Several issues in the news include the opioid Opana, the trade name for oxymorphone, which is becoming more popular as OxyContin and Vicodin are more closely watched. New federal laws were signed by the president outlawing synthetic marijuana and “bath salts”, as well as tunnels used for smuggling. Also, a new nicotine vaccination, and a discussion of true gateway drugs: alcohol and cigarettes.
Transcript (edited):
Podcast #117
HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions, I am Howard La Mere. Our plate runneth over with news this week of drug news, treatment news, and regulation news. So much so, that I just thought we would do a potpourri of topics. What should we start out with? Weve got Obamas banning of synthetic marijuana. Weve got a new federal initiative to train family docs about opioid pain medicine prescriptions. Weve got laws about border tunneling. Weve got stories about a replacement for Oxycontin. What should we start with first? What captivates you’re interest?
DARRYL: I love to use that word potpourri potpourri however you pronounce it and another word I like to use is plethora. There is certainly a plethora of addiction and drug related news today and I think I would like to start off with Opana, the prescription drug Opana, which contains oxymorphone, which is related to the opiate family specifically oxycodone, which is Oxycontin or hydrocodone, which is Vicodin. All are related of course to morphine and heroin. And its news breaking out big on the east coast and in the Midwest. The media and health officials are actually now reporting an epidemic of prescription drug abuse and the source is the diversion of pain killing opiate drugs or opiate pain killers with Oxycontin, Vicodin and methadone leading the way for many years. Pharmaceutical companies responded by trying to prevent that by coming out in late 2010, with a new formulation of Oxycontin making it even more difficult to either melt and cook up for injection or to smash the pills with a hammer so that the time release mechanism was destroyed and more of the drug was delivered at one time. What happened with that of course was that the street learned how to defeat that by learning how to freeze the new Oxycontin product.
HOWARD: And this is to make it injectable, right? Because thats the preferred method of intake?
DARRYL: Not so much injectable, but if you freeze it and then smash it up with a hammer it breaks away that sort of gummy property of the chemicals that Purdue Pharma put into it. And so, if you snort it doesnt gum up or if you cook it up for injection, it doesnt gum up the way the manufacturer intended as a way to prevent it from being diverted in abuse. Oxycontin in the 80 mg form is 80 mg of oxycodone of which Percodan, the standard for oxycodone was only 5 mg and Purdue Pharma was allowed to produce pills containing 80 mg and 120 mg by saying “we can make it time release”. The theory was that even if a person takes, you know, a bunch of tablets, only a small amount is going to be released over time, so theyre not going to get that full bolus or that rush of oxycodone into their brain that addicts love. Thats what they seek is that rush of opiates.
HOWARD: So then wouldnt it make more sense to go back to the low dosage.
DARRYL: Well sure, but the pain killing experts are saying the low dose isnt strong enough. It doesnt produce enough pain killing effects and people need more and today health care providers are more compassionate about giving enough pain killing medications. Plus the fact that if they gave more Oxycontin in the low dose form to a patient, and the patient needed to take 8 or 10 at a time, they would be also taking 8 or 10 Tylenol at a time
HOWARD: And we know thats no good.
DARRYL: And thats not good, so thats why they came out with the original long acting, delayed release Oxycontin pill. But the changes had unintended consequences. Thats always a good term I like to use now .
HOWARD: Thats another one of those!
DARRYL: And the unintended consequence is that the street is just too smart. You know, addicts are extremely intelligent people and dealers are extremely intelligent people and they looked around and they said, “alright youre going to play that game, well what what else is in the PDR? What else is in your old medical bags of tricks and they said, well look at this – this thing called numorphan or Opana, which consists of oxymorphone which is just as good or better than oxycodone in the first place and nobody seems to be paying attention to that” – so theyve turned into Opana abusers . Opana users are responsible for the big robberies the big busts. People who overdose come in because of abuse of oxymorphone in the shape of the prescription drug Opana.
HOWARD: This is a very confusing name game here.
DARRYL: Maybe that has something to do with it. But, the interesting thing about that is the whole field of abused drugs I call it the Whack-a-mole syndrome like that game . Whack-a-mole, where you whack one mole and another one pops up and you try to see how many you can whack down as quickly as possible, but there is a never ending supply of moles popping up and this is how
HOWARD: Thats why we drown them!
DARRYL: Well, .I dont think that will work in terms of drugs of abuse and addiction.
HOWARD: I dont know if it works with moles either.
DARRYL: I dont know whos leading the charge here. Maybe the pharmaceutical companies are learning from the drug abuse industry or the drug abuse industry is learning from the pharmaceutical company, but thats what we have. We have .
HOWARD: Its a symbiotic relationship for sure.
DARRYL: Bath salts and the synthetic marijuanas that are out there now and another ones going to pop up as soon as we whack one of them or we knock one down and the same thing happens with prescription opiates and prescription sedatives and prescription drugs – you try and control the abuse of one, but theres another one out there ready to be diverted and abused and it’s a continuous situation.
HOWARD: This reminds me of another story that dealt with a lack of mental health care for baby boomers and, in large part that seems focused on addiction drug abuse issues. My recollection is that those people are some of the largest users and abusers. Is that true or are we looking at young people as well?
