his family, but he was a known khat addict so the US wouldn’t let him in.  I said,” Sure we can detoxify him.”   We detoxify methamphetamine users so we had it all set up and I never heard from the guy.  He never showed up for treatment.  About 5 years later he gets busted for growing khat trees in Monterey!  So there might be some local crop available on the west coast. Khat is definitely an upper and mephedrome or MCAT or whatever they want to call it – synthetic cathinone – looks like it’s going to be another drug that’s is now on the DEA’s radar to classify very soon.

CNS:   I think the UK is talking about taking action immediately because it is   apparently being sold as a plant fertilizer.

DARRYL:      So is synthetic marijuana which is now causing a lot of problems and sold as incense as well.  And I remember isobutyl nitrite – Russian locker room – sold as a room deodorizer, and sometimes it is sold as shoe polish.  You know….as long as you don’t call it a food, drug or cosmetic, you don’t come in violation of any drug laws for testing or anything and you can market it for what you’re using, but what happens if it gets abused strongly?  Then the government has to look at it a different way and maybe reclassify it.

CNS:   Is there anything else we can say to expand on pharming – the off-label use of pharmaceuticals that is becoming an ever increasing phenomenon, especially amongst young people.

DARRYL:      Well we’ve been watching that develop for a long time in our area.   Over the last 3 years there have been conferences and reports and such indicating an incredible increase in the abuse of diverted prescription drugs, by adolescences They get them from the internet or by raiding their parents and grandparents medicine cabinets, and more often when young kids go to dinner with their parents to their neighbor’s or their parents friend’s home they rush into the bathrooms to see what they’ve got and take everything that’s available.  There was a recent bust I believe in Oregon, where millions of dollars worth of pharmaceuticals were stolen.  The thieves busted in like a major sophisticated theft operation, like a sting….like a diamond or art theft …they broke in from the ceiling, cutting through and lowered  themselves down with these special belts and stuff and hauled off something like 73 million dollars worth of pharmaceuticals.

More kids are taking prescription drugs and diverting prescription drugs than are abusing marijuana, cocaine, heroin and a lot of other drugs.  Actually right now, the statistics show that prescription drugs are being abused by 20% of the teen population in the United States and probably a little bit higher here in Oregon because Oregon ranks towards the top.  I have noticed that during the last 5 years or so, a 500 or 600% increase in abuse among teenagers than in the previous era.  And between 1995 and 2004, there was a 3000% increase in abuse of prescription drugs.  OxyContin, Vicodin – those are still the preferred drugs The sad part about that is that once people get addicted to opiates, their thirst and their tolerance for opiates grows exponentially.  OxyContin is expensive on the street, selling for like 50 dollars a pill.  And the heroin  glut that’s on the market from Afghanistan, Mexico, South America, Golden Triangle, Southwest Crescent, the golden crescent – all those areas have now actually decreased the price of heroin to like 5 dollars a bag. A nickel bag or a nickel paper was last heard of during the early 1960’s.  So heroin with costing 5 dollars a nickel bag and OxyContin costing 50 dollars a pill, it becomes very attractive for prescription drug abusers to turn their attentions to heroin, and once they turn their attention to heroin, the number of users who use intravenously is so much higher than with other drugs.  We are seeing another epidemic of intravenous drug abuse and intravenous heroin abuse because of the way prescription drugs are being diverted.

CNS:   And all the complications that leads to – hepatitis and potentially HIV.   I know you’re not an economist, but if we legalize marijuana, what will be the fate of all those who have illegally made so much money through the years …it’s not like these people are just going to go straight.  They’re going to find something else to sell under the radar. We’re seeing that in California, there is a lot of violence associated with small towns, small operation growers bumping up against people stealing from them, or feeling competition from the major drug smugglers.

