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.
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 states growing prescription drug abuse problem. Weve 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 60s. How does the cycle of use go?
DARRYL: Well, Howard, its not just heroin its 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 publics 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. Weve been in an upper cycle since the 1980s when crack cocaine exploded and that was followed by Ice and crystal meth through into the 2000s and if were right on track with past cycles, were 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 were 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 1960s and 50s. 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 1960s and 70s, when I was working with Dr. George (Skip) Gay we published a paper with Dr. John Newmeyer warning Heroin, its so good. Dont even try it once because weve 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, its just much easier spread than other viruses.
CNS: And of course, increasingly these viruses are immune to the drugs that weve developed to treat them, creating an even larger problem. Once you get it, youve got it.
DARRYL: The reason for heroins 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 Im 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. Ive tried to figure out exactly what constitutes euphoria and the closest Ive 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 youre 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 dont bother you anymore. I still dont 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 wont 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 theyre willing to inject something in their arm – suffer the nausea and vomiting, suffer the pain from the injection in order to seek what? Im 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 doesnt 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 dont 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.