DARRYL: I think its everyone and addiction can occur at any age as we know due to a combination of a person’s genetics and their stressors, environmental traumas and their exposure to drugs.
HOWARD: But we know that baby boomers are more prone than the prior generation towards these issues.
DARRYL: I think prone because it was an era of exploration and its the largest uncontrolled human drug experiment in the history of the world until now. I dont know what were calling this generation of young people now in their adolescent years and their early 20s. I know it was the X and then the Y, so I dont know what theyre calling the current generation, but because of the bath salts and synthetic marijuanas and synthetic chemicals and new plant substances that are out there and when we look at reports worldwide, were looking at probably the second wave or the second largest or maybe now the largest experimentation, uncontrolled drug experimentation ever which will lead to major problems. Baby boomers did a lot of experimentation with drugs. Some of them were early tragedies and immediately developed problems, overdoses, suicides and whatever. These got all the news headlines, but a significant number of others developed their problems during midlife and now another large group is experiencing problems as they become senior citizens. The adoption of the health care affordability act, it is projected by many of the drug abuse experts will open the doors for up to 5 million more people who havent been able to access addiction treatment.
HOWARD: However, there are nowhere near enough providers, or trained addiction counselors.
DARRYL: Or nowhere near enough programs. But what will happen is – if it is going to be paid for … they will build it. That type of a thing! There will be some fly by night operations and instant cure companies that promise “come in and we’ll fix you right up – just give us 30,000 dollars of your insurance money” but we may be able to offer greater access to treatment for a large number of people who need it. Also in the news was President Obama on Monday of this week signing a new law banning synthetic chemicals are used in the manufacture of the bath salts and of the herbal marijuanas
HOWARD: I didnt see that .I was going to ask you about that because I didnt see anything about bath salts only synthetic marijuana.
DARRYL: I read this in a couple of places – one put out by the Partnership for Drug Free America and they did mention the bath salts were also part of it but there are problems with that already – I heard my clients laugh at that law, saying theres no way its going to control anything. It named bath salts specifically and it named spice and the same herbal marijuana specifically, but what is to prevent people from selling their stuff as they do now as glass cleaner, jewelry cleaner, plant food, potpourri, and aroma therapy.
HOWARD: Fish food.
DARRYL: Exactly and you cant control it all so its kind of a joke that we sort of pass laws to try and stop these things, but it’s never going to be totally complete or effective. Laws are much more transparent than our legislators or our governments. The street sees through the laws very quickly finds the fallacies there are problems with the laws. Another thing that was in the news took place in Arizona. They just evoked a very little known law that makes it illegal for people to construct tunnels in order to transport or smuggle drugs into the country.
HOWARD: You mean it was legal to construct tunnels before that for other purposes?!
DARRYL: Yeah, its so crazy because you know, first of all they’ve been smuggling illegal drugs for decades and when was that ever legal? Whether it is brought in through a tunnel or on someone’s back and carried over – it is illegal. So they pass the law making it illegal for a person to dig a tunnel to smuggle in drugs and they are holding the property owner responsible. But the problem with that is the government has to prove the property owner they knowingly allowed this.
HOWARD: And some of them are really long.
DARRYL: And some of them
HOWARD: I mean, really long!
DARRYL: And some of them are really deep. How is someone going to know what is going on 60 feet down?
HOWARD: And how far down do you own the land anyway?
DARRYL: Well, thats the crazy part. Theyre making whoever owns the property responsible. They haven’t defined how deep you are responsible for. But it just brings to mind all these attempts to try and stop the supply side of drugs when in fact, I still think were missing the boat in all of addiction by not investing more into treatment and prevention of these conditions rather than trying to stop drugs from entering our country.
HOWARD: Well, its a failed effort. Why keep pouring money into it? Good money after bad. And no money into prevention and no money into treatment.
DARRYL: The sad thing is were pouring hundreds of millions of dollars into our war on drugs, but very ..
HOWARD: Which no longer exists.
DARRYL: Yes. Which is now called something else. I forget the metaphor theyre using for the war on drugs, but the thing is they spend all that money to try and keep drugs from being grown or smuggled or whatever and more drugs keep coming in and yet we have effectiveness in treatment prevention, but very little gets spent on that part of the equation, so that is a tragedy.
HOWARD: Speaking of prevention, there is another story in our multiple story list saying something we have talked about before, and thats that marijuana is not the gateway drug to other drug addictions, but rather alcohol, which is much easier for a young person to come by.
DARRYL: Well, if you ask me, nicotine is a gateway drug. So is sugar. A “gateway” to me is the first mind altering substance capable of producing compulsivity and obsession that a person gets their hands on. Whatever that is enacts the brain processes involved with addiction – whether its marijuana or cocaine or methamphetamine, heroin, caffeine or whatever.
HOWARD: I dont know its kind of iffy about sugar though. You can make the case but what kid doesnt like a lot of sugar?