DARRYL:      Well, the political climate has changed towards legalizing marijuana.  Not just for medical purposes, but just to legalize it overall.  I think in the 1990’s, in California, only 22% of the polled voters favored legalizing marijuana.  In the year 2006 or so, you are looking at 46% and current polls are saying that 56…or over half the voters now favor legalizing marijuana.  Not for social or health reasons but purely because of the economic factor involved.  Governor Brown…Willy Brown, San Francisco mayor, California governor…writes an op-ed column in the San Francisco Chronicle and he wrote, “truth be told, there’s just too much money to be made both by the people who grow marijuana in the cities and counties that would like to tax it, not to vote for it.”  So that whole scene has changed where even Governor Schwarzenegger is saying we need to look at this, we need to look at the potential revenue.  There is a 9 block area in Oakland, California called “Oaksterdam” and a guy – Richard Lee is making millions of dollars through several pot shops set up already where you can get weed to smoke a lot faster than you can get a cup of coffee. People like him are going to be in the forefront of financing the lobby to get marijuana legalized.  This is too lucrative a thing to pass up and what I don’t understand is why nobody is looking at the long-term costs.  You know the short term gains are going to be huge.  You know people are going to jump on the bandwagon.  They will probably tax the paraphernalia, the names, everything about it. Nicotine….caffeine, heroin, cocaine – they all generate money.  People are just going to do whatever they can to get the money necessary to continue accessing these things.  But in the long run, what about the traffic accidents?  We know marijuana can cause traffic accidents.  What about the health issues?  We know it causes airway disease.  Maybe not as much cancer as does nicotine but certainly emphysema and a lot of airway diseases that come about from it.  All of these costs are not being looked at.  The fact is….it’s the general public will be voting on this – not the experts – and the general public seems to be of the mind to make marijuana legal.  It’s a threat, I think, to recovering people.  There are people who recognize that they are addicted to marijuana and are struggling to stay clean.  If it becomes legal, it will make it a lot harder because people will be smoking it wherever, and those in recovery will smell it and perhaps make them crave it.  Marijuana is one of those psychoactive drugs that operate in the same place in the brain where fat operates and as we predicted a long time ago – does the same thing to a brain as does cocaine, heroin and other drugs. If people who are vulnerable to addiction, or are in recovery use it – it can lead them to relapse by creating a craving for the drug that they most want and prefer.

CNS:   As is often the case throughout human history, we tend to act on the basis of short-term gains and don’t consider the long-term picture.  To our listeners – if you have comments or questions, send us an email.

 
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Coca growing in Bolivia, heroin instead of methadone, and demand reduction

Wednesday, August 26th, 2009

Our addiction radio podcast this week looks at news of increased coca growing in Bolivia and its complications, the War on Drugs and reports of more opium being grown in Afghanistan on less acres,  and differences in efforts at supply reduction vs. new ideas on demand reduction.

Transcript of podcast (click to listen):

CNS: Hello and once again welcome to the internet radio addiction pod cast from CNS. I’m Howard LaMere here with Dr Darryl Inaba and Darryl … a variety of interesting things in the news starting off, I was watching John Stewart show last night and there was a comment about cocaine – nine out of ten dollar bills or, US currency apparently have cocaine residue on them, which is really amazing.

Darryl: That, that’s actually, that’s actually a very old story and one of my favorite stories that dates back to the peak of the cocaine epidemic and the starting of freebase and all that back in the mid to late 1980’s and it does lead to the questions about cocaine. Behind all this meth and ecstasy, and heroin increasing, prescription drugs, you know in a way people have forgotten a little bit about cocaine. But cocaine is also on the rise I believe in, in the United States and in the rest of the world. The DEA and the office of National Drug Control Policy made the war on drugs (into a) war on cocaine and that was under General Barry McCaffrey and may have put in a lot of money and put all their efforts not at all drugs, but they said lets really concentrate on cocaine and they went to Columbia, got the government to basically outlaw any cocaine. Cocaine became outlawed in Columbia the largest growing region and, and people forget that the South Americans from the Incas on down have a real cultural tradition of chewing coca leaves.

CNS: Hundreds of thousands of years.

