Downers – especially oxycontin and vicodin – are becoming the new drugs of choice for young people, and surprisingly, suburbanites. Viewed as less dangerous than heroin because these are pharmaceutics, they are actually becoming the new gateway TO heroin. We look at the neurotransmitter dopamine, how drugs affect it, and the brain’s GO and OFF switch functions; also practices and regulation of the pharmaceutical industry, the FDA role, and doctor training around these powerful drugs.
Transcript (edited):
CNS: Hi and welcome once again to the CNS Addiction Podcast, Howard LaMere here with Dr. Darryl Inaba. A lot of stories in the news this week were about downers. All over the place, all over the news one reported on a major bust of OxyContin on Interstate 5 in southern Oregon – a half a million dollars worth the cops stopped them for speeding ..why would someone speed when they are transporting illegal drugs?
DARRYL: Good question – any abused drug that acts centrally actually turns off major portions of the brain the cognitive, the thinking, the logical portions of the brain are just turned off.
CNS: drugs just turn it off
DARRYL: Yes, if you take drugs.. you turn it off. It is no wonder that people who are abusers do crazy things like carry 8000 hits of OxyContin in his car, speeds down I-5 and is surprised when he gets pulled over for speeding and is busted. I once had a client in San Francisco who was a meth addict and he got so paranoid on meth he thought his neighbors were coming in to steal his stock of drugs his stash, so he calls the cops! He calls the cops! I couldnt believe it. The story has a tragic ending the guy had a shotgun in his hands when the cops showed up and they see this guy is wired out he is tweaking, he is hollering incoherently and he has a shotgun in his hand. They told him to put it down and he didnt. They shot him and today he is a paraplegic. So the question of what was he thinking is really that he was NOT thinking because he was too loaded out on drugs.
CNS: Well, that answers the question, thank you! So, as weve commented over the last several weeks, we do seem to be headed into a depressive cycle. Not the economic depression, but into a downers cycle.
I want to focus a little bit on dopamine here. To what degree does dopamine play a role in all addictions, but depressive addictions in particular downer addictions?
DARRYL: Well, its role is the same in every drug that can cause compulsivity and addiction disorder. It is the natural chemical in the brain that magnifies or turns on the go switch that is part of the reward/reinforcement circuitry and it is responsible for that drive or the compulsion or the survival impulse the user has to access and continue use of the drug. Its that same dopamine in the brain that projects a little further to the frontal cortex of the brain setting in motion the stop switch the orbital prefrontal cortex sends a message back to the go switch saying, youve had enough its great, but you dont need to do any more. Drug use makes dopamine dysfunctional in both of those parts. It doesnt matter if the drug is an upper or a downer or an all arounder like marijuana, addictive behavior happens when the on or the go switch gets stuck. That causes the stop switch to malfunction and it also causes damage to some of the fibers that connect the stop switch to the go switch which is one of the reasons people get stuck and become addicted.
Now the thing about the downer phase that is on the horizon is, it is looking like its going to be an opiate downer phase. Other countries, like Russia are staggering with a heroin epidemic right now, but I think our biggest danger is the pharmaceuticals. Its our prescription drugs and it shouldnt surprise us at all, but its still surprising how irresponsible the pharmaceutical industry is. First of all they promoted OxyContin as a non-abusable or hard to divert medication because they tied up all the Oxycodone in a polymer that prevented it from being absorbed all at once, so you get a slow release of the chemical in your system to kill pain – the slow release didnt produce a rush. The drug companies promoted that, but from the beginning it was very clear how easy it would be to disable the slow release property – street addicts just crushed the tablets and chewed them. The pharmaceutical companies first tried to deny it, and then they tried to say this is only happening in France, and patients really need this medication. Now its a huge epidemic there is more abuse of OxyContin and Vicodin than there is of methamphetamine, and cocaine. Its almost as much as marijuana and yet the pharmaceutical industry is still fighting with the FDA and DEA and the government to come up with responsible ways of cutting back on the diversion and abuse of their drug by offering alternatives because what the FDA want that is just so Mickey Mouse.
CNS: There was a story about the FDA advisory committee coming out and saying that the proposed new rules for training doctors in the prescription of opioid medications were not strict enough, they just said, no youve got to go back and do it again because its not enough. And I thought that was really interesting because the FDA almost always abides by what their advisory committees say.
DARRYL: Well, the FDA wanted mandatory training. Anybody who gets a DEA number and is allowed to prescribe OxyContin, Vicodin, morphine or whatever must go through special training the way those who prescribe Buprenorphine do. The training addresses manipulations, over prescribing, addictions so that a doctor doesnt get trapped into unwise prescribing habits. You are made fully aware of what this will mean to your future and your license.