DARRYL: That is true – but in the 1940s the US needed to beef up the citizens so they would be strong enough to serve in the military so corn syrup was added to every product imaginable that kids could get their hands on and now we have the highest metabolic disorder rate in the whole world. The highest rate of obesity. The highest rate of type 2 diabetes and diabetes type 1, which is, to me, a reflection of sugars addictive liability sugar is addictive and yet we havent paid attention to that. So, a gateway is just a drug a person uses that illicits excitation of their survival reinforcement circuitry or the dopamine circuitries in their mid-brain that makes them crave something and/or makes them want to engage in some behavior to excess. As we know, there are certain people who are vulnerable to that and other people who arent. And so marijuana as a gateway drug that was promoted for years and now its alcohol. Eventually I believe nicotine will be considered the biggest gateway drug there is.
HOWARD: Well, I think nicotine and alcohol would certainly compete. Did we talk about the new nicotine addiction vaccine? This vaccine actually creates in the subjects liver a veritable factory that manufactures antibodies that consume or that counteract the effects of nicotine.
DARRYL: Well, I think we talked about it in different podcasts before, but probably not in much depth. Several of the conferences I’ve attended on addiction treatment have featured announcements on vaccines – I heard that there are 400 vaccines in development to treat addiction and many of the scientists believe this is the way were going to go. Researchers in southern California are looking at nicotine, heroin, cannabis, methamphetamine, cocaine vaccines and a lot of other vaccines that will recognize the chemical, the drug, as it enters the body anywhere it enters the body… as a virus or as an influence of some sort, bind with it as an antibody like a vaccine would do and then ties it up activating it or making it unavailable to be taken into the brain or in many cases, unavailable to any biological organ. It would protect the heart, liver, lungs and other vital organs so that the drug cannot affect those anymore. Basically making the person immune to ever developing addiction or need to take the alcohol vaccine.
HOWARD: Well, that brings up a question – part of the reason that marijuana works is because it mimics cannabinoids, is this vaccine going to inhibit that?
DARRYL: Thats the question.
HOWARD: This is going to call for a lot of research because the potentials for complication are profound, I think.
DARRYL: Well, theyve been working on this for a good 25 years or more and we thought we thought the cocaine vaccine would come out, but it was only shown to be about 50% effective for the length of time they were hoping it would protect the brain and the body from cocaine.
HOWARD: And so this one is different because its universal? Its just one shot
DARRYL: Oh, no, no, no.
HOWARD: Its continuous. Oh, this new one that were talking about here.
DARRYL: Im not sure the new one is universal either.
HOWARD: Well, not universal in terms of what it treats. It is focused on nicotine, but it is just one shot and then your body
DARRYL: Oh, I see what youre saying
HOWARD: Then your body generates .
DARRYL: Its lifetime immunity that its inducing.
HOWARD: Yes, your body, your liver then generates the antibodies continuously.
DARRYL: Right, right, right. And those to take are even harder to develop than the temporary ones where a person gets an injection every month containing enough antibodies for that month.
HOWARD: Yes, thats what I mean. Something that works automatically like this that sounds like if you got something wrong and it doesnt show up for 10 years, youre in deep doo doo.
DARRYL: All of these drugs work through natural neurotransmitters and so they interfere with natural biological balance and activity. Scientists are also talking about genetic therapy and pharmacogenetics and making medications specifically genes or actually, in the case of Kenny Blum who is working with rats right now, injecting genes into the brains of mice and turning addictive alcoholic mice into normie mice who wont drink excessively and heralding that as a great achievement and a great thing for addicts, but I am quick to remind my addicts that there are some wonderful things that your genes give you that make you an addict, but they also make you wonderful – bestowing intelligence, creativity, sensitivity, awareness, compassion and if we change people’s genes there is the potential that all of that will be to sacrificed to become one of our terrible normies.
HOWARD: Yes, theres a lot that hearkens to 1984.
DARRYL: It also shows you the state of desperation addicts are in and if youre an addict, youre not a happy camper. Its not something you like doing. You want to be a normie more than anything else in the world. You want to be able to get high off of alcohol without having catastrophic events occur because you cant stop. And thats terrible. And this also shows you the degree of science thats been developed in terms of understanding addiction as a true biological medical illness or disease, such that medicine is becoming so precise in attacking it in these various ways in much the same way we attack cancer treatment, diabetes or hypertension. As a matter of fact, theyre developing genetic therapy for diabetes – they want to inject genes into the pancreas that would change pancreatic beta cell production eliminating diabetes. But, this is the degree that weve come to recognize addiction from a scientific point of view and them from an addict point of view, the desperation point of view. But the 70% of the population who are normies still want to believe addiction is a moral weakness or a crime, so theres not a lot of movement to change the funding focus to treatment and prevention rather than on things like blocking tunnels from being built and thwarting the smugglers which hasnt worked at all.
HOWARD: No more tunnels! No more tunnels for any reason whatsoever. Okay, we could go on and on here, but I think weve run out of time so we better call it good for now. Thanks for listening and your comments, questions and suggestions are always welcome. You can do that by stopping by the website, cnsproductions, and drop us a note. Darryl
DARRYL: Hey, great questions, Howard. Thank you.
HOWARD: That wraps our pod for today. Please check back soon for the next in the series and visit our website, www.cnsproductions.com