Darryl: Yeah, and they, they pick the leaves and they don’t extract the cocaine from it they just chew the leaves with some sort of alkaloid. I really like it because in the old days with the Incas they used to mix it with a bird crap and strangely enough I think there’s a lot of evidence that show that, that was a lot healthier than, than what they evolve into and that’s mixing it with lime or soda-lime or mixing it with ashes, now they mix burnt palm leaves that they burn down to ashes and they mix with it, and that the guano, the bat crap was actually organic. It was actually balanced, it was an actual alkaline substrate that in, in your mucus membranes it didn’t have that much damage to your gums and to your teeth and things like that where as now days using much more hygienic, they say and sterile things they’re getting all kinds of denture problems and gum problems from chewing the coca leaves. But this is as you say, for thousands of years it’s been part of the culture.  And to think that we can just eradicate it overnight just by making it illegal in Columbia and that people won’t want to do it anymore and not that I’m saying it’s addicting it’s just like coffee or um, it’s, it’s a cultural…

CNS: Norm.

Darryl: People chew coca leaves and they don’t go crazy, they don’t rob other people for it, they don’t have paranoid dilutions, they don’t crave it when they’re taken into the armed services for six or eight years to serve as, as a citizen and they don’t go through withdrawal or anything. So it, it has been a culturally  accepted norm thing but eradicating it for Columbia, stimulated Bolivia and the Bolivian President Evo Morales came in, he avowed that this, this is such an important thing to my people we are going to be, I am going to be more liberal and allow coca growing especially targeted for commercial purposes for the chewing of the leaves. I think he chewed the leaves with Oliver Stone on TV just to show, you know, how he’s behind that and it’s not a major addiction issue. For shampoos some of the ingredients, are good in shampoo, and for even tooth paste and things like that he is going to promote more cocaine growing because cocaine is a fairly resistant, it’s a good cash crop, so he’s encouraged that with the belief that the cocaine growing cash crop to Bolivia replaced what Columbia has now, the actual cocaine, the war on drugs the DEA and the Office of National Drug Control Policy were, were actually proud of the fact that there’s major decrease of cocaine production coming out of Columbia and that’s pretty much eradicated. But they didn’t look next door which is Bolivia and Bolivia now is growing a lot of coca, a lot more coca leaves actually they say it’s increased to about 65% than previous years more cocaine growing, cocaine processing. But unfortunately for President Morales there’s been a huge increase in cocaine production. He didn’t want, he wanted coca leaf production, while discouraging cocaine production.

CNS: Probably hard to keep them separate though.

Darryl: Well that’s what he’s finding out. They’re finding out that it’s hard to separate it and now that the former Columbian cartel is a Mexican cartels have all moved into Bolivia where it’s more liberalized to grow it and they’re producing the cocaine now out of, out of Bolivia. I have concern of, of different species, there are several different species of cocaine. One the Erythroxylum-ipadu plant produces different kinds of alkaloids, different types of cocaine alkaloids, that seem to be producing a much greater dependency on South Americans who are using cocaine and not the coca leaf of course and there was a concern that going into other regions, growing different species and doing the process is, it’s just going to accelerate it, it, it sort of also talks about or reminds us that the war on drugs is pretty much a failure. As far back as you look in the history of the war on drugs we continue to invest on the supply side of the equation, the two equations are demand side and the supply side and eight out of ten dollars that are spent in the war of drugs, are spent predominantly on reducing the supply. You know trying to eradicate countries from growing it, the growers, the traffickers, and all of that and it seems like every, the more we spend the more drugs there are coming into this country. Interesting thing about that was they, because they thought that had won the war on cocaine with Columbia, the Office of National Drug Control Policy really went into working on eradication of opium poppy and therefore heroin production out of Afghanistan and they bought up the crops and stopped this, put in this intervention, that intervention and they announced earlier in 2008 that they had decreased the number of acreage that was going to produce opium poppy that’s on it’s way to heroin in Afghanistan and then earlier this year they announced unfortunately that there’s more opium and more heroin being produced because somehow even though there was less acreage being planted there was much greater productivity out of the acreage that was there. But that’s all fluff because what the reality is, is I don’t think we’re ever going to accomplish anything by putting all our efforts I’m saying you can’t totally remove your efforts on supply reduction. But as shown efficacy and I keep harping on this is when you look at the demand side of the equation. You know, treatment, prevention, you look at intervention and, and different ways in which we’re approaching addicts and alcoholics and different medical developments to treat addicts now, its continued to result in improved out comes of people are getting recovered. People understand recovery. There’s less abuse now in the United States of illicit drugs among young people then there ever has been and you know for the last twenty years or so. There’s been a decrease. Unfortunately they didn’t monitor the increase in prescription drug abuse in the interim.