CNS: It would seem like it would be incumbent to careful train patients too.
DARRYL: Right, but what happened was the advisory panel sort of agreed with the pharmaceutical company and said, well lets make it voluntary training. I mean what is that?! And so the FDA is saying, what is going on here? Its irresponsible of the drug companies not to take a strong stand in order to protect the proper use of their medication. They think their medication is the best thing for pain. Thats what I would think, but obviously what they believe there is more profit to be made if more people use the drug. According to the police, the guy arrested with 8000 OxyContin tablets in his car would have sold them for 80 dollars apiece.
CNS: They actually range from 30 dollars apiece to 80 dollars apiece, but it is still about a half million dollars worth of drugs.
DARRYL: People are willing to pay or were prices have dropped right now for heroin because markets are emerging and it is becoming more available. Maybe its due to Afghanistans bounty crop flooding the market. Its the biggest crop theyve ever had despite DEA claims that we cut down on the acreage. They simply planted additional fields other places. Its a boom crop of heroin and opium in Afghanistan. There are people still willing to pay up to 25 dollars for a tenth for a tenth of a gram of heroin so if you extend that to an equal dosage of equal potency Oxycodone, maybe 80 dollars isnt that farfetched.
CNS: In other news related to dopamine, coming out of CNN about fatty foods being very much like addictive drugs. Is this it the same kind of dopamine or is it something else?
DARRYL: Its not that unrelated. Its been known for a long time that the eating disorders – compulsive over eating, bulimia, anorexia nervosa, things like that were also linked to inappropriate dopamine imbalances of dopamine within the brain. The natural occurring dopamine in your brain turns off your hunger and makes you feel satiated. But first you have to eat. The dopamine in the GO area of the brain, reward/reinforcement center, says this is important – youve got to do this to survive. Once the dopamine levels in a functional prefrontal cortex rise, it stops you by saying youve had enough, no need to overeat and shuts off the eating message. That same mechanism occurs when someone takes a drug. Not everyone gets the message; there are people vulnerable to eating disorders. I say there are people prone to alcoholism .are people prone toward addiction and when those individuals eat especially fatty food like that offered by the fast food industry .high salt, high fat, high caloric intake the food triggers a movement towards more. Youve got to do this; you must eat more even though you are totally satiated. People dont feel satiated; they just keep eating and wind up obese. Its hard for most people to imagine putting another morsel of food into their system when they are full, but people with a dopamine malfunction are going to continue to stuff themselves, even though physically their body is full. Their receptor sites in the stomach, the receptor sites in the colon, receptor sites elsewhere try and warn the body that its overloaded with of food, but in certain susceptible individuals, none of those warnings stops them from continuing to eat.
CNS: That can be seen in rats too, its pretty easy to convert a healthy rat into an obese rat or into an addicted rat. Is that largely a genetic factor?
DARRYL: Well, I dont know to what extent its genetics, but addictions, and I classify eating disorders as addiction, are chronic persistent disorders. Like diabetes, like epilepsy, like hypertension, asthma. All chronic persistent disorders have 2 origins or 2 polarities of origin or etiologies. One is genetic you can have a high genetic predisposition to a certain condition, but the other is acquired. The acquired predisposition could include certain factors that involve a genetic proclivity and are tied to environment, stress, and certain foods, – these can all contribute to the manifestation of that disorder. For example, diabetes, there is type I – you are born with that and you are brittle and you have a nonfunctioning pancreas right from the get-go. Type II develops later in life, it has a more gradual onset and is usually caused by eating fatty foods, poor diet, and lack of exercise.
The rat studies on compulsive overeating and genetic disposition go back to 1948 and the OBOB rat. The OBOB rat was born with a gene favoring obesity. OBOB rats were put in the same cage as normal rats, they were both given the same amount of attention, same amount of food, but the OBOB rat becomes obese, the other rat does not. There is always a genetic factor involved with chronic persistent disorders. How much it contributes to the manifestation of the disorder – well, that jury is still out. Some people say as little as 30%, some say as much as 80% when it comes to addiction. But I think it is a combination of environmental, genetic and toxicity factors.
CNS: And of course that points to new possibilities for therapy and treatment..
DARRYL: That is the future. My University of California School of Pharmacy in San Francisco is working towards this huge molecular genomics, they call it, which is actually guiding medical pharmaceutical therapy based upon a persons genes. There are about two or three hundred different antidepressant drugs and it takes quite a while for a patient to find the one that actually works for them, but genomics allows a doctor to read the genes of the patient and then match the most appropriate treatment. Within about 10 or 20 years we might have a lot of genomic therapy going on.
CNS: Fascinating. Okay, thats about all the time we have. If readers have comments or questions, please drop us a note and well respond if we can. Darryl, thank you, as always.