In the 1960s, the drug culture was known for psychedelics, LSD and marijuana. Eventually, some of those users sought a stronger high, and that led them down the path to heroin. At least that was the message pushed by the government in its fight against drugs.
Heroin was actually not that common and it was often a drug of addiction found in Vietnam veterans due to its availability in that region. Intense drug programs and interventions to rid production significantly reduced heroin use in the U.S. from the 1970’s through about 2000. In the 1990’s, the era of everyone needing opioid pain management began and along came Oxycontin. The quick and easy option for most doctors to treat pain was to write a prescription for the magical opioid pill. For the last ten years, we now have discovered the rising tide of opioid addiction and now deaths from overdoses is catching up to the number from auto accidents.
Link Between Pills and Heroin
Oxycontin first came on the market in the 1990’s and was extensively marketed as a safe drug for management of pain. The manufacturer would fly physicians to resorts, wine and dine them, and then try to hire them to lecture other doctors on the wonder of their drug. By about 2005, some of the problems with addiction were becoming evident. The government convinced the manufacturer to develop a formulation that would deter abuse by making anti-crush pills, and these came on the market around 2010. It was still a potent drug, but it was not as fun to take and the pills became expensive on the black market. However, the damage had been done and now the main way to treat pain was with opioids, any many people had become addicted to the powerful medication.
A study recently done by the University of Pennsylvania and the Rand Corporation explains why heroin has now become a problem. The development of the new formulation of Oxycontin made this drug more expensive and harder to abuse. Heroin has become cheap, more pure, and once you’re hooked on opioids, it is now easier and less expensive to obtain. So once a person is addicted to pain pills, the cheaper route to get high and prevent drug withdrawal is to use heroin.
Now the latest trick for those with an opioid addiction to get high is to use heroin or oxycodone that is mixed with another synthetic opioid like fentanyl or cor-fentanyl which are a hundred to over a thousand times stronger. These drugs are often been manufactured in China or India, and they can be easily mailed anonymously without much suspicion into the U.S. If mixed wrong, these newer synthetic opioids are often deadly.
Takeaway Points
The message from the opioid crisis is that pain has many ways to be treated, and left unregulated the use of opioids is often more dangerous then helpful. Addiction is a disease; without treatment, some resort to the use of heroin since it is cheap, and many cut that drug with other potent drugs that are deadly.
Stopping the opioid crisis will take time and effort. Treating pain is not just about taking opioids – that has led to the addiction crisis. Money needs to be spent on pain research and the development of better pain management strategies. A third of the population has issues with pain, making it more prevalent than heart disease, cancer and diabetes combined. To solve the problem of pain and drug abuse, a concerted government investment into pain research and better medical management is needed.
The death of Prince has been a turning point of how serious the opioid addiction epidemic has become. Almost every medical pain specialist has been aware of the problems with opioids, pain and addiction, but now others are taking note. There are many concerns with prescribing opioids, from whether they actually help control pain, are there better treatments, and how many additional problems they are causing. We know one of the big problems caused by opioids that has become horribly worse is opioid addiction. Many people with and without pain are addicted to opioids. A new way to help treat addiction is in development – vaccines.
The information for this blog comes mainly from an article by Susan Giados published in the July 9,2016 issue of Science News Magazine. For those who are interested in a variety of scientific topics, this is a twice a month magazine, usually about 30 pages long packed with short fascinating articles. Well worth looking into.
The Heroin Scene
Heroin and opioid medications are accounting for about 30,000 overdose deaths a year. Here’s how it came to be popular in the US.
1960’s – Heroin first came on the drug scene in big numbers in the early 1960’s. It was a strong drug that produced an intense high. Most users came to the drug while searching for more intense highs, but the drug was not particularly pure or cheap.
1970’s – Major education and opium eradication efforts into the 1970’s suppressed its use.
1980’s and 1990’s – The late 1980’s introduced long acting opioids like OxyContin onto the market, and big pharma pushed these drugs as safe and as the answer to any all pain was simply to take a pill.
2000’s – By the early 2000’s opioids were the first and most common way to treat pain, and every doctor was prescribing them. The rate of addiction rose drastically, and as the awareness has grown, the access to prescriptions has slowly become harder. Opioid addicts now were everywhere.
Now comes into play some very interesting economics. Addiction itself has driven a market to supply people with opioid medication. It spawned an under culture of “pill mills” where almost anyone could go and get a supply of opioid pills. Many people would “doctor shop” for pills, use some and sell the rest for money. Drug cartels started to get into the mix manufacturing and selling them, further fueling addicts. The government then started clamping down on the supply since about 2010. The drug cartels have long had the ability to make heroin, and now they knew they could make large, pure amounts cheaply. For addicts, those who got hooked on pain pills for any number of reasons now saw heroin as a cheaper and often easier to obtain option than prescription medications. Now heroin has become a major problem as more addicts are turning to that to treat their cravings and pain.
Addiction to opioids has become a huge problem. There now are three medications that are used in the treatment of addiction; methadone, buprenorphine, and naltrexone. Methadone and buprenorphine are used to reduce cravings, and must be continued indefinitely. Naltrexone is used to block receptors and is used almost exclusively to reverse opioid overdoses. Unfortunately of those who seek treatment for addiction, only 25% end up receiving medications to help prevent relapsing back into addiction. Vaccines were first attempted in the 1970’s, but the science and cost of development were barriers, and the methadone was cheap and easy to use.
Addition and Vaccines
Now a little additional primer on addiction. Opioid drugs alter the brain pleasure circuitry and cause changes in the structure and function of the brain. Opioids act on the nucleus accumbens in the brain, and they increase the amount of dopamine in the brain. Opioids also act on the mu receptors throughout the nervous system, stimulating dopamine. These are the same chemicals that stimulate the pleasure centers in the brain and reinforce enjoyable activities like eating, sex or listening to good music. Dopamine, in other words, is what is stimulated by compounds like opioids and by stimulating pleasure. Over time, drugs of abuse can change the circuitry in the brain, decreasing the sensitivity of the reward centers and disrupt the centers involved in self control. Addicts tend to lose the ability to enjoy the normal every day activities, and then they need higher and higher doses of drugs to stimulate euphoric/happy feelings. The need to feel pleasure drives the brain, impairs decision making and self-control, and then the only drive is to take drugs just to stay on an even level.
The goal of a vaccine is to train the body’s own immune system to identify the specific offending drug molecules and rid the body of them at even high doses. One of the vaccines being developed is aimed at heroin and its breakdown product morphine. To be effective, heroin in the body breaks down quickly to morphine, and both these compounds need to be targeted to be helpful. The other problem is when going after a drug, there are millions of molecules in the body suddenly, unlike an infection with a few replicating viruses. So to develop a robust vaccine to stimulate the body’s immune systems and chemicals to rid it of certain compounds like opioids is a bit difficult.
So far scientists have been successful in developing a vaccine specific for heroin and the breakdown to morphine that works in rats. The vaccine trains the immune system to neutralize the compounds and even fatal doses of drugs can be handled. The intake of heroin or morphine no longer produces a high, and drug seeking is not pleasurable. A series of three shots was able to produce months of ability to block drug seeking and pleasure by specific opioids. A second vaccine similar to the one for heroin is being developed for fentanyl. After a number of months, the brain starts to reset to more normal patterns of stimuli producing pleasure versus the strong pull to using narcotics. Blocking the drug seeking and pleasure of opioids does also affect all the pain relieving abilities, and the vaccines essentially cause the body to destroy these compounds making them ineffective for any purpose.
Using vaccines is another tool to control addictive behavior in the future once they are perfected for human use. They will be only for specific compounds, like heroin, morphine and fentanyl and not every single narcotic in general. They will be targeted at the most abused compounds and in that way allow a person still to be able to use certain other opioids if necessary for pain control.
Addiction does occur in the pain patient population. The percent of addicted patients in studies is highly variable, on the low side it may be 2-5 percent, although a common number is up to 17% or higher. Addiction is occurring when the need to take a drug is overriding, judgement is impaired and normal activities are suppressed over the needs for getting and taking the medication. Further, the amount of drug needed is escalating fairly rapidly. When addiction becomes an issue, then being weaned from the whole category of drug is needed and appropriate psychological help for addiction and full treatment is necessary.
Heroin abuse used to be considered a rare problem. Over the last five years it has become a major concern, along with the abuse of prescription opioids like Percocet, Norco, oxycodone, hydromorphone and hydrocodone. When prescription drugs are hard to find or to costly, people may turn heroin since it is relatively cheap. Heroin is also becoming cheaper and more pure. It can also be deadly just like prescription opioids.
All narcotics/opioids have beneficial uses for the treatment of pain. They are only one of many tools available to treat painful conditions. All chronic users can become dependent on such medications, meaning that they will have withdrawal symptoms if they suddenly stop their use. Addiction is the use of a substance despite its harm to the person and the inability of the person to stop its use despite knowing the damage the drug is causing.
How Addiction Occurs
Narcotic addiction occurs in many different ways. Often it starts with appropriate medication use and changes to use to get high and numb the brain. Others like getting high off of recreational drugs like marijauna and move from other substances including alcohol and more potent drugs. In the United States, starting in about the late 1980’s, opioids began being pushed for the treatment of pain. Probably over 90% of all opioids used for pain in the world are used in the United States. With the abundance of drugs for pain being used, unused and stolen, supplies have flooded the streets, leading to a massive addiction problem across this country.
Heroin is a potent derivative from the opium plant that gives a person a narcotic type of high. In the 1960’s and before it was crudely derived and not very pure, and was not greatly used. More recently it is much more pure, being manufactured by drug cartels in Mexico, and now it can often be purchased for much cheaper than prescription opioids. As addicts need stronger doses of opioids to get high, they begin to substitute heroin when their drug of choice is not available. Heroin is now being found everywhere in this country, from city to suburb, urban to rural areas.
The newest problem with heroin is that it is being mixed with very potent opioids, especially fentanyl to deliver a stronger high. Unfortunately the mixing of fentanyl may be quite random, and very small amounts are 50 to 100 times more potent than most other opioids. This mixed heroin with fentanyl has now become a deadly problem on the street. If one takes their usual amount of heroin and if it also contains fentanyl, it can cause a lethal overdose. Opioids can be reversed with a drug called naloxone, but only if it is given before the opioids stop a person’s breathing.
The drug addiction crisis with opioids is a multifaceted problem. More money needs to be spent on the treatment of addiction, and managing this as an illness. But to reduce opioids overall, much more money needs to be spent on pain research to better understand all aspects of pain and to develop new and better approaches to managing and curing painful conditions.
The number of heroin-related deaths has drastically increased over the last several years in Minnesota and across the nation. In the past, heroin was a drug in the shadows, shot up into veins for an immediate high. It was a problem in the 1960’s and early 1970’s and then faded away for a while. Today, it is back with a vengeance, and its resurgence is linked to prescription pain medications.
Heroin & Prescription Drugs
Today heroin is more pure than ever and is relatively cheap at small amounts. The street cost of heroin is often less than that of prescription narcotics. The availability of both heroin and prescription narcotics has led to our current crisis. When prescription drugs are not available, people turn to heroin to obtain the high they need to prevent narcotic withdrawal. Unfortunately, overdosing on heroin is easy.
A heroin addiction often begins with prescription opioids or narcotics. These medications can be legitimately used to treat pain, but they have become overly prescribed and not closely monitored by physicians. Many people are not controlling the medications they receive and are selling them for personal profit. The movement of prescription opioids to the street, and the use of these medications for a high is now a major problem.
Pain Cannot be Cured by a Magic Pill
Patients today often think that medicine has a magical solution to their pain and that they are entitled to opioid pain medications. There are many treatments for pain, but there is no magical pill that will resolve a person’s pain entirely. In the United States, we prescribe over 90% of all opioids in the world – surely we do not have that much more pain.
At one time, pain was undertreated and ignored by medication. Education and awareness over time improved treatment, but the pendulum has swung past the rational treatment of pain. Opioid medication has become the simple and easy treatment option for those in pain. But pain medicine is a complex specialty aimed at an appropriate management of the problem. Good pain management is a comprehensive treatment, not an opioid pill.
The Solution is Proper Pain Management
Heroin and opioid drug abuse are now significantly intertwined. Addiction is a disease that does not go away. Once a person has an issue with addiction, no matter what the drug, they will always be prone to addiction to other compounds.
Addiction is a serious problem, and treatment of pain is much more than treatment with opioids. To decrease drug abuse across the country, physicians need to use pain management experts to develop good treatment programs for pain beyond just a pill.
In the 1960s, the drug culture was known for psychedelics, LSD and marijuana. Eventually, some of those users sought a stronger high, and that led them down the path to heroin. At least that was the message pushed by the government in its fight against drugs.