CNS: Right which we talked about that not too long ago.

Darryl: Right it’s, it’s a busy prescription drug abuse. But it does show overall that if we target our prevention, focus our prevention efforts and then especially in treatment, if we can provide treatment on demand. People for what ever reason, what ever time of day, what ever day of the week, they decide you now this, I’ve got to do something about my marijuana use, I’ve got to do something about my cocaine use, my meth use, my ecstasy what ever the drug is, that if they make a call they make a call they can get immediate interaction. Interaction with somebody who can give them some advise, they can come into treatment right away or very quickly there’s no waiting list and, and, and when that occurs I think we will finally be able to see some viable evidence that we, we could win this war on drugs.

CNS: This is a, the Europeans seem to be in many respects ahead of us. Do they have shorter lists or more treatment options then we do here?

Darryl: No they really don’t. There, there is you know the Portugal experiment that we wrote about recently that, that was interesting. The last I, I looked at that it was having some, some really good results in terms of treatment. But unfortunately in terms of, of primary prevention, stopping people from even initiating drug use it had, seemed to have the opposite effect. There was definitely a decrease in real hard drugs, heroin decreased, cocaine decreased, even ecstasy decreased, but there was a, a major increase in marijuana. I think it doubled and so then they were faced with having to deal with why was there, this is a great increase from these drugs and what can they do to stem that. But definitely they then put a lot of, or they, they began to change where their emphases was they weren’t emphasizing supply reduction they put their emphasis on demand reduction and I think that we need to look at that sort of approach. Europe also recently just two a, this week, two a publications in the New England Journal of Medicine which is a very prestigious medical journal, surprisingly published a case of promoting heroin use for treatment of heroin addiction in the United States and they, they sited studies I think one of the researchers was actually here at Oregon Health, Health and Science University in Portland, who analyzed the, the provision of heroin in some European countries to patients who were not able to engage in the methanon treatment approach. The whole converted to the US methanon approach pretty much. But some countries are going back to providing heroin legally as a treatment for heroin addicts in harm reduction approach and they’ve had some solid statistics or enough to satisfy New England Journal medicine head writers.

CNS: Looking at that study in my reading of it, that, it’s gone on for a number of years. It’s not a cursory study.

Darryl: But it’s showing a longitudinal data as you, as you mentioned it’s showing is that these people were put on the heroin maintenance and heroin replacement therapy or how ever you want to refer to it actually, they decreased their use of illicit drugs, cause they got heroin free. But you know the problem here with methadone although they might decrease heroin use with methadone, they greatly increase cocaine use or other ecstasy or other drugs that are out there, sedative use. But the heroin treated people in Europe seemed to decrease their abuse of all other drugs. They seem to be able to get jobs and hold jobs and they seem to be doing a lot better in comparison to their methanon contemporaries who are treated with methanon. So New England Journal of Medicine published that report and then they think it looks convincing enough and the data’s convincing enough to look at that. Unfortunately the whole history of why methanon developed was just this gut reaction fear by society about heroin, what heroin does. So I don’t know if it’s going to go any place because that reaction is still there and the prejudges is still there but it, it’s another thing to look at in terms of how we approach substance abuse treatment.

CNS: That wraps our pod for today. Thanks for visiting the CNS pod cast. Please check back soon for the next in the series and visit our website www.cnsproductions.com.

 